My medical skills are a billion points

Hypoglycemic coma can be ruled out.

After an electrocardiogram, it showed that there was only some myocardial ischemia, but it would not cause coma.

Therefore, the current patient is most likely coma caused by cerebral hemorrhage.

Because the current patient's performance, in addition to coma and unequal pupils, there is also a situation where the muscle strength of the right limb is 0.

Various signs and physical examination indicated that this patient was likely to have cerebral hemorrhage, which had caused cerebral herniation.

This situation must be surgically treated as soon as possible, otherwise the patient will soon suffer respiratory and cardiac arrest and die.

Of course, if this patient is to be diagnosed, the most important step of examination is still needed, which is to check the head CT.

As long as brain hemorrhage is diagnosed after head CT examination, craniotomy is needed as soon as possible.

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

According to the current situation of the patient, after the cause is diagnosed as soon as possible, if the craniotomy is performed as soon as possible, there is still a glimmer of hope.

But when the old lady was asked to go through the hospitalization procedures, she didn't bring much money.

Originally, she went to see a doctor with her husband today to adjust the high blood pressure medicine.

Who would have thought that this would happen, so she didn't bring much money, and the old man didn't know how to use mobile phones, WeChat, Alipay and the like.

However, in this kind of emergency, the emergency department will usually deal with special cases because the family members and patients are not prepared for the sudden illness and do not bring enough money.

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

The hospitalization procedures were quickly completed, and I had a hospitalization number.

Zhao Fangshu immediately issued a head CT examination form, and then asked Liu Qing and others to push the patient for CT examination.

Soon the CT scan came out.

Zhao Fangshu 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, which has exceeded 40 milliliters. It seems that surgery is needed as soon as possible!"

Not all cerebral hemorrhage patients require surgery.

Cerebral hemorrhage is also indicated for surgery, and there are relatively clear boundaries.

Surgical indications for cerebral hemorrhage mainly depend on the location and amount of bleeding.

First, for example, for cerebellar hemorrhage, if the bleeding volume is greater than 14ml, there are clinical indications for surgery.

Because the cerebellum is close to the brainstem, its hemorrhage can easily compress the brainstem, so the surgical indications for hemorrhage are relatively broad.

Second, if the cerebral hemorrhage is located in the ventricle, causing acute hydrocephalus, surgical treatment is also required.

Because of ventricular hemorrhage, it is very easy to cause obstruction of the cerebrospinal fluid circulation pathway, leading to obstructive hydrocephalus, which leads to increased intracranial pressure, so surgical treatment is required.

Third, if the basal ganglia hemorrhage is greater than 30ml or the neurological function deteriorates progressively, surgical treatment is also required.

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

Finally, if the patient is comatose and the pupils on both sides are unequal, it means that the brain herniation is caused by cerebral hemorrhage, and surgery must be performed as soon as possible.

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

Moreover, he was already in a deep coma, and his pupils were unequal in size. He had to undergo emergency surgery immediately, and his life might be saved.

Patients with massive cerebral hemorrhage like this may not be able to save their lives even though surgical treatment is performed, but for patients, there is still hope for life.

And if this kind of patient gives up surgical treatment and only uses conservative treatment with drugs, there will be no hope, and 100% will not survive.

Chapter 136 Why don't I try it?

Due to a large amount of cerebral hemorrhage, the brain pressure is too high, forming a brain herniation, and bilateral pupil dilation and fixation will soon appear, that is, brain death has already occurred, and the patient will soon suffer respiratory and cardiac arrest.

In any case, as long as patients with massive cerebral hemorrhage undergo surgery, there is still a glimmer of hope.

Without surgery for treatment, there is no hope of survival.

Needless to say, this patient must be treated with a craniotomy as soon as possible, otherwise he will undoubtedly die.

As the patient's first doctor, Zhao Fangshu called the old lady into the office and explained to her the severity of the patient's condition.

Zhao Fangshu talked with the old lady in detail for a while in plain language.

In short, it was to let the old lady understand the severity of her wife's condition, and she needed immediate surgery, otherwise she would lose her life.

The old lady burst into tears and cried, "Doctor, I beg you, you must save my wife. I, I kneel down for you."

The old lady was crying and wanted to kneel down and beg Zhao Fangshu.

Zhao Fangshu was startled, she stood up quickly, supported the old lady, and was determined not to let her kneel down.

Just kidding, let an old man who is nearly 70 years old kneel down to her a young man.

She can't bear it.

It will be life-threatening!

Zhao Fangshu supported the old lady and explained: "Old lady, I can understand your feelings, but after all, the condition of the old man is too serious, we can only say that we will do our best to treat it. Also, you should go to the hospital as soon as possible." Pay some money to the account, we are going to have surgery soon."

I will definitely need a neurosurgery consultation in a while, and I will definitely need an operation.

Surgery like this is all cerebral hemorrhage hematoma evacuation and decompressive craniectomy.

If there is no tens of thousands of yuan, it will not come down.

The neurosurgery department sees that there is no money in the account, but it does not know how to operate.

