Because just now Zhou Chao had already discovered that the patient's bilateral pupils were no longer equal.

Bilateral unequal pupils are an important sign of cerebrovascular problems.

In patients with sudden coma without warning, the most common causes are cerebrovascular disease, cardiovascular disease, and then a hypoglycemic coma.

When encountering such a patient who suddenly falls into a coma, a clear examination must be carried out first, and the condition can be clarified before further treatment can be carried out.

At present, the patient's oxygen saturation is as high as 98%, which means that the respiratory function is acceptable.

Therefore, only nasal cannula oxygen is required, and a ventilator is not needed for the time being.

Zhou Chao immediately issued a doctor's order and asked the nurse to draw the blood for relevant examinations, and soon the blood sugar results came out and were not low.

Hypoglycemic coma can be ruled out.

After an electrocardiogram (ECG), it showed that there was only some myocardial ischemia, but it did not cause coma.

So at present, this patient is most likely to be in a coma caused by cerebral hemorrhage.

Because of the current patient's performance, in addition to coma and pupil unequality, there is also a condition where the muscle strength of the right limb is grade 0.

All signs and physical examination indicate that the patient is likely to have a cerebral hemorrhage, which has caused brain herniation.

This condition must be treated with surgery as soon as possible, otherwise the patient will soon develop respiratory cardiac arrest and die.

Of course, in order to confirm the diagnosis of this patient, the most important step is to check the head CT.

As long as the CT scan of the brain is confirmed to be a cerebral hemorrhage, a craniotomy is required as soon as possible.

Otherwise, the patient's bilateral pupils are dilated, and there is no hope of treatment.

Based on the patient's current condition, there is still a glimmer of hope if the craniotomy is diagnosed as soon as possible.

But when the old lady went to the hospital, she didn't bring much money.

Originally, she came to see a doctor with her wife today and adjusted her high blood pressure medication.

Who would have thought that this would happen, so she didn't bring much money, and the elderly would not use mobile phones WeChat, Alipay and the like.

However, in an emergency like this, when a patient suddenly falls ill, the emergency department will usually take special care because the family and the patient are not prepared in the slightest and do not bring enough money.

Although the old lady brought little money, Lin Yi first asked her to pay a few hundred yuan, go through the hospitalization procedures first, and have a hospitalization number before she could do more examinations.

The hospitalization procedures were quickly completed, and the hospitalization number was obtained.

Zhou Chao immediately opened a CT scan of the head, and then asked Song Borui and others to push the patient to do a CT examination.

Soon the CT scan came out.

Zhou Chao opened the CT image on the computer, pointed to the picture, and said to everyone: "The patient really has a cerebral hemorrhage, and it is a left basal ganglia hemorrhage, the amount of bleeding is very large, it has exceeded 40 ml, it seems that surgery is needed as soon as possible!" ”

Not all patients with intracerebral hemorrhage need surgery.

Intracerebral hemorrhage is also indicated for surgery, with clear boundaries.

The indication for surgery for intracerebral hemorrhage depends on the location and amount of bleeding.

First, for example, for cerebellar hemorrhage, if the amount of bleeding is greater than 14ml, there is a clinical indication for surgery.

Because the cerebellum is close to the brainstem, its hemorrhage can easily compress the brainstem, so the indication for hemorrhage surgery is relatively wide.

Second, if the intracerebral hemorrhage is located in the ventricles and causes acute hydrocephalus, surgery is also required.

Because ventricular hemorrhage can easily cause a disorder of cerebrospinal fluid circulation, resulting in obstructive hydrocephalus, which leads to increased intracranial pressure, surgery is required.

Third, if the basal ganglia hemorrhage is greater than 30ml or the neurological function is progressively deteriorating, surgery is also required.

Fourth, for moderate to large hemorrhage in the cerebral cortex, surgical treatment is also required.

Finally, if the patient is in a coma with unequal bilateral pupils, it means that cerebral herniation has been caused by cerebral hemorrhage and must be treated with surgery as soon as possible.

And now this patient, a CT scan of the head has confirmed that his bleeding volume has reached more than 40 ml.

Moreover, he was already in a deep coma, with unequal pupils on both sides, and he had to perform emergency surgery immediately, which could save his life.

