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

Because this operation requires imported stents, the emergency department does not have such stocks.

In the end, it was Chen Bin who carried his old face and went to the vascular surgery department to transfer the stent and related application materials.

Lin Yi performed this operation with ease.

This operation needs to be performed in the digital subtraction angiography (DSA) room.

Under the shadowless lamp, the patient was under general anesthesia, lying on his back, and a urinary catheter was placed.

Lin Yi was the main operator, Chen Bin was his deputy, and Zhou Chao was on the sidelines preparing relevant materials.

Routine disinfection of the skin of the left upper extremity and bilateral groin area, and laying sterile drape.

The reason why the bilateral groins were disinfected was to prevent the brachial artery puncture from failing, and the femoral artery puncture was replaced.

Therefore, it is necessary to disinfect in advance.

Lin Yi used the Seldinger technique to puncture the left brachial artery, insert a 5F angiography catheter to the opening of the left subclavian artery, and perform angiography of the aorta to distinguish the true and false lumens of the dissection.

Seeing Lin Yi's accurate piercing and his incomparably skillful movements, Chen Bin felt relieved.

Lin Yi's technique experience is really too professional.

Chen Bin could tell at a glance that Lin Yi was definitely a master in vascular intervention.

While being shocked, I really couldn't figure out how Lin Yi could undergo so many surgeries at such a young age!

It was too unexpected!
Zhou Chao on the side also heaved a sigh of relief.

He knew that the patient's operation should be fine.

Lin Yi was concentrating on the operation.

After all, it was a level [-] surgery, so there was no room for carelessness.

Lin Yi first marked the opening of the left subclavian artery and the opening of the dissected intima on the monitor screen.

The distance between them and the maximum diameter of the normal aorta proximal to the tumor were measured.

The maximum diameter of the tumor and the length of the dilated aorta were compared with the preoperative spiral CT results.

Choose grafts of appropriate caliber and length.

The iliac artery on one side without obvious stenosis, distortion and dissection was selected.

A small incision was made at the root of the femur, and the common femoral artery was freed about 3 cm.

Puncture into the guide wire, after systemic heparinization (1mg/kg intravenous injection).

The femoral artery was transected to about 1/2 of its circumference, and the Telent catheter was introduced into the descending aorta through the femoral artery along the guide wire.

Lin Yi performed the operation meticulously, and Chen Bin, as the deputy, became more and more shocked as he watched.

Although he has never undergone vascular interventional surgery, he has seen a video of the director of the vascular department performing surgery during academic exchanges.

In comparison, he felt that Lin Yi's operation techniques were more skillful and superb than the director's.

Zhou Chao could also see that Lin Yi's manipulation techniques were beyond the reach of ordinary people.

Lin Yi, on the other hand, concentrated on the operation without distraction.

When the upper edge of the graft overlaps with the lower edge of the opening of the left subclavian artery, controlled decompression is required.

Fix the inner sheath, slowly withdraw the outer sheath, and the memory alloy stent will automatically expand.

The proximal end is fixed below the intimal tear in the dissection, and the stent is properly fixed by expanding it with a balloon.

If there is an endoleak at the proximal or distal end of the graft, another graft can be placed again and connected to the proximal or distal end of the original graft to seal the endoleak.

All of the aortic blood flows into the true lumen of the dissection through the graft.

The intimal tear and false lumen are completely closed.

At this point, the entire operation is considered to be successfully completed.

By the way, in the examination room, another angiography was performed.

It was found that the aortic dissection had been completely closed, the blood flow was smooth, and the alloy stent was firmly fixed.

The whole operation took just over an hour.

Seeing Lin Yi complete the operation with ease, Chen Bin couldn't help admiring.

"Doctor Lin, I didn't expect you to be able to do this kind of operation. I'm really convinced!"

"Small idea."

Lin Yi looked at him and said with a smile.

After finishing the work, Lin Yi went back to the office to rest.

Fortunately, I exchanged for the energy boost before, otherwise my body would not be able to bear it if I worked so hard.

Before his bum was hot, a doctor ran in.

"Doctor Lin, something happened in the obstetrics department, please go and have a look!"

"what happened?"

Lin Yi asked with a frown.

"There was a child in the obstetrics department, and I didn't know what went wrong, but suddenly started to have a fever and convulsions this morning.

The obstetrics department has done emergency rescue for the child, but there is still no effect.

They are almost dying! "

"Go, go and see!"

