episode_0077

Episode 77. Return to daily life (2)

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Our first patient of the day.

His name is Josef, and he looks a bit old for a young man. He works as a farmer and has been doing a lot of outdoor activities lately.

The reason for the visit was said to be due to multiple symptoms including redness of the skin, palpitations, rapid breathing, dizziness, and swelling around the neck.

However, most of the symptoms are non-specific.

I thought of tsutsugamushi disease first. The season, the outdoor activities, the symptoms like enlarged lymph nodes and high fever.

Amy concluded that it was pneumonia based on the information given. It was worth checking, although it didn’t seem to be pneumonia.

I looked at Amy.

“Differential diagnosis of pneumonia. What should I do?”

Amy tilted her head. It couldn’t be pneumonia. Still, it would be best for her to draw her own conclusions.

“This is Cheongjin.”

“Then listen to it.”

“Yes.”

Amy listened to the patient’s back with a very serious expression. I had done it before, but instead of the crackles caused by pneumonia, I heard tachypnea and wheezing caused by bronchial constriction.

“Oh, the auscultation is normal.”

“Right… …. There’s no phlegm sound.”

As expected, it’s not pneumonia.

It could be due to smoking or other underlying diseases. But if it is a new symptom caused by this disease… …. Could it be that the bronchi have narrowed due to a systemic inflammatory response?

I looked at Mr. Joseph lying in the hospital bed. That was the conclusion. This is tsutsugamushi disease or something similar.

An insect-borne bacterial infection, popularly known as being caused by ticks.

For insect-borne bacterial infections, treatment is usually doxycycline. Also for plague.

It would be nice to be able to pinpoint exactly what kind of bacteria it is, but there are more than a few similar bacteria.

Just look at the diseases that were lumped together as killer tick diseases in Korea. Tsutsugamushi disease, leptospirosis, hemorrhagic fever with renal syndrome, severe fever with thrombocytopenia syndrome, etc. They are quite diverse… … .

Fortunately, the solutions are similar: monitoring vital signs, symptomatic treatment, and doxycycline.

In the case of hemorrhagic fever with renal syndrome and severe fever with thrombocytopenia syndrome, you do need to be careful because complications can remain, right?

“It’s a tick-borne disease.”

“Murder? Am I going to die?”

It is true that it is a disease that can be cured, but it is notorious as a killer tick for a reason. It is called that because so many people have died from it.

My thoughts were short. No, who gave me that nickname? It’s making the patient feel cold.

“Ah. That’s what they usually call it.”

“Then will I die?”

“No. It will get better if you take medicine.”

I shook my head, and Mr. Joseph looked at me with eyes full of suspicion. Of course, it was a natural reaction to hear the word murder.

“The patient’s disease is thought to be an insect-borne infectious disease caused by a tick bite. In this case, nonspecific systemic symptoms may appear without a vector organ when the pathogen is directly injected into the blood.”

“Oh, is that so… … ?”

“They say symptoms appear all over the body.”

The patient who was lying down nodded to my words, although his expression was a bit confused.

“Yes. The disease seems to be caused by ticks. It will get better after taking medicine for a few days. It is dangerous, so you will need to be hospitalized for two days. It may take about a week for the disease to completely disappear.”

If it were a modern hospital, they would have confirmed it with a blood antibody test, but that’s not possible here.

“Okay, I understand.”

“But it is a disease that can be treated.”

“Before I give you the medicine, I need to find the insect bite wound to confirm the diagnosis, right?”

“Yes?”

“The tick may still be attached to you, or there may be a scab attached to the tick bite. You need to find that.”

Commonly called a keratosis. A red, erythematous lesion with a scab or tick attached to it, like a target. The patient squinted.

“How do I do it?”

“I’ll come over in the evening and give you some medicine. Until then, you can either look for ticks or find tick bites. ”

Tick bites are a little different from mosquito bites.

They are usually not itchy and you may not even notice that you have been bitten. Ticks usually bite in places that are out of sight, such as in the folds of the skin. If you don’t look for them carefully, you will usually miss them.

I hope you’re successful in finding the tick. If you can’t find it, you’ll have to have a medical professional look for it, and if that doesn’t work, you’ll have to consider another diagnosis.

“That’s right, patient. Just one thing. If you notice any unusual bruising or changes in urine color, you need to let me know right away. There hasn’t been any of that, right?”

“Yes.”

“Thank you for your hard work. Then, please check carefully to see if there are any ticks, and I will see you later.”

****

I took Amy and left the place.

Amy was writing something down on the medical record against the wall, then looked over the patient’s shoulder to check his expression again.

– Patient’s consciousness: Clear.

