Chapter 627: Three major sequelae of thalamic hemorrhage, the doctor is kind
After looking at the brain CT scan, Zhou Can's expression suddenly became extremely serious.
The patient's condition was more serious than expected.
Dark shadows can be seen in the thalamus and caudate nucleus, and even a small amount of water flushing can be seen, indicating that the bleeding site is in the thalamus, and the amount of bleeding must be far more than 5ml.
There are two types of intracranial hemorrhage. One is in the brain layer, such as the gyrus. Even if the bleeding in these parts exceeds 5ml, it is not considered serious. As long as the bleeding can be controlled, surgery is usually not required. The patient can absorb the bleeding by himself and then recover.
In fact, neurosurgery occasionally encounters some special patients, such as those with malignant tumors or accidental injuries, which ultimately result in more than one-fifth of the patient's head being cut off.
But the patient eventually survived and was able to take care of himself.
Therefore, the location of cerebral hemorrhage determines whether it is high-risk.
The bleeding site of the patient in front of him was in the thalamus. What worried Zhou Can the most was that there was also bleeding in the brain stem.
Many people think that the thalamus is the brain stem, but it is not.
It is part of the diencephalon and is divided into left and right parts, located on both sides of the third ventricle. The left and right thalamus are connected by gray matter masses.
In medicine, the thalamus is a sensory center. The nerve impulses sent by sensory receptors throughout the body must be transferred through the thalamus before being transmitted to the cerebral cortex.
Zhou Can just checked on the patient and found that she was unresponsive, unconscious, and in a deep coma.
This is also what worries him most.
Thalamic hemorrhage can cause serious problems in the human body, but this patient is in a deep coma and has symptoms such as respiratory failure and heart failure, which makes people wonder whether the bleeding site is not limited to the thalamus?
Zhou Can is not very good in the field of neurosurgery, but he knows much more than the average neurosurgeon.
After all, I followed a chief physician during my neurosurgery training and he had performed many major intracranial surgeries. His knowledge and experience were all there.
After completing his neurosurgery training, he was often invited by neurosurgeons to help perform some cranial endoscopic surgeries or diagnose difficult cases.
Even Wu Baihe had discussed this with him many times.
So his neurosurgery skills are not bad.
The impact of thalamic hemorrhage should be analyzed from its three major sequelae.
The first is the physical symptoms. The patient will feel severe and obvious pain in the head. Usually, few people's bodies can tolerate this pain, so gastrointestinal symptoms will occur.
Such as nausea, vomiting, etc.
Others may experience hemiplegia or weakness of one side of the limbs.
If limb paralysis occurs, it means that the patient's thalamic hemorrhage is very serious.
This is a bad sign and the prognosis is often not ideal.
The second biggest sequelae is sensory impairment.
The thalamus is a relay station for the gray matter to receive nerve signals from the brain centers and sensory organs throughout the body.
After the nerve signals from the brain center and the sensory organs throughout the body are sent out, they will be "translated" by the thalamus and then transmitted to the cerebral cortex.
From this we can see that the thalamus plays an extremely important role in the processing of sensory nerve signals throughout the body.
When problems occur, it can have disastrous consequences for both the nerve centers and the brain.
For example, a large dam was built.
If the raging torrent directly hits the large dam, it is very easy to break it down. So clever engineers thought of designing a backwater area to buffer the huge impact of the torrent and reduce the stress on the dam.
Thereby greatly improving the safety performance of the dam.
The largest dam built by India was destroyed by floods on the day of its completion. In addition to the substandard quality caused by corruption, the failure to master some key technologies was also one of the reasons.
The thalamus acts as both a translator and a buffer station.
When there is a problem with it, the patient may experience decreased sensation or even loss of sensation. For example, the most common one is numbness, where a part of the limb loses pain or the pain sensation is severely reduced.
A while ago, many patients infected with the new coronavirus experienced loss of taste and smell, which may be caused by the impact on the thalamus.
When there is a problem with the thalamus, we may not be able to smell some irritating smells that we normally find unbearable.
Or just a little bit.
Of course, the sense of smell is related to the nose, as well as internal tissues and organs such as the olfactory bulb.
This requires comprehensive diagnosis. If the sense of smell is lost, it cannot be concluded that there is a problem with the thalamus.
The third sequelae is impaired consciousness.
Trauma or problems with almost any tissue within the brain can cause impaired consciousness.