For patients with massive cerebral hemorrhage, although surgery may not be able to save their lives, there is still hope for life for patients.

However, if such patients give up surgical treatment and only use drugs for conservative treatment, there is no hope and 100% will not survive.

Because of a large amount of cerebral hemorrhage, the cerebral pressure is too high, and brain herniation is formed, and soon there will be bilateral pupil dilation and fixation, that is, brain death has been formed, and the patient will soon have respiratory and cardiac arrest.

In any case, as long as it is a patient with a large amount of cerebral hemorrhage, there is still a glimmer of hope for surgery.

Without surgery, there is no hope of survival.

I didn't say it, now this patient must be surgically treated with a craniotomy as soon as possible, otherwise he will definitely die.

Zhou Chao, as the patient's first doctor, called the old lady into the office and explained to her the severity of the patient's condition.

Zhou Chao spoke in detail to the old lady in easy-to-understand language for a while.

In short, the old lady understood the severity of her wife's condition and needed immediate surgery, otherwise she would not be able to save herself.

The old lady's tears came down with a "whoosh", and she cried and said, "Doctor, I beg you, you must save my wife." I, I'll kneel for you. ”

The old lady was crying, and she wanted to kneel down and beg Zhou Chao.

Zhou Chao was startled, hurriedly stood up, supported the old lady, and resolutely refused to let her kneel.

Just kidding, let an old man who is almost 70 years old give her a little young kneel.

She couldn't afford it.

It's going to be a long one!

Zhou Chao helped the old lady and explained: "Old lady, I can understand your feelings, but after all, the old man's condition is too serious, we can only say that we will do our best to treat it." Also, you better pay some money to the account as soon as possible, we are going to have surgery soon. ”

A neurosurgeon consultation will definitely be required in a moment, and surgery will definitely be required.

Surgeries like this are cerebral hemorrhage hematoma removal and bone flap decompression.

If you don't have tens of thousands of yuan, you can't get down.

The neurosurgeon didn't have any money in his account, but he wouldn't have surgery.

That's why Zhou Chaocai urged the old lady to pay the money.

If it is an emergency and there is no money in the emergency department, it can be rescued for the time being.

But if you have surgery, you don't have any money in your account, and people in neurosurgery will never go under surgery.

As soon as she heard that she had to pay the money, the old lady's tears fell again.

"Doctor, old lady, I have already paid all the hundreds of dollars on me, and I can't get any money, I called my son, he is out of town now, and he won't be able to come for a while. I'm here now, what am I going to do? ”

The old lady crying and telling about her family's situation makes people sound very sad, not a taste.

Every family has a scripture that is difficult to read.

This kind of situation can be said to be a common occurrence in the emergency department.

Although Zhou Chao was a doctor, he played the role of saving lives and helping the wounded.

But she is not the God of Wealth, nor is she a charity ambassador, it is impossible for every patient to complain about poverty, she goes to advance money to the patient.

But if this old lady doesn't pay today, I'm afraid this operation will not be done.

After all, neurosurgery must see that there is money in the account before the operation can be performed.

Otherwise, they won't be able to keep accounts after the surgery.

If it was really because the money was not available and the operation could not be done, resulting in the death of this patient, then Zhou Chao could not do anything.

When he first started working, Zhou Chao was enthusiastic about what he was doing in the emergency department.

When she met those poor patients who couldn't even eat, she would help them and take care of them for a meal or two.

But as I work longer and longer, my experience becomes richer and richer.

Zhou Chao will no longer do this kind of thing to help patients take care of food.

Because of such poor patients, there are too many families who can't eat.

With her salary, she can't manage how many people eat.

So now the Zhou Dynasty is just trying his best to treat the patient, and resolutely does not care about the patient's money.

Because it's not something she can solve.

Zhou Chao looked at the old lady's begging face, and he was also very helpless.

But she couldn't help the old lady much.

