Practicing Medical Skills in a Small Clinic novel Chapter 760

Chapter 760: Chapter 353: All Predictions Came True, Reverse-Engineering the Virus Type

It was precisely because of Li Jingsheng’s excellent performance that her trust in him skyrocketed.

Though it couldn’t be said to be blind trust, it wasn’t far from it.

"You need not be so concerned. Since I am here, I will certainly give my all. However, as you know, medicine is an extremely complex discipline. My knowledge is limited, and I can only do my best. Ultimately, saving your son relies mainly on the experts present here."

Li Jingsheng dared not claim all the credit.

With just a few understated words, he shifted the credit and responsibility to the experts present.

He was merely a junior attending physician, and though he had some skills, he would never dare to act as if he were the top dog in front of these bigwigs.

"Dr. Li, please have a seat, and let’s quickly discuss the condition! The child’s current situation is particularly dangerous. So far, we’ve only determined that he has acute encephalitis, myocarditis, and pulmonary edema. Since he was brought over to us, we’ve conducted initial symptomatic treatment. Only by identifying all the causes can we possibly use targeted medication or other means to rescue him."

Rong Xuekai was clearly the true leader of this consultation.

After inviting Li Jingsheng to sit down, everyone continued discussing the child’s condition.

Before Li Jingsheng arrived, they seemed to have already had an initial discussion.

"Dr. Li, please share your thoughts first. You should understand the child’s condition better than we do."

"Then let me start by offering a few personal insights. First, I think the likelihood that the child’s encephalitis and myocarditis are caused by a virus is very high. It could be that myocarditis occurred first, triggering encephalitis. The child had rheumatic heart disease at the age of four. I suspect there might be some pathological changes in his heart, which have led to this episode of myocarditis.

However, the rescue effort should first aim to control the progression of the brain condition.

If possible, we can even consider drilling to investigate intracranial conditions.

Second, the child’s lungs show edema, and subsequent respiratory failure may indicate pulmonary congestion.

Should anticoagulation treatment be considered?"

Li Jingsheng did not hold back, expressing all his thoughts.

"Regarding Dr. Li’s first point, we discussed it earlier, and we share a similar view that the possibility of viral infection causing encephalitis is extremely high. However, there are many pathogens that can cause viral encephalitis, and we haven’t been able to identify the specific virus yet, so there’s no way to use targeted medication. As for the skull drilling investigation, your hospital’s ER has already done that.

Your side suspected subdural hematoma at the time, which might be compressing important nerves causing issues, so the drilling was done to explore that possibility.

Though no subdural hematoma was found, the procedure gained valuable insights.

It was also beneficial in reducing intracranial pressure."

Director Rong seemed to be covering for the Second Hospital in front of the family.

Director Luo from Neurology obstinately held that the child’s hemiplegia was caused by brain concussion and subdural hematoma resulting from a fall.

He only gave up after the child underwent skull drilling examination.

It couldn’t be said that he was ignorant, nor that his skills were lacking. He had his reasons for insisting on this examination.

Many doctors, when diagnosing causes, especially when facing life-threatening illnesses, often adopt any inspection they deem necessary.

Many patients have likely encountered similar situations.

For example, some patients who feel unwell and go to the hospital for examination find that the doctors cannot diagnose the cause. At that point, they might suggest the patient be hospitalized for further checks, like 24-hour EEG monitoring, ECG monitoring, and so forth.

There are others like the exploratory surgery for this child or other examinations.

Ultimately, following the doctor’s advice, the patient is hospitalized for examination and treatment, yet the cause remains undiagnosed. The condition worsens.

In such cases, nine out of ten patients will smartly request discharge.

Transferring to another hospital as soon as possible is the right course of action.

Otherwise, a person who was fine going in might indeed be carried out.

Such doctors are often cursed as quacks by patients.

Some of them may have studied hard but have their heads buried in books, lacking the ability to synthesize and flexibly apply the knowledge in practice. Instead, they recite from books, applying medical knowledge as if using a formula.

Encountering such doctors is truly unfortunate for patients.

