Doctor: I Can Synthesize Infinite Entries

Chapter 96: Chapter 96: Abdominal Paracentesis on the Ambulance

Hearing that it might be an acute myocardial infarction, the expressions on the faces of the rescue team members turned grim.

After confirming with the patient’s family, the driver, Old Zhou, started the ambulance immediately.

An acute myocardial infarction is myocardial necrosis caused by acute and persistent ischemia and hypoxia of the coronary arteries. It’s a relatively common cardiovascular disease, characterized by its sudden onset and severe danger.

If not treated in time, this condition could very well be fatal. Old Zhou didn’t dare to delay for a second, striving to get the patient back to the hospital within the optimal treatment window.

Soon, the ambulance arrived at the residential complex.

It was a new complex, so the roads were clear. The building also had elevators, so the rescue team quickly reached the patient’s apartment.

Seeing Wu Ting and the others, the family was extremely anxious.

The patient’s son, Dong Chen, was a master’s student. Being well-educated, he had already looked up the symptoms on Baidu before the ambulance arrived and suspected his father was having a heart attack.

His father had experienced similar symptoms before and was treated at City First Hospital. The condition had been under control for over half a year.

”Doctor, you’re finally here. My father was just sleeping, then he suddenly felt a burning pain in his heart area. It’s been getting progressively worse, and he’s also nauseous and has heart palpitations...”

Looking at the pained expression on the patient, Dong Jianguo, both Xiao Xixi and Wu Ting stepped forward to examine him. The patient’s temperature was also beginning to rise.

”How long has he been in pain?”

Wu Ting asked carefully.

”For about half an hour, maybe more.”

”Doctor, it hurts here, and my upper back hurts a little too.”

Dong Jianguo felt a tightness in his chest and was agitated and terrified. He was also sweating profusely.

”BLEGH...”

During Wu Ting’s physical examination, Dong Jianguo started to vomit.

”Patient has an accelerated heart rate, dizziness, fatigue, fever, and cold sweats...”

Xiao Xixi observed from the side. ’It really could be a myocardial infarction,’ she thought.

”The golden window for treating a heart attack is within 90 minutes of onset. Get the patient on the stretcher and into the ambulance immediately. We’ll start pre-hospital emergency care.”

The driver, Old Zhou, and the stretcher-bearer immediately lifted the patient onto the stretcher and began moving him.

Dong Chen hurried after them, continuing to add his thoughts.

”Doctor, my father is 65 this year. He has a history of coronary heart disease. He’s had angina before, as well as abdominal bloating, nausea, and vomiting. He was seen at the City First Hospital’s cardiology department for it...”

Dong Chen relayed the patient’s medical history, wanting to give the doctors as much information as possible.

Once on the ambulance, they began pre-hospital emergency care.

”Start heart rate monitoring... Blood pressure...”

Xiao Xixi assisted with the monitoring, while Wu Ting continued the physical exam. After all, a family member’s diagnosis isn’t the truth; a doctor had to trust their own professional judgment.

After a careful examination, Wu Ting noticed something unusual: the patient’s heart and lungs were fine.

He also noted the abdomen was flat, with no obvious gastric contour or peristaltic waves. There was mild muscle tension in the patient’s upper abdomen.

’Could it not be a heart attack, but some kind of acute abdomen?’

With a preliminary theory in mind, Wu Ting began pressing on the patient’s upper right abdomen.

”Sir, does it hurt when I press here?”

The patient shook his head.

Wu Ting palpated the abdomen again. There were no masses, no tenderness at McBurney’s point, and no rebound tenderness.

Watching Wu Ting’s examination methods, Xiao Xixi was a bit confused.

”Dr. Wu, you don’t think it’s a heart attack?”

Wu Ting nodded.

”Based on my current physical exam, although the patient’s history and symptoms point to an acute myocardial infarction, further checks revealed no problems with his heart or lungs. I suspect it’s a form of acute abdomen.”

”I’ve ruled out acute appendicitis, so I suspect there’s a problem with the patient’s gallbladder.”

Empowered by Director Huo’s Diagnostic Skill for Gallbladder and Biliary Tract Diseases (Violet), Wu Ting managed to find a lead through the minor details. However, he would still need an abdominal paracentesis and a B-scan at the hospital to confirm the diagnosis.

”Gallbladder and biliary tract disease?”

Xiao Xixi was surprised.

The patient’s son, Dong Chen, who had been by his side the whole time, paled when he heard Wu Ting’s deduction.

”Doctor, I’m not questioning you. And it’s not that I don’t trust you, but there’s something I need to make clear. It’s impossible for my father to have a gallbladder problem.”

”Maybe you’re just too young, so your judgment is flawed. I looked it up on Baidu, and the symptoms for a heart attack are very similar to my father’s.”

Xiao Xixi and Wu Ting both looked at Dong Chen. For a master’s student, he was being quite reasonable, his tone calm and his argument logical.

