medical simulator

Chapter 477 Ningling's Panic Crisis (Subscribe)
"I just said it was weird." After hearing Zhou Cheng's advice, Ning Ling suddenly realized that some of the mysteries he had considered before became clear in an instant.

Although Ning Ling understood it, the others did not fully understand it.

Among them, Chen Xuehua and Xue Guoqing were the two who performed quite well.

Chen Xuehua and Xue Guoqing didn't make it too obvious because of their face. Li Neng squinted his eyes and pondered for a while, then asked, "Professor Ning, how do you explain this?"

Li can simplify the problem and express exactly how to explain the patient's symptoms.

Ning Ling pointed to the physical examination part of Zhou Cheng's medical record before his death, and said, "Professor Li, I personally did the physical examination of this patient. When I did the physical examination, I actually pointed to it, not the central Neuroinhibition."

"If it's centrally active inhibition, then the tone of the muscles, that is, the muscles innervated by the peripheral nerves, will increase."

"And if the peripheral nerves are blocked naturally, then the muscle tension will be relaxed! Professor Li, it is the characteristic of paralysis. Spastic paralysis or flaccid paralysis!"

In spastic paralysis, since the cortical motor area and descending pyramidal tracts control the muscle groups more intensively, the lesion often leads to paralysis of the whole limb, paralysis of one limb and bilateral lesions can cause paralysis of both lower limbs or quadriplegia.

Such paralyzed limbs have increased muscle tension, hyperreflexia, weakened or disappeared shallow reflexes, pathological reflexes, no muscle atrophy and fasciculation, but disuse muscle atrophy can be seen after long-term paralysis.Electromyography showed normal nerve conduction velocity and no denervation potentials.

Flaccid paralysis is caused by lesions of the anterior horn cells of the spinal cord or the motor nuclei of the brainstem cranial nerves and their nerve fibers.It is the final common pathway to receive various impulses from the pyramidal tract, extrapyramidal system and cerebellar system, and is transmitted to the motor end plate of skeletal muscle through the anterior root and peripheral nerves.

Visible fasciculations, no pathological reflexes.Electromyography showed decreased nerve conduction velocity and denervation potentials.Often only one muscle group is affected.

After Ning Ling gave everyone a certain amount of time to react, he concluded: "We found that the patient's muscles were paralyzed, not all muscles were paralyzed, and the electromyography showed no decrease in nerve transmission speed or denervation potential. "

"This kind of performance combines two paralyzed qualities, but does not even have one of them. It is very strange, and it is not in our cognitive reserve."

"Moreover, we found no lesions in the brain or in the spinal canal, and we didn't find any special space-occupying extrusion lesions in the segment where the nerves go. This can be explained clearly."

Ning Ling's explanation left a lot of blanks, but other people with more clinical experience understood it.

This is an uncommon but typical clinical manifestation of paralysis.

Especially Chen Xuehua and others have a deep understanding.

"Professor Ning, now that the diagnosis is clear, then the follow-up treatment will be arranged by Professor Ning and Professor Li. It's getting late, so I'll take my leave first!" Zhou Cheng didn't dare to express his opinion any more. .

According to what he has learned so far, the patient's paralysis is largely related to iatrogenics, which will involve the hospital where the old man performed hemorrhoid surgery.

This is not a question for Zhou Cheng to argue about. Whether to make it clear or not depends on the attitudes and opinions of Ning Ling and Li Neng.

This problem is not difficult, and it is easy to solve it, but if you can't find it, you won't know how to start.

Hearing this, Ning Ling looked at the time on his watch and found that it was already past four o'clock, close to five o'clock.

Then he said: "Doctor Zhou, this patient is still fasting. Now that the diagnosis is clear, an operation will be arranged today."

"How about this, Director Xue, you go to complete the pre-operation first, and I will send Dr. Zhou off first."

Li Neng also stood up when he heard the words: "Professor Ning, let's send Dr. Zhou off together. Today is indeed too much trouble for Dr. Zhou."

The two professors said so, and Chen Xuehua, Xue Guoqing and others also proposed to send them off, but Zhou Cheng refused.

In the end, under Zhou Cheng's insistence, only Ning Ling walked out of the department with Zhou Chengyi.Li Neng and others were in charge of arranging the operation.

This case is very special, but by finding out the main points of muscle paralysis, it can be made into a special case, which has guiding significance for future treatment.

Although the bone was difficult to chew, after gnawing it, the improvement was great. Therefore, Li Neng did not refuse, and stayed and continued to discuss the operation plan with several other directors!

