I can see the status bar

Chapter 691 Apathetic Silence
This should not be a reaction to a drug overdose.

Doctors from the anesthesiology department came for consultation at the request of Zhou Ce.After some simple stimulation checks, the doctors in the anesthesiology department gave their own consultation opinions, "This is not a coma caused by drug overdose."

In fact, the doctors in the anesthesiology department can make such a judgment based on the dosage alone.But the human body is always unusual in one way or another, and maybe some people are not in the same state as ordinary people-they will really overdose because of two milliliters of diazepam injection.

In order to exclude this, the doctors in the anesthesiology department brought out the EEG analyzer to examine Cao Zhiquan.The results of the examination fully confirmed the judgment of the anesthesiologists - Cao Zhiquan's EEG (electroencephalogram) showed a typical three-phase wave structure.

"We are not gods, and EEG is not as professional as others." When Sun Lien rushed to the ward, the doctor in the anesthesiology department was explaining his findings to Zhou Ce, "However, there will be no three-phase wave in drug overdose-this stuff is usually metabolic. Patients with encephalopathy, Alzheimer's disease, encephalitis or drug-induced encephalopathy."

"Three-phase wave?" Sun Lien greeted the anesthesiologist in the room, then nodded to Zhou Ce, who looked a little anxious, and then took the EEG to look at it.

For clinicians, the EEG is an uninteresting and confusing graph - not only patients can't understand this large pile of irregular and disorganized waveform graphs, doctors in non-related departments generally also see it. I don't quite understand.

Sun Lien is between "I don't understand much" and "I don't understand too much".When training old things, EEG is a kind of material that appears frequently.So even with Sun Li'en, I can't see too little.As an important tool in the clinical analysis of patients with impaired consciousness, he has some understanding of it.

"The waveform is fine, it is indeed a three-phase wave..." Sun Lien looked at the EEG, and found the position of the three-phase wave in the chaotic and complicated graphics that could even be called "chaos".The waveform is quite typical, but you still have to look for it carefully.

"Have you checked his liver function?" Sun Lien also thought of metabolic encephalopathy first.Moreover, metabolic encephalopathy is also consistent with symptoms suggestive of high signal intensity on diffusion-weighted imaging of the whole brain cortex.Among metabolic encephalopathy, Sun Lien is most familiar with hepatic encephalopathy.Hence the question.

"The nurse hasn't come to draw blood just now." Zhou Ce shook his head and added, "I also ordered kidney function and blood sugar tests at the same time... If it is metabolic encephalopathy, these should be checked together."

Zhou Ce's consideration is a mature and prudent move, and Sun Li'en will naturally not object.While nodding his head, he started to observe Cao Zhiquan's status bar again - when he was first admitted to the hospital, Cao Zhiquan's status would definitely be very different from his current load.If the cause of the change can be found through the difference between the two status bars before and after, it may be helpful for diagnosis.

“曹志全，男，44岁。全脑皮层弥散加权成像高信号（12833.19.41）、亚急性痴呆（127833.19.41）、阵发性肌肉痉挛（1438.39.50）、无动性缄默（07.24.51）”

Sure enough, the status bar suggested a new action.But Sun Li'en didn't get any valuable information from it - after all, he is not a doctor of the gods.Of course, the apathetic silence is an important hint. This hint can at least allow Sun Lien to confirm that Cao Zhiquan's coma state has little to do with diazepam.

But what does this state... have to do with his current symptoms?What do they have in common with his global brain lesions, subacute dementia, and paroxysmal muscle spasms?
Sun Li'en felt that he had some headaches. This kind of pain was a typical feeling when he used his brain too much.

From an optimistic point of view, at least akinetic mutism can help the diagnostic team avoid detours.Cao Zhiquan certainly did not have any metabolic encephalopathy.Akinetic mutism generally occurs in patients with damage to the upper brainstem reticular activating system and the prefrontal-limbic system.It is generally caused by primary brain tumors, pineal tumors, metastatic tumors, and cerebrovascular diseases.Relatively speaking, this is a very serious symptom.

