My medical skills add experience

Chapter 627 Three major sequelae of thalamic hemorrhage, doctor Huairen

After seeing the brain CT film, Zhou Can's expression instantly became extremely serious.

The patient's condition was more serious than imagined.

The thalamus and caudate nucleus can see shadows, and even a small amount of water flushing zone can be seen.It shows 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 the brain layer, such as the gyrus, and the bleeding in these parts is not serious even if it exceeds 5ml.As long as the bleeding is controlled, patients are able to absorb the bleeding on their own, usually without surgery, and then recover.

In fact, brain surgery occasionally encounters some special patients, such as malignant tumors, or accidental injuries, which eventually lead to the removal of nearly one-fifth of the patient's head.

But the patient eventually survived and was able to take care of himself.

Therefore, the site of cerebral hemorrhage determines whether the high risk.

The bleeding site of the patient in front of him was in the thalamus, and what worried Zhou Can most was that there was also bleeding in the brainstem.

Many people think that the thalamus is the brainstem, but it is not.

It is part of the diencephalon, divided into left and right parts, located on both sides of the third ventricle, and the left and right thalamus are connected by a mass of gray matter.

In medicine, the thalamus belongs to the sensory center, and the nerve impulses sent by the sensory receptors in the whole body are transmitted to the cerebral cortex after being transferred through the thalamus.

Zhou Can checked the patient's condition just now and found that she was unconscious and in a state of deep coma.

This is what worries him the most.

Thalamic hemorrhage can cause serious problems in the human body, but this patient is deeply comatose, and has symptoms such as respiratory failure and heart failure, which makes people have to wonder if the bleeding site is not limited to the thalamus?
Zhou Can is not very good at the field of supernatural surgery, but he knows a lot more than the average supernatural doctor.

After all, I was with the chief physician during the regular training, and I have personally performed many major intracranial surgeries.Knowledge and experience are all there.

After the completion of the regular training, he is often invited by Shenwai to help with some endoscopic surgery or diagnose difficult cases.

Even Wu Baihe had discussions with him N times.

So his level of supernatural medicine is not bad.

The impact of thalamic hemorrhage should be analyzed from its three major sequelae.

The first is physical symptoms. Patients will feel severe head pain, which is extremely obvious.Often, few people's bodies can tolerate the pain, and gastrointestinal symptoms develop.

Such as nausea, vomiting, etc.

Others may experience hemiplegia or weakness on one side of the limb.

If limb paralysis occurs, it means that the patient's thalamic hemorrhage is very serious.

It is a bad signal, and the prognosis is often very unsatisfactory.

The second major sequela is sensory disturbance.

The thalamus is a relay station for the gray matter of the brain to receive nerve signals from the brain center and sensory organs throughout the body.

After the nerve signals from the brain center and the sensory organs of the whole body are sent out, they will be "translated" by the thalamus, and then transmitted to the cerebral cortex.

It can be seen from this that the thalamus plays an extremely important role in the processing of sensory nerve signals throughout the body.

When it goes wrong, it will have disastrous consequences for the nerve center and brain.

For example, building a large dam.

If the turbulent torrent hits the big dam directly, it is very easy to wash it down.So smart engineers thought about designing the backwater area to buffer the huge impact of the flood and reduce the stress on the dam.

Thereby greatly improving the safety performance of the dam.

The largest dam built by Ah San was destroyed by floods on the day of completion. In addition to the substandard quality caused by corruption, failure to master some key technologies was also one of the reasons.

The thalamus acts as both a translator and a buffer station.

When it goes wrong, patients may experience hypoesthesia, or even loss of sensation.For example, the most common is numbness, a loss of pain sensation in a certain part of the body or a severe decrease in pain sensation.

A while ago, many patients infected with the new coronavirus experienced loss of taste and smell, which may be caused by the thalamus being affected.

After a problem with the thalamus, we may not be able to smell some irritating smells that we usually cannot bear.

Or just a little bit.

Of course, the sense of smell is related to the nose, as well as the internal olfactory bulb and other tissues and organs.

This requires comprehensive dialectics. If loss of smell cannot occur, it is determined that there is a problem with the thalamus.

The third sequelae, disturbance of consciousness.

Trauma or problems with almost any tissue in the brain can cause disturbance of consciousness.

