Chapter 618 Spinal cord transection is basically ruled out, terrible infection
In addition to necrosis, nerve rupture caused by spinal cord transection is also irreversible.
There are reasons why so many doctors in clinical practice regard the spinal cord as a neural forbidden zone.
Based on the somatosensory potential induction, it has been basically confirmed that the first pair of spinal nerves of this little boy is abnormal. This is a bit troublesome.
Let’s first talk about the structure of the brainstem.
The brainstem is known as a forbidden zone for life and surgery, and many experienced neurosurgeons are terrified when talking about the brainstem.
Because the brain stem is the most core part of the human body's nerve center, it is also the most delicate and fragile part.
The brainstem includes the medulla oblongata, pons, and midbrain.
In fact, the gyrus-like structure we often see in books is the human brain.
Sometimes, if there is a tumor or a broken blood vessel in the brain, as long as it does not involve the brain stem area, neurosurgeons can basically operate without any taboos. Even now, endoscopy surgery has become quite mature.
The operation can be completed by drilling two or three small holes in the head, which is both efficient and safe.
The surgical trauma to the patient will also be minimal.
Endoscopic cranial surgery is very friendly to patients who are physically weak or whose lesions are not particularly complex. Some patients do not meet the indications for traditional craniotomy and cannot meet the requirements for surgery, so they can only choose conservative treatment.
As you can imagine, in the end, it's basically the same as waiting to die.
It is not a big deal if there are lesions in the brain, cerebellum or other parts of the cranial cavity, but a small brainstem hemorrhage is enough to leave doctors helpless.
Of course, many large hospitals in China now already have strong neurosurgery teams, and the brainstem is no longer an absolute forbidden area.
They dare to treat some brainstem injuries that are not particularly serious, or lesions that do not involve the midbrain.
According to the anatomical structure of the brainstem, the function of the medulla oblongata is to connect to the pons above and the spinal cord below, which is equivalent to the throat of the human body's nerves.
Unfortunately, the first cervical nerve is located in the medulla oblongata.
Located at the junction of the spinal cord and the medulla oblongata.
With Zhou Can's current surgical skills, he can try to treat such a critical position, but the result is uncertain and the chances of success are not particularly high.
If surgical exploration reveals that the spinal cord is transected and the nerves are severed, there is basically nothing he can do.
He can now suture most of the nerves, but as for repairing a severed spinal cord, he feels he is not yet at that level.
"The child's lower central nervous system is unobstructed, at least on the left side of the body. The pain nerve reflex below the neck also exists, but it gradually weakens 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's illness.
"Jiang Wei, I remember when this child fell, the hematoma on his neck occurred on the right side, right?"
He asked Jiang Wei who was beside him.
"Yes, the injury is on the right side of the neck."
Jiang Wei nodded in affirmation.
Although she is just a nurse, she is very eager to learn. Following Zhou Can in surgeries and ward rounds, and sometimes diagnosing difficult cases together, has greatly helped her improve her skills.
"The injury is on the right side of the back of the neck, and the left side's low-level central nervous system reflexes are normal, which means the possibility of spinal cord rupture is very small."
Zhou Can said to himself.
According to the laws of physics, when one surface is hit hard, the first thing to break is often the other surface.
The child's lower central nervous system on the right side of the body was abnormal, but it still existed, indicating that the right spinal cord gray matter was more likely to be damaged. If this is the case, then the child's fall did not cause nerve rupture, at most just some damage.
If this is true, then Zhou Can has a good chance of repairing it through surgery.
"When the cerebrospinal fluid test results come out from the laboratory, let me know. If there is no infection or inflammation in the cerebrospinal fluid test, the child can consider surgery. However, when the surgical plan is formulated, I will invite Director Wu of the Neurosurgery Department to help review it."
Zhou Can's eyes were as bright as stars.
After working on this difficult case for two days, I finally saw some light at the end of the tunnel.
If this child can be cured, all the efforts will be worth it.
Inviting the 'top scalpel' of neurosurgery for a consultation can be said so casually, as if asking an old friend to come over for help. Perhaps only Zhou Can has this style.
Each department has strict regulations for emergency consultations.
Ask doctors from other departments to come to the emergency consultation. If no doctor is specified, that department must send a doctor to the emergency department within 10 minutes. Of course, this is often not possible.
Especially when the emergency department was weak in the past, some important departments were slow to respond, and being able to arrive within half an hour was considered a courtesy.
