"The child had rigidity on the right side of his neck and a weak knee reflex in his right leg, which meant there was a problem with the nerve conduction circuit. Also, the fact that the lower nerve centers are open does not mean that all nerve centers are open. Combined with the fact that the child fell from a high altitude and found out that there was an obvious hematoma in the neck, it can be concluded that there is an injury to the cervical spine. And it's likely that the spinal cord is damaged. ”

Director Yin saw that he agreed, and began to seriously discuss the cause of the child.

Every time he discussed the cause, he would naturally show this serious expression, meticulous.

Being able to become an ace expert in neurology naturally has its own merits.

The rigorous attitude towards medicine is worth learning.

"In addition to the possible damage to the spinal cord in the neck, I think it's likely that the child's brain was also damaged."

Director Yin continued.

The brain and neck spinal cord are damaged, which is the compound neurological disease that Director Yin said.

"But the child's head was checked by CT and color ultrasound and nothing abnormal!"

CT has a strong diagnostic significance for tissue lesions, tumors, and hemangiomas. If the color ultrasound checks the head, it is generally to check the blood flow of the head.

There are blood vessels compressed, blood vessels ruptured, etc., all of which have good examination results.

A careful look at the child's examination report revealed nothing unusual.

His self-examination ability to read films has been tempered by all these years, and his diagnostic level has been promoted to the director level, and many surgical skills have also been promoted to the director level, and the level of watching films is even higher than that of ordinary chief physicians and technicians in the medical technology department.

He was able to find some small problems that others couldn't find.

"Brain damage is sometimes not visible with ultrasound, CT, X-rays, etc. Even the highest level of precision NMR cannot be detected. Because brain tissue is as brittle and tender as water tofu, a violent blow to the head can cause them to have problems. Especially in children, the skull has just been completely closed, the body is immature, and many organs are not fully developed, and they are more likely to be damaged. ”

"Like the most common concussions."

Director Yin provided his own diagnostic insights.

This can be regarded as giving Zhou Can more diagnostic enlightenment.

"You mean, you're looking at the child's brain, neck, spinal cord, both at the same time, right?"

"Not bad!"

Director Yin showed a teachable satisfied expression.

"I can also give you another diagnostic reference. Some people have pre-existing medical conditions that have not yet flare-up or have less obvious symptoms. In particular, symptoms in the prodromal phase of a disease are often subtle. I'm just making an analogy, is it possible that this child has a neurological or spinal cord disease, and this high fall injury became the fuse, detonating the disease, resulting in a sudden high paraplegia? ”

This is indeed another very empirical diagnostic idea.

Young doctors rarely think about it.

Zhou Can came to visit Director Yin this time, gained a lot, and got up to say goodbye.

"Don't hurry to leave, I'm not done yet!" Director Yin glared at him dissatisfied.

Zhou Can had to sit down again.

"There are two enlargements of the spinal cord, the upper one is called cervical enlargement, which is located in the third segment of the cervical cord to the second segment of the thoracic medulla. The lower one is a bulging waist. Generally, when a patient has a typical spinal cord paralysis, these two areas are examined. This child is a high paraplegic and it is recommended that you focus on cervical distention. If necessary, a puncture examination and minimally invasive exploration can be done. In terms of invasive exploration, if you don't understand something, you can go to Director Wu of the Department of Neurosurgery for advice, which is his strength. ”

Director Yin provided another diagnostic opinion.

These are the words of his many years of experience. Now all of them are selflessly shared with Zhou Can, which makes Zhou Can very grateful.

After Director Yin finished speaking, Zhou Can sat still and looked at him quietly.

"No, all the advice I can provide is gone. Is there anything else you'd like to hear? Why don't I share with you a few more classic difficult cases in neurology? Director Yin asked narrowly.

"Uh...... Come back next time, come back next time. I got the scriptures from you today, and I have to go back and read it, the paraplegic kid is still waiting! Thank you for your careful guidance! ”

Zhou Can stood up and waved his hand repeatedly.

"Your tea here is so delicious, in fact, we have good tea in the emergency department. As long as you go over, I promise to steal Director Lou's best tea leaves to make tea for you to drink. ”

It's a joke.

Zhou Can is now the deputy director of the department, and the department has applied for an office for him in order to win his heart.

Even Deputy Director Han Changqing, who is much older than him, does not have this treatment.

