Chapter 2974: with translation of chapter title

Boss, look at how much trouble you've caused people." Su Yun said disdainfully.

I always feel the patient has a problem." Zheng Ren couldn't say the Big Pig Trotter's Xitong Diagnosis, so he could only give a vague answer.

That's too far-fetched." Su Yun said, "The patient's presentation is just lots of sputum blocking the airway, causing hypoxia. Tell me, how did you consider the suspicion of a foreign body?"

You also saw how the patient's family looked when we were eating skewers." Zheng Ren said, "It's clearly an accident; my feeling was that the old man was fine when we set up the stall, but a few hours later he developed convulsions and dropping blood oxygen saturation, leaving the family helpless."

Um… maybe, but don't you think it could be the patient's family's own problem?" Su Yun looked at Zheng Ren doubtfully and said, "You seem to have guessed something."

Zheng Ren shrugged, shook his head, and said, "I feel there's a problem; a doctor's intuition, just go in and take a look—it's not troublesome, and incidentally we can suction out as much of the accumulated sputum as possible."

Su Yun accepted Zheng Ren's explanation, although he was eating late-night snacks and singing, suddenly running to the ICU to perform a bronchoscopy and bronchoalveolar lavage seemed odd.

Soon, the ICU Inpatient Chief had the bronchoscope equipment ready. Zheng Ren approached the patient, found a suitable angle, and began inserting the tube.

Under anesthesia, if a regular bronchoscope were used, it would cause a sensation of suffocation, which feels quite terrible.

Zheng Ren held the bronchoscope lens in his left hand, carefully observing while using his right hand to slowly advance the fiber tube into the patient's airway.

There was indeed a lot of sputum, but Zheng Ren didn't pay much attention to the sputum in the upper airway; this part belonged to what could be suctioned out.

After sending the tube into the right main bronchus, he slowly suctioned out sputum while moving along. Zheng Ren carefully observed the airway and patiently suctioned.

It seemed not to be a problem on this side; after checking the right airway, Zheng Ren sent the tube to the left side.

Just after entering the left main bronchus about 5 cm, Zheng Ren saw two scaffold-like objects stuck in the airway wall.

Grasping forceps." Zheng Ren said in a low voice.

What did you see!" Su Yun at that moment hated the damned bronchoscope intensely, because it had no screen—only the operator could see inside.

The boss wanting the grasping forceps meant he had seen a foreign body in the airway. But a foreign body… that made no sense; the patient's presentation didn't look like the airway was blocked.

While pondering, Zheng Ren moved the lens aside and said, "Take a look."

Su Yun immediately leaned in.

Two drug scaffolds came into view.

Wow… the Bai Xintong drug scaffold!" Su Yun exclaimed in surprise.

Huh? How do you know it's Bai Xintong? Have you studied this before?" Zheng Ren blinked.

Last time I saw Director Lin in the Medical Department explaining this to a patient's family with opinions, I went back and bought a box, studied it carefully. It's the scaffold pattern of an imported drug; turns out the pill got stuck!

The ICU Inpatient Chief assembled the grasping forceps and other instruments and handed them to Zheng Ren.

Zheng Ren slowly sent it in, firmly grasped one drug scaffold and pulled it out. This maneuver wasn't difficult—at least for Zheng Ren it posed no difficulty at all.

The second drug scaffold was also removed; Zheng Ren didn't end the examination. Since he had already begun suctioning sputum under direct vision, he might as well suction a bit more, which could greatly shorten the patient's recovery period.

Ten minutes later, Zheng Ren withdrew the fiber tube and laughed, "All clear—about 80 ml of sputum was suctioned out, not a small amount."

Boss Zheng, how did you know there was a foreign body?" the ICU Inpatient Chief, still not recovered, asked doubtfully.

Because of the patient's symptoms." Zheng Ren began to spout nonsense, since solving the problem was what mattered; he didn't need to tell her the truth about how he judged it.

At first the patient had spasms, convulsions, and acute hypoxia. Later he improved, but the sputum volume was large, which doesn't explain the sudden symptoms. I considered that there might have been an initial obstruction that gradually improved somewhat, but because the obstruction remained, there was still irritation, and only a scaffold-type sustained-release formulation could perfectly explain it.

Complete obstruction, then the drug was absorbed by the body, but irritation remained. The irritation causing increased sputum is also a contributing factor." Zheng Ren added another sentence, wanting to be clearer.

Once the answer was known, working backward became much easier; Zheng Ren shared his idea, leaving the ICU Inpatient Chief stunned.

Even Su Yun felt that his boss's explanation made good sense.

Yun Ge'er, what is this? A toy the patient was playing with?" a little nurse asked upon seeing the removed Bai Xintong drug scaffold shell.

No, it's the scaffold shell of the nifedipine controlled-release tablet.

…" the little nurse stared for a moment.

Bai Xintong consists of a film-coated tablet and a swellable hydrogel layer… this hydrogel layer contains polyethylene oxide and hydroxypropyl methylcellulose. After the latter is eroded, via the membrane-controlled push-pull osmotic pump principle, it can release nifedipine at an approximately constant rate over 24 hours, allowing the drug to be released at a zero-order rate?

Here, look—there's still drug unreleased on top; it's a bit lacking, probably because some got carried down when the boss operated.

Bai Xintong looks like this?!

Right, many people don't know. Not long ago, someone in the Medical Department complained, saying the doctors' prescriptions were fake drugs. I think they wanted the hospital to pay a hundred or two hundred thousand; after Director Lin explained it, the person just ran off." Su Yun and the little nurse chatted familiarly.

Zheng Ren looked at Su Yun helplessly, wondering how he'd get through the days ahead—did he have to stare at Chang Yue's black face every day?

Hurry up and get married, leave these two guys. Every day seeing Chang Yue unhappy made Zheng Ren feel he himself was not doing well.

What other medications is the patient taking?" Su Yun said, then suddenly asked the ICU Inpatient Chief.

Also Daiwen and Luo De.

Both of those are absorbable, so you can't see them." Su Yun continued, "The patient has a history of cerebral infarction, has been bedridden long-term, and has some degree of swallowing dysfunction—mainly because long-term bed rest, if nursing is improper, easily leads to aspiration.

Let's try going offline in three hours." Zheng Ren laughed, "If everything goes smoothly, we could probably transfer out of the ICU tomorrow.

Okay, okay." the ICU Inpatient Chief said repeatedly, "Boss Zheng, should you explain things to the patient's family, or should I?

When the patient was brought in, Boss Zheng and Yun Ge'er arrived; they probably know each other. The ICU Inpatient Chief asked that, also pondering not to overstep.

You go ahead; we're heading home." Zheng Ren said.

Sure." the ICU Inpatient Chief found a disposable container for sputum culture, put on gloves, placed the Bai Xintong drug scaffold inside, and prepared to take it to show the patient's family.