Some organizations cannot cause disturbance of consciousness by themselves, but can affect them indirectly.

For example, hematoma, direct compression of the cranial cavity, or a sharp increase in intracranial pressure and so on.

The most common disturbances of consciousness caused by problems in the thalamus are drowsiness, vision, confusion, lethargy, etc.In the most severe cases, coma can occur, but it is relatively rare clinically.

Decreased level of consciousness, dulling or 'psychotic' is more common, complete loss of consciousness may sometimes occur.

After analyzing the three major sequelae that may be caused by the damage to the thalamus, the area affected by the lesion can be reversed based on the patient's symptoms.

This is why Zhou Can feels that his condition is more serious than he imagined.

In the first case, if the thalamus caused the patient's deep coma, it means that the patient's thalamus was extremely damaged.

In the second case, if it is not a deep coma caused by the thalamus, it is likely that there is also a hemorrhage in the brainstem.

Either way, it's tricky.

The doctors in several departments did not dare to take it, probably because of the huge risks involved.

What if the patient dies after being taken over, and the family members make trouble and file a lawsuit?
People know how to seek advantages and avoid disadvantages from birth.

No matter how kind the doctor is, he will naturally not do things that are obviously not good for him.

Otherwise it becomes silly.

Zhou Can continued to study the patient's data.

The small county hospital even gave the patient an MRI.

You know, the price of the MRI detector is not cheap.At least they are all above 2000 million, and most of them are in the 3000 million range.

There is no cheap imported equipment.

It's hard for foreigners to earn such technical fees.

They make a lot of money when they sell the equipment to us, and then they have to continue to make money for the maintenance and repair of the equipment.

It doesn't even let us look when it installs.

I believe that many factory owners have suffered such losses when buying imported equipment from abroad. To buy the equipment back, they have to hire two foreign technicians.Food and lodging included, travel expenses included, salary included, just like an ancestor.

The installation and commissioning of the equipment, as well as problems in operation, all need to rely on these two foreign technicians.

This feeling of being choked by the throat at the technical level has made countless Chinese people feel aggrieved.

But there was no way, that was the condition at the time.

I can only learn from Goujian, the king of Yue, to endure hardships and endure first.When we develop, we can get rid of these technical bottlenecks.

The county-level hospitals that can have nuclear magnetic resonance detectors show that the scale is not small.

Otherwise, even if the leaders of the hospital have a feverish brain and want to buy an inspection equipment worth tens of millions, it will be difficult for the higher authorities to approve it.

Zhou Can thought to himself, the doctors in the county hospital also have experts!
It shows that after consultation, the doctors in the county hospital also realized that the patient's lesion might not be that simple.

It should not be a simple thalamic hemorrhage.

The accuracy of CT is very high, but the ruler is long and the inch is short.

Each inspection instrument has its advantages and disadvantages.

MRI is currently recognized as an imaging inspection device with the highest inspection accuracy.

But even MRI detectors have different levels.

The highest accuracy can reach the millimeter level.

Tuya installed one.

It is extremely difficult to get an appointment, waiting in line for a week is good.

Zhou Can took the MRI of the patient's head and looked at it carefully, and suddenly had a bottom line in his mind.

"Cheng Xiaolu!"

"Ok!"

"Your mother's intracranial hemorrhage is not optimistic. If you treat it conservatively, there is almost no hope. Moreover, she will definitely be admitted to the intensive care unit in this situation, and the daily treatment cost will be astronomical."

Zhou Can understands the hardships of ordinary people.

Her father was disabled after an accident at the construction site, and her mother worked as a farmer at home, occasionally doing odd jobs for others, and her income was very limited.

Moreover, supporting her to finish college and graduate school is enough to exhaust all the savings of this difficult family.

After she finished reading the book and came out, she entered the pharmaceutical department of Tuya Hospital to work.

However, the pharmaceutical department is in a state of loss every year, and the salary of technical research and development personnel is not very high.At most, it is at the normal level of the industry to ensure that talents are not lost.

If she chooses conservative treatment, her mother must be admitted to the intensive care unit.The patient's current condition must be put on a ventilator, and the daily cost will be at least 1 yuan.

To be honest, it is almost impossible to transfer from the intensive care unit to the general ward if you want to stay for a day or two.

