In addition to necrosis, nerve rupture caused by spinal cord transection injury is also irreversible.

Clinically, so many doctors regard the spinal cord as a neurological forbidden area, and they have their own reasons.

According to the somatosensory potential induction, it has been basically identified that the first pair of spinal nerves in this little boy is abnormal. That's a bit of a problem.

Let's start with the structure of the brainstem.

The brainstem is known as the forbidden area of life and the forbidden area of surgery, and many senior brain surgeons talk about the discoloration of the brainstem.

Because the brainstem is the most central part of the human nerve center, it is also the most delicate and fragile part.

The brainstem includes the medulla oblongata, pons, and midbrain.

In fact, we can often see the gyrulotic structure in books, which is the brain of the human body.

Sometimes there is a tumor in the brain or a blood vessel is broken, as long as the brainstem area is not involved, brain surgeons can basically dare to go under the knife without any contraindications. Even today's cranial endoscopic surgery is quite mature.

Only two to three small holes need to be drilled in the head to complete the surgery, which is both efficient and safe.

The patient's surgery will also be less traumatic.

Cranial endoscopic surgery is extremely friendly for some patients who are frail or whose lesions are not particularly complex. Some patients do not meet the indications for traditional craniotomy and cannot meet the surgical requirements, so conservative treatment can only be chosen.

In the end, it can be imagined that it is basically the same as waiting for death.

Lesions in the brain, cerebellum, or other parts of the cranial cavity are not scary. But a small brainstem hemorrhage is enough to leave the doctor helpless.

Of course, now that many large hospitals in China already have strong brain surgery teams, the brainstem is no longer an absolute forbidden area.

Some brainstem injuries that are not particularly serious, or lesions that do not involve the midbrain, they dare to touch.

According to the anatomy of the brainstem, the medulla oblongata connects the pons up and the spinal cord below, which is equivalent to the throat artery of the human nerves.

Unfortunately, the first cervical nerve is located in the medulla oblongata.

Located at the site of the medullary junction of the spinal cord.

Such a critical position, with Zhou Can's current surgical level, can be challenged, but the result is uncertain, and the grasp is not particularly large.

If the spinal cord is transcribed and the nerve is ruptured after surgical exploration, then there is basically nothing he can do.

He can now anastomoses most of the nerves, and as for repairing the broken spinal cord, he doesn't get to that yet.

"The child's lower central nervous system is patency, at least the left part of the body. The pain nerve reflex from the neck down is also present, but it is attenuated further downward. This suggests that the spinal cord is less likely to be transection. ”

Zhou Can was silently thinking about the cause of this child.

"Jiang Wei, I remember that when this child just fell and was injured, the hematoma in the neck occurred on the right side, right?"

He asked Jiang Wei next to him.

"Yes, it's on the right side of the neck."

Jiang Wei nodded in affirmation.

Don't look at her as just a nurse, but she has a strong desire to learn. followed Zhou Can to do surgeries, ward rounds, and sometimes diagnose difficult cases together, which was of great help to her level.

"If the injury is on the right side of the back of the neck and the lower central nervous reflex on the left side is normal, it means that the possibility of spinal cord rupture is very small."

Zhou Can muttered to himself.

According to the laws of physics, when one face is violently impacted, it is often the other side that breaks first.

The child's right side of the lower central nervous system was abnormal, but it was still present, indicating that the right side of the spinal cord was more likely to be damaged. If this is inferred, then the child's high fall injury did not cause nerve rupture, at most it was just some damage.

If this is the case, then Zhou Can has a great deal of confidence that it will be repaired through surgery.

"Wait for the results of the spinal fluid test in the lab to come out, let me know. If the spinal fluid test is not infected, inflamed, the child may be considered for surgery. However, when the surgical plan is formulated, I will ask Director Wu of the Department of Neurosurgery to help check it. ”

Zhou Can's eyes were as bright as stars.

After two days of gnawing on this difficult case, I finally saw the light of day.

If this child can be cured, all the effort will be worth it.

Inviting the 'peak scalpel' of neurosurgery to consult can be said so casually, just like calling an old friend to come over to help, I'm afraid only Zhou Can has this style.

There are strict regulations for emergency consultation in all departments.

Ask doctors from other departments to come to the emergency department for a consultation, and if a doctor is not designated, the department will send a doctor to the emergency department within 10 minutes. Of course, many times it can't be done.

Especially when the emergency department used to win and weaken, some weighted departments dragged on, and it was considered to save face if they could arrive in half an hour.

