(Thanks to my friend mangmangliu, Chensi's, man line, empty and lonely cold 671112, 緣起緣滅緣自緣, Yuze monthly pass for encouragement)

After the patient's parents arrived at the emergency center, Liu Banxia also explained to them again. After they understood, the patient was given a drug-induced coma.

Don't look at the patient and explain it clearly, the patient is still an adult and can be responsible for himself. In non-emergency situations, it is also not possible to operate directly.

Otherwise, her parents came to the scene and saw that the good girl had so many tubes in her mouth, she would either be scared, or she would make a fuss, or both.

"Ladies and gentlemen, this is the current result of electroencephalogram, brain CT, blood test and urine test, this is the first hard bone that our emergency center encounters, and it must be gnawed out. After coming to the small conference room, Liu Banxia said.

"I would like to inform the patient again, a 26-year-old woman with a history of headaches for almost three years. There are transient seizures, 3-5 seconds, frequent seizures. EEG showed that there had been brain damage and was now inducing coma. ”

"Mr. Liu, I just looked at the blood test and urine test reports, is there hemolytic anemia?

"When I discussed with Brother Zhao and Brother Zhang just now, I also felt that it was similar, but after examining the patient, I did not find any symptoms of jaundice and spleen enlargement. Liu Banxia nodded.

"But this has to be written down as well, it's an idea. Anyway, now everyone has to brainstorm and strive to diagnose patients in the shortest time and with the fewest examinations. ”

"In fact, it is very likely that hemolytic anemia has a long course of disease, and it may not have reached the point where it shows symptoms such as jaundice, splenomegaly, chills, and fever. Wang Huan said.

"Combined with the fact that the patient has a history of epilepsy, it may be an autoimmune disease. You have to do a lumbar puncture, at least you can rule out meningitis and encephalitis. ”

"It is also necessary to do systemic lupus erythematosus and systemic vascular screening, the former is more common in women, and the latter is more common in men, but it cannot be ruled out. ”

"Then let's do a lumbar puncture first and see what the results are, and then screen for lupus erythematosus and vasculitis?" asked Liu Banxia.

The three of them looked at each other and nodded.

It can only be like this first, step by step. Similarly, I also know why Liu Banxia attaches so much importance to this case. Like he said, it's a tough nut to crack, and if it can be diagnosed, it's a very uplifting thing.

Lumbar puncture is also a surgical procedure, which can be used to diagnose various inflammatory diseases of the central nervous system, vascular diseases, spinal cord lesions, etc.

However, in many cases, the test is not particularly recommended in the hospital and is only done if the indication is clear.

Because there are many complications that can be caused by lumbar puncture, low pressure syndrome, low back pain, bloody cerebrospinal fluid, hypocritical meningitis and so on. After all, the puncture site is the lumbar spine, so you have to be cautious when doing surgery.

After carefully explaining to the patient's parents, Liu Banxia came to do it himself.

"Huang Bo, how to determine the puncture point of lumbar puncture. Liu Banxia asked while making preoperative preparations.

"Choose the cone gap between the third and fourth lumps, choose the position to go to the occipital lateral decubitus position, bend the neck, hips, and knees, and hold the knees with both hands to make the lumbar vertebrae arch out to ensure that the spine is straight and not bent. Huang Bo said.

Liu Yiqing and Xu Yipromise helped the patient set up the position, disinfect it, and mark the location. Liu Banxia continued.

The two hurriedly put on gloves and operated on the hospital bed.

"Actually, all the puncture tests are done in the same way, and we can easily find the location where the puncture needs to be done, because this is what we can see with our eyes. Liu Banxia said.

"But no matter what kind of puncture, one problem that needs to be paid attention to is the problem of needle insertion. How do we judge that? We can only judge by the feel. ”

"When we do a paracentesis, we feel the pleasure of breaking through the resistance in our hand when we insert the needle, which means that we have penetrated the peritoneum and reached the position. The same goes for lumbar punctures, except that there is a slight tilt towards the head after the needle is inserted. ”

"When we feel the hand loose, it proves that we have pierced the dura and reached the subarachnoid space. Miao Rui, what do we need to pay attention to at this time? ”

"The needle insertion speed should be kept slow. Otherwise, because of the reduced resistance, it is easy to injure the organs in the abdominal cavity or the spinal cord. Miao Rui said.

"Very good, Li Hao will be my assistant, and then send it for inspection. Liu Banxia nodded.

Miao Rui, who was still a little excited, scratched his scalp embarrassedly, but he didn't expect Liu Banxia to be skinny at this time, and thought that the reward of being an assistant was for himself.

"After a long time, there are more patients, and you will be able to access all kinds of operations. Liu Banxia said.