Sun Li'en walked to Cao Zhiquan's side, and began to try to wake him up, "Mr. Cao, Mr. Cao?"

This attempt didn't work very well.Cao Zhiquan's eyelids moved slightly, but his eyes were still closed.

Akinetic mutism is also known as "wake-like coma" and "hypersomnia". Patients in this state basically show a low level of consciousness and reflexive limb movements in response to stimuli, but lack voluntary movement and talking to themselves. and emotional responses.Some patients may have spontaneous eye opening, gaze and even pursuit movements.

Since there's not much response to sound stimuli... let's try haptics.

Sun Li'en imitated Zhou Jun's appearance, and pressed Cao Zhiquan's supraorbital notches with his thumbs. After a little force, Cao Zhiquan frowned, and moved his hands and feet.

"There is a reflex to pain, and the degree of coma is not very deep." Sun Lien said to Zhou Ce, "It looks a bit like apathetic silence."

Zhou Ce didn't know much about the neurology department, so he thought for a while and suggested, "I'd better ask for a consultation with the neurology department. This patient's condition is a bit beyond my ability."

The patient's situation was beyond Zhou Ce's ability, and even Sun Li'en himself was a bit uncertain.After all, Cao Zhiquan had done a head MRI.In addition to brain atrophy and global cortical diffusion-weighted imaging hyperintensity, there were no other symptoms, and the examination results did not support the corresponding cerebral vascular lesion and solid brain tumor.

At this point in the matter, Sun Li'en also found it a bit difficult to handle.If it's just to solve a puzzle, there are still many ways that can be used.But Cao Zhiquan is not just a "puzzle", he is also a person, a father, and a husband.

If it is just a mouse, in order to solve the problem, the researchers can even consider dissecting the mouse, extracting the brain tissue and grinding it for material analysis, or slice it for observation.Anyway, it’s just a guinea pig—in the face of the need to solve a problem, it’s not unacceptable to execute an experimental animal.

But Cao Zhiquan can't do it.

Even taking a sample of brain tissue for biopsy is bound to cause irreparable damage to the brain.Moreover, the damage has a large uncertainty.No matter how skilled a neurosurgeon is, he cannot guarantee that the brain tissue he extracts will not affect the normal function of the brain.There is no guarantee that the extracted brain tissue can just become the last piece of the jigsaw puzzle for a diagnosed patient.

Solve puzzles at the risk of completely or partially incapacitating the breadwinner of a family?Unless the puzzle is related to the patient's life, Sun Li'en will never do this.

To be a doctor, this degree of humanitarian principles is necessary.

"Let's have a consultation with God... Give him bromocriptine and Madopa first." Sun Li'en thought over and over again, and decided to follow the standard treatment first.The combination of bromocriptine and madopa is a well-established therapy for patients with severe traumatic brain injury who exhibit akinetic mutism.It should be pointed out that although this is the main treatment option now, the effective rate is still not satisfactory.The total effective rate of this combination treatment is about 60%, and only 25% of patients can recover consciousness and self-care.

For patients with traumatic brain injury, the most precious thing is always the time of treatment.The sooner treatment is started, the better the recovery will generally be.

Sun Li'en looked at Cao Zhiquan lying on the hospital bed, feeling a little heavy.

If only he could still stand up and embrace his life and his loved ones.

　Luo's lumbar injury is recovering, and the degree of pain has significantly weakened.

　　But at first the frequency of the pain was increasing, and the location was also shifting - I judged this to be a normal response to tissue repair.

　　So it is even more troublesome to update now...not only do you have to stand up to type, but you usually have to lie down for a while.

　　What's more troublesome is that Luo has a bad writing problem-once he stops working, it takes a long time to pick it up again.The result is that as soon as he regains his state, he has to lie down again.

　　Fortunately, I am recovering. Fortunately, everyone seems to be used to my occasional cooing...

　　With [-] apologies, Sanguan begs everyone to give me a little more time and patience.

　　It should be ready soon!

　　
　
(End of this chapter)