Healing Doctor

Chapter 384 Low Probability Events

"Old Lu, the patient's condition..." The head of the respiratory department didn't finish his sentence, frowning as he looked at Lu Gang.

The ventilator couldn't keep the patient breathing, and the blood gas analysis results were extremely poor.

"Director, the blood gas analysis results are in!" A junior doctor rushed in with an A4 sheet of paper.

The head of the respiratory medicine department took the form and glanced at it.

pH: 7.104, PCO2: 89.4mmHg (1mmHg=0.133kPa), PO2: 47mmHg, BE: -2mmol/L, HCO3: 28.0 mmol/L

The data presented a very challenging problem for her, so she handed the order to Lu Gang.

The patient's condition was so bad that even the ventilator could barely keep up.

If we force a bronchoscopy as Lu Gang suggested, it's not impossible, but there are risks involved, and most importantly, there's no guaranteed benefit.

Lu Gang glanced at the test results, then subconsciously raised his hand to gather the strand of hair on top of his head, pretending that he had a full head of hair.

"Have you all studied the documents issued by the medical affairs department?" Lu Gang asked an unrelated question.

"Huh?" The head of the respiratory medicine department was taken aback.

"A while ago, a patient came to complain that the hospital had prescribed him fake medicine." Lu Gang wasn't in a hurry. Looking at the patient's monitor, he started gossiping.

"..." The head of the respiratory medicine department didn't know why Lu Gang was bringing this up at such a critical moment in the rescue.

But everyone knows Lu Gang's diagnostic skills and his awful temper, so the head of the respiratory department didn't want to get into trouble.

"The patient who complained keeps looking back after defecating every day, and I don't know why. He's taking nifedipine orally. Tell me, what would be in his stool?"

"The hydrogel shell of the 'Bai Xin Tong'," the head of the respiratory medicine department replied.

"I explained for a long time, but the patient just wouldn't listen. So I drafted it, and after Director Bai reviewed it, it was distributed to all departments, mainly the cardiology department. In the future, when prescribing nifedipine, we must clearly explain the pharmacological effects to the patient and their family."

"Well……"

"This patient is also taking Adalat, an oral antihypertensive drug," Lu Gang said.

The head of the respiratory medicine department seemed to remember something, but then quickly dismissed the answer.

"Old Lu, do you mean the patient accidentally aspirated Nifedipine into their airway while taking it orally, and then the outer shell got stuck?"

"Yes!" Lu Gang's eyes and bald head simultaneously emitted a faint gleam.

"Impossible!" said the head of the respiratory department. "If it were Bai Xintong, it wouldn't be blocked that badly..."

"Your word doesn't count. Get the bronchoscopy ready and take a look," Lu Gang said with a wave of his hand, leaving no room for argument.

"Well..." The head of the respiratory medicine department hesitated slightly.

"I'll contact Director Bai," Lu Gang reassured the head of the respiratory department.

Although the head of the respiratory department didn't believe it, the hospital's "experts" offered their opinions, and he had no better solutions, so he could only try it as a last resort.

She went about her business, and after Lu Gang made a phone call to Director Bai, he took Ji Xiang to a secluded spot.

"Dr. Ji, I also don't think it's that serious, but right now there's no other explanation besides the outer shell of the benzodiazepine blocking the patient's airway. What do you think about this?"

Lu Gang, disregarding any sense of propriety, asked bluntly.

"One pill won't do, what if it's two?" Ji Xiang asked.

"!!!"

"When you're on a ventilator, the pressure is quite high, and the more it blows, the more blocked the affected side becomes. If there were only one outer shell, it wouldn't be so bad, but if two nifedipine pills were present along with the outer shell, it could very well have led to the current situation."

"But the probability of accidentally inhaling both pills at the same time is too low."

"It wasn't at the same time," Ji Xiang interrupted Lu Gang. "I estimate it was most likely caused by two different aspirations."

Lu Gang remained silent. Even so, the probability of such a thing happening was truly low.

"The patient has a history of cerebral infarction, some degree of swallowing dysfunction, and has been bedridden for a long time. If not properly cared for, aspiration can easily occur."

He may have had other medications—such as devanlos—accidentally ingested into his airway, but since they are all soluble, only the outer shell of nifedipine was found in his airway.

"Although the possibility of two BBIN shells blocking the airway is not high, we still need to take a look."

"After watching the film, I also feel there's something wrong with it," Lu Gang pondered.

"Give it a try," Ji Xiang said with a smile, encouraging Lu Gang.

Lu Gang was taken aback. It seemed like things were reversed. He should be the one encouraging Ji Xiang, a clinical newbie, instead of the other way around!

However, having been in the medical team for some time, Lu Gang had more or less gotten used to Ji Xiang's way of doing things.

Habits are a terrible thing; they subtly and gradually make everything that is irrational seem reasonable.

"Then I'll give it a try," Lu Gang said.

The two went back and waited for a while. The head of the respiratory medicine department returned with the signed form and began preparing the bronchoscopy equipment.

Because the patient had difficulty moving around and was wearing many machines, she simply pushed in a simple bronchoscope.

First, local anesthesia was administered to the patient using tetracaine. Then, the head of the respiratory medicine department inserted the bronchoscope through the patient's nasal cavity to the pharynx, past the glottis, and little by little down into the main airway.

The patient had a lot of phlegm and was suctioning it while walking.

"Director Tang, how did you explain this to the patient's family?" Lu Gang didn't lift a finger; his practical skills were practically nonexistent, but he was proficient in theory and diagnosis.

So Lu Gang looked at the screen of the bronchoscopy and chatted with the head of the respiratory medicine department.

"I didn't dare say that there was a foreign object in the patient's airway, because it would be hard to explain if there wasn't. I just said that I would use a bronchoscope to suction out the phlegm that was blocking the airway."

The hissing sound of the suction tube made Ji Xiang feel uncomfortable, as if the tube was pressed against his throat, making him feel anxious and short of breath, causing his blood oxygen saturation to drop significantly, and even giving him a vague feeling of altitude sickness.

"It still takes the veterans to step up," Lu Gang said with a forced smile.

"It's all your fault. You insisted on having a bronchoscope because of the presence of benzodiazepines." The head of the respiratory medicine department complained while monitoring the patient's blood oxygen saturation during the bronchoscopy.

If blood oxygen saturation drops suddenly, the procedure may need to be stopped.

But an "accident" still happened—as the bronchoscope in the hands of the head of the respiratory medicine department moved down, a piece of nifedipine shell was "wrapped" in respiratory secretions and appeared in the surgical field.

"!!!" the head of the respiratory medicine department exclaimed in shock, "Old Lu, it really is!"

"Let me see, let me see!" Lu Gang leaned over and took a look.

Just as expected, Lu Gang immediately calmed down, exuding the demeanor of a senior doctor.

"I told you so."

The head of the respiratory department stopped nagging and used instruments to remove the outer shell of the nifedipine, finally letting out a sigh of relief.

"Continue," Lu Gang said.

"It's already been removed, what's the point of continuing?" The head of the respiratory department was ready to call it quits. She looked at the electrocardiogram monitor and saw that the patient's blood oxygen saturation had returned to normal.

The head of the respiratory department was quite satisfied with this, at least the patient's crisis had been resolved.

(End of this chapter)