Reasoning diagnosis: Big brother, your wife has been prescribed medicine!

Because just now Zhou Chao had discovered that the patient's pupils were not equal in size.

Bilateral pupillary unequal size is an important sign of cerebrovascular problems.

In patients who suddenly coma without any warning, the most common causes are cerebrovascular disease and cardiovascular disease, and there is also a hypoglycemic coma.

When encountering this kind of sudden coma patient, a clear examination must be carried out first to clarify the condition before further treatment.

At present, the patient's blood oxygen saturation is as high as 98%, which means that the respiratory function is acceptable.

Therefore, only the nasal cannula is needed to inhale oxygen, and the ventilator is not used for the time being.

Zhou Chao immediately issued a doctor's order to ask the nurse to draw blood for relevant examinations, and soon the blood sugar results were not low.

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, Lin Yi asked her to pay a few hundred yuan first, go through the hospitalization procedures, and have a hospital number before she can do more examinations.

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

Zhou Chao immediately issued a head CT checklist, and then asked Song Borui and others to push the patient for a CT scan.

Soon the CT scan came out.

Zhou Chao 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.

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, Zhou Chao called the old lady into the office and explained to her the severity of the patient's condition.

Zhou Chao 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 Zhou Chao.

Zhou Chao was startled, stood up quickly, supported the old lady, and firmly refused 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!

Zhou Chao 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 try your best to treat it 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 Zhou Chao 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 Zhou Chao 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 the Zhou Dynasty would be helpless.

When he first started working, Zhou Chao 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.

Zhou Chao 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 the Zhou Dynasty is just doing its best to treat the patients, and resolutely ignores the patient's money.

Because it's not something she can handle.

Seeing the begging face of the old lady, Zhou Chao felt very helpless.

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?"

Zhou Chao patiently explained: "Old lady, the old man's condition is very serious now, and he needs to undergo surgery as soon as possible, not to mention waiting for a few hours, even an hour, otherwise once his pupils dilate, when the time comes Even if I want to have an operation again, there is no chance.”

Zhou Chao 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 Zhou Chao 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.

Zhou Chao 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.

Zhou Chao 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.

Looking at the situation of the old lady, Lin Yi couldn't bear it, so he walked over to Zhou Chao and said, "Don't we have emergency relief funds in our department? Let the old man use it first, and then we can do the operation first?"

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.

Zhou Chao 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!"

Zhou Chao spread his hands: "But this patient must go to neurosurgery for craniotomy. In our emergency department, no one has studied brain surgery!"

"Or, I'll try it!"

Lin Yi never thought about taking the neurosurgery job.

But the patient's situation was very urgent, and a neurosurgery doctor could not be invited to do it. In order to save his life, Lin Yi had no choice but to stand up.

"what?"

Zhou Chao's eyes widened suddenly, as if he had seen something extraordinary.

"Lin Yi, are you saying that you will also undergo brain surgery?"

Lin Yi just nodded, without deliberately expressing that he was good at this operation.

Now in Zhou Chao's heart, he was completely shocked and didn't know why.

And now Lin Yi said that he can also do brain surgery.

It's unbelievable how Lin Yi can do so many surgeries by himself!

Could it be that Lin Yi is an almighty god?

This is really beyond everyone's understanding of the profession of doctors.

Everyone in the medical circle knows that all well-known experts in the country or in the province are very good at a certain aspect, a certain field.

It is also famous for it.

Whether in the province or in the country, there is no one who has become a well-known expert because he is good at various fields.

Because it is impossible.

After all, human energy is limited. A doctor who is good at a certain field and can become a well-known expert is already very remarkable.

Where is it possible to become a well-known expert in the entire medical field!

"Brother Yi, you are too good, you can even do brain surgery."

"You can do head, chest, abdomen, and orthopedic surgery. By the way, you can also do interventional surgery. You can do all systems of the human body. You are omnipotent!"

Wu Jiang looked at Lin Yi immediately, and couldn't help admiring!