However, Director Han is about to retire.

I won't pursue these things on the line, what Director Han wants to pursue should be the security after retirement.

Doctors with a staff are usually paid no less than 80% of their pre-retirement salary after retirement. Therefore, before everyone retreats, they will try their best to rush and make the level higher.

When the time comes, you will be able to get more retirement salary.

Zhou Can has his own tea, which is better than the tea collected by Director Lou.

And he has a wide variety of teas.

As one of the big bosses behind the scenes of Jinyu Interactive, although he is unusually low-key, those who want to be motivated, when they give gifts to Li Xuan, they will always sensibly bring a copy to Zhou Can.

Zhou Can told Li Xuan every time not to take it for him, but every time Li Xuan waited for him to go to the company, he would ask someone to fill his trunk.

When I don't have money, I feel precious for those tea leaves and good wines.

It's really at Zhou Can's level, but it's very light.

Scarcity is expensive.

It is a famous saying that people are self-exalted when they have nothing to do.

These gifts were received softly, and they didn't even know who gave them. The person who gave the gift didn't think that Zhou Can had to remember his name, but he was in the heart of not being blamed for many people.

If you don't give Zhou Can a gift, in case Zhou Can has an opinion when he is promoted or selected for an important position, he can stir up the yellow with one sentence.

Countless artists who want to get ahead, not to mention spending money to give some gifts, even if they are cleaned and dressed up beautifully, they are willing to send them to the door to accompany Zhou Can to talk at night.

There are also those advertisers who cooperate with the entertainment industry, companies that have major interests with Jinyu Interactive, and it is normal to give some gifts to the two bosses of Jinyu Interactive during the New Year's holidays.

After coming out of Director Yin's office, it was already 8:26 p.m.

Time flies so fast.

He seemed to feel that time was never running out.

There will always be endless patients and endless work.

Back in the emergency department, he was ready to take on the challenge of finding out if he could find out the cause of the child tonight.

Now as the deputy director of the emergency department, he still has a lot of power.

The use of many medical resources can no longer be directly mobilized without going through Director Lou and Dr. Xu.

Another advantage of the emergency department that a specialty department does not have is that it operates 24 hours a day.

When it was time for the specialist department to close, many doctors and nurses were off duty, leaving only the doctors on duty to deal with the inpatients. In this case, there is no way to do a lot of things.

Because of its peculiarity, the emergency department is available 24 hours a day.

Acute patients and critically ill patients can be sent to the emergency department at any time, and effective rescue can be carried out at the first time. There is no such thing as waiting until the next day to go to work.

Emergency inspections can also be done at any time.

Including surgery, even at 3 o'clock in the middle of the night, the emergency department can carry out as soon as the patient needs it.

He took the child's examination report and all the documents and studied them carefully.

Nerves can be divided into central and peripheral nerves.

But in terms of connection types, there are only two. One is the nerve that is connected to the brain, and the other is the nerve that is connected to the spinal cord, also known as the spinal nerve.

Director Yin's diagnosis suggested that the child may have problems with both cranial and spinal nerves at the same time.

This requires Zhou Can to find a way to verify them one by one.

Then, from the function of the nerves, they can be divided into two categories: sensory nerves and motor nerves.

Zhou Can decided to re-enter the ward to test the child's sensory nerve function.

Sometimes don't bother the doctor.

Normally, doctors will want to find out the cause of the disease at once. However, when encountering such a difficult neurological disease, let alone a few checks, even if it is checked dozens or hundreds of times, as long as the doctor is willing to spend precious time on the patient's diagnosis, the patient will have fun.

Because it shows that you have met a good doctor who is responsible.

If the patient and his family are ignorant, they still speak ill of such a doctor, and their attitude is extremely uncooperative.

As you can imagine, after the doctor feels cold, he can recommend that the patient be transferred to another hospital or take some defensive medical measures. When the time comes, the patient will have to eat the bitter fruit on its own.

Imagine that doctors could spend all their precious time on more patients, rather than on one patient.

In the diagnosis and treatment of such difficult cases, the investment is seriously disproportionate to the gain.

If the performance commission for treating an ordinary patient is 50 yuan, the performance commission for treating a difficult case can reach 300 yuan. Doctors are also at a loss.

And the more complex and difficult the cause, the greater the risk to the doctor.