Some tissues cannot cause disturbances of consciousness themselves, but can have an indirect impact.
For example, a hematoma may occur, directly compressing the cranial cavity or causing a sharp increase in intracranial pressure.
When the thalamus has problems, the most common disturbances of consciousness are drowsiness, gazing, confusion, lethargy, etc. In the most serious cases, coma may occur, but it is relatively rare clinically.
A decreased level of consciousness, obtundation or 'psychosis' is common, and complete loss of consciousness may sometimes occur.
After analyzing the three major sequelae that may be caused by damage to the thalamus, we can reversely infer the area affected by the lesion based on the patient's symptoms.
This is also the reason why Zhou Can felt that his condition was more serious than he had imagined.
In the first case, if the thalamus causes the patient to fall into a deep coma, it means that the patient's thalamus is severely damaged.
In the second case, if the deep coma is not caused by the thalamus, it is very likely that there is bleeding in the brain stem.
Either way, it's a very tricky situation.
Doctors from several departments did not dare to take the call, probably because they considered the huge risks involved.
What if the patient dies after being admitted and his family makes trouble and files a lawsuit?
People know how to seek benefits and avoid harm from the moment they are born.
No matter how kind-hearted a doctor is, he will not do anything that is obviously disadvantageous to him.
Otherwise it would be stupid.
Zhou Can continued to study the patient's information.
The small county hospital actually performed MRI on the patient.
You know, the price of a nuclear magnetic resonance detector is not cheap. It costs at least 20 million, and most of them are in the 30 million range.
There is no cheap imported instrument or equipment.
Foreigners make a lot of money from this kind of technology fees.
They make a lot of money when they sell the equipment to us, and then they continue to make money from the maintenance and repair of the equipment.
They didn't even let us see it while it was being installed.
I believe that many factory owners have suffered such losses when purchasing imported equipment from abroad. After buying the equipment, they have to hire two foreign technicians, provide food and accommodation, travel expenses, and wages, and treat them like ancestors.
The installation and debugging of the equipment, as well as any problems encountered during operation, all require the support of these two foreign technicians.
This feeling of being strangled by the throat at the technical level makes countless Chinese people feel suffocated.
But there was no way, that was the condition at the time.
We can only learn from Gou Jian, King of Yue, who slept on straw and tasted gall, and endured it for now. When we develop, we can get rid of these technical bottlenecks.
A county-level hospital that has an MRI scanner is obviously not small in scale.
Otherwise, even if the hospital leaders were impulsive and wanted to purchase a piece of inspection equipment worth tens of millions, it would be difficult to obtain approval from higher-ups.
Zhou Can thought to himself, there are also experts among the doctors in the county hospital!
This shows that after consultation, the doctors at the county hospital also realized that the patient's lesion might not be that simple.
It should not be a simple thalamic hemorrhage.
CT is very accurate, but every inch has its strengths and weaknesses.
Each inspection instrument has its advantages and disadvantages.
Magnetic resonance imaging is currently recognized as the imaging device with the highest accuracy.
However, even MRI detectors are divided into different levels.
The highest accuracy can reach millimeter level.
Tuya installed one.
It is extremely difficult to make an appointment, and you may have to wait in line for a week.
Zhou Can took the patient's head MRI and looked at it carefully, and he immediately had a clue in his mind.
"Cheng Xiaolu!"
"Um!"
"Your mother's intracranial hemorrhage is not optimistic. There is almost no hope for conservative treatment. Moreover, she will definitely need to be admitted to the intensive care unit. The daily treatment cost will be an astronomical figure."
Zhou Can can understand the hardships of ordinary people.
Her father became disabled after an accident at a construction site, and her mother works on the farm at home and occasionally does odd jobs for others, and her income is very limited.
Moreover, he supported her through college and took her to graduate school, which was enough to use up all the savings of this poor family.
After she finished her studies, she went to work in the pharmaceutical department of Tuya Hospital.
However, the pharmaceutical department is in a loss-making state every year, and the salary of technical R&D personnel is not very high. At most, it is at the normal level of the industry to ensure that there is no loss of talent.
If she chooses conservative treatment, her mother will definitely have to be admitted to the intensive care unit. The patient's current condition will definitely require a ventilator, and the cost per day will be at least more than 10,000 yuan.
To be honest, it is almost impossible to be transferred from the intensive care unit to the general ward within just one or two days.
It takes at least half a month to prepare.
This is still the most optimistic and conservative estimate.
