I'm really an intern

Chapter 224

"I have a question."

Zhang Tianyang went through the old lady's diagnosis and treatment in his mind.

"I just saw that the old lady had the operation on the third day after she was admitted to the hospital, which means that the drainage tube in her head has been placed up for ten days."

After a pause, he didn't directly ask "why not pull it out".

However, after half an hour of clamping, the old lady's intracranial pressure rose to a life-threatening level, and it would have to be removed!

Asking like this, there is a risk of being resented.

He changed the question.

"I have two questions.

First, the longer the drainage tube is placed, the more likely it is to be infected. How to solve this problem?

Second, I saw that there were many records of lumbar puncture for the old lady during the course of the disease. Why not use lumbar puncture to replace this drainage tube? "

As soon as these two questions were asked, there was a chain reaction immediately.

Song Changkong Director Song was obviously taken aback for a moment, and then responded with even greater kindness.

He even looked around, and then personally grabbed a chair for Zhang Tianyang and let him sit on it.

In order not to let him refuse, Song Changkong also took one himself.

The attending doctor looked at Zhang Tianyang more and more appreciatively.

As soon as the experts make a move, they will know if there is any.

How long has this classmate Xiao Zhang been here?

How long will it take him to sort out the whole process of the old lady's diagnosis and treatment?

To be able to see the two core problems of the old lady so quickly.

Really good!

Not at all like an intern.

Isn't it worse than the three residents under him?

Such a good ability, such a pleasing appearance, and such a humble personality, no wonder it can cause a bloodbath.

It's only been a long time, and he's already tempted!

What should I do, do I want to end up grabbing Xiao Zhang's permanent property rights?

But what can neurology department do that can be used as bait!

Hurry, wait online!

Zhang Tianyang was scared, but he remained calm on the surface.

"What's wrong, teacher, is there something wrong with what I asked?"

"Ah, no, no!"

The attending doctor seemed to wake up from a dream, and looked at Zhang Tianyang with even more fiery eyes and even wider smiles.

"You asked very well, it's very important."

Thinking of the old lady's illness, the smile on his face faded, and he became serious.

"These two questions you asked are exactly the ones we've been struggling with recently."

"First of all, the issue of drainage tube infection."

"It is definitely impossible to remove it. You have seen the situation today. The problem of infection can only be suppressed with strong antibiotics first."

The attending doctor's tone was quite helpless.

Hearing this, Zhang Tianyang nodded, expressing his understanding.

No matter which part of the drainage tube it is, it will be infected if left for a long time.

Abdominal drainage, intracranial drainage, even a urinary catheter.

Because of the existence of the tube, the sterile environment in the body is in contact with the sterile environment outside.

Even if it is disinfected every day, it opens a door after all.

The longer the drain is left in place, the more likely it is to develop an infection.

And when it was placed on the old lady, a vicious circle was created.

The cerebrospinal fluid that is constantly produced and cannot be absorbed by itself will not be drained in time, and things like today will happen.

So a drain is needed.

However, the existence of the drainage tube increases the possibility of causing intracranial infection.

This old lady had suffered from subarachnoid hemorrhage, a near-death disease, and then had an intracranial infection, so she shouldn't die too quickly.

So, this comes back to the second question.

Zhang Tianyang asked again, "Then, why not use lumbar puncture to help drain the cerebrospinal fluid?"

The entire production and flow process of cerebrospinal fluid is not limited to the intracranial.

After filling the ventricles, it also fills all the way down through the pores.

To put it bluntly, it is equivalent to a tube starting from your brain and extending down your spine, probably to the lower waist.

The entire tube is filled with cerebrospinal fluid.

Then there are things called "arachnoid granules," which are like lots of tiny "drainage pipes."

Cerebrospinal fluid is continuously produced and "drained" into the blood system, forming a balanced state.

And now, with a subarachnoid hemorrhage, blood clots are clogging those tiny drains.

The old lady's cerebrospinal fluid only increased and did not decrease. In order to prevent the "Yellow River from flooding" and invading other brain tissues, the doctors had to artificially create a drainage channel for her.

What Zhang Tianyang wondered was why the opening had to be made on the upper part at the risk of infection, instead of under the water pipe, that is, at the waist.

