My medical skills add experience

Chapter 615 Brain Injury Including Visible and Invisible, Deep Check of Spinal Cord

"The boy has stiffness on the right side of the neck and weak knee reflexes in his right leg, all of which mean that there is a problem with the nerve conduction circuit. Also, the fact that the lower nerve centers are unobstructed does not mean that all nerves The central nervous system is connected. Combined with the child’s high fall, it is found that there is an obvious hematoma in the neck, and it can be concluded that there is an injury to the cervical spine. And it is likely that the spinal cord was injured.”

Seeing that he agreed, Director Yin began to seriously discuss the child's cause.

Every time he discusses the cause, he will naturally show this serious and meticulous expression.

Being able to become an ace expert in neurology naturally has its own advantages.

The rigorous attitude towards medicine is worth learning.

"In addition to the possible damage to the spinal cord in the neck, I think it's very likely that the child's brain was damaged as well."

Director Yin continued.

Both the brain and cervical spinal cord were damaged, which is the compound neurological disease Director Yin said.

"But the child's head was checked by CT and color Doppler ultrasound, and nothing abnormal was found!"

CT has strong diagnostic significance for tissue lesions, tumors, and hemangiomas.If the head is checked by color Doppler ultrasound, the blood supply in the head is usually checked.

There are blood vessels being compressed, blood vessel rupture, etc., all of which have good inspection results.

After carefully reading the child's inspection report, nothing abnormal was found.

He asked himself that his ability to read films was not weak after these years of tempering. In addition, the level of diagnosis has risen to the director level, and many medical skills in surgery have also been promoted to the director level. Technicians are better.

He can find some small problems that others can't find.

"Brain damage is sometimes invisible through color Doppler ultrasound, CT, and X-ray examinations. Even the highest-level MRI cannot be detected. Because the brain tissue is as crisp and tender as tofu, violent head injuries When they are hit, they may cause problems. Especially children, the skull has just closed completely, the body is immature, and many organs have not yet fully matured, so they are more prone to damage."

"Like the most common concussion."

Director Yin provided his own diagnostic insights.

This can be regarded as giving Zhou Can more diagnostic inspiration.

"You mean to look at the child's brain and cervical spinal cord at the same time, right?"

"Not bad!"

Director Yin showed a childish expression of satisfaction.

"In addition, I can also provide you with a diagnostic reference direction. Some patients have the disease themselves, but the symptoms have not yet developed or the symptoms are not obvious. Especially the symptoms of the prodromal period of the disease are often not obvious. I am just making an analogy, this Is it possible that the child has a neurological or spinal cord disease, and the injury from this high fall became the fuse, detonating the disease, leading to sudden high paraplegia?"

This is indeed another very experienced diagnostic thinking.

Young doctors rarely think about it.

Zhou Can came to visit Director Yin this time and gained a lot, so he got up to leave.

"Don't rush away, I haven't finished yet!" Director Yin gave him a dissatisfied look.

Zhou Can had no choice but to sit down again.

"There are two enlargements in the spinal cord. The upper one is called cervical enlargement, which is located from the third segment of the cervical cord to the second segment of the thoracic cord. The lower one is lumbar enlargement. Generally, when a patient develops typical spinal cord paralysis, focus on checking these two parts .This sick child is high paraplegia. I suggest that you focus on checking for cervical enlargement. If necessary, you can do puncture examination and minimally invasive exploration. In terms of invasive exploration, if you don’t understand, you can ask Director Wu of Neurosurgery for advice. That aspect is his forte."

Director Yin provided another diagnostic opinion.

These are the words of his accumulated experience over the years.Zhou Can is very grateful for sharing everything selflessly with Zhou Can now.

After Director Yin finished speaking, Zhou Can sat still and looked at him quietly.

"It's gone, all the opinions that can be provided have been provided. What else do you want to hear? How about I share with you some classic difficult neurology cases?" Director Yin asked anxiously.

"Uh... come back next time, come back next time. I got a scripture from you today, and I have to go back and read it quickly. The paraplegic child is still waiting! Thank you for your careful guidance, let's go!"

Zhou Can stood up and waved his hands again and again.

"The tea here is really delicious. In fact, our emergency department also has good tea. As long as you come over, I promise to steal Director Lou's best tea and make tea for you."

This is a joke.

Zhou Can is now the deputy director of the department. In order to win over his heart, the department has already applied for an office for him.