Patients only have one New Rural Cooperative Medical Scheme, and those who understand it will understand the reimbursement ratio.
If the patient is treated at a township health center where he lives, the reimbursement rate is high. If the patient is treated at Tuya Hospital, it can only be said that it is better to buy the medicine than not to buy it.
The one with the highest reimbursement rate is employee medical insurance.
Of course, the most amazing thing is the medical insurance for veteran cadres.
However, this kind of medical insurance is not available to ordinary people, so for ordinary people, the most reliable is employee medical insurance. As long as you pay for 25 years, you can get lifelong medical insurance, which is also very good.
Most ordinary people do not have any illnesses when they are young, but various illnesses begin to emerge when they get old.
This is also a normal process of birth, aging, illness and death.
As people age, their metabolism slows down, the body's cell division and renewal will gradually come to a near standstill, all aspects of their body functions will continue to age and weaken, and their immunity will become increasingly worse.
For a child, a common cold may be cured by just one night's sleep.
But for the elderly, it can be fatal.
"I suggest that your mother undergo surgery. The total cost should not exceed 50,000 yuan, but surgery carries huge potential risks, including the possibility of accidents during the operation and serious complications after the operation. And given her current condition, the neurosurgery department may not agree to the surgery ."
Zhou Can also sympathized with this family, which is why he gave advice that was in the best interests of the patient.
However, before surgery, there will be a preoperative risk assessment.
The current status of the patient is mostly that they fail the assessment, which is a big problem.
Zhou Can couldn't force the neurosurgery department to accept the patient and perform surgery on him. Even if he had such a big face, the consequence would probably be a thankless task.
"Doctor Zhou, I know you are a good person. As long as you can save my mother, I will be willing to work like a slave for the rest of my life to repay you."
After all, she worked in Tuya Pharmaceutical Department. She might not be familiar with the clinical rules, but she knew some of them.
After listening to Zhou Can's advice, she felt unprecedented despair.
Looking at my unconscious mother, if she didn't receive timely treatment at Tuya Hospital, she might not live for a few days.
If it were in ancient times, she would be willing to pawn herself to Zhou Can as a maid.
"Don't do this, don't do this, get up quickly!"
Zhou Can didn't know how to help her, so he could only stretch out his hands and signal her to get up quickly.
Fortunately, the nurse was smart and quickly walked over to help her up.
You can see that she is already in tears.
For poor people, facing the terrible disease and cruel reality, there is nothing they can do except shed tears.
"How about this, you wait here for a while, I will discuss it with the department leaders. If possible, first admit the patient to the emergency department, and then I will try to invite Director Wu of the neurosurgery department to help with the joint operation. However, the operation is very difficult, and it requires your family's high cooperation and trust."
There was one thing Zhou Can didn't say clearly.
That is, if the patient dies after the operation, the family members cannot make trouble.
The thing that cannot stand the test the most is human nature.
Tuya Hospital has a special legal team in this area. When encountering such cases, professional lawyers will come forward to sign a corresponding agreement with the family members to ensure that the family members will not make a fuss if the patient dies after the operation.
Large hospitals are indeed much better able to bear the risk of medical disputes than small hospitals.
Not to mention county-level hospitals, even medium-sized and large hospitals at the municipal level usually transfer high-risk patients away or provide conservative treatment.
Zhou Can reported the matter to Director Lou and Dr. Xu.
After the discussion, Director Lou was somewhat opposed to accepting this patient. However, people are all human, and after hearing Zhou Can's description of the patient's family situation, Director Lou remained silent.
As the head of a department, I am responsible for the safety and development of the department, and sometimes I can't help but be full of compassion.
We can only cruelly reject some patients.
But he could see that Zhou Can's desire to help this family was obvious.
There was no strong opposition.
Dr. Xu looks stern, but he actually has a very kind heart.
If he can help, he will try to help.
Even though a medical accident happened and things were miserable for him, he still remained true to his original intention.
"Xiao Zhou, I should be firmly opposed to this matter. But as long as the risk to the family members can be controlled, I will let you do it. At most, it will increase the mortality rate of our emergency department, and this price is still within the acceptable range."
Director Lou pondered for a moment and gave his opinion.
He is the head coach of the emergency department, and the opinion he gives is basically the final word.
"Thank you, Director Lou. I will discuss this with the patient's family and admit the patient after confirming that there is no problem."
After getting Director Lou's nod, Zhou Can felt a lot more relieved.
