My medical skills add experience

In addition to necrosis, nerve rupture caused by spinal cord transection is also irreversible.

Clinically, so many doctors regard the spinal cord as a restricted area of ​​nerves, and they have their own reasons.

According to the induction of somatosensory potential, it has been basically found out that the first pair of spinal nerves of this little boy is abnormal.This can be a bit troublesome.

Let’s talk about the structure of the brain stem first.

The brainstem is known as the restricted area of ​​life and the restricted area of ​​surgery. Many senior brain surgeons talk about the discoloration of the brain stem.

Because the brain stem is the core part of the human nerve center, and it is also the most delicate and fragile part.

The brainstem includes the medulla, pons, and midbrain.

In fact, the back-groove structure we often see in books is the brain of the human body.

Sometimes there are tumors or broken blood vessels in the brain. As long as the brain stem area is not involved, brain surgeons can basically have no taboos and dare to use the knife.Even the current endoscopic surgery is quite mature.

Only two to three small holes need to be drilled in the head to complete the operation, which is efficient and safe.

The surgical trauma to the patient will also be minimal.

Endoscopic surgery is very friendly to some patients who are physically weak or whose lesions are not particularly complicated.Some patients do not meet the indications for traditional craniotomy and fail to meet the surgical requirements, so they can only choose conservative treatment.

In the end, it is conceivable that it is basically the same as waiting to die.

Lesions in the brain, cerebellum, or other parts of the cranial cavity are not scary.But a small brain stem hemorrhage is enough to make doctors helpless.

Of course, many major hospitals in China already have strong brain surgery teams, and the brain stem is no longer an absolute forbidden zone.

They dare to touch some not particularly serious brainstem injuries, or lesions that do not involve the midbrain.

According to the anatomical structure of the brainstem, the role of the medulla oblongata is to connect the pons at the top and the spinal cord at the bottom, which is equivalent to the throat of the human nerves.

Unfortunately, the first cervical nerve is located in the medulla.

Located at the junction of the spinal cord and the medulla.

Such a crucial position, with Zhou Can's current surgical level, can be challenged, but the result is uncertain, and the confidence is not particularly great.

If the spinal cord is transected and the nerves are broken after surgical exploration, then he is basically powerless.

He can now anastomose most of the nerves. As for repairing the broken spinal cord, he has not yet reached that level.

"The child's lower central nervous system is unobstructed, at least the left part of the body is unobstructed. And the pain nerve reflex below the neck also exists, but it continues to attenuate as it goes down. This shows that the possibility of spinal cord transection is relatively small."

Zhou Can was silently thinking about the cause of the child.

"Jiang Wei, I remember when this child just fell, did the neck hematoma occur on the right side?"

He asked Jiang Wei next to him.

"Yes, the injury is on the right side of the neck."

Jiang Wei nodded affirmatively.

Although she is just a nurse, she has a strong desire to learn.Following Zhou Can in surgery, ward rounds, and sometimes diagnosing difficult cases together has greatly helped her improve her level.

"The injury is on the right side of the back of the neck, and the low-level central nervous reflex on the left is normal, which means that the possibility of spinal cord rupture is very small."

Zhou Can said to himself.

According to the laws of physics, when one face is hit hard, it is often the other face that breaks first.

The lower central nervous system on the right side of the child's body was abnormal, but it still existed, indicating that the gray matter of the right spinal cord may be more damaged.If it is inferred in this way, then the child's high fall injury did not cause nerve rupture, at most it was just some damage.

If this is the case, then Zhou Can has great confidence to repair it through surgery.

"Let me know when the results of the spinal fluid test in the laboratory come out. If there is no infection or inflammation in the spinal fluid test, the child can be considered for surgery. However, when the surgical plan is formulated, I will invite neurosurgery experts The director will help check it out."

Zhou Can's eyes were as bright as stars.

After working on this difficult case for two days, I finally saw the light of day.

If the child can be cured, all the sacrifices are worthwhile.

Inviting the "Peak Scalpel" consultation of neurosurgery can be said so casually, as easy as calling an old friend over to help, probably only Zhou Can has this style.

All departments have strict rules for emergency consultation.

Invite doctors from other departments to attend the emergency consultation. If no doctor is designated, that department must send a doctor to the emergency department within 10 minutes.Of course, many times it can't be done.

Especially when the emergency department was weak in the past, some weighty departments procrastinated, and it was a face to arrive in half an hour.

Invite doctors from other departments to participate in the general consultation, do not appoint a doctor, usually within 24 hours.

But in reality, this time limit is three days.