“Is this a disease caused by ticks?”

“Yeah.”

“No problem, right?”

“If you just take your medicine, you’ll be fine.”

As long as it’s not a hemorrhagic fever with nephrotic syndrome or a disease that causes thrombocytopenia, that’s fine. In this case, if the kidneys fail, dialysis or platelet transfusions are difficult.

We need to manage it well so that it doesn’t turn out like that.

“Continue checking the patient’s complexion and whether their hands are swollen. Also ask how many times they urinate.”

“Ah. Is that all?”

I nodded. It wouldn’t matter if I knew what kind of bacteria caused the disease, but since I don’t know the species, I have to be careful.

Amy finished what she had been writing.

“Have you organized your medical records?”

“Yes.”

“Who is the second patient?”

“I heard you got bitten by a dog.”

“You must have been in pain.”

“I put a band-aid on it earlier.”

You have to see this yourself. If there is an infection in the wound, it could develop into a life-threatening disease. There could also be other problems involved.

The patient was lying in bed with a bandage wrapped around his calf. How long had it been since the bandage was put on? Should it be re-wrapped?

“Hello, patient.”

“Oh, hello… … .”

“What is your name?”

“This is Amanda.”

Amanda. She looked like she was about the age of a student, but she didn’t look like an Academy student. After all, would you get bitten by a dog at the Academy?

“When did you get the bandage?”

“Yesterday.”

“Let me unravel it briefly.”

I disinfected my hands and carefully unwrapped the bandage from the patient’s leg. It felt a little pressed, but it was better than I thought. There was some redness, though.

“Amy, bring me some distilled water.”

“Yes.”

“It seems to be healing well. There is no problem, but I will clean the wound again and prescribe preventive medicine to prevent gangrene.”

“Oh, yes.”

“Please stretch your legs out of the bed.”

It must have been a rather large dog. There were tears in addition to simple teeth wounds.

“Amy. Look.”

“Yes.”

“If there is fever or redness in the wound, there is a risk of gangrene.”

“Yes.”

“Do not directly disinfect the inside of the wound. If possible, clean the wound with distilled water. This will allow you to check if there are any foreign substances left inside.”

“Yes, I understand.”

“Do you think I need to sew this up, though?”

“Yes.”

Well, it’s better than nothing. If you leave it alone, the wound might not heal properly. I took out a needle and thread from the side.

“Oh. I think the patient’s wound needs stitches. It’s bigger than I thought.”

“Ah… … . Are you sick?”

“I will anesthetize you.”

Anyway, let’s do it quickly. We cleaned the inside of the wound with distilled water, disinfected the area around the wound with red medicine, and injected local anesthetic.

That’s it. I pinched the area around the wound with tweezers to check if the anesthesia was working properly. It seemed to be working properly, at this point.

“Needle.”

Amy handed me a needle.

“Amy… … . Look closely. If the wound is 1 centimeter deep, the needle should be inserted deeper than that to stitch it up. That way, there won’t be any space under the wound.”

“Aha, yep.”

“If you tie the knot too tightly, the blood flow will be cut off and the flesh will die. Tie it moderately. But if it is not tightly closed, it will be fine.”

“Okay.”

Finishing. The wound was bigger than I thought, so I had to tie 6 knots.

“Cover the wound with a bandage or plaster, and check the bandage daily if possible.”

“Yes.”

Thank goodness it wasn’t a serious illness. I put my stitches aside and stepped back next to Amy.

“I’ll give you two pills, so take them now.”

“Yes. Do you only eat it for one day?”

Since it is a preventive antibiotic, one dose is enough.

The prophylactic antibiotic dose used before surgery is 2 grams of amoxicillin. It is different if the wound is infected with bacteria. In that case, antibiotics must be taken until the infection is gone.

Right, something to check further.

“Why did you get bitten? If a dog bites you for no reason, it could be rabies.”

“It was a dog that guarded someone else’s house. I don’t think it was a crazy dog.”

As I was thinking about it, I remembered one more thing I should do for the patient. Since it was a contaminated wound, I think I should also take precautions against tetanus.

I guess I’ll have to administer tetanus antitoxin too.

I gave the patient one last injection and then left the bed.

“Please tell me immediately if you notice any changes in your physical condition. You may suddenly develop rabies or tetanus symptoms… … .”

“Oh, yes.”

Amanda nodded.

I thought about it for a long time.

It’s really frustrating that molecular testing isn’t available in these cases. The chances of it being tetanus or rabies are low, but these two diseases are very dangerous, and there’s no way to treat them once symptoms appear.

No, I can’t go because I’m worried. I think it would be better to get rabies antibodies and then go…