Chapter 608: The lower nerve center is unobstructed, and there is inexplicable bleeding
People who study medicine know that the knee jerk reflex is the simplest type of neural reflex, and its completion process involves only two neurons, a sensory neuron and a motor neuron.
Bang!
After the hammer hit the stimulation point on the knee, the child's left leg bounced upward.
Zhou Can's face suddenly showed joy.
The nerve center of the knee jerk reflex is a low-level nerve center located in the gray matter of the spinal cord. However, when the knee jerk reflex is completed, the nerves in the spinal cord that lead to the brain will transmit this nerve impulse to the brain, making people feel that their knees are tapped. This causes the legs to bounce.
This child is paralyzed from the waist down. Logically, the nerves below the head and neck are blocked.
Zhou Can has now used a simple test to prove that there is no interruption between the nerve centers of the lower limbs and the brain, indicating that there is still hope for the child to be saved.
Even though only the lower nerve centers were stimulated, it was enough to make him feel excited.
This is like feeling a patient's pulse, which basically means you can determine that the patient has a heart rate.
However, heart rate and pulse are not the same thing. Heart rate is the number of times the heart beats in one minute. Pulse is the number of times the artery beats, also known as pulse rate. When a large amount of blood enters the artery, the arterial pressure will increase and the diameter of the artery will expand. This expansion can be felt in the superficial arteries on the body surface, which is the so-called pulse.
Under normal circumstances, the heart rate is consistent with the pulse.
In some patients, the heart rate may be higher than the pulse.
The nerve center is more complex than the pulse and heart rate. Now it is found that the child's low-level nerve center reflexes are unobstructed, which means that the child's nerve damage is not as serious as imagined.
After testing the child's left leg, Zhou Can tested the right leg again.
The knee jerk reflex is also present, but it is weaker in the right leg.
After multiple consecutive tests, he found that the child's right leg knee jerk reflex was indeed much weaker than that of the left leg, but the reflex reaction still existed.
At this time, he once again thought of the child's neck stiffness.
The left side of the neck is soft, and the right side is obviously stiff.
Everything seemed to point to a serious problem with the nerve conduction on the right side of the child's body. Or, on the contrary, the left side was seriously injured, but the right side was fine?
At least it gave him a diagnostic direction.
Neck stiffness indicates that there is a pain reaction or other reaction in the neck, and the muscles are tight. It is like when a doctor examines a patient's abdomen, a soft abdomen and a hard abdomen are two completely different diagnostic concepts.
A soft and flat abdomen usually means there is no major problem.
If the abdomen feels hard, it means that the patient's abdomen is pressed and has severe pain, causing the patient to involuntarily protect himself by tightening his abdominal muscles.
This is a normal body defense response.
First of all, one thing must be made clear, whether it is abdominal muscle contraction or neck stiffness, it is the effect produced after the muscles exert force and tighten.
Muscle contraction relies on nerve signal stimulation.
Without nerve signals, the muscle will become a piece of meat without any mobility.
This is also the main reason why Zhou Can is not sure whether the child’s nerves on the right side of the body are seriously damaged.
He even wondered if the child's right neck muscles were always tense, affecting nerve conduction?
There are too many diagnostic ideas that need to be sorted out, and many of them need to be verified one by one.
If you want to obtain certification, you must undergo necessary auxiliary examinations.
Although the patient had undergone a lot of tests in the first two hospitals, Zhou Can still felt it necessary to do some additional tests at Tuya Hospital to clarify the cause of the disease. If necessary, even surgical exploration is required.
Of course, many family members are reluctant when they hear about surgical exploration, and even resist this type of invasive examination.
Just like when rescuing critically ill patients, it is often necessary to cut the trachea and use invasive ventilators, and at this time the family members will be particularly resistant. There are even many who miss the chance of rescue because of this.
"Director Zhou, Director Zhou, there is a patient in the operating room who needs emergency surgery. Doctor Xu is busy, so I would like you to go over and preside over it."
A nurse ran over in a hurry and asked Zhou Can for help.
Currently, only Dr. Xu and Dr. Zhou Can in the emergency department's operating room have level three or above surgical capabilities.
When it comes to rescuing critically ill patients, Zhou Can is even better than his teacher and his ability in this regard has surpassed that of Dr. Xu.
"Okay, I'll be right there."
The purpose of the emergency department is to save the patient's life.
There is a patient who needs urgent surgery now, so this child with high paraplegia has to be put aside for the time being.
Moreover, it will take time to diagnose this child.