At least half a month is the bottom line.

This is still the most optimistic conservative estimate.

The patient has only one new rural medical system, and anyone who understands the reimbursement ratio understands it.

The reimbursement rate is high for treatment in the township health center where the patient lives.Treated in Tuya Hospital, it can only be said that buying it is better than not buying it.

The really high proportion of reimbursement has to be the employee medical insurance.

Of course, the best 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 have lifelong medical insurance, which is also very good.

Most people don't have any ailments when they are young, but when they get old, various ailments begin to emerge.

This is also a normal process of birth, old age, sickness and death.

When a person gets old, the metabolism slows down, and the cell division and renewal of the body will gradually come to a standstill. The body functions in all aspects will continue to age and weaken, and the immunity will become worse and worse.

A common cold, for a child, may recover after a night's sleep.

But for the elderly, it can be fatal.

"I suggest to give your mother an operation. The total cost should not exceed 5 yuan, but there are huge potential risks in the operation, including the possibility of accidents during the operation, serious complications after the operation, etc. And her current state , Shenwai may not necessarily agree to the operation."

Zhou Can also sympathizes with this family, and only then will he give advice that is in the best interest of the patient.

Before surgery, however, there will be a preoperative risk assessment.

The current status of patients is mostly failing the assessment, which is a big problem.

It is also impossible for Zhou Can to force Shenwai to accept the patient and then perform an operation.Even if he has such a big face, the consequences are likely to be thankless.

"Doctor Zhou, I know you are a good person. As long as you can save my mother, I will be willing to repay you all my life."

Anyway, she works in the Tuya Pharmaceutical Department, so she may not know much about the clinical rules, but she does know a little.

After listening to Zhou Can's suggestion, she felt unprecedented despair.

Looking at the unconscious mother, if she can't get timely treatment in Tuya Hospital, she probably won't 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!"

It was also difficult for Zhou Can to help her, so he could only raise his hand repeatedly, signaling her to get up quickly.

Fortunately, the nurse was clever, and hurried over to help her up.

You could see she was in tears.

For the poor people, facing the terrible disease and the cruel reality, there is really nothing they can do except shed tears.

"That's all right, you guys wait here for a while, I'll discuss it with the department leaders. If possible, first admit the person and live in the emergency department, and then I will find a way to invite Director Wu from Shenwai to help with the joint operation .However, the operation is very difficult, and requires a high degree of cooperation and trust from your family members."

Zhou Can didn't say a word.

That is, in case the patient dies after the operation, the family members cannot make trouble.

The most vulnerable thing is human nature.

Tuya Hospital has a dedicated legal team in this area.When encountering such a case, a professional lawyer will come forward and sign a corresponding agreement with the family to ensure that the patient dies after the operation and the family will not make trouble.

Large hospitals are indeed much better than small hospitals in terms of bearing the risk of such medical troubles.

Not to mention county-level hospitals, even medium-to-large hospitals at the prefecture-level city level, high-risk patients are usually pushed away or treated conservatively.

Zhou Can reported the matter to Director Lou and Dr. Xu.

After discussion, Director Lou somewhat objected to accepting this patient.But the human heart is full of flesh. After Zhou Can finished talking about the patient's family situation, Director Lou fell silent.

As the director of a department, he is responsible for the safety and development of a department, and sometimes he cannot be overwhelmed with sympathy.

We can only cruelly reject some patients.

But he could see that Zhou Can's desire to help the family was obvious.

There is no too strong opposition.

Dr. Xu looks serious, but he is actually very kind-hearted.

If he can help, he will try his best to help.

Even if there was a medical accident and the mess was miserable, I still didn't change my original intention.

"Xiao Zhou, it stands to reason that I should be firmly opposed to this matter. But as long as the risk of the family members can be controlled, it is up to you. At most, it will increase the mortality rate of our emergency department. It's still within tolerance."

After a moment of contemplation, Director Lou gave his opinion.

He is the head coach of the emergency department, and the opinions he gives are basically the final word.

"Thank you, Director Lou, then I will discuss with the patient's family members and admit the patient first after confirming that there is no problem."

Director Lou nodded on this matter, and Zhou Can immediately felt a lot more relaxed.

(End of this chapter)