Downstairs in the inpatient building of Shashi Third People's Hospital, Zhou Cheng said, "Professor Ning, let's go back first, there is still work to do."

"It's hot outside, and it's time to sweat."

Ning Ling smiled when he heard the words: "Xiao Zhou, you don't need to meet with me, and I don't treat you as an outsider, so I called you here. This is to blame me for living in vain at my age."

"I'll take you to your destination. The surgery here is a long way from nerve exploration and suturing."

Zhou Chenglian said he didn't dare, he definitely didn't mean that.

Ning Ling hooked Zhou Cheng's back with his hands and walked towards the parking lot.

Then he explained: "Doctor Zhou, it's actually like this. I called you today. It's this patient. We're already planning to go on stage. Then, before the operation, there was a problem with the indicator of the last review result."

"Director Zheng of the anesthesiology department was worried that the patient's condition would change and he didn't want to undergo surgery, so he stopped the operation halfway."

"But I think this patient can still look forward to the quality of life after surgery, so I made a decision with Professor Li and invited a hospital-wide general consultation."

"Of course, before the operation started, I didn't know the crux of the patient's muscle paralysis, so I wanted to watch while doing it."

When Zhou Cheng heard this, his face was slightly troubled.

Ning Ling insisted on surgery even though he was not sure that he would get off the stage?

Isn't this Ning Ling's style?
Are the waves blowing?

Zhou Cheng's face and emotions were complicated: "Professor Ning, if that's the case? Why didn't you just refuse the operation?"

Ning Ling looked at his phone and said, "Of course I have to try it."

"Doctor Zhou, although you are young, your technical and knowledge reserves are actually deeper than mine, and I will always try to go beyond my circle of competence, but if things are within the threshold of competence, I will not be able to grow. "

"Unlike Dr. Zhou, you have solid basic skills and a solid foundation. You don't need to set foot in unknown depths of sea, and you can do it with ease!"

Ning Ling's tone, gaze, and expression did not hold back his envious look, and his eyes were sincere, as if he was intentionally eccentric.

"Professor Ning's reputation is too modest." Zhou Cheng smiled back.

When Ning Ling was about to speak, the car was already in front of him, and he planned to open the door for Zhou Cheng, but Zhou Cheng preempted him.

Ning Ling said: "Doctor Zhou, it's okay. In fact, I have wanted to chat with you for a long time, but I have never had such an opportunity before. It's just a matter of asking for advice."

"Don't dare, Professor Ning." Zhou Cheng hurriedly replied. Ning Ling's performance today was indeed slightly different from before. Could it be because he refused to do the nerve suture project with him?
Or simply put too much pressure on him.

Ning Ling sat in the driver's seat, and said, "Xiao Zhou, you're too nervous, where did I just talk? Oh, don't try the depth of the sea."

"Actually, Dr. Zhou, you should know that we doctors, when we work, are like iceberg theory. What we show is the tip of the iceberg, but in fact, the knowledge reserve that needs to be hidden inside is extremely huge."

"On the surface of the sea, there are countless mountains. If we want to go to another mountain from where we are, we have to trek across the sea. If the foundation is sufficient, the road we pass will be the beach, like a stroll in the garden."

"If the foundation is not enough, then one step further, it will be subverted into the abyss of the sea! What do you think, Doctor Zhou?"

Hearing this, Zhou Cheng was thoughtful.

Professor Ning Ling's analogy is very novel, and naturally he has deep thoughts to make such an analogy.

Diseases that seem to be common clinically have many pitfalls, and some people will step on them, and even if there are precedents, there will still be people to step on.

If you don't step on it, you may pass it, if you step on it, you may be subverted and annihilated.

"Professor Ning, this is the first time I've heard such a statement, but it makes sense. You need to walk on thin ice in clinical practice." Zhou Cheng sighed.

Even Zhou Cheng, there are times when he can't do anything, such as the current situation of Lu Ganzhou's wife Yue Xin, he doesn't know how to intervene directly, so he has to give her a recovery plan.

While driving, Ning Ling said cautiously: "Doctor Zhou, let's take this iceberg that we created ourselves as our own circle of competence. I know these places, and I will definitely be able to go there."

"But in other places under the iceberg, we can only proceed cautiously."

"According to the experience of some predecessors, we probably know the approximate extent of the beach we hide under the water, and whether we can forge ahead towards each mountain."

"This is our cognitive domain, and whether we can go through it is our ability threshold."

"If you can swim and the weather is good, maybe we can pass."