"This child needs to be hospitalized first, and then treated after the cause of the disease is found. Are the family members willing to let the child be hospitalized here? First of all, we at Tuya Hospital can only do our best, and we dare not guarantee that the child can be cured."
Zhou Can looked at the family members and the owner of the inflatable castle.
"Yes, yes! Doctor Zhou is very good. He just checked my grandson's knee jerk reflex and it showed improvement. We are very willing to be hospitalized here for treatment. I also ask Doctor Zhou to take my grandson's condition to heart and help him with treatment when you are not so busy."
The child's grandfather is quite knowledgeable.
I didn't look down on Zhou Can just because he was young.
Having just witnessed Zhou Can's unique diagnostic and treatment methods, he became even more confident in Zhou Can.
A man's reputation is like the shadow of a tree.
This young doctor Zhou has such a great reputation, even has a certain fame in the imperial capital, he must have some extraordinary qualities.
Trust the people you employ; don’t employ people you don’t trust.
He chose to trust Zhou Can.
"Please take care of it, Dr. Zhou."
The child's mother also had tears in her eyes and kept clasping her hands and begging Zhou Can.
The child's grandmother was a little embarrassed because she had recently shown off her son's official power in front of Zhou Can, which made Zhou Can unhappy.
"Don't worry, I will pay attention to every patient. Since you agree, I will ask other doctors to arrange hospitalization for the child. I think the child may need surgery, so let's admit him to the surgical inpatient ward first!"
After Zhou Can finished speaking, he looked at the owner of the inflatable castle.
This person is also unlucky to have encountered such a big thing. His situation is probably similar to that of Dr. Xu back then.
Because the father of this child has a very special identity.
His only child got into an accident while using the inflatable castle. As the boss and the person primarily responsible, he certainly cannot escape blame.
Do your best to make up for the loss and provide treatment; this is the only way to survive.
Otherwise, he would have probably been controlled and locked up long ago.
"From the results of the knee jerk test and the tests he had at the first two hospitals, it's not too bad. At least I think there's a slight chance of recovery. But the chance may be only 10% or even lower. As for the treatment costs, if you have medical insurance, try to get them reimbursed. When you go to the hospital later, ask Dr. Xie to teach you how to transfer your medical insurance to another city."
Zhou Can had seen the miserable situation Dr. Xu was in after the accident, so he felt very sympathetic towards this unfortunate boss.
Try to reduce the losses for the other party as much as possible.
The vast majority of residents in the imperial capital have formal medical insurance, and the reimbursement rate is higher than that of the New Rural Cooperative Medical Scheme and urban and rural medical insurance.
Of course, if the child does not have formal medical insurance, there is nothing we can do.
"Thank you, thank you! My friend said that you are kind and compassionate, and I have seen it with my own eyes today. I made the right decision to come all the way from the capital to see you."
The boss's eyes were a little moist.
He was really touched that Dr. Zhou still considered him as the person who caused the accident at this difficult time.
"My son has bought medical insurance, but he has always been worried that he won't be able to get reimbursement for medical expenses in other places. It is great that he can receive medical treatment in another place." The fact that the child's mother can say this is enough to show that she is a kind and wise woman.
If we really put all the burden on the owner of the inflatable castle, he will be overwhelmed and it will not be good for anyone.
"Don't worry, you can usually transfer to another place's medical insurance, and the most you'll get is a reduction in the reimbursement rate."
Zhou Can has been practicing medicine for so long that he knows that the biggest factor hindering patient treatment is money.
The significance of medical insurance is to allow ordinary people to be hospitalized and receive treatment after they fall ill.
Especially some treatment options that cost hundreds of thousands or millions, you can dare to choose and use them.
The bouncy castle project itself has purchased commercial insurance, and combined with the child’s formal medical insurance, the treatment costs should not be too much in the end.
The main expenses are other medical expenses incurred in other places, as well as the subsequent recovery treatment costs for the child.
Many rehabilitation treatments are not reimbursable.
"Doctor Xie, please help them with that. I'll come back to develop a diagnosis plan after the surgery. We may need to do some additional tests."
After Zhou Can settled the child who had come see him, he hurried to the operating room.
"Director Zhou, the patient is in operating room 3."
The emergency department now has three operating rooms, one Class 100 operating room, one Class 10,000 operating room, and one of the oldest ordinary operating rooms.
Zhou Can and Dr. Xu basically perform surgeries in a Class 100 operating room, also known as Operating Room No. 2.