Even Deputy Director Han Changqing, who was much older than him, did not have this treatment.

But Director Han is going to retire soon.

Rather, he would not pursue these superficial things. What Director Han wanted to pursue should be the protection after retirement.

For doctors with established staff, their post-retirement salaries are usually not lower than 80% of their pre-retirement salaries.Therefore, before retiring, everyone will try their best to rush forward and raise the level higher.

At that time, the retirement salary can also get more.

Zhou Can has his own tea, which is better than the tea that Director Lou collected.

And he has a rich variety of tea.

As one of the behind-the-scenes big bosses of Jinyu Interactive, although he is extremely low-key, those who want to make progress, when giving gifts to Li Lao, they will always give Zhou Can a gift in a sensible way.

Zhou Can always told Li Luo not to give it to him, but every time Li Luo waited for him to go to the company, he would ask someone to fill his trunk.

When there is no money, any box of tea and good wine is precious.

When he really reached Zhou Can's level, he took it very lightly.

Things are rare.

It is a famous saying through the ages that no one seeks self-exaltation.

These gifts are received softly, and they don't even know who sent them.The person who gave the gift didn't think that Zhou Can must remember his name, but he just thought that many people would not be surprised by the gift.

If Zhou Can was not given a gift, in case Zhou Can had any objections when he was promoted or selected for an important position, a single word would be enough to stir up trouble.

Countless entertainers who want to make their mark, not to mention spending money to give some gifts, even if they are clean and well-dressed, sending them to their door to accompany Zhou Can to talk at night while holding candles is a sweet treat.

There are also advertisers that cooperate with them, companies that have significant interests in the entertainment industry and Jinyu Interactive, and it is normal for them to give gifts to the two bosses of Jinyu Interactive during the holidays.

After leaving Director Yin's office, it was already 26:[-] in the evening.

time flies.

He seemed to feel that there was never enough time.

There will always be endless patients and endless work.

Back in the emergency department, he was ready to challenge and see if he could find out the cause of the child tonight.

Now, as the deputy director of the emergency department, he still has quite a lot of power.

The use of many medical resources can be mobilized directly without going through Director Lou and Dr. Xu.

The emergency department also has an advantage that specialized departments do not have, that is, it operates 24 hours a day.

As soon as the specialist departments are off work, many doctors and nurses are off work, leaving only the on-duty doctors and nurses to deal with inpatients.In this case, many things cannot be done.

Because of its particularity, the emergency department is open 24 hours a day.

Emergency patients and critically ill patients can be sent to the emergency department at any time, and effective rescue can be carried out immediately.There is no saying that you have to wait until the next day to go to work before rescuing.

Various emergency inspections can also be done at any time.

Including surgery, even at three o'clock in the middle of the night, as long as the patient needs it, the emergency department can carry it out immediately.

He took the child's inspection report and various materials to study carefully again.

Nerves can be divided into central and peripheral nerves.

But in terms of connection types, there are only two.One is the nerve connected to the brain, and the other is the nerve connected to the spinal cord, also known as the spinal nerve.

Director Yin's diagnosis suggestion is that the child may have problems with both cranial nerves and spinal nerves at the same time.

This requires Zhou Can to find a way to verify one by one.

Nerves can be divided into two categories, sensory nerves and motor nerves.

Zhou Can decided to re-enter the ward to test the child's sensory nerve function.

Don't bother doctors sometimes.

Under normal circumstances, doctors definitely hope to find out the cause of the patient at one time.But when encountering such a difficult neurological disease, let alone check it a few times, even if you check it dozens of times, hundreds of times, as long as the doctor is willing to spend precious time on the diagnosis and examination of the patient, the patient will enjoy it secretly.

Because this shows that I have met a responsible and good doctor.

If the patients and their family members are not sensible, and they still speak bad words to such doctors, their attitudes are extremely uncooperative.

It is conceivable that after the doctor feels chilled, he can suggest that the patient be transferred to another hospital or take some defensive medical measures.At that time, the patient can only eat the bitter fruit.

Just imagine, doctors can use these precious time to deal with more patients instead of wasting on one patient.

Diagnosis and treatment of such difficult cases, the investment is seriously out of proportion to the harvest.

If the performance commission for treating an ordinary patient is 50 yuan, the performance commission for treating a difficult case can reach 300 yuan.Doctors are also at a loss.

