Chapter 1371

Liu Xu zhi skillfully pulled out two medical record folders and handed them to Zheng Ren with both hands.

"It's not a pre-op patient; I saw him yesterday, just go check his condition later." Zheng Ren smiled slightly, "Look at the malaria patient's chart."

"……" Liu Xu zhi froze for a moment.

"Let him look at it, otherwise this guy won't even sleep well." Su Yun held her phone, not playing games but contacting something. Hearing Zheng Ren's words, she didn't even lift her eyes, saying contemptuously.

Su Yun knew exactly what kind of person her boss was.

"Oh." Liu Xu zhi didn't know why, but responded.

"Old Liu." Zheng Ren suddenly said, "Does the patient have widespread red maculopapular rash?"

"Uh……" Liu Xu zhi's eyes widened, as if he'd seen a ghost.

"Zheng……Zheng Lao Ban, how do you know?" Liu Xu zhi stammered.

"He has X-ray vision; before, in Haicheng he peeked at a widow bathing and almost got beaten to death." Su Yun added timely.

Zheng Ren glanced at him helplessly and explained, "Malaria's specific drug is quinine; it's not expensive, I believe you use it often here."

Liu Xu zhi nodded. Although he wasn't an internal medicine doctor, he knew this.

Town residents rarely get malaria, but the grassland herders often have it as a common epidemic.

"Old Liu, have you read the quinine instructions?"

Liu Xu zhi nodded, then shook his head.

Quinine, also known as Golden Chicken Frost, is specifically for malaria and must not get into the eyes. Liu Xu zhi knew these basics, but he immediately thought what Zheng Lao Ban said couldn't be simple, so he shook his head.

"Quinine can trigger immune system abnormalities, though it's uncommon. Generally, the most common reaction is the Golden Chicken Frost reaction." Zheng Ren said: "After using quinine for malaria, if other symptoms appear requiring antibiotic escalation, it's rare. So I suspect it's a complication from quinine; let's keep thinking."

"Nodular panniculitis?" Su Yun continued playing with her phone, then interjected.

"Hmm, it's possible; we should do an ultrasound to check. With an ultrasound, we can basically confirm." Zheng Ren felt a bit embarrassed, "Old Liu, tell the gastroenterology doctor to see if I can get an ultrasound."

"Boss, begging people isn't worth it." Su Yun said: "You just sit here steadily, waiting for people to come begging you—that would be great."

"They're not Director Luo… Besides, even if it were Ward 912, Director Luo couldn't diagnose quinine-induced nodular panniculitis either." Zheng Ren laughed and didn't care.

Healing the sick was, to Zheng Ren, just something that should be done, having nothing at all to do with putting on airs from on high.

Liu Xu zhi sweated profusely.

After saying that, he himself didn't know how to respond.

Full of confidence? Or… but they really have this skill, you can't refuse to accept it.

After standing in the hallway a moment, hearing himself say the word malaria, he deduced the possible disease.

Right, what is nodular panniculitis?

What does this diagnosis mean? Liu Xu zhi didn't know.

He scratched his head and said, "I'll go ask; it should be fine."

After saying that, Liu Xu zhi turned to leave, and Zheng Ren shouted, "Old Liu, help me find the chart!"

Liu Xu zhi hurriedly found the medical record folder, handed it over with both hands, then ran out.

After Liu Xu zhi walked out, Su Yun looked up and said with a smile: "Boss, I feel you're especially tired, you can't get a break wherever you go. This has nothing to do with us; just do the surgery and leave. Doing this, you might not even realize if you'll make the local doctors dislike you."

"Having seen it, we can't just pretend we didn't see it. They also didn't make a clear diagnosis; I'm just bringing it up casually, it's not a big deal. If you see it and don't speak up, you'll end up delaying diagnosis and treatment, and you'll feel guilty." Zheng Ren also felt helpless.

"Sister Lin replied, she'll be here soon." Su Yun raised their phone.

Zheng Ren focused on the medical record, and answered casually.

The pasted lab report is also something legendary.

It is said that Haicheng Shi Yiyuan, 15 years ago, before electronic medical records, the lab department would send report slips to the clinical departments, and then doctors would paste each lab slip onto white paper and file them in the medical records.

This is really retro, Zheng Ren carefully flipped through page by page. I never expected that in this day and age, there would still be handwritten medical records and pasted lab reports.

"Nodular panniculitis? What kind of diagnosis is that?" a voice came from the doorway.

Zheng Ren looked up and saw a female doctor in her thirties, wearing glasses, hurrying in.

"You're the... teacher from 912?" She originally wanted to be more confrontational, but upon meeting Zheng Ren's gaze and seeing that he was a young person, she hesitated.

She was afraid of mistaking the person, which would be embarrassing.

"Well, I'm the doctor from 912." Zheng Ren was holding the medical record and flipping through it; he already had a plan in mind. It didn't differ much from his own judgment; just doing a B-ultrasound would suffice. As for pathology, he estimated they couldn't wait that long.

"Teacher, does your diagnosis have any basis?" asked the doctor from Xiao Hua Nei Ke.

Blood test: WBC 19.62×10^9/L, N% 89%, CRP 192.0 mg/L; after Luo's Fen anti-infection treatment, diarrhea eased but fever persisted. One day before admission, scattered subcutaneous red nodules appeared on the limbs, accompanied by tenderness, and the patient was admitted for infectious fever. Zheng Ren looked at what was written in the medical record and simply said: "With medical history and tender red nodules, the diagnosis is quite obvious."

The young doctor at Xilin Zhen Yiyuan was covered in sweat.

Zheng Ren felt helpless; if this were Haicheng Shi Yiyuan, saying all that would already be enough. The medical standards here are truly mediocre, but there's nothing much to be done.

Expecting all doctors' levels to be the same as those at 912 is just wishful thinking.

He chuckled, trying to keep his attitude as gentle as possible: "Nodular panniculitis, also called idiopathic lobular panniculitis or relapsing febrile non-suppurative panniculitis."

The characteristics of this disease are crops of recurring subcutaneous nodules; the nodules are painful and tender, most flare-ups are accompanied by fever, and a definitive diagnosis can be made by combining with second-stage histopathology.

"Old Liu, can your pathology department here perform this kind of diagnosis?" Zheng Ren then looked at Liu Xu zhi and asked.

Liu Xu zhi shook their head blankly.

"At first I thought it was a severe abdominal infection, the red maculopapular rash caused by drug allergy. But later, considering it differed from allergic maculopapular rash, I dismissed that idea." The doctor from Xiao Hua Nei Ke also muttered to themselves in bewilderment.

"Red maculopapular rash accompanying allergy does not cause pain."

"What should we do then?"

"What medicine should we use?" Zheng Ren asked gently.

"Piperacillin-tazobactam isn't working well; I'm preparing to use vancomycin. This isn't because of recent antibiotic controls—high‑grade antibiotics can't be obtained without proper approval review; I'm about to submit an application." The doctor from Xiao Hua Nei Ke said, "Teacher, what do you think we should do?"