The last 10,000-level operating room built was Operating Room No. 3.
Generally, other attending doctors will lead the surgery.
Most surgeries are secondary.
"Why not send the patient directly to operating room No. 2?"
Zhou Can asked in some confusion.
Since it was an emergency operation and he, the deputy team leader of the operating room, had to perform the operation personally, it meant that the patient's condition was very serious.
There are definitely some differences between a 10,000-level operating room and a 100-level operating room.
The most fully equipped operating room is the Class 100 operating room.
When hospitals purchase some more expensive equipment, they really spend it wisely.
It is impossible to equip every operating room with these.
In the entire emergency department, there is only one set of surgical equipment, which is basically placed in operating room No. 2. Of course, the endoscopy room in the emergency department is also well built. Endoscopic surgeries or examinations have been carried out one after another.
This itself is also a major development trend.
However, it is basically impossible for endoscopic surgery to replace traditional surgery.
For many serious diseases or complex major surgeries, traditional laparotomy, thoracotomy and craniotomy are more beneficial.
When performing any surgery, in addition to considering the harm the surgery may cause to the patient, we must also consider the success rate and efficacy of the surgery.
For example, in cardiac surgery, even if it is just a simple right ventricular hypertrophy, open-chest safer.
Endoscopic operations do have certain limitations after all. They will restrict the doctor's medical skills and will hinder many surgical procedures.
Therefore, it is basically impossible for endoscopic surgery to completely replace traditional surgery.
"The patient was originally undergoing a subcutaneous tumor removal surgery, but she unexpectedly suffered a sudden massive bleeding from her lower body during the operation and is currently being treated for the disease."
The nurse didn't know much.
Because she didn't work in the operating room, she was just responsible for managing surgical patients outside.
"Go get busy!"
Zhou Can's heart sank slightly and his expression became solemn.
As the deputy director of the department and deputy team leader of the operating room, such a medical accident inevitably made him nervous.
If something goes wrong, the doctor involved will definitely be punished.
However, the heads of the operating room and department will also be affected, and the reputation and image of the department will be negatively affected.
After pushing open the door of the operating room with his foot, he changed into sterile surgical clothes and walked quickly into the operating room.
When he came in, he felt a solemn atmosphere.
There were medical staff running around, looking nervous.
"What's wrong with the patient?"
Zhou Can asked expressionlessly.
"It was originally just a subcutaneous tumor removal, a simple second-level operation. Who would have thought that during the operation, the patient suddenly had a heavy bleeding. The blood pressure kept dropping, and the breathing became rapid and heavy... Director Zhou, what do you think we should do now?"
Tang Wangnian was the attending physician, and was on the cusp of striving for the title of associate senior professional. When such an incident happened, he probably wanted to die.
In the past, I was very dissatisfied and angry with Zhou Can.
Something happened at this moment, and seeing Zhou Can coming was like seeing his ancestor.
He almost knelt on the ground and begged Zhou Can to help him.
"What else can we do? We must try to save the patient's life first."
Zhou Can glared at him unhappily and walked straight to the operating table.
The patient is a young woman in her twenties. She had a subcutaneous tumor on the inner side of her left thigh, which had been growing larger recently. She was afraid that it might be cancerous, so she came to Tuya Hospital for treatment.
Because the emergency department has a good reputation, she chose to perform the subcutaneous tumor removal surgery in the emergency department.
It can be done by general surgery.
The gynecology department is also capable of handling it.
For subcutaneous tumors, as long as they are not too complicated and the surgical risk factor is not particularly high, basically most surgeons can perform the operation.
Logically speaking, cutting a tumor in the thigh should not cause heavy bleeding in the patient's lower body.
There were many doctors and nurses on the scene, and the possibility that Tang Wangnian would do something out of line while the patient was under anesthesia was almost zero.
So what is the cause of the bleeding?
At this moment, the patient's breathing was very scary, rapid, heavy, and his chest rose and fell violently.
This means she has to work hard to breathe fresh air.
In addition, her blood pressure was alarmingly low and was still falling.
The patient's abdomen was relatively flat.
Zhou Can pressed her abdomen slightly with his hands, and a large amount of blood immediately gushed out from her lower body. The color was bright red.
This means that bleeding is still occurring and there is a large amount of blood accumulated in the abdominal cavity.
"Did the patient undergo a pregnancy test before surgery?"
After Zhou Can stared at the patient's body and face, he asked Dr. Tang Wangnian.
Her physical appearance resembles that of a pregnant woman.