That's why Zhao Fangshu urged the old lady to pay the money.

If it is an emergency rescue, there is no money in the emergency department, and emergency treatment can be temporarily provided.

But for surgery, there is no money in the account, and the neurosurgery people will never use the knife.

As soon as she heard that she had to pay, the old lady burst into tears again.

"Doctor, old lady, I have already handed in all the hundreds of dollars I have on me, and I can't afford any more money. I will call my son. He is out of town now, and he won't be able to make it in a while. Come on. Now here I am, what shall I do?"

The old lady cried and told her family's situation, which made people sound very sad, not tasteful.

Every family has its cupboard.

Situations like this can be said to be frequently staged in the emergency department and are commonplace.

Although Zhao Fangshu is a doctor, he plays the role of saving lives and healing 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, and she will advance money to the patient.

But if the old lady doesn't pay the money today, I'm afraid the operation won't be possible.

After all, in other neurosurgeries, surgery must be performed only when there is money in the account.

Otherwise, they will not be able to keep accounts after the operation.

If it was really because the money was not in place that the operation could not be performed and the patient died, then Zhao Fangshu would be helpless.

When she first started working, Zhao Fangshu was full of enthusiasm in the emergency department.

When encountering those poor patients who can't even eat, she will help them and take care of them for one or two meals.

But as the working hours get longer and longer, the experience becomes richer and richer.

Zhao Fangshu no longer does this kind of thing of helping patients manage their meals.

Because there are too many poor patients whose family members cannot afford food.

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

So now Zhao Fangshu is just doing his best to treat the patients, regardless of the patient's money.

Because it's not something she can handle.

Zhao Fangshu felt helpless seeing the old lady begging.

But she can't help the old lady with anything.

I had no choice but to bite the bullet and said: "Old lady, if you don't have money in your account, the neurosurgery department won't operate, and I can't help it. I suggest you hurry up and urge your son to come back, or ask him to pay the bill first." You can transfer the money, too."

With tears on her face, the old lady said with a sad face: "I'm old, I don't know how to transfer money, and I don't know how to use your smart phone. It will be a few hours before my son comes back, doctor, can you help me?" Can't wait for my son to come back and then operate?"

Zhao Fangshu patiently explained: "Old lady, the old man's condition is very serious now, and the operation must be performed as soon as possible, not to mention waiting for a few hours, even an hour, otherwise once his pupils dilate, even if the time comes If you want to have surgery again, there is no chance.”

Zhao Fangshu also told the truth.

Because of this patient, the bilateral pupils are now unequal.

If the operation is performed as soon as possible, and the bone flap is removed to remove the hematoma and decompress, it may also cause the dilated pupil to shrink back.

It would be pointless to wait for the pupils on both sides to dilate before undergoing surgery.

Therefore, in the current situation of the patient, it is impossible to wait a few hours before performing an operation.

The old lady was dumbfounded all of a sudden.

She stared at Zhao Fangshu in a daze.

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

The old lady was bewildered and helpless.

Just like a helpless child, standing there is full of sadness.

Zhao Fangshu also sympathized with the two old people very much, but she really had nothing to do.

Her major is general surgery, and she is good at performing abdominal surgery. She absolutely does not understand brain surgery.

And other neurosurgeons, seeing that there is no money in the account, will never perform surgery.

Unless the dean can say hello and let them perform the operation first and then pay the money.

Seeing the old man standing there helplessly, at a loss, like a child.

Zhao Fangshu was also very upset, but there were some problems that she could not solve.

The patient's condition is already at stake. If the operation is not performed as soon as possible, it may be too late.

Several doctors in the office, looking at the helpless old lady, are also clever women who can't do anything without rice.

I can only sigh silently in my heart, sympathizing with the old lady's experience.

Who let her have only one son, and it was so far away from home.

Seeing the situation of the old lady, Xiao Chu couldn't bear it, so he walked over to Zhao Fangshu and said, "Don't we have emergency relief funds in our department? First use it for the old man, and then we can do the surgery first, then we can't talk about it?"

The emergency departments of tertiary hospitals in cities generally have emergency funds.

It is mainly used to deal with those emergencies without money.

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

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

"That is to say, this patient can only use the emergency fund if he has an operation in our department?"

"Yup!"

Zhao Fangshu spread her hands: "But this patient must go to the neurosurgery department for craniotomy. In our emergency department, no doctor has learned brain surgery!"

"Or, I'll try it!"

Xiao Chu paused and said.

Chapter 137 Step aside, let me do it

Xiao Chu never thought about taking the neurosurgery job.

But the patient's condition is very urgent, and a neurosurgery doctor cannot be invited to do it. In order to save his life, Xiao Chu had no choice but to stand up.

"what?"

Zhao Fangshu's eyes widened all of a sudden, as if he had seen something extraordinary.

"Xiao Chu, are you saying that you can also perform brain surgery?"

Xiao Chu just nodded, not expressing that he is very good at this operation.

For Xiao Chu, doing any surgery is just a matter of waving his fingers and consuming points.

Now Zhao Fangshu was so shocked that he didn't know why.