The attending doctor paused and smiled wryly.

"Xiao Zhang's idea is very good, but do you think we haven't thought about it?"

"Ok?"

"Because I can't wear it."

The attending doctor spread his hands helplessly.

"If a lumbar puncture channel can be opened to release cerebrospinal fluid, of course we welcome it. It can be worn twice a day."

"But the problem is, it can't be worn out."

"Xiao Zhang, you understand the lumbar puncture, right? There is a sense of emptiness, but no cerebrospinal fluid flows out."

Song Changkong added from the side.

"I, the resident doctor, and this teacher have all tried it myself, and I wore it once yesterday, and it didn't come out."

Can't get out the cerebrospinal fluid?

This is a bit of a hassle.

Zhang Tianyang reacted instantly, and vaguely understood why the old lady's treatment had reached an impasse, and the doctors had no hope for her prognosis.

If you can't wear it, there are two possibilities.First, the level is not enough, and second, there is no such thing.

In the emergency department, Zhang Tianyang would not hesitate to think it was the former.

But now it is the neurology ICU ward.

A lumbar puncture is like drinking water. If you ask a doctor without experience in [-] cases of lumbar puncture, you will be ashamed to say that you are from the neurology department of Dongfang Hospital.

The attendant has already left the field in person, and he still can't wear it, which is very tricky.

He looked at the attending doctor.

"A blood clot is blocking the passage of cerebrospinal fluid from the top to the bottom?"

The attending ruler nodded helplessly. "possible."

Zhang Tianyang frowned, and explained why they were not optimistic about the old lady's prognosis.

"The blood clot blocked the channel. Anticoagulant drugs should be used to clear the normal channel of cerebrospinal fluid. Otherwise, the drainage tube has been kept, and the old lady will suffer from intracranial infection and die sooner or later."

"But the old lady herself has subarachnoid hemorrhage, so anticoagulant drugs are banned, and there is a risk of causing another hemorrhage. Cerebral hemorrhage itself is a disease with a very high mortality rate. If there is another hemorrhage, the old lady will probably want it again."

Use is not.

No need or no.

Further is death.

Taking a step back is like dying.

It's just that the way of death is different.

Really difficult!

Zhang Tianyang also fell into a daze for a while.

What he thought of, the attendant also thought of, did, and failed.

What else can I do?

His mind turned sharply, thinking about countermeasures.

"Have the old lady's family members notified, did they know this, this situation?"

This question is actually a bit inappropriate, as if Zhang Tianyang is the superior doctor.

But he can't care less now.

Song Changkong didn't care too much about these things, and took the initiative to answer the questions.

"I have talked several times in the past two days. I was going to talk again today to explain the risks of anticoagulant drugs in detail, and then I used them if it didn't work."

This is a very helpless choice.

No, definitely dead.

If you use it, you will most likely die.

At this point where advance and retreat are dead, you can only give it a try.

Having said that, the attending doctor was a little disappointed.

He thought that Zhang Tianyang could find another way and come up with some other feasible ideas.

But after thinking about it, he couldn't help laughing again.

Where did other ideas come from!It's just that he is looking forward to a miracle!

He is already an attending doctor himself, and years of clinical experience tell him that this is reality!

On the contrary, Zhang Tianyang was able to sort out his thoughts in such a short period of time, and pointed out the old lady's problem to the point. This level is estimated to have far surpassed that of a resident doctor.

In this way, he felt rather surprised.

Zhang Tianyang is really a big baby!

Although the patient's condition is really serious, it is estimated that he will not survive.

However, there are still so many patients in the ICU, and various emergencies may occur at any time.

He has only one person, and it is impossible to guard at any time, and sometimes it is beyond his reach.

With Xiao Zhang sitting in charge, he feels at ease.

The mood improved a lot, and the doctor in charge had a smile on his face again.

He asked casually, "By the way, I'm going to try another waist puncture this afternoon. If it doesn't work, I can only talk and take medicine."

"Xiao Zhang, do you want to try?"

God knows, he just asked casually as his heart moved.

But who knows, Zhang Tianyang raised his head suddenly, without any excuses, and directly agreed.

"it is good."

　Ah, the monthly pass~

　　

　

(End of this chapter)