My Medical Skills Give Me Experience Points

Chapter 1246: Chapter 491: Unexplained High Fever Reaction, Multiple Sources of Hemorrhage (Part 2)

It’s already quite late now, and she worries that the cafeteria’s food will be sold out.

"You guys go ahead and eat! I’ll get my own meal once I’m done here."

Zhou Can realized that this patient with digestive tract bleeding is quite difficult to handle.

It’s still uncertain how long it will take.

Why did the patient develop a high fever within just three to four hours after medication?

Following Ali into the emergency room, they saw the patient lying on the bed, eyes closed, with a slightly pale face. However, compared to when he was first admitted in the morning, there had been a significant improvement.

The transfusion volume reached 1000ml, which is actually quite astounding.

"Did you use ranitidine?"

After reviewing the patient’s condition, Zhou Can asked Dr. Ali.

The Emergency Department implements a first-visit system for emergency patients. Whoever takes the case is responsible for it.

New doctors are particularly afraid of handling critically ill patients.

However, as long as there is an attending physician or above on duty, they will immediately rush to take over when hearing a patient needs rescuing. It is not the practice to let a new doctor handle a critical patient alone without senior supervision.

"Yes, we did!"

Ali nodded.

Ranitidine is commonly used to treat duodenal ulcers, gastric ulcers, reflux esophagitis, Zhuo Ai Syndrome, and other high gastric acid secretion diseases. Sometimes, it is also used to treat Helicobacter pylori infections.

The cause of the patient’s fever is a major problem perplexing Ali.

This is also the main reason she asked Zhou Can to assist in the consultation.

"The patient’s other vital signs are fairly stable, with no chills, only a high fever, which is quite bizarre. The possibility of an intestinal infectious disease cannot be ruled out."

Zhou Can’s brow furrowed slightly as he began to fully diagnose the patient’s condition.

Blood transfusion could not have caused the fever, so this factor can basically be ruled out.

Ali was very cautious with the medication, using only the two hemostatic drugs she discussed with Zhou Can. Ranitidine for treating gastric ulcers is a commonly used drug.

Logically, the likelihood of the medication causing a high fever is also very low.

But indeed, the patient developed a high fever only after being treated in the hospital for three to four hours.

From the nurse’s temperature records, it’s clear to see that the patient’s temperature rose on a relatively stable gradient over four hours.

It wasn’t a sudden fever.

The initial suspicion still lies with the medication.

Zhou Can’s current pathology diagnosis is at a level five, akin almost to an Associate Chief Physician. His pharmacological differentiation is also level five, having recently reached the intermediate level of an Associate Chief Physician.

There is a significant gap compared to his pathology diagnosis.

The patient received a light blood transfusion of 1000ml, which barely restored hemoglobin to a more ideal level. But his anemia did not improve significantly.

Zhou Can couldn’t help but pick up the patient’s emergency endoscopy report again.

Logically, bleeding caused by gastric mucosal erosion shouldn’t be so large, even over a month of continuous bleeding, it shouldn’t cause severe anemia or sudden shock in the patient.

Where exactly is the problem?

At this point, Zhou Can began to suspect that the patient’s issue wasn’t just simple gastritis bleeding.

Also, erosive hemorrhagic gastritis usually stops on its own quickly; this disease has a good self-limiting nature. However, the patient had black stool for more than a month, which contradicts this.

This further confirms that the patient doesn’t merely have gastritis bleeding.

His mind raced, desperately pondering whether there might be another bleeding source?

The fact that the patient developed severe anemia, even shock, indicates a very large loss of blood.

If there’s massive bleeding in the stomach or duodenum, the blood should backflow into the stomach, causing the patient to vomit coffee-like contents of the stomach, or even vomit blood directly.

For instance, the "Three Kingdoms" records that Zhuge Liang berated Wang Lang to the point of vomiting blood to death right on the battlefield.

The novel surmised Wang Lang died from heart rupture, which is certainly unscientific.

The heart is in the chest cavity, and even cardiovascular rupture rarely causes one to directly vomit blood. Usually, only upper gastrointestinal and upper airway bleeding cause direct, profuse hematemesis.

Upper respiratory tract bleeding more often presents with blood-tinged froth.

In the case of a patient suddenly vomiting blood and collapsing, doctors often rely on the color and presence of foam in the blood expelled from the patient’s mouth and nose to determine the specific bleeding source.

Pulmonary bleeding typically presents with blood-tinged froth, accompanied by coughing, mainly as hemoptysis.

Bleeding from the stomach or duodenum results in copious hematemesis.

This patient does not exhibit clinical symptoms of vomiting.

The possibility of massive upper gastrointestinal bleeding occurring in a short period can largely be excluded.

However, the patient’s sudden nosebleed before the shock episode is a point worthy of caution.

The human pharynx and nasal cavity have a very complex structure.

The nasal mucosa is rich in blood vessels, and during inflammation or injury to the nose, nosebleeds occur easily.

Sometimes, the bleeding can be quite alarming with its volume.

However, neither the patient nor family members reported frequent nosebleeds. This cause might be put on hold for now.

The pressing matter is to quickly identify the real bleeding source of the patient.

Although the patient’s vital signs are currently stable post-rescue, if the real cause of such massive bleeding isn’t identified, danger could arise in an instant.

After admission, via infusion and blood transfusion, the patient developed symptoms of a high fever.

Is it a coincidence, or is there another reason?

There were only three infusion drugs; whether it be ranitidine for treating gastric ulcers, or Batroxobin and tranexamic acid for hemostasis, none of them would cause the patient to develop a high fever suddenly.