This miracle doctor just wants to be fired!

When Zhou Cheng returned to the doctor's office, Fang Hang was still pondering a patient's electrocardiogram. He seemed quite interested in interpreting electrocardiograms lately and had been studying it extensively.

Upon seeing Zhou Cheng enter, Fang Hang immediately waved: "Junior brother, come and take a look at this question. I always thought it was ventricular tachycardia, but I just asked Teacher Li, and he said it was supraventricular tachycardia with differential conduction. Can you help me analyze it?"

Zhou Cheng walked over, bent down to look at the electrocardiogram on the table, thought for a moment, and then said:

"Senior, the QRS complex in this image is slightly wide, the RR interval is slightly irregular, and the V1 lead shows an rsR' shape. The waveform looks wide, but it doesn't have the characteristics of ventricular tachycardia, so it should be supraventricular tachycardia with aberrant conduction."

"However, this is just my personal opinion."

Fang Hang nodded upon hearing this, "Okay, then I'll compare them again."

He may lack clinical experience, but he has a very strong logical thinking ability; otherwise, he wouldn't have mastered such a skill.

Just then, a nurse's shout came from outside the office.

"Dr. Zhou! The patient in bed 3 is suddenly feeling unwell again, complaining of severe chest tightness and palpitations that prevent them from lying down!"

"Come and take a look!"

"Okay, I'm coming right now!" Zhou Cheng replied loudly, then picked up the stethoscope on the table and strode towards the ward.

Fang Hang, who had nothing else to do at the moment, followed along.

He had just heard about the patient who swallowed 1000 blood pressure pills and was thinking of going up to check on him.

……

As soon as the two arrived at the ward door, they heard the patient's suppressed breathing.

The heart rate on the monitor jumped to 130 beats per minute, but the blood pressure dropped to 75/50 mmHg, which was much lower than before.

Zhou Cheng arrived at the bedside and found the patient with his eyes closed, his hands gripping the sheets tightly, and his forehead covered in cold sweat.

The patient was muttering something in a low, painful voice, but it was impossible to understand what he was saying.

Zhou Cheng immediately listened to her lungs.

The rales are more pronounced than before, which most likely indicates that the heart failure has worsened!

Zhou Cheng stood up and turned to Zou Qian, who had just arrived, saying, "Sister Zou, increase the dosage of norepinephrine a little more, and do another blood gas analysis!"

After saying this, he looked at Fang Hang beside him and said, "Senior, could you please go and call Teacher Li? He might be in the emergency room."

"Okay, I'll go right now!"

……

Within minutes, Li Degang rushed over and frowned immediately upon seeing the patient's condition.

He didn't speak immediately. Instead, he walked to the other side of the bed, bent down close to the patient, and softly asked, "Can you hear me? How are you feeling now?"

The patient in the hospital bed only shook his head slightly, and his breathing became heavier.

Li Degang straightened up, felt the patient's pulse, then opened the patient's eyelids to look at the pupils, and then reached out and pressed on the patient's lower limbs.

Her swelling had spread to her knees; pressing on them left a deep indentation that wouldn't bounce back for a long time.

"My heart failure has worsened, and my peripheral circulation has also deteriorated."

He turned to Zou Qian, speaking rapidly, "Have you adjusted your norepinephrine? When will the blood gas analysis results be available? Continue with calcium supplements!"

Zou Qian immediately replied, "Zhou Cheng has already given instructions. The kidney was transferred, the blood gas sample was just sent, and calcium gluconate has been continuously supplemented."

Li Degang nodded, then looked at Zhou Cheng standing to the side, his eyes filled with seriousness, and said in a low voice, "Did you talk to the family about the ICU just now?"

Zhou Cheng said helplessly, "We've talked to them, but the family said they can't afford the expenses and are unwilling to go."

"Even if you don't want to, I have to persuade you again!" Li Degang walked up to the middle-aged woman, his tone was a little gentler than before, but it was still serious and unquestionable. "Sister, look at your daughter's condition now. She could suffer respiratory failure or shock at any time. Even if you want to send her to the ICU, it may be too late! The ICU has blood purification equipment, and relying on medication to keep her going in a regular ward is much more effective!"

"Regarding the money, we can apply to the hospital to see if we can get reimbursement through special medical insurance for this condition, or we can pay a portion in advance. We can't just watch something happen to our child!"

The middle-aged woman's tears fell even harder, her hands tightly gripping the hem of her clothes, her voice trembling with sobs.

"Dr. Li, I know you mean well, but I really can't... My husband passed away early, and I work two jobs. After paying rent and her antidepressants, I have no savings at all. I simply can't afford the ICU fees; I'm afraid I won't be able to pay them!"

Silence fell in the ward. Li Degang sighed and took out his phone to contact the ICU to discuss the cost.

Most top-tier hospitals offer certain fee reductions or exemptions for such special patients.

Zhou Cheng also stood to the side with a solemn expression.

We've used so many vasopressors and given so much fluid, why is my blood pressure still not going up?

Why is my heart failure getting worse?

At this moment, Fang Hang, who was looking at the medical record, suddenly whispered to Zhou Cheng, "Junior brother, she swallowed 1000 nifedipine sustained-release tablets at once. That's a lot of pills; it must have taken her a long time to swallow them, right?"

These words struck Zhou Cheng like a bolt of lightning. He abruptly looked up at Zou Qian: "Sister Zou, after the patient's stomach was pumped at noon, was an abdominal CT scan performed?"

They all overlooked one point: in cases of conventional drug poisoning, if the drug is liquid, prolonged gastric lavage should be able to remove the undigested portion.

But it's different if it's a solid tablet.

The pills could become lodged in the folds of the stomach or mixed with food, making it unrealistic to expect to completely remove everything from the stomach through gastric lavage.

They all subconsciously felt that if their stomachs were pumped, the contents would definitely be gone.

The reason the patient experiences symptoms is that the medication has been digested and released into the bloodstream.

But the truth is not necessarily true!

Zou Qian paused for a moment, then shook her head: "No, a CT scan is usually not done after a routine gastric lavage, and the patient didn't mention anything about abdominal pain at the time..."

Upon hearing this, Zhou Cheng immediately walked quickly to Li Degang's side: "Teacher, I think we should get an abdominal CT scan?"

Li Degang was taken aback. "An abdominal CT scan?"

Zhou Cheng nodded: "What Senior Brother Fang Hang said just now suddenly reminded me that 1000 nifedipine sustained-release tablets—that's 1000 tablets! Even with a long period of gastric lavage, it's impossible to wash them all out!"

"Extended-release tablets have an outer shell, which may stick to the stomach wall or accumulate at the bottom of the stomach, mixing with food and not being digested immediately."

"But the medication will be released slowly, causing the patient's blood pressure to keep dropping and their heart failure to improve!"

"Only a CT scan can determine if there is any residue in the stomach. Otherwise, the continuous release of medication will cause the patient's blood pressure to keep dropping and their heart failure to improve! Only a CT scan can determine if there is any residue in the stomach; otherwise, no matter what medication is used, it will only treat the symptoms, not the root cause!"

Everyone in the ward was stunned. Li Degang was initially surprised, but then he realized what was happening and immediately nodded, "Right! How could I not have thought of that! The characteristic of sustained-release tablets is that they release slowly. If there's any residue in the stomach, the medication will continue to be absorbed, and the medication we're using now definitely won't be effective!"

Fortunately, it's a sustained-release tablet.

If it were nifedipine tablets, the drug would be released into the bloodstream rapidly, and the patient might already be in critical condition.

"Zou Qian, contact the radiology department immediately and get an abdominal CT scan done through the emergency entrance!"