Doctors from other departments are invited to attend the general consultation, and the consultation is usually completed within 24 hours without a doctor.

But in reality, the time limit is three days.

For example, Zhou Can wants to invite a neurosurgeon to come for a consultation, and the patient's condition is not urgent, that is, an ordinary consultation. It takes about a day to make an application and get it approved.

After receiving the notice, it will take another day to arrange for the doctor to come for consultation.

Therefore, it is usually not until the third day that a doctor comes to the consultation.

Everyone is busy, each doctor has his own job, and attending the consultation can be regarded as an obligation or an affection.

If it is really unpleasant, or if you ask for this or that during the consultation, it is too harsh, and the other department will send a regular trainee or a trainee to ensure that you are more uncomfortable than eating a dead fly.

Even if you want to find a medical department review, people will say, I'm sorry, our department is too busy, although Dr. XX is only a regular training, but the level is still quite good.

It is excellent in diagnosing this type of case.

Then the head of the medical department will not say anything more.

After all, people have already sent reinforcements over, you are so dissatisfied, you have the ability to diagnose yourself!

This is also a situation that many patients often encounter when they go to the hospital to see a doctor, and the doctor who receives the doctor will say to the patient, "Or you will return the number, your disease is not good at our department, you have to hang such and such a department." ”

This is a doctor who is more indifferent, or a doctor who has little connections.

Directly push the patient to other departments.

If it is a well-connected doctor, he happens to know the doctor in such and such a department, and he is familiar with it, he will directly call the doctor and say yes. I have a patient here, what is the disease, I can't be sure, you can help take a look.

Most of the other party will agree.

This is equivalent to introducing a patient to him.

No matter how small a mosquito is, it is still meat.

One more patient is one more income. Sometimes picking up a big deal, it is a win-win situation for performance and word of mouth.

If it is assigned by the girl who registers in the outpatient clinic, or if the patient chooses by himself, it is likely that such an opportunity will be missed.

Let's talk about the hospital's little secret about registration.

If you make an appointment by yourself, you can choose a general doctor directly for minor problems. Those who are qualified to sit for consultation are basically above the attending level. Even if the other party is only at the level of a resident doctor, it is still the best in it.

If you go to the window to register, the hospital staff will have a default rule. As long as there is an expert number in the department where you register, you will be registered with an expert number.

Anyway, it is to prioritize the assignment of patients to high-ranking doctors.

Special Needs Specialist numbers are not included in this list.

On the one hand, the price of the special needs expert number is expensive, at least more than 50 yuan, and the slightly more expensive ones basically start at 300.

Many patients themselves have returned to poverty due to illness, and if you give him a number of a few hundred yuan, he will not spray you on the spot, that is his honesty.

Therefore, when the patient registers, if he feels that his illness is not serious and complicated, he can also take the initiative to ask the girl at the window to give you an ordinary number. They usually readily agree.

You know, whether it's the girl who registers at the window, or the doctor in the outpatient clinic, or the nurse, everyone is a part-time worker.

Everyone has a kindness in their hearts.

No one is going to embarrass a patient for no reason.

Zhou Can knows the directors and top experts of many departments, which is indeed a very big advantage.

Every patient who comes to him has the opportunity to enjoy the top VIP treatment.

It only costs 8 yuan to register his number, but he has the opportunity to enjoy the help of various special needs experts for consultation.

You must know that Wu Baihe and Director Yin Hua, these special needs experts, can't be grabbed.

Of course, Zhou Can will also squander the resources in his hands indiscriminately.

Every time he asked other directors to help with the consultation, he needed to return the favor.

……

At noon, because the surgery was relatively late, the operation was almost 1 o'clock, so I ordered food and ate it in the operating lounge.

Some tertiary surgeries are quite difficult.

In fact, only a surgical master like Zhou Can thinks that doing ordinary tertiary surgery is as simple as drinking water and eating. For many doctors, even senior deputy chief physicians, when doing any tertiary surgery, they are walking on thin ice and trembling.

Zhou Can was in awe when he did any surgery, but the strength was there, and there were basically few things that could not be done.

Now even if it involves orthopedic surgery, he can handle one or two.

"Boss, the child's test results are out."

Jiang Wei specially asked someone to bring the child's test results.

"There is a bacterial infection!"

After Zhou Can saw it, he couldn't help but exclaim.

This was something he never expected.

I thought that the child's high paraplegia was caused by a fall and injured his cervical spine, but now it seems that things are a little unexpected.

At that time, I was fortunate to visit Director Yin Hua overnight.

These old experts have nothing else, but they are well-informed, experienced, and stable.