After arriving at the inpatient ward, the child's mother was taking care of the child.

Grandparents stay in the hotel temporarily.

Including the owner of the bouncy castle and the young woman, who were also not in the ward.

According to common sense, the owner of the bouncy castle only needs to provide the cost of treatment, and it is okay not to come in person. After all, it's too far away.

But the father of this child is not an ordinary person, and if the boss involved does not show enthusiasm, the loss will be even greater if he is sued. Even if a problem is found, it is possible to be arrested and prosecuted.

Nobody wants to go to jail.

The owner of the bouncy castle showed a positive attitude, just to make the family satisfied and not to sue him.

Strive to keep this matter private.

The people do not hold the people accountable, and the officials do not hold them accountable, which is applicable all over the world.

And it has been applicable since ancient times.

To take the simplest example, a restaurant, a steamed bun shop, or a cake shop, which one dares to be inspected? It's okay if you don't check, but you can definitely find out the problem if you check it.

As long as the diners are okay after eating, and everyone does not report it, the store will be able to open normally.

"Doctor Zhou, you're here!"

The little boy's mother saw Zhou Can enter the ward and came straight to the bed, and quickly stood up to say hello.

She should belong to a dignified and virtuous woman with a gentle temperament.

"You came all the way from the imperial capital to see me, and if you don't find out the cause of this child, I can't sleep well! I'll test the sensory nerves from the neck down again. We generally have several levels to do this test. The gentlest is to touch the surface of the skin, if the child does not feel it, then the epidermis needs to be stimulated with a sharp object or an electric current. Do you think it's okay? ”

Zhou Can is actually reluctant to test the sensory nerve function of children.

Today's parents treat their children as the tip of their hearts.

Seeing the doctor hit the child's body with an electric current, they dared to fight with the doctor.

In fact, the doctor was not ill-intentioned, and he was also bent on finding out the cause of the child's illness.

In addition, doctor-patient disputes often occur in the emergency room.

In particular, patients with cardiac arrest or ventricular fibrillation need to be resuscitated with electric shocks. When the shock occurs, the patient screams.

When the family members heard this, they thought that the doctor was torturing the patient, and immediately banged on the door angrily, wanting to rush into the emergency room and beat the doctor.

"Will it hurt the child?"

The little boy's mother asked with some concern.

"If his body feels that the nerves are normal, he will feel pain. If it is not normal, there is no manifestation. When we do the test, it will be well controlled and will not cause any physical damage to the patient. ”

Zhou Can explained.

"Okay then! When we get here, we choose to trust you. ”

The child's mother agreed.

Zhou Can started the sensory nerve test for the little boy.

Above the neck, the child can feel his touch and stroke, but below the neck, the sensory nerves are very weak.

Ordinary touches are not felt at all.

You can only feel some if the skin is irritated by a cold object or sharp object.

As for very hot objects, they are generally not used in clinical tests.

The main fear is that he will be beaten by his family.

In case it is not well controlled, the soup hurts the skin, even if it is just a red mark, the family may hold on to it.

Through the test, Zhou Can also found a phenomenon, the further down, the worse the child's neurosensory function.

The sensory function of the soles of the feet is the worst.

He also made a major discovery in this test. Director Yin told him to focus on the examination of the child's spinal cord and neck distention. When testing sensory function, he found that the child's neurological function was weakened, starting at the medulla oblongata.

Explain that the problem should be in the medulla oblongata or above.

For example, pons.

The distended neck area and below, there should be no problem.

The internal structure of the spinal cord is very complex, and it is extremely difficult to dissect.

Any spine surgery should be done with caution.

Don't look at the doctors in those big hospitals boasting about how many lumbar disc herniation surgeries and cervical spine surgeries they have done, and how good the results are. There are many patients who may only have pain before surgery.

However, after the operation, the pain is not so painful, but it needs to be in a wheelchair, or even a high paraplegia, and I can't take care of myself while lying in bed.

Wheelchair patients are slightly better, and patients who are unable to take care of themselves in bed are usually miserable.

There is no filial son in front of the bed for a long time.

For the rest of his life, he needs to be sick in bed and need to be taken care of. Eating, drinking, scrubbing the body, massaging the muscles, stretching and moving the limbs, whether it is a child or a significant other, it is difficult to take care of it for a long time.

(End of chapter)