I had to bite the bullet and say: "Old lady, if you don't have money in your account, people won't operate on neurosurgery, and I can't do it, I suggest that you hurry up and urge your son to come back, or let him transfer money to you first." ”

The old lady had tears on her face, and said with a sad face: "I'm so old, I don't know what money transfer, and I can't use your smart phone, it will take a few hours for my son to come back, doctor, can you wait for my son to come back and then operate?" ”

Zhou Chao patiently explained: "Old lady, now the old man's condition is very serious, and he must have surgery as soon as possible, not to mention waiting for a few hours, even if he can't wait for an hour, otherwise once his pupils are dilated, even if he wants to have surgery again, there will be no chance." ”

The Zhou Dynasty also told the truth.

Because this patient is now bilateral, unequal pupils.

If surgery is done as soon as possible to remove the bone flap to remove the hematoma and decompress, it may cause the dilated pupils to retract.

If you wait until all the pupils on both sides are dilated before going for surgery, there is no point.

So now the patient's situation, it is simply impossible to wait for a few hours before undergoing surgery.

The old lady was dumbfounded.

She stared at Zhou Chao in a daze.

He muttered to himself, "Old man, I'm sorry for you, what should I do?" ”

The old lady has no master and is at a loss.

It's like a helpless child, standing there full of sadness.

Zhou Chao was also very sympathetic to the two old men, but she really had no choice.

Her specialty is general surgery, and her specialty is abdominal surgery, and she absolutely does not understand cranial surgery.

And the neurosurgery department, when he sees that there is no money in the account, will never have surgery.

Unless you can get the dean to say hello and ask them to have surgery first, and then pay the money.

I saw the old man standing there helplessly, dazed, like a child.

Zhou Chao also felt very uncomfortable in his heart, but there were some problems that she could not solve.

Now the patient's condition is in danger, and if the surgery is not done as soon as possible, I am afraid it will be too late.

A few doctors in the office, looking at the helpless old lady, are also a good woman who has no rice to cook and is powerless.

I could only sigh silently in my heart and sympathize with the old lady's experience.

Who made her have a son, and it was so far from home?

Lin Yi looked at the old lady's situation, and couldn't bear it, so he walked over and said to Zhou Chao: "Don't we have emergency rescue funds in the department?" Use it for the old man first, and then say no, after the operation is done? ”

The emergency department of a tertiary hospital in the city usually has an emergency fund.

It is mainly used to deal with those who are in emergency situations and have no money.

Under normal circumstances, it is based on saving lives first and then paying money to deal with it.

Zhou Chao said with a wry smile: "I know that our department has an emergency fund, but this emergency fund can only be used in our department, but this patient needs to go to the neurosurgery department for surgery, and the emergency fund cannot be credited to their account." ”

"In other words, this patient can only use the emergency fund if he has surgery in our department?"

"That's right!"

Zhou Chao spread his hands: "But this patient must go to the neurosurgery department for craniotomy, no one in our emergency department has ever studied brain surgery!" ”

"Otherwise, I'll try!"

Lin Yi never thought that he would rob the job of neurosurgery.

But this patient's condition is very urgent, and he can't ask a neurosurgeon to do it, so in order to save someone's life, Lin Yi had to stand up.

"What?"

Zhou Chao's eyes widened suddenly, as if he had seen something extraordinary.

"Lin Yi, are you saying that you will also have extracerebral surgery?"

Lin Yi just nodded, and did not deliberately say that he was very good at this operation.

Now Zhou Chao's heart is simply shocked and I don't know why.

And now Lin Yi said that he will also do brain surgery.

It's unbelievable, how could Lin Yi do surgery in so many fields alone!

Could it be that Lin Yi is an all-powerful god?

This is really beyond everyone's understanding of the profession of doctors.

People in the medical circle know that all well-known experts in China or in the province are very good at a certain aspect and a certain field.

It is also famous for this.

Whether in the province or in the country, there is no one who has become a well-known expert because he is good at various fields.

Because it's impossible.

After all, human energy is limited, and it is already remarkable for a doctor to be good at a certain field and become a well-known expert.

Where else is it possible to become a well-known expert in the entire field of medicine!

"Brother Yi, you're too powerful, you can even do brain surgery."

"Head, chest, abdomen, orthopedic surgery you do. By the way, you will also do interventional surgery, the operation of all systems of the whole human body, you will do it, you are almighty! ”

Wu Jiang suddenly looked at Lin Yi and couldn't help but admire!