After finishing speaking, Lin Yi walked quickly to the operating room with him.

At this time, the family members of the patients outside the operating room were already crying.

They never imagined that their children would have to face such pain when they first came to this world.

Lin Yi quickly put on the sterile gown and gloves, sanitized his hands and entered the operating room.

In the operating room, Director Liu of the Obstetrics Department looked anxious.

For some reason, the moment she saw Lin Yi, her nervousness relaxed.

"High fever and convulsions all over the body, we judged it to be epilepsy in children.

Moreover, the body temperature is about to break through 40 degrees Celsius now! "

Director Liu took two steps forward and briefly introduced the current situation of the child to Lin Yi.

Lin Yi turned his head and looked at the child lying on the operating bed.

He was twitching intermittently at the moment, and his lips were blue-purple.

Director Liu's judgment is correct, this is indeed a symptom of epilepsy in children.

Although Director Liu knew it was childhood epilepsy.However, Director Liu is not particularly good at this kind of disease.

Childhood epilepsy is a neurological syndrome caused by complex etiology, recurrent, paroxysmal, and temporary brain dysfunction that is common in children from 0 to 18 years old.

The cause of disease is divided into two kinds of primary and secondary.

The etiology of epilepsy in children is mostly caused by perinatal ischemia and hypoxia, cortical dysplasia, low-grade glioma, encephalitis, trauma, etc.

From the neonatal period to adolescence, the structure and function of the nervous system are in the process of rapid development and shaping. Therefore, epilepsy in different age groups is different from adults in many aspects in terms of etiology, pathogenesis, clinical features, and prognosis.

The etiology of epilepsy in children is diverse, and the clinical manifestations are different. The etiological diagnosis should be done as much as possible. Therefore, appropriate and appropriate treatment must be selected.

Especially under the age of 6, it is a critical period for brain development, and the most suitable treatment plan is needed to ensure the normal growth and development of children.

Afterwards, Lin Yi turned his head and asked Director Liu.

"How about the child's previous examination results?"

Director Liu quickly said:
"Before we did blood routine, urine routine, and a full set of blood biochemistry for the child, the results showed that the child's sugar, calcium, phosphorus, and electrolytes were all within the range.

Liver and kidney functions were normal, and chromosomes were normal. "

After listening to what Director Liu said, Lin Yi frowned slightly, and then asked.

"Is there any family history?"

Director Liu continued:
"We also asked the parents of the child, they had no family history.

Therefore, primary epilepsy is basically ruled out! "

Epilepsy is a short-term episodic brain dysfunction caused by abnormal discharge of brain nerve cells. According to the etiology, it can be divided into two types: primary and secondary.

Primary epilepsy, also known as true epilepsy, idiopathic epilepsy, functional epilepsy, cryptogenic epilepsy, etc., is more common in children and adolescents, and most of them develop before the age of 30.

There is no apparent etiology other than genetic factors.

Primary epilepsy, although there is no obvious organic disease and metabolic disease in the brain, but it has certain heredity.

Moreover, in recent years, in epilepsy genetics and molecular biology research, many epilepsy-related genes have been discovered, and the epilepsy-causing mechanism of mutant genes has been explored to a certain extent.

More than half of the children in epileptic families with no history of epileptic seizures showed epileptic waveforms in EEG examination, suggesting that epilepsy has an obvious genetic predisposition.

The general heredity rate is 3% to 5%. Among the relatives of primary patients, the closer the blood relationship, the higher the incidence rate, and vice versa.

Since the current situation has ruled out primary epilepsy, then only secondary epilepsy remains.

Suddenly, Director Liu said to Lin Yi as if recalling something.

"That's right, Doctor Lin.

Could the cause of childhood epilepsy be related to the brain? "

Lin Yi glanced at Director Liu and said.

"Of course it has a direct relationship with the brain!
What's the matter, why is this question suddenly asked? "

Director Liu thought about it and said.

"I suspect childhood epilepsy induced by cerebrovascular disease or surgical complications."

Lin Yi looked at Director Liu in bewilderment and asked.

"Could this child have undergone surgery before?"

Director Liu nodded and said:

"Sorry, I forgot one thing.

This child had previous head surgery.

Then this situation may be caused by postoperative complications. "

Lin Yi nodded and said.

"There are still many complications in head surgery, especially in children.

After all, this thing cannot be completely avoided by technology. "

Afterwards, Lin Yi gave the child a doctor's order.

Do head MRI first.