Director Yin Hua told him to be wary of causes other than spinal cord injury.

When he came back, he also wanted to get insurance, so he applied for a spinal fluid test for the child. Now it seems that this step is the right one.

There's nothing wrong with being careful.

Through today's incident, he also realized that practicing medicine needs to be cautious and cautious, careful and careful.

If you miss this unconventional test and have surgery on your child, the consequences will be unimaginable.

Spinal cord infections are sometimes difficult to detect with a routine blood count.

And this child's spinal cord infection is actually the most difficult tuberculosis bacteria.

Zhou Can was stunned.

Tuberculosis is a well-known and stubborn disease in clinical practice, which is difficult to diagnose, difficult to treat, and prone to recurrence.

The large number of extracellular flora of tuberculosis bacteria and the vigorous metabolic reproduction are its two major advantages. Let it be able to cope with many drugs.

Clinical treatment of tuberculosis often requires a combination of drugs.

And it's a long-term medication.

Why is tuberculosis so difficult to treat?

Tuberculosis bacteria can be roughly divided into two groups in the human body.

One is the extracellular flora, which often parasitizes caseous lesions, tuberculous nodules and cavities, and these flora can fully exert their killing effect only with antituberculosis drugs.

However, due to the large number of extracellular flora and strong metabolic reproduction, if there is no combination of drugs in the treatment plan or the combination is improper, it may lead to selective reproduction, mutation, and drug resistance, so it is recurrent and difficult to cure.

There is also an intracellular flora, which metabolizes and multiplies much more slowly than the extracellular flora.

Its metabolism is slow, which leads to a significant reduction in the rapid killing effect of anti-tuberculosis drugs, which is one of the reasons for its refractory treatment.

Clinically, even a single tuberculosis is enough to make doctors anxious.

Not to mention that it is the spinal cord that is now infected.

This is the nerve center of the human body!

If the test results were from the outer hospital, Zhou Can would even wonder if it was a mistake?

The laboratory of Tuya Hospital is one of the best in China, especially in terms of germ detection, because of the sufficient funds, the hospital also attaches great importance to this area. Often, at any cost.

For example, a patient test costs $80.

A single lab test may not give you an accurate result, or it may be suspicious. At this time, it is necessary to re-check, or even three or four inspections.

It is conceivable that if it takes four inspections to finally get accurate test results, the total cost is 320 yuan.

What is this fee charged by the patient?

It is estimated that patients will directly dismantle the hospital's billing window.

Hospitals can only cover this cost themselves.

According to Zhou Can's understanding, almost all responsible large hospital laboratories are not profitable.

This has something to do with the rigor of the big hospitals.

Small hospitals can check the disease and do some ordinary routine laboratory tests. If you can't find out, tell the patient directly, we have limited technology and conditions for your disease, and if you can't find it, you have to go to a big hospital to investigate.

Then the patient went to the big hospital to see a doctor.

It is conceivable that all such patients encountered by grassroots hospitals are pushed to large hospitals, and large hospitals cannot refuse.

I can only silently accept the patient with tears in my eyes, and do what tests I should do.

You have to do it at a loss.

How did word of mouth come about? That's what you get at any cost.

Large hospitals not only do laboratory tests regardless of the cost, but also find out accurate results at a loss. The same is true for critically ill patients in ICU wards.

Looking at the cost of ICU treatment as high as 20,000 or 30,000 a day, or even hundreds of thousands, patients feel that the hospital is really fucking black and really fucking profitable.

The hospital was secretly wiping away tears.

How well equipped the ICU ward is, I believe every doctor knows it. When rescuing patients, all kinds of equipment, consumables, and manpower are all inputs regardless of cost. And the ICU is in three shifts.

There are special doctors and nurses responsible for guarding and taking care of them 24 hours a day.

How much does this cost?

There are also hundreds of thousands of dollars for a day in the ICU, either with extracorporeal membrane lungs, or with special drugs and consumables.

Many of them are 100% imported, and the cost is that expensive.

In the past, the import price of a titanium alloy nail was more than 6,000 yuan. It can't be made domestically, so it can only be imported.

The patient's bones are broken and cracked, and if they are not used to fix them, the patient can only become crippled.

After using it, there is a great hope of healing.

And you don't need to take it out for life, so you can keep it in your body forever.

Domestic, first of all, the rejection reaction is strong, and then the corrosion resistance, strength and other aspects do not meet such high requirements.

Both patients and doctors will give preference to imports.

The ICU ward does not make money, but earns word-of-mouth, which is the success rate of rescue of critically ill patients.