For example, if Zhou Can wants to invite a neurosurgery doctor to come for a consultation, if the patient's condition is not urgent, it will be a general consultation.It takes about a day to apply and get approved.

After the other department received the notification, it took another day to arrange for a doctor to come for consultation.

Therefore, it is usually on the third day that a doctor rushes over for consultation.

Everyone is very busy, and every doctor has his own job. Participating in the consultation can be regarded as a duty, or it can also be said to be affection.

If it is really unpleasant, or if you ask for this or that during the consultation, it is too harsh, and the other department will send a regular trainee or a trainee to come over, and I will guarantee that it will make you feel worse than eating a dead fly.

Even if you want to ask the medical department for evaluation, people will say plausibly, sorry, our department is too busy. Although doctor XX is only a regular trainee, his level is quite good.

Excellent in diagnosing this type of case.

Then the leader of the medical department will not say anything more.

After all, they have already sent reinforcements there, you are so dissatisfied, you can diagnose yourself if you are capable!

This is also a situation that many patients often encounter when they go to the hospital to see a doctor. After a brief understanding of the doctor, they say to the patient, "Why don't you cancel your account? Our department is not good at your disease. You have to go to a certain hospital. A certain department."

This is a relatively indifferent doctor, or a doctor with little connections.

Directly and bluntly push the patient to other departments.

If it is a doctor with a wide network, he happens to know a doctor in a certain department, and he is familiar with it, he will call the doctor directly to make an agreement.I have a patient here. I'm not sure what kind of disease it is. Please help me to find out.

Most of the other party will agree.

This is equivalent to introducing a patient to him.

Mosquitoes are meat no matter how small they are.

Diagnosing and treating one more patient means more income.Sometimes picking up a big product is a win-win situation for performance and word-of-mouth.

If it is assigned by the girl who registers in the outpatient clinic, or if the patient chooses by himself, such an opportunity may be missed.

Let me tell you a little secret about registration in the hospital.

If you make an appointment for registration by yourself, you can directly choose a general doctor for minor problems.Those who are qualified to sit for a consultation are basically above attending.Even if the opponent is only at the resident level, he is still the best among them.

If you register at the window, the hospital staff will have a default rule.As long as the department you register with has an expert account, it will give you an expert account.

Anyway, the priority is to assign patients to high-ranking doctors.

The number of experts with special needs is not listed here.

On the one hand, the special needs expert account is expensive, at least more than 50 yuan, and the slightly more expensive ones basically start at 300 yuan.

Many patients have returned to poverty due to illness. If you give him an account worth a few hundred dollars, if he doesn’t spit on you on the spot, that’s because he’s being honest.

Therefore, when the patient registers, if he feels that his illness is not serious or complicated, he can also ask the girl at the window to register for an ordinary number for you.They generally readily agree.

You know, no matter the girl who registers at the window, or the doctor or nurse in the outpatient clinic, everyone is working part-time.

There is a kindness in everyone's heart.

No one would embarrass a patient for no reason.

Zhou Can knows many department directors and top experts, which is indeed a great advantage.

Every patient who sees him has the opportunity to enjoy top VIP treatment.

It only costs 8 yuan to register with him, but he has the opportunity to enjoy consultations with various special needs experts.

You know, Wu Baihe, Director Yin Hua, these special-needed expert accounts, can't be grabbed.

Of course, Zhou Can will also squander the resources in his hands.

Every time he asks other directors to help with consultation, he needs to return the favor.

……

At noon, because the operation was relatively late, the operation was completed at almost 1:[-], so I ordered a meal to eat in the operation lounge.

Some tertiary operations are quite difficult.

In fact, only a surgical expert like Zhou Can thinks that ordinary tertiary surgery is as easy as drinking water and eating.For many doctors, even senior deputy chief physicians, when performing any tertiary surgery, they are walking on thin ice and trembling.

Zhou Can has a sense of awe when performing any operation, but basically there are few things he can't handle because of his strength.

Now even if it involves orthopedic surgery, he can handle it a little bit.

"Boss, the child's test results are back."

Jiang Wei specially asked someone to bring over the child's test results.

"There is a bacterial infection!"

After Zhou Can saw it, he couldn't help exclaiming.

This was something he never imagined.

I thought that the child's high paraplegia was caused by a fall on the cervical spine, but now it seems that things are a bit unexpected.

Fortunately, I visited Director Yin Hua overnight.

These old experts have nothing else, that is, they are well-informed, experienced, and very stable.

Director Yin Hua told him to be wary of causes other than spinal cord injuries.

