This miracle doctor just wants to be fired!

Several doctors followed Zhou Cheng to the emergency room to check on the patient's condition.

After the emergency treatment, the patient's condition has stabilized somewhat.

Liu Chi and Li Yaping inquired about the medical history of the patients they were interested in, and then conducted a physical examination.

On the other side, Wang Jianming, the director of the emergency department, was also working tirelessly to apply for a multidisciplinary consultation across the entire hospital.

……

About ten minutes later, when the door to the emergency department's conference room was pushed open, it was already packed with people.

On either side of the conference table, Liu Chi, deputy director of the Department of Neurology, and Li Yaping, director of the Department of Cardiology, were already seated.

Physicians from the ICU, respiratory department, endocrinology department, and rheumatology and immunology department also arrived one after another; they are all key personnel from their respective departments.

The table was covered with patients' medical records, examination reports, and imaging films.

The projector was on, and the screen was displaying the patient's latest cranial MRI images.

The atmosphere in the entire conference room was extremely somber.

Wang Jianming and Li Degang walked in, and the doctors who had been talking in hushed tones immediately fell silent.

Wang Jianming walked to the head seat and sat down. He glanced at everyone and said in a deep voice, "You are all key members of your respective departments. The reason I invited you all here today is because the condition of this 14-year-old female patient is really special and complicated."

"He had experienced multiple cardiac arrests, delirium, and visual hallucinations. He had just undergone a lumbar puncture to rule out infectious meningitis when he suddenly developed epilepsy accompanied by bradycardia. The cause of his illness is still unclear."

"Time is of the essence, and the patient's condition is critical. We hope everyone can work together to help us find a direction for treatment."

After speaking, he turned to Zhou Cheng and said, "Zhou Cheng, you are now the patient's attending physician and have participated in the entire diagnosis and treatment process. Please give us a detailed report on the patient's medical history and examination results."

Zhou Cheng immediately nodded, stood up, walked to the projector, and began his report.

"The patient, a 14-year-old girl, was admitted to the hospital due to 'abnormal emotions for one month, followed by sudden respiratory distress and confusion for half an hour'."

"One month ago, the patient experienced mood swings after failing his final exams. He became irritable and prone to throwing things at night, and was lethargic and quiet during the day, talking to himself. He also experienced weight loss, poor appetite, and insomnia. His family did not take it seriously..."

Zhou Cheng paused slightly, switched to the examination report page, and continued to add: "After admission, relevant examinations were completed. The head CT scan showed no obvious abnormalities, and the blood amylase and urine amylase were normal, ruling out pancreatitis."

"Subsequent cranial MRI was normal, and the electroencephalogram showed diffuse slow waves; the cerebrospinal fluid obtained from lumbar puncture was normal in both routine and biochemical tests, ruling out infectious meningitis."

"Just now, the patient suddenly had a grand mal seizure, accompanied by bradycardia, with a heart rate as low as 43 beats per minute. After treatment with atropine and diazepam, the seizures were controlled, and the heart rate returned to 48 beats per minute."

"The patient's current vital signs are: heart rate 50 beats/min, blood pressure 90/55 mmHg, and blood oxygen saturation 92% (with high-flow oxygen therapy)."

After Zhou Cheng finished his report, he returned to his seat.

There was a brief silence in the conference room before Dr. Liu Chi, the director of the Department of Neurology, spoke first.

He adjusted his glasses and said in a deep voice, "Judging from the patient's symptoms, delirium, visual hallucinations, and epileptic seizures are the core symptoms of the central nervous system. Although the cerebrospinal fluid was normal, ruling out infectious meningitis, the diffuse slow waves on the electroencephalogram still point to an abnormal inflammatory response in the central nervous system. Considering the clear emotional stress that triggered the onset of the illness, I highly suspect autoimmune encephalitis."

"These types of diseases often show no specific abnormalities in cerebrospinal fluid examinations, but they can affect the central nervous system, causing mental symptoms, seizures, and even affecting the cardiovascular center, leading to bradycardia, which closely matches the patient's symptoms."

Liu Chi was the first to speak, and he spoke quickly, clearly after careful consideration.

"I agree with Director Liu's point of view, but we cannot ignore the cardiac issues." Li Yaping from the cardiology department immediately chimed in, "The patient suddenly suffered cardiac arrest and just now showed obvious bradycardia. This cannot be simply attributed to a central nervous system lesion."

"Although the previous electrocardiogram and cardiac enzyme tests showed no obvious abnormalities, the possibility of occult myocarditis or centrally mediated arrhythmia cannot be ruled out. It is recommended to complete Holter monitoring to monitor heart rate changes, repeat cardiac enzyme and troponin tests, and, if necessary, perform echocardiography to rule out organic lesions of the heart itself."

Li Yaping's remarks were fairly conventional, not completely ruling out heart disease, which is the most common defensive medical practice.

After Li Yaping finished speaking, the doctors from the remaining departments also spoke one after another.

"From a respiratory specialist's perspective, the patient's core issue isn't currently in the lungs," the pulmonologist added, putting down the medical record. "However, we need to be alert to systemic inflammatory response syndrome (SIRS) triggered by the lung infection. This type of response can affect the central nervous system and the heart, leading to multi-system dysfunction. We recommend a follow-up chest CT scan to assess the control of the lung infection, and also to complete tests for inflammatory markers such as procalcitonin and C-reactive protein to determine if there is any activation of systemic inflammation."

The ICU doctor frowned, his tone grave: "Regardless of the cause, the patient's condition is extremely critical. He is not yet conscious and carries the risk of status epilepticus and bradycardia. He could experience another respiratory and cardiac arrest at any time. We recommend close monitoring of vital signs and, if necessary, endotracheal intubation and mechanical ventilation to ensure airway safety and provide stable life support for subsequent examinations and treatments."

"I'd like to add that endocrine issues cannot be ruled out." The endocrinologist handed over a list of tests. "The patient experienced weight loss, loss of appetite, and insomnia before the onset of symptoms. Although the previous electrolyte imbalance has been corrected, metabolic diseases such as thyroid dysfunction and adrenal insufficiency cannot be ruled out. These diseases can also cause abnormal mental states, slowed heart rate, and even trigger a crisis. I recommend completing tests for thyroid function, adrenocorticotropic hormone (ACTH), cortisol, and other related parameters to rule out endocrine-related diseases."

The last speaker was Dr. Zhao from the Department of Rheumatology and Immunology. Based on the previous examination results, he analyzed, "Autoimmune encephalitis is indeed an important area of ​​investigation, but we cannot rule out the possibility of other autoimmune diseases affecting the central nervous system and heart, such as systemic lupus erythematosus and Sjögren's syndrome. These diseases often present with multi-system involvement and complex and diverse symptoms. I recommend completing an autoantibody profile test, including antinuclear antibodies, anti-double-stranded DNA antibodies, and anti-neutrophil cytoplasmic antibodies, to further clarify whether a systemic autoimmune disease exists."

The discussion in the conference room quickly became more heated.

Physicians from different departments offered different diagnostic directions and screening suggestions based on their own expertise.