Chapter 615: Brain damage includes visible and invisible damage, deep examination of the spinal cord
"The patient had stiffness on the right side of his neck and a weak reflex at his right knee joint, which means there is a problem with the nerve conduction circuit. Also, the fact that the lower nerve centers are open does not mean that all nerve centers are open. Combined with the obvious hematoma on the neck after the child fell from a high place, it can be concluded that the cervical spine is injured. And it is very likely that the spinal cord is injured."
Seeing that he agreed, Director Yin began to seriously discuss the cause of the child's illness.
Every time he discussed the cause of the disease, he would naturally show this serious expression and look meticulous.
To be able to become an ace expert in neurology, he must have his own strengths.
The rigorous attitude towards medicine is worth learning.
"In addition to possible spinal cord damage in the neck, I think it's very likely that this child also had brain damage."
Director Yin continued.
Both the brain and the cervical spinal cord are damaged. This is what Director Yin calls a complex neurological disease.
"But the CT scan and color Doppler ultrasound of the child's head showed no abnormalities!"
CT has a strong diagnostic value for tissue lesions, tumors, and hemangiomas. Color Doppler ultrasound is generally used to check the blood flow of the head.
It can detect compressed blood vessels, ruptured blood vessels, etc. and has good results in the examination.
I carefully read the child's examination report and found no abnormalities.
He thought his film-reading ability had been quite good after all these years of training. In addition, his diagnostic level had been raised to the director level, and his multiple surgical skills had also been raised to the director level. His film-reading ability was even better than that of ordinary chief physicians and technicians in the medical technology department.
He can find some small problems that others cannot find.
"Sometimes brain damage cannot be detected through color Doppler ultrasound, CT scan, or X-ray. Even the most accurate MRI cannot detect it. Because brain tissue is as fragile as tofu, severe impacts to the head can cause problems. Children are especially vulnerable to damage because their skulls have just closed completely, their bodies are tender, and many organs are not yet fully developed."
"For example, the most common concussion."
Director Yin provided his own diagnostic insights.
This also gave Zhou Can more diagnostic insights.
"You mean to examine the child's brain and cervical spinal cord at the same time, right?"
"good!"
Director Yin showed a satisfied expression, showing that the student was teachable.
"In addition, I can also provide you with a reference direction for diagnosis. Some patients already have a disease, but it has not yet occurred or the symptoms are not very obvious. In particular, the symptoms of a disease in the prodromal stage are often not obvious. I am just giving an example. Is it possible that this child already has a neurological or spinal cord disease, and this high-fall injury became the fuse, triggering the disease and causing sudden high-level paraplegia?"
This is indeed another highly experienced diagnostic approach.
Young doctors rarely think about this.
Zhou Can had a fruitful visit to Director Yin this time and stood up to say goodbye.
"Don't leave in such a hurry. I haven't finished talking yet!" Director Yin glared at him in dissatisfaction.
Zhou Can had no choice but to sit down again.
"The spinal cord has two enlargements. The upper one is called the cervical enlargement, which is located between the third section of the cervical cord and the second section of the thoracic cord. The lower one is the lumbar enlargement. Generally, when a patient has typical spinal cord paralysis, these two parts are examined. This patient has high paraplegia, so I suggest you focus on examining the cervical enlargement. If necessary, you can do a puncture examination and minimally invasive exploration. If you don't understand invasive exploration, you can ask Director Wu of the Department of Neurosurgery for advice. This is his strong point."
Director Yin provided another diagnostic opinion.
These are all the experiences he has accumulated over many years. Now he is sharing them all selflessly with Zhou Can, which makes Zhou Can very grateful.
After Director Yin finished speaking, Zhou Can sat still and looked at him quietly.
"That's all. I've provided all the opinions I can. Is there anything else you want to hear? How about I share with you some classic and difficult neurology cases?" Director Yin asked mischievously.
"Uh... I'll come again next time. I got the sutra from you today, and I have to go back and recite it. The paraplegic child is still waiting! Thank you for your careful guidance. Let's go!"
Zhou Can stood up and waved his hands repeatedly.
"The tea here is really delicious. In fact, we have good tea in the emergency department as well. If you come over, I will 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 his heart, the department has specially applied for an office for him.