After all, the most important thing now is to identify the triggers of childhood epilepsy.

If it is due to surgery, it can be resolved through correction.

If there is a potential tumor, then we can only think of a way to resect the tumor...

The priority now is to identify the cause of the epilepsy.

If it is really a tumor, the only option is to ask someone from the brain surgery department for consultation and then remove the tumor.

Other than that, there is no other way.

In this case, especially with such a small patient, the options for treatment are extremely limited...

Everyone is silently looking forward to it in their hearts, hoping to get good news.

Soon, the test results were retrieved.

It also fully confirmed Lin Yi's previous guess.

It is epilepsy.

But what causes children with epilepsy?

After Lin Yi looked at the test results, he frowned and said.

"Could subarachnoid hemorrhage caused by cerebral angiography cause epilepsy in children?

This situation is not unheard of!

A subarachnoid hemorrhage is bleeding in the space between the brain and the surrounding membrane.

The main symptom is a sudden, severe headache, sometimes accompanied by nausea, vomiting, and brief loss of consciousness.

Bleeding is usually due to rupture of abnormally dilated blood vessels, aneurysms, in the brain.

Sometimes bleeding is caused by trauma, abnormal tangles of blood vessels in the brain, arteriovenous malformations, or other blood vessel or health problems.

If left untreated, a subarachnoid hemorrhage can cause permanent brain damage or death.

Moreover, epilepsy is also a relatively common symptom.

Thinking of this, Lin Yi couldn't help but give the doctor's order:

"Issue the critical illness notice first!

Inform the family and prepare for the worst.

Then we did our best to rescue them.

Give nimodipine first! "

Nimodipine is a dihydropyridine calcium antagonist, which can easily pass through the blood-brain barrier and act on cerebral blood vessels and nerve cells.

The pharmacological property is to selectively dilate cerebral blood vessels without stealing blood, and increase cerebral blood flow without affecting brain metabolism.

At the same time, it also treats cerebral vasospasm caused by subarachnoid hemorrhage.

The psychotropic effect is antidepressant and improves learning and memory functions.

In addition, it can reduce the fragility of red blood cells, plasma viscosity and inhibit platelet aggregation.

Then, the doctor inside walked out of the operating room.

The doctor's name is Wang Ning.

The patient's family members ran up anxiously after seeing him and asked.

"Doctor, how is my baby?"

His face was a little ugly at the moment, and he said:
"I'm very sorry, you need to sign the critical illness notice first."

Immediately, the patient's mother sat on the ground as soon as her legs softened.

"What, critical illness notice?
Isn't the child all right?

Why is this happening?

Why is there a critical illness notice? "

In the operating room, after discussing with several doctors, Lin Yi decided to perform an angiography on the child again.

After all, only angiography can further rule out the cause of epilepsy.

On Wang Ning's side, after the nurse sent the critical illness notice, the child's mother could no longer lift her hand.

And the father of the child was shaking the pen in his hand, and no one could see clearly what he wrote.

After receiving the notice, the doctors in the operating room quickly performed an angiography on the child.

Fortunately, the results of angiography confirmed that it was not an aneurysm or a ruptured blood vessel in the brain.

If it is really a ruptured aneurysm, then the situation is very dangerous.Even if everyone tried their best to save the life of the child, they left a vegetative consequence.

Fortunately, it was only a rupture of a superficial blood vessel, which is considered a blessing in misfortune...

Half an hour later, the anesthesiologist sighed and said.

"The patient's blood pressure stabilized and the intracranial pressure was under control."

At this moment, everyone in the operating room breathed a sigh of relief.

Although everyone has relaxed, it does not mean that the danger is over.

If you find any problem near the brain of the child, it will be a fatal blow to the child.

However, this is good news.

The next step is to treat the patient.

Of course, the operation must be done by Lin Yilai.

After all, some people now more or less know how powerful this Internet celebrity doctor is.

Naturally, he is also willing to entrust this high-risk thing to him.

After all, this kind of operation is extremely risky, and if something goes wrong, the family members of the patient will definitely not let it go.

Then, if it is more serious, you may have to say goodbye to the position of doctor in this life.

Therefore, most people are unwilling to step on this mine.

But Lin Yi didn't care about these things, and was willing to win such an opportunity for surgery.

Under such circumstances, everyone naturally gave up the chance of surgery to those who need it most!

After everything was ready, Lin Yi skillfully cut open the child's skin.

This knife is quite accurate.Also, there was hardly any bloodshed.