"The reason why he was asked to be an assistant is because he is the least hands-on among you. Anyway, I'm the principle, whoever sends whoever comes. ”

"It's a reward and a punishment. His hands are still a little less stable, so he has to work hard when he turns back to rest. We're thinking that we should give you a chance to perform surgery. ”

These interns, who were still listening calmly, suddenly had a different spirit, and their eyes were full of fire when they looked at Liu Banxia.

Not to mention promising them about this matter, even Su Wenhao felt a little urgent.

"Don't get excited, appendectomy or gallbladder removal. It may be a normal incision or it may be laparoscopic. Prepare well, anyway, if you don't do a good job in the first person, the next chance to be the main knife will be postponed for a month. Liu Banxia continued.

As he spoke, the puncture needle had already been pierced, and at this time he pulled out the needle core, and Li Hao hurriedly assisted.

"Doctor, what kind of disease does Jingjing have?" asked the patient's father after the puncture.

"It's not certain yet, but having a spinal fluid test can help us make further judgments. Liu Banxia said.

"At the moment, our drug-induced coma has stabilized her condition, and we are doing the corresponding tests to clarify the symptoms. We have diagnosed her with hemolytic anemia and epilepsy, which are all manifestations of the disease. ”

"Doctor, we must find out, we are this girl. The patient's father said with tears in his eyes.

"Don't worry, I've gathered the doctors at the emergency center for consultation. Liu Banxia said seriously.

He didn't dare to say that he would be able to understand it, that was nonsense, and he was fooling people. Although there are some clues, the exact disease has not yet been diagnosed.

You have made a promise to the patient's family now, but the diagnosis has not been made, how will you explain to the family then?

The waiting time was a little anxious, and after the results came out, Liu Banxia called these people to the small conference room again, and then consulted.

Systemic lupus erythematosus, systemic vasculitis were excluded, and hemolytic anemia was identified. Spinal fluid is measured with an elevated number of white blood cells.

"I don't know if the big guy is the same as I thought? Next, will you go directly to the chest, abdomen and pelvis combined MRI examination?" asked Liu Banxia.

"Do you think it's teratoma?" asked Wang Huan curiously.

"If it's a teratoma, why do you induce so many epilepsy? Could it be that there is brain tissue in the teratoma?" Zhao Bo frowned and said.

"Anyway, now is the only answer I can think of, and this is the only one that can explain it, right?" Liu Banxia said.

"Only when there is brain tissue in the teratoma, the white blood cells will also take the normal brain tissue as the object to be removed, which is why the number of white blood cells in the spinal fluid is so high. ”

Waves of white blood cells washed out, causing the patient to have frequent transient seizures, which also caused damage to her cranial nerves. Once or twice may not matter, but too many times?"

"And it may be precisely because of the changes in the patient's teratoma that hemolytic anemia can occur. White blood cells are also attacking those red blood cells, shortening their life cycle. ”

"In fact, there have been many similar cases over the years, and I think our patient is similar, which is also completely in line with her current symptoms. ”

"Okay, this one is better than encephalitis and meningitis. Sweep it out, take it off directly, people are still normal people, and they don't have to suffer from this trouble. Wang Huan said with a smile.

Even if there is a plan for the next step of diagnosis, Liu Banxia took the intern out to explain to the patient's family.

For the families of today's patients, they will accept any kind of examination, and treating their daughters is the first priority. also felt that Liu Banxia attached great importance to their daughter, otherwise he would not have held a meeting to study the results of the examination.

"Mr. Liu, how many times have you removed the teratoma?" Xu Yinuo asked curiously.

"I haven't said it once, I haven't come across it, but I've only seen it in a journal. Liu Banxia said.

"You can't just call me a teacher and think I'm old, okay? I'm only 29, not yet 30. The whole industry has been in the industry for more than five years, and the first four and a half years were still soy sauce. ”

They listened to Xu Yi's promise very angrily, yes, Mr. Liu is not very old. If you do the math, it seems to be two years older than you.

"Don't look at me like that, who made me learn more than you in the morning, but I don't have as much education as you. Is there anyone who wants to study for a PhD?" asked Liu Banxia with a smile.

"Hey...... , Kaobo should work for two years first, and then talk about getting back to blood. Xu Yinuo sighed.

The gap is a bit big, and I really didn't think about age before. I thought that Liu Banxia was seven or eight years older than them, but he just looked young.

After chatting with them for a while, the results of the MRI scan also came out, but Liu Banxia frowned after carefully checking it. The thoracic cavity is normal, the abdominal cavity is normal, and only the right ovary in the pelvis has some signs of inflammation and does not sweep out the teratoma.

It's a sure thing, why hasn't it been swept out?