Even Deputy Director Han Changqing, who has much more experience than him, did not receive such treatment.
But Director Han is about to retire.
Director Han is not pursuing these superficial things. What he wants is probably the security after retirement.
For doctors with a permanent position, their salary after retirement is usually no less than 80% of their pre-retirement salary. Therefore, before retiring, everyone will try their best to get a higher rank.
By then, you can get more retirement pay.
Zhou Can has his own tea, which is better than Director Lou’s collection.
And he has a rich variety of tea.
As one of the big bosses behind Jinyu Interactive, although he is extremely low-key, those who want to get ahead will always be sensible enough to give Zhou Can a gift as well when they give it to Li Lao.
Zhou Can always told Li Lao not to give him any money. As a result, every time Li Lao waited for him to go to the company, he would ask someone to fill up his trunk.
When I had no money, any box of tea or good wine seemed precious.
When it comes to Zhou Can's level, he actually takes it lightly.
Scarcity makes things valuable.
It is an eternal saying that when a person has no desires, his character is naturally noble.
He received so many gifts that he didn't even know who sent them. The person who sent the gifts didn't think that Zhou Can had to remember his name, but just thought that the more gifts, the less blame.
If I didn't give Zhou Can any gifts, if Zhou Can had any objections when it came to promotion or appointment to an important position, just one word could ruin the deal.
Countless artists who want to make a name for themselves, let alone spending money on gifts, would be happy to just wash themselves clean, dress up beautifully, and go to Zhou Can's house to chat late into the night.
There are also those cooperating advertisers and companies in the entertainment industry that have significant interests with Jinyu Interactive. It is normal for them to give gifts to the two bosses of Jinyu Interactive during the holidays.
When I came out of Director Yin's office, it was already 8:26 in the evening.
Time flies by so fast.
He seemed to feel that there was never enough time.
There are always endless patients to treat and endless work to do.
Back in the emergency department, he was ready to challenge himself to see if he could find out the cause of the child's illness tonight.
Now as the deputy director of the emergency department, I have quite a lot of power.
The use of many medical resources no longer requires the approval of Director Lou and Dr. Xu and can be mobilized directly.
The emergency department has an advantage that other specialist departments do not have, which is that it operates 24 hours a day.
When it is time to get off work in the specialist department, many medical staff have gone off work, leaving only the medical staff on duty to treat inpatients. In this situation, many things cannot be done.
Because of its special nature, the emergency department operates 24 hours a day.
Emergency patients and critically ill patients can be effectively rescued at the first time whenever they are sent to the emergency department. There is no such thing as waiting until the next day to rescue them.
Various emergency inspections can also be done at any time.
Including surgery, even at three o'clock in the morning, as long as the patient needs it, the emergency department can start immediately.
He took the child's examination report and various materials and studied them carefully again .
Nerves can be divided into central nerves and peripheral nerves.
But in terms of connection type, there are only two types: one is the nerve connected to the brain, and the other is the nerve connected to the spinal cord, also called spinal nerves.
Director Yin’s diagnostic suggestion was that the child might have problems with both his cranial nerves and spinal nerves.
This requires Zhou Can to find a way to verify them one by one.
Then based on the function of the nerves, they can be divided into two categories: sensory nerves and motor nerves.
Zhou Can decided to go back into the ward to test the child's sensory nerve function.
Sometimes don't think the doctor is troublesome.
Under normal circumstances, doctors would definitely want to find out the cause of the patient's illness in one go. But when it comes to such a difficult neurological disease, let alone checking it a few times, even if it is checked dozens or hundreds of times, as long as the doctor is willing to spend precious time examining the patient, the patient will be happy.
Because this means you have met a good and responsible doctor.
If the patient and his family are ignorant, they will speak badly to such doctors and be extremely uncooperative.
It is conceivable that after the doctor feels disappointed, he may suggest that the patient transfer to another hospital or take some defensive medical measures. At that time, the patient can only suffer the consequences.
Just imagine, doctors could use this precious time to treat more patients instead of wasting it on just one patient.
When treating such difficult cases, the input and output are seriously disproportionate.