When these doctors encounter slightly difficult diseases, they most likely conduct a full set of checks on the patient.

Truly skilled and experienced experts charge expensive consultation fees, but possibly just by listening to the patient’s description of symptoms and observing their condition, they prescribe without conducting any checks.

"As for Dr. Li’s second point, Director Lian has also mentioned it. The test results should be available very soon."

The doctors at the People’s Hospital were highly skilled, and everything Li Jingsheng thought of had already crossed their minds.

"This is the result of the intracranial endoscopy. We conducted an enhanced examination after the patient was transferred to our hospital. There is evident expansion in the brain and subarachnoid space with signs of congestion. A few lymphocytes and neutrophils infiltrated. The cerebral cortex, midbrain, pons, medulla, and thalamus all have neural cell degeneration. In the area near the lenticular nucleus, there is demyelination. The walls of blood vessels and surrounding brain tissue exhibit deep blue staining gathering in calcified portions of the perivascular space..."

Reviewing the intracranial exploration and examination results, Li Jingsheng felt a chill in his heart.

The child’s condition was more challenging and perilous than imagined.

The intracerebral lesion had reached an alarming severity.

"The urgent task is to first identify the etiology of meningitis! Regarding the heart, both the endocardium and valves have been diagnosed as normal by Professor Wang Weiwei."

Director Rong steered the conversation toward the most pressing issues.

Li Jingsheng quickly considered one potential viral encephalitis pathogen after another.

Japanese encephalitis virus, enterovirus, herpes virus, adenovirus, paramyxovirus, encephalomyocarditis virus...

There were too many viruses that could cause this illness.

"No, relying on virus type for diagnosis is too difficult. Laboratory testing is the most accurate, but the child’s condition is critical and can’t afford to wait that long."

To perform virus isolation and antibody determination on the sampled specimen, by the time the test results were out, the child’s body would likely have already turned stiff.

Li Jingsheng changed his approach, deciding to start with the pathogenesis.

Over twenty-five types of viruses could cause this child’s acute viral encephalitis.

And this is just the number that Li Jingsheng knows.

He considered his medical knowledge not particularly extensive; perhaps a more experienced professor could list up to thirty types.

There are several types of enteroviruses alone, such as the Coxsackie virus and poliovirus, which were once extremely terrifying and widespread. Even today, children still need to be vaccinated against this virus at the appropriate age.

Some parents hesitate to spend a few hundred yuan, not knowing the tremendous harm this virus can cause.

If infected, the treatment costs would be terrifying, and the prognosis is generally poor, with disability or cerebral palsy being very common.

It can be transmitted through fecal-oral or oral-oral routes.

Once infected, a child’s life is almost ruined.

Many people still habitually call this virus "polio."

Li Jingsheng diligently screened each compatible virus.

For example, he could immediately rule out chickenpox encephalitis, as he examined the child and found no blisters or rashes.

Likewise, mumps virus-induced encephalitis could also be basically ruled out.

...

At this moment, Director Rong received a phone call.

After hanging up, he said to everyone, "It has just been confirmed that the child has pulmonary congestion."

Upon hearing this, everyone looked towards both Lian Tao and Li Jingsheng.

Both of them had mentioned this point, indicating that both were highly skilled.

"Director Rong, after our discussion, we can now basically confirm that the child has acute viral encephalitis. Currently, there is no specific medication for this disease. It would probably take at least twenty-four hours, if not more, to determine the virus type. Can we first undertake some symptomatic treatment to maintain the child’s vital signs, and plan from there?"

"Director Nie makes a very valid point, I will arrange it immediately."

Director Rong gladly agreed.

After the child was transferred, a series of supportive treatments were already underway.

What can be done now is likely maintaining water and electrolyte balance, respiratory intubation support, and anticoagulation.

If cerebral edema is severe, mannitol can be intravenously injected.

Furosemide can be used in conjunction to enhance the anti-cerebral edema treatment effect.

"I have a small diagnostic viewpoint—to check for cryptococcal meningitis?"

At this critical moment, Li Jingsheng once again offered a suggestion.