"But the safest thing is for us to lay the foundation of our mountain to the extent that it can become the widest area, and then reach it directly. After all, we humans are animals that walk on two lower limbs. Walking around the area is the safest."

"But if all of these fail, we can only test the depth of the sea, take a step, take a step!"

"Take today's case as an example. I probably know where the problem is, and I also know which places are not allowed to go. There is an abyss."

"However, until I don't have a particularly clear and accurate path forward, I don't know which direction to go, which direction to turn back, which direction to go, and then I won't be able to turn back..."

When Ning Ling continued to speak, Zhou Cheng's expression continued to become serious.

To be honest, this is the first time that Zhou Cheng has really gotten to know other seniors in the same industry seriously.

Although Ning Ling is only an associate professor, he also has the word "professor".

Ning Ling really changed Zhou Cheng's opinion of the word "professor". Not to mention that all professors have a level, but at least most of the professors, even associate professors, are beyond the reach of ordinary people.

Ability circle, cognitive domain, ability threshold, iceberg, sea surface.

These analogies are not only Ning Ling explaining to him why he insisted on the operation, but also analyzing Ning Ling's mentality when facing cases that he cannot grasp.

He wants to make progress and make progress.

But if you want to progress steadily and steadily, you have to make all the preparations.

For example, the cognitive domain, which must be the degree of understanding of a disease, such as rare diseases, cutting-edge research on treatment, etc., if I can do it without overturning the cart, at least I know where to go.

As far as this medical record is concerned, Ning Ling knows that the biggest consequence is to return without success, and it will not lead to amputation or other bad consequences!

Then there is the ability threshold. Ning Ling himself said that his own ability threshold is neurotomy, nerve detection, and nerve suture. These are his best skills, so as long as he can find problems, you can basically solve them.

However, the real circle of competence is actually in terms of apparent nerve damage, where damage can be seen, so it can be accomplished overnight.

This is telling Zhou Cheng, as long as you point out where the damage is, I can solve the problem, don't worry anymore.

However, the cognitive domain, in fact, in addition to the potential cognitive domain, also has a real cognitive domain, which is the real diagnosis, including the qualitative and positioning of the diagnosis.

And Zhou Cheng, what he can do is the real cognitive domain, knowing that there is damage, and pointing it out, Ning Ling can do it.

Before the operation, what Ning Ling could do was the potential cognitive domain. I knew that it was not a nerve space-occupying lesion. It must be on this nerve of the lower limbs, not anywhere else. one time!
After talking for a while, Ning Ling said, "So Xiao Zhou, I really hope and look forward to it, that you can figure out your level theory and learning theory earlier."

"Because if you can thoroughly classify the corresponding diseases and skill levels, we can figure out our own strength more clearly, whether we can handle the corresponding diseases, and whether there will be mistakes, reducing our With inner panic, I have a clearer and more objective understanding of my own strength."

"When my teacher talked about this matter with me, I just thought about it. This not only has important guiding significance for young doctors, but also enables middle-aged doctors like us to have a clearer self-understanding. Know how to challenge and in which direction to challenge."

"Actually, I'm not afraid of your jokes. The position I am in now is the most fearful and panicky."

"There is no teacher at the top to ask, and there are students who want to know the truth and teach. They have some theoretical and technical reserves, but they are relatively limited. They are not as deep as the teacher's skills. In the eyes of others, I will eventually become a master who can carry a side. flag character."

"But I know in my heart that I have inherited what my teacher has learned, but only [-]% to [-]%, and there is still a big gap. Then, in the clinic, when I encounter a disease, I don't know how to judge it, and I don't know whether I should fight it or not. "

"When I made the wrong choice and when I made the right choice, I was even more anxious!"

"It's just like last time!" Ning Ling told Zhou Cheng almost heartfeltly.

Zhou Cheng didn't have these pressures, because Zhou Cheng didn't lead the group like him now, so he definitely didn't have the pressure like him. Zhou Cheng was not as good as him now, and needed to take over the mantle of the teacher.

"Professor Ning, you are already good enough."

"If you want, we can communicate in private in advance, because I still don't know the level theory of my teaching, good or bad, right or wrong, so I dare not speak nonsense to comment on Professor Ning's learning and skills depth."

"There may be some areas that need to be improved by you, Professor Ning." Zhou Cheng said formally.

Indeed, Zhou Cheng felt that if he directly objectified the corresponding standards, he might hurt some people. After all, different people have different ideas. If there are absolute standards, it would be a bit silly.

But how to reformulate the standard is really a question that needs to be discussed.

(End of this chapter)