Ask doctors from other departments to participate in general consultations. No doctor is specified and the consultation is usually completed within 24 hours.
But in reality, the time limit is three days.
For example, if Zhou Can wants to invite a neurosurgeon to come for a consultation, and the patient's condition is not urgent, it is a regular consultation. It takes about a .
After the other department receives the notification, it takes another day to arrange for a doctor to come for consultation.
So usually a doctor will come for consultation on the third day.
Everyone is busy and every doctor has his or her own job. Participating in consultations can be considered an obligation or a favor.
If things really get unpleasant, or if you ask for this and that during the consultation and are too demanding, the other department will send a resident or trainee over, and I guarantee you'll feel worse than eating a dead fly.
Even if you want to ask the medical department for justice, they will confidently say that they are sorry, our department is too busy, and that although Doctor XX is only a resident intern, his level is still quite good.
Excellent in diagnosing this type of case.
Then the leader of the medical department will not say anything else.
After all, they have already sent reinforcements. If you are so ungrateful, why don’t you diagnose the problem yourself if you have the ability?
This is also a situation that many patients often encounter when they go to the hospital for treatment. After a brief understanding, the doctor who receives the patient says to the patient, "Why don't you cancel your appointment? Our department is not good at treating your disease. You have to go to a certain department."
This is a relatively indifferent doctor, or a doctor who has few connections.
Directly and bluntly push the patient to other departments.
If the doctor has a wide network of contacts and happens to know a doctor in a certain department, and they are quite familiar with each other, he will directly call the doctor and say, "I have a patient here, but I am not sure what disease he has. Can you help me take a look?"
The other party will most likely agree.
This is equivalent to referring a patient to him.
No matter how small a mosquito is, it is still meat.
Treating one more patient can bring in more income. Sometimes picking up a big deal can be a win-win for both performance and reputation.
If the appointment is made by the girl at the outpatient clinic, or if the patient chooses on his own, he will probably miss the opportunity.
Let me tell you another little secret about registration in the hospital.
If you make an appointment on your own, you can just choose a general doctor for minor ailments. Those who are qualified to see patients are basically attending physicians or above. Even if the other party is only a resident doctor, he is still the best among them.
If you go to the counter to register, the hospital staff will have a default rule. As long as the department you are registering in has specialist numbers, you will be given a specialist number.
Anyway, patients are assigned to doctors with higher levels first.
Special expert numbers are not included.
On the one hand, the price of a special expert appointment is expensive, at least 50 yuan or more, and the more expensive ones basically start at 300 yuan.
Many patients have fallen back into poverty due to illness, and you still make an appointment for them that costs several hundred dollars. If they don't spit in your face on the spot, that's because they are honest.
Therefore, when patients register, if they feel that their illness is not serious or complicated, they can also take the initiative to ask the girls at the window to give them a regular number. They will generally agree happily.
You have to know that no matter whether it is the girl processing the registration at the window, the doctor in the outpatient clinic, or the nurse, they are all working.
Everyone has kindness in their heart.
No one would make things difficult for a patient for no reason.
Zhou Can knows many department directors and top experts, which is indeed a huge advantage.
Every patient who sees him has the opportunity to enjoy top VIP treatment.
It only costs 8 yuan to make an appointment with him, and you will have the opportunity to consult with various special experts.
You know, it’s hard to get an appointment with special experts like Wu Baihe and Director Yin Hua.
Of course, Zhou Can would also squander the resources in his hands.
Every time he asked other directors for help in a consultation, he had to repay the favor.
…
Because the surgery was done late at noon and was completed at almost 1 o'clock, I ordered a meal and ate in the operating room.
Some level 3 surgeries are quite difficult.
In fact, only surgical experts like Zhou Can think that performing ordinary level 3 surgery is as simple as drinking water and eating. For many doctors, even senior deputy chief physicians, they are treading on thin ice and trembling with fear when performing any level 3 surgery.
Zhou Can is always in awe when performing any surgery, but his ability is there and there are basically very few operations that he cannot handle.
Now, he can even handle orthopedic surgeries.
"Boss, the test results of that child are out."
Jiang Wei specially asked someone to bring the child's test results.
"There is a germ infection!"
After Zhou Can saw it, he couldn't help but exclaimed.
This was something he never expected.
I thought the child's high-level paraplegia was caused by a cervical spine injury, but now it seems that the matter is a little unexpected.
Fortunately, I visited Director Yin Hua overnight.
These old experts are knowledgeable, experienced and steady.
Director Yin Hua told him to be alert to causes other than spinal cord injury.