When he came back, he also asked for insurance, so he applied for a spinal fluid test for the child.It now appears that this step is the right one.

Be careful.

Through today's incident, he also realized that practicing medicine needs to be more cautious and more careful.

If this unconventional inspection is missed and the child is operated on, the consequences will be disastrous.

For spinal cord infection, it is sometimes difficult to find abnormalities through ordinary blood routine tests.

And the child's spinal cord infection turned out to be the most difficult tuberculosis.

Zhou Can was stunned.

Tuberculosis is a well-known chronic disease clinically, difficult to diagnose, difficult to treat, and easy to relapse.

Mycobacterium tuberculosis has a large number of extracellular flora and strong metabolic reproduction, which are its two major advantages.Make it calm in the face of many drugs.

Clinical treatment of tuberculosis often requires a combination of drugs.

And it's a long-term medication.

Why is tuberculosis so difficult to treat?
Tuberculosis bacteria can be roughly divided into two groups in the human body.

One is extracellular flora, which often parasitize in caseous lesions, tuberculosis nodules and cavities, and these flora can fully kill them only by using anti-tuberculosis drugs.

However, due to the large number of extracellular flora and strong metabolic reproduction, if there is no combination of drugs or improper combination in the treatment plan, it may lead to selective reproduction, mutation, and drug resistance. Therefore, it recurs and is difficult to cure.

There is also the intracellular flora. Compared with the extracellular flora, the metabolism and reproduction of the intracellular flora are much slower.

Its slow metabolism will greatly weaken the rapid killing effect of anti-tuberculosis drugs on it, which is also one of the reasons for its refractory treatment.

Clinically, even a case of pulmonary tuberculosis is enough to make doctors feel overwhelmed.

Not to mention that the spinal cord is actually infected now.

This is the nerve center of the human body!
If the test result is from an outside hospital, Zhou Can even wonders if there is a mistake?
The laboratory of Tuya Hospital is one of the best in the country, especially in terms of germ detection. Because of sufficient funds, the hospital also attaches great importance to this area.Often at no cost.

For example, the patient charges 80 yuan for one test.

One laboratory test may not be able to obtain accurate results, or there may be doubts.At this time, a re-examination, or even a third inspection, or a fourth inspection is required.

It is conceivable that if an accurate test result is obtained after four inspections, the total cost will be 320 yuan.

Is this fee charged to the patient?

It is estimated that patients will directly dismantle the charging window of the hospital.

The hospital can only bear the cost by itself.

According to Zhou Can's understanding, almost all responsible large hospital laboratories are not profitable.

This has something to do with the rigor of a large hospital.

In a small hospital, it is enough to do some common routine laboratory tests.If you can’t find it out, tell the patient directly that we have limited technology and conditions for your disease. If you can’t find it out, you have to go to a big hospital for investigation.

Then the patient went to a big hospital to see a doctor.

It is conceivable that when encountering such patients in grassroots hospitals, they all recommend them to large hospitals, and large hospitals cannot refuse them.

I can only accept the patient silently with tears in my eyes, and do whatever checks should be done.

You have to do it even at a loss.

How did word of mouth win?That was obtained regardless of the cost.

Not only do large hospitals ignore the cost of laboratory tests, but they also need to find out accurate results at a loss. The same is true for the rescue of critically ill patients in the ICU ward.

Looking at the ICU treatment costs as high as 10,000 to [-], or even [-]+ a day, patients feel that the hospital is really fucking black and making money.

The hospital was secretly wiping tears.

I believe every doctor and nurse knows how well-equipped the ICU ward is.When rescuing patients, all kinds of equipment, consumables, and manpower are invested regardless of cost.And the ICU works in three shifts.

There are dedicated doctors and nurses who are responsible for guarding and taking good care of you 24 hours a day.

How high is this cost?
There is also the cost of living in the ICU of 10,000+ for one day, either using extracorporeal membrane lungs, or using special drugs and consumables.

Many are 100% imported, and the cost is that expensive.

In the past, the import price of a titanium alloy nail was more than 6000 yuan.It cannot be produced domestically, but can only be imported.

The patient's bones were broken and split, and if it were not held in place, the patient would be crippled.

After using it, there is great hope for a cure.

And it doesn't need to be taken out for life, it can stay in the body all the time.

Domestic products, first of all, have a strong rejection reaction, and then they cannot meet such high requirements in terms of corrosion resistance and strength.

Patients and doctors will give priority to imported products.

The ICU ward does not make money, but earns word of mouth, which is the success rate of rescue of critically ill patients.