If the commission for treating an ordinary patient is 50 yuan, even if the commission for treating a difficult case can reach 300 yuan, the doctor will still lose money.
Moreover, the more complex the cause of the disease, the higher the difficulty, and the greater the risk the doctor bears.
After arriving at the inpatient ward, the child's mother was taking care of the child.
Grandpa and grandma are staying in the hotel temporarily.
Including the owner of the inflatable castle and the young woman, they were also not in the ward.
Normally, the owner of the bouncy castle only needs to pay for the treatment and does not need to come in person. After all, the journey is too far.
But the father of this child is not an ordinary person. If the boss involved does not show some initiative, the loss will be even greater if he is sued. He may even be arrested and prosecuted if he is found to have problems.
No one wants to go to jail.
The owner of the inflatable castle took a positive attitude in order to satisfy the family members and prevent them from suing him.
Try to settle this matter privately.
If the people don't report, the officials won't investigate. This applies all over the world.
And it has been applicable since ancient times.
Let's take the simplest example. Which restaurant, bun shop, or cake shop dares to be inspected? If they don't, it's fine. Once they are inspected, they will definitely find problems.
As long as the diners are fine after eating there and no one reports it, the store will be able to operate normally.
"Doctor Zhou, you are here!"
The little boy's mother saw Zhou Can enter the ward and go straight to the bed, and quickly stood up to greet him.
She should be a dignified and virtuous woman with a gentle temperament.
"You have come all the way from the capital to see me. If you don't find out the cause of this child's illness, I won't be able to sleep well! I will test the child's sensory nerves below the neck. We usually have several levels for this test. The mildest is to touch the surface of the skin. If the child can't feel it, we need to stimulate the epidermis with a sharp object or electric current. Do you think it's okay?"
Zhou Can was actually reluctant to test the sensory nerve function of children.
Today's parents treat their children as the apple of their eye.
When they saw the doctor using electric current to shock the child's body, they dared to fight with the doctor.
In fact, the doctor had no ill intentions and was only trying to find out the cause of the child's illness.
In addition, medical disputes often occur in the emergency room.
Especially for patients with cardiac arrest or ventricular fibrillation, electric shock is needed to perform cardiopulmonary resuscitation. When the electric shock is given, the patient will scream.
When the family members heard this outside, they thought the doctor was torturing the patient and immediately slammed the door in anger, 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's sensory nerves are normal, he will feel pain. If they are not normal, there will be no symptoms. When we do the test, we will control it and will not cause any substantial damage to the patient."
Zhou Can explained.
"Okay then! Now that we're here, we choose to trust you."
The child's mother agreed.
Zhou Can started 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 can't be felt at all.
Only when cold or sharp objects stimulate the skin can you feel something.
As for very hot objects, they are generally not used in clinical tests.
The main fear is 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 still make a fuss.
Through testing, Zhou Can also discovered a phenomenon: the further down the child goes, the worse the child's neurosensory function becomes.
The sensory function of the sole of the foot is the worst.
He also made a major discovery during this test. Director Yin told him to focus on the enlarged part of the child's spinal cord. When testing the sensory function, he found that the child's nerve function was weakened, starting from the medulla oblongata.
This indicates that the problem is probably in the medulla oblongata or above.
For example, the pons.
There should be nothing wrong with the enlarged neck area and below.
The internal structure of the spinal cord is actually very complex, and its dissection is extremely difficult.
Any spinal surgery should be performed with caution.
Don’t be fooled by doctors in big hospitals bragging about how many lumbar disc herniation surgeries and cervical spine surgeries they have performed and how good the results are. Many patients may just be in pain .
But after the operation, the pain is not as severe anymore, but I still need to use a wheelchair, or even become a high-level paraplegic, lying in bed and unable to take care of myself.
Those in wheelchairs are slightly better off, but patients who are bedridden and unable to take care of themselves are usually in a miserable state.
There will be no filial son for a patient who has been ill for a long time.
You will need to stay in bed for the rest of your life and need someone to take care of you. It is difficult for your children or your significant other to take care of you for a long time, including eating, drinking, defecating, washing your body, massaging your muscles, and stretching your limbs.