When he came back, he applied for a spinal fluid test for the child just to be on the safe side. Now it seems that this was the right move.
It's better to be careful.
Through today's incident, he also realized that practicing medicine requires extreme caution and carefulness.
If this unconventional examination is missed and the child undergoes surgery, the consequences will be disastrous.
Spinal cord infection is sometimes difficult to detect abnormalities through routine blood tests.
What's more, the child's spinal cord infection turned out to be the most difficult type of tuberculosis.
Zhou Can was stunned.
Tuberculosis is a well-known stubborn disease in clinical practice. It is difficult to diagnose, difficult to treat and prone to relapse.
The large number of extracellular flora of tuberculosis bacteria and their strong metabolic reproduction are its two major advantages, which allow it to deal with many drugs with ease.
Clinical treatment of tuberculosis often requires combination of drugs.
And it is 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 the extracellular flora, which often parasitize in caseous lesions, tuberculous nodules and cavities. These flora can be fully killed by using anti-tuberculosis drugs.
However, due to the large number of extracellular bacteria and their strong metabolic reproduction capacity, if the treatment plan is not combined with other drugs or the combination is improper, it may lead to their selective reproduction, mutation and drug resistance, thus causing repeated attacks and making it difficult to cure.
Another type is the intracellular flora. Compared with the extracellular flora, the metabolism and reproduction of the intracellular flora are much slower.
Its slow metabolism will greatly reduce the rapid killing effect of anti-tuberculosis drugs on it, which is also one of the reasons why it is difficult to treat.
Clinically, even a case of tuberculosis is enough to make doctors anxious.
Not to mention that the infected part now is the spinal cord.
This is the nerve center of the human body!
If the test results were from another hospital, Zhou Can would even suspect that there was a mistake?
The laboratory of Tuya Hospital is one of the best in China, especially in the field of pathogen detection. Because of the sufficient funding, the hospital attaches great importance to this area and often does not care about the cost.
For example, a patient's laboratory test is charged 80 yuan.
A single laboratory test may not give an accurate result, or there may be doubts. In this case, a retest, or even a third or fourth test is needed.
It is conceivable that if it takes four examinations to finally get accurate test results, the total cost will be 320 yuan.
Should this fee be charged to the patient?
I guess patients will simply tear down the hospital’s payment windows.
The hospital can only bear the cost itself.
According to Zhou Can, almost all responsible laboratories in large hospitals cannot achieve profitability.
This has to do with the rigor of large hospitals.
Small hospitals only need to do some routine tests to diagnose a disease. If they can’t find the cause, they will directly tell the patient that their technology and conditions are limited and they can’t find the cause. They should go to a large hospital for a checkup.
Then the patient rushed to a big hospital for treatment.
It is conceivable that when grassroots hospitals encounter such patients, they will all be pushed to large hospitals, and large hospitals cannot refuse them.
I could only accept the patient silently with tears in my eyes and perform necessary tests.
We have to do it even if it means losing money.
How did you gain a good reputation? You didn’t care about the cost.
Large hospitals not only do not care about the cost when conducting tests in their laboratories, they also make losses in order to get accurate results. The same is true for rescuing critically ill patients in ICU wards.
Looking at the ICU treatment costs of up to 20,000 to 30,000 yuan, or even more than 100,000 yuan a day, patients feel that hospitals are really fucking corrupt and are really just trying to make money.
The hospital was secretly wiping away tears.
I believe every medical staff knows how complete the ICU ward is. When rescuing patients, all kinds of equipment, consumables, and manpower are invested regardless of cost. Moreover, the ICU operates in three shifts.
There are dedicated doctors and nurses on duty 24 hours a day to provide careful care.
How much does this cost?
The cost of staying in the ICU for one day is more than 100,000 yuan, and either extracorporeal membrane oxygenation or special drugs and consumables are used.
Many are 100% imported, so the cost is that expensive.
In the past, the import price of a titanium alloy rivet was more than 6,000 yuan. It could not be produced domestically, so it had to be imported.
The patient's bones are broken or cracked, and if it is not used to fix them, the patient will become disabled.
After using it, there is a great hope of recovery.
And it does not need to be removed throughout your life and can remain in the body.
Domestic products, first of all, have a strong rejection reaction, and then they cannot meet such high requirements in terms of corrosion resistance, strength, etc.
Patients and doctors will give priority to imported ones.
The ICU ward does not make money, but it earns reputation and the success rate of rescuing critically ill patients.