The basis for Dong Chen’s firm explanation was this:

”My father had a cholecystectomy 10 years ago. His gallbladder was removed a long time ago, so it can’t be a disease caused by cholecystitis.”

”As for his appendix, that was also removed 5 years ago.”

Xiao Xixi also checked the patient’s condition from the side.

”Dr. Wu, Dong has a point. The patient’s skin and sclera aren’t jaundiced, and his gallbladder has been removed. It definitely can’t be cholecystitis.”

Just then, the patient cried out again.

”Ah... It hurts, it hurts! Doctor, I can’t take it anymore! Aiyah...”

Seeing his father in so much pain, Dong Chen grew anxious. He felt that what Dr. Wu was doing was futile and would only prolong his father’s suffering.

”Dr. Wu, my father definitely doesn’t have cholecystitis! It’s not like I’ve never heard of it. How could it be this severe?”

”You should just try treating it as an acute heart attack...”

”We’re almost at the hospital, just hang in there...”

Xiao Xixi tried to comfort Dong Chen.

”Dr. Wu, be ready for CPR at any moment...”

Xiao Xixi reminded him from the side. This was a matter of life and death; she couldn’t afford to be careless.

In a situation like this, an ordinary junior doctor would have had their resolve shaken long ago.

But Wu Ting remained steadfast in his judgment.

”I’m the doctor. I’ll take responsibility.”

”Sister Xiao, help me perform an abdominal paracentesis on the patient!”

”I still insist it’s a biliary tract problem. I wasn’t completely sure at first, but now that Dong mentioned his father had a cholecystectomy, it actually supports my hypothesis. It’s highly likely the patient is suffering from acute abdomen caused by a perforated bile duct...”

Abdominal paracentesis is a procedure of great significance in diagnosing surgical acute abdomen. It can effectively bypass the trouble of auxiliary examinations and is the fastest and most convenient way to get results.

However, for the first-responding doctor, it requires extensive experience and precise judgment.

”Okay!”

Xiao Xixi stopped wasting words. Since Wu Ting had been chosen as the accompanying doctor on this run, she had to follow his orders.

”The conditions in the ambulance are limited. We can only use the most basic equipment.”

Xiao Xixi first assisted by injecting the patient with a sedative.

”. . . Number 7 needle. . . 5ml syringe . . .”

Seeing that Wu Ting was about to perform a paracentesis on Dong Jianguo, Dong Chen was clearly reluctant. He questioned the effectiveness of the procedure, especially since Wu Ting looked so young.

But they were the doctors, after all, so he didn’t dare say more.

He took out his phone and started searching about abdominal paracentesis and acute abdomen. The more he read, the less he understood.

’My father is obviously having a heart attack, so why does he insist it’s a gallbladder problem?’

’Still, we’re about to reach City First Hospital. According to what I read online, there’s still time for emergency treatment for a heart attack. My father’s condition isn’t at its worst yet. There’s still time.’

Dong Chen silently comforted himself. He’d just wait until they got to the City First Hospital emergency department and find a senior doctor. He would tell a seasoned expert his own diagnosis.

Wu Ting had already begun the abdominal paracentesis, inserting the needle slowly, carefully feeling the layers of the abdominal wall. After entering the abdominal cavity, he began to aspirate while withdrawing.

Watching Wu Ting’s skilled movements, Xiao Xixi was astonished. ’This Dr. Wu really is an all-rounder.’

Abdominal paracentesis required solid fundamental skills. If one’s technique was rusty, it would be easy to puncture the intestinal wall. But Wu Ting’s technique, movements, and rhythm were clearly gentle and controlled.

After a moment, a small amount of puncture fluid was visible. Wu Ting immediately adjusted the needle’s direction and repeated the aspiration twice. Once he had drawn fluid, he withdrew the needle to the abdominal wall and gradually released the negative pressure to avoid aspirating blood from the wall, which could affect the results.

”Sister Xiao... 5ml of saline...”

Watching Wu Ting’s procedure, Xiao Xixi was filled with admiration. ’He’s like a senior director with years of experience! Using saline to dilute the abdominal fluid to increase the positive rate... that’s a technique only a very experienced old expert would know.’

Soon, the results of Wu Ting’s paracentesis were in:

Bile-like ascitic fluid!

At that moment, the patient’s condition worsened again. There was tenderness across the entire abdomen, but still no rebound tenderness.

”Sister Xiao, we’re almost at the hospital. As soon as we arrive, immediately arrange for the patient to have an abdominal B-scan. Examine the common bile duct carefully. Notify Director Jiang and Director Huo. Once the diagnosis is confirmed, we operate immediately.”

Wu Ting was now 99% certain.

Xiao Xixi clearly hadn’t expected this. ’It really is bile-like ascitic fluid. But... wasn’t the patient’s gallbladder removed?’

Dong Chen didn’t quite understand, but he could tell that they had likely found the cause of his father’s illness.