Moreover, the more complex the etiology, the higher the difficulty, and the greater the risk for doctors.

After arriving at the inpatient ward, the child's mother was taking care of the child.

Grandparents live in the hotel temporarily.

Including the boss of the bouncy castle and the young woman, they were also not in the ward.

According to common sense, the owner of the bouncy castle only needs to provide the treatment fee, and it is okay not to come in person.After all, the journey is too far away.

But the father of this child is not an ordinary person. If the boss involved does not act positively, the loss will be even greater if he is sued.Even if it is found that there is a problem, it is possible to be arrested and prosecuted.

No one wants to go to jail.

The boss of the bouncy castle took a positive attitude, just to satisfy the family members, don't sue him.

Try to keep it private.

People do not raise, officials do not investigate, which is applicable all over the world.

And it has been applicable since ancient times.

To give the simplest example, restaurants, steamed stuffed bun shops, cake shops, which one dares to be inspected?It's okay not to check, but a check will definitely find the problem.

As long as the diners are fine and everyone does not report, the store can continue to operate normally.

"Doctor Zhou, you are here!"

The little boy's mother saw Zhou Can come straight to the bed after entering the ward, and stood up quickly to say hello.

She should belong to a dignified and virtuous woman with a gentle temperament.

"You have come all the way from the imperial capital to see me. If you don't find out the cause of this child, I will not sleep well! I will test the sensory nerves below the neck for the child. We usually have several levels for this test. The gentlest thing is to touch the surface of the skin. If the child can’t feel it, then you need to stimulate the skin with a sharp object or electric current. Do you think it’s okay?”

Zhou Can is actually not willing to test the sensory nerve function of children.

Parents nowadays regard their children as sharp-edged.

Seeing the doctor beat the child's body with electric current, they dared to fight the doctor desperately.

In fact, the doctor did not have any malicious intentions, and he was dedicated to finding out the cause of the child.

In addition, doctor-patient disputes often occur in the emergency room.

Especially for patients with cardiac arrest or ventricular fibrillation, electric shocks are needed for cardiopulmonary resuscitation.During the electric shock, the patient will scream.

When the family members heard it outside, they felt that the doctor was torturing the patient, and immediately knocked on the door angrily, wanting to rush into the emergency room and beat the doctor.

"Will it hurt the child?"

The little boy's mother asked with some concern.

"If his body feels normal, he will feel pain. If it is not normal, there will be no symptoms. When we do the test, it will be well controlled and will not cause any substantial damage to the patient."

Zhou Can explained.

"That's fine! When we get here, we choose to trust you."

The child's mother agreed.

Zhou Can began to do sensory nerve tests on the little boy.

Above the neck, the child can feel his touch and caress, but below the neck, the sensory nerves are very weak.

Ordinary touch is not felt at all.

Only cold objects or sharp objects stimulate the skin to feel some.

As for very hot objects, it is generally not used in clinical tests.

Mainly for fear of being beaten by family members.

If it is not controlled well and the soup hurts the skin, even if it is just a red mark, the family members may not let it go.

Through the test, Zhou Can also discovered a phenomenon, the lower the child's neurosensory function is, the worse it is.

The sensory function of the bottom of the foot is the worst.

He also made another major discovery in this test.Director Yin told him to focus on checking the swelling of the child's spinal cord and neck.When testing sensory function, he found that the child's neurological function weakened, starting from the location of the medulla.

Explain that the problem should be in the medulla oblongata or above.

Like the pons.

There should be nothing wrong with the enlarged neck and below.

The internal structure of the spinal cord is actually very complicated, and its anatomy is extremely difficult.

Any spinal surgery should be done with caution.

Don't look at the doctors in those big hospitals bragging about how many lumbar disc herniation operations and cervical spine operations they have done, and how good the results are.There are many patients who may only have pain before surgery.

But after the operation, the pain is not so painful, but still need to sit in a wheelchair, or even high paraplegia, lying in bed can not take care of themselves.

Those in wheelchairs are a little better, and those who cannot take care of themselves while lying in bed are usually miserable.

There is no filial son in front of the long sick bed.

For the rest of his life, he will need to be bedridden and need someone to take care of him.Eating, drinking, lax, scrubbing the body, massaging the muscles, stretching and moving the limbs, whether it is the children or the other half, it is difficult to take good care of them for a long time.

(End of this chapter)