"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 undergone surgery on the third day of admission, which means that the drainage tube on her head has been in place for ten days. ”

After a pause, he didn't directly ask, "Why haven't you pulled it out yet?"

It's just that after half an hour of clamping, the pressure in the old lady's skull has risen to the point of life-threatening, and she has to be removed!

If you ask like this, you risk being scolded.

He asked in a different way.

"I have two questions.

First, the longer the drain is placed, the more likely it is to become infected.

Second, I saw that there were many lumbar puncture operations for the old lady during the course of the disease, so why not use the lumbar puncture to drain the fluid instead of this drain?"

As soon as these two questions were asked, there was an immediate ripple effect.

Director Song Changkong and Song were obviously stunned for a moment, and then gave back even greater kindness.

He even looked around, and then personally scooped up a chair for Zhang Tianyang to sit on.

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

The attending doctor's eyes looked at Zhang Tianyang with more and more appreciation.

As soon as the connoisseur makes a move, he will know if there is one.

How long has this Xiao Zhang been here?

How long did it take him to sort out the whole process of this old lady's treatment?

was able to see the old lady's two core problems so quickly.

That's a lot of good!

Not at all like an intern.

It's not worse than the three resident doctors under your hands, right?

With such a good ability, such a pleasing appearance, and such a humble character, it is no wonder that it can cause a bloody storm.

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

What should I do, do you want to go down and grab Xiao Zhang's permanent property rights?

But what can the neurology department do as bait?

Urgent, online, etc.!

Zhang Tianyang was furious when he was seen, but he was still calm on the surface.

"What's the matter, teacher, is there anything wrong with what I'm asking?"

"Ah, no, no!"

The attending doctor woke up like a dream, and looked at Zhang Tianyang with a more fiery gaze and a more smiling smile.

"You're asking a good question, it's critical. ”

Thinking of the old lady's condition, the smile on his face retracted, and the whole person became serious.

"The two questions you asked are exactly the ones we've been struggling with lately. ”

"First of all, the problem of drain infection. ”

"It is definitely impossible to pull it out, and you have seen the situation today, the problem of infection can only be suppressed with strong antibiotics first. ”

The attending doctor's tone was rather helpless.

Hearing this, Zhang Tianyang nodded his head to show understanding.

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

Abdominal drainage, intracranial drainage, and even urinary catheters.

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

Even if it is disinfected every day, it is still an open door.

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

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

Cerebrospinal fluid, which is constantly produced and cannot be absorbed on its own, is not drained in time, and what happened today.

So a drain is needed.

However, the presence of drainage tubes increases the likelihood of intracranial infection.

This old lady was originally suffering from subarachnoid hemorrhage, a lifelong illness, and then an intracranial infection, so she didn't die too quickly.

So, this brings us back to the second question.

Zhang Tianyang asked again, "So, why don't you take the means of lumbar puncture to help drain cerebrospinal fluid?"

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

After filling the ventricles, it will also fill down through the orifice.

To put it more simply, it's like having a tube that starts in your brain and runs down your spine, probably down to the waist.

The entire tube is filled with cerebrospinal fluid.

And then there's something called "arachnoid particles," which are like a lot of tiny "drains."

Cerebrospinal fluid is constantly produced and "drained" into the blood system, creating a state of equilibrium.

And now, because of the subarachnoid hemorrhage, blood clots have blocked these tiny drains.

The old lady's cerebrospinal fluid only increased, and in order to avoid the "flooding of the Yellow River" and the invasion of other brain tissues, the doctors had to artificially open a drainage channel for her.

Zhang Tianyang wondered why this opening had to be opened at the risk of infection, and not under the water pipe, that is, at the waist level.

The attending doctor paused and smiled wryly.

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

"Huh?"

"Because, you can't wear it. ”

The attending doctor spread his hands helplessly.

"If we can open a lumbar puncture channel to put cerebrospinal fluid, of course we welcome it, and you can wear it twice a day. ”

"But the problem is, you can't wear it. ”

"Xiao Zhang, you know how to wear a waist piercing, right? There is a sense of frustration, but there is no cerebrospinal fluid flowing out. ”

Song Changkong added next to him.

"I, the resident teacher, and this teacher have all done it myself, and I wore it once yesterday, but I didn't wear it out. ”

Can't wear out cerebrospinal fluid?

That's 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 one in itself.

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

But now it's a neurology ICU ward.

A lumbar puncture is like drinking water, and a doctor who pulls it casually is embarrassed to say that he is a place in the neurology department of the East Hospital without 180 cases of lumbar puncture experience in his hands.

The directors are all down in person, and they can't wear it yet, which is very tricky.

He looked at the attending doctor.

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

The director nodded helplessly. "Possibly. ”

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

"If the clot blocks the passage, anticoagulants should be used to unblock the normal passage of cerebrospinal fluid. Otherwise, the drain was kept in place, and sooner or later the old lady died of an intracranial infection. ”

"But the old lady herself has a subarachnoid hemorrhage, so anticoagulants are prohibited, and there is a risk of causing rebleeding. Cerebral hemorrhage itself is a disease with a very high mortality rate, and if it bleeds again, the old lady will have to ...... nine times out of ten."

No, it doesn't.

No, no, no.

Further is death.

Taking a step back is the same as death.

If you go up to the sky, you have a different way of dying.

It's so hard!

Zhang Tianyang was also at a loss for a while.

What he thought of, the chief thought of, did it, and failed.

What else can I do?

His mind raced, thinking about what to do.

"Did the old lady's family inform them, did they get to this point, this situation?"

This sentence is actually a bit inappropriate, as if Zhang Tianyang is a senior doctor.

But he couldn't care much now.

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

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

It's a very helpless choice.

No, I'm sure I'll die.

If you use it, you will probably die.

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

At this point, the attending doctor was a little disappointed.

He also thought that Zhang Tianyang could find another way and give some other feasible ideas.

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

What other ideas came from! It was just that he was hoping for a miracle!

He himself is already an attending patient, and years of clinical experience have taught him that this is the reality!

On the contrary, Zhang Tianyang can sort out his thoughts like this in a short period of time, and point out the old lady's problem to the point, which is estimated to be far beyond that of a resident doctor.

In this way, he felt quite surprised.

Zhang Tianyang is really a big baby!

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

But there are still so many patients in the ICU, and various situations can break out at any time.

He was only one man, and he couldn't be on guard at all times, and sometimes he couldn't reach it.

With Xiao Zhang in charge, he is at ease.

The mood has improved a lot, and the attending doctor's face has returned to smiling.

casually asked, "By the way, I'm going to try the lumbar puncture again this afternoon, but if it doesn't work, I can only talk about medication." ”

"Xiao Zhang, do you want to try it?"

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

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

"Good. ”

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