medical simulator

After a while, Xue Guoqing returned again.

Then when he walked in, he found that the junior doctors and nurses were gone, and the others seemed to be waiting for him.

"Director Chen, Professor Ning, Professor Li, now, the problem of surgical contraindications and the anesthesiology department not accepting patients has been resolved."

"But we still need to carefully discuss whether the current patient's disease is suitable for surgery, how to do it, or whether there are other treatment options?" Xue Guoqing felt a little headache.

If you want to say that this patient is a hand surgery problem, you Ning Ling is so active, so it’s fine, but he is still a fracture patient in the trauma surgery department, and he is paid here because of muscle dysfunction.

I invited Ning Ling to come over for consultation and surgery, but who knew there would be such changes in the middle?

Of course, Xue Guoqing can also understand the pressure Ning Ling is facing now. Part of it is that the disease that is being discussed in depth is diabetic foot. On the other hand, there is also the pressure of second-hand surgery.

Ning Ling still actively asked him to find a way to solve the problem of surgery, Ning Ling wanted to challenge himself.

Ning Ling was invited here by himself, and you can't help but give this face.But for this patient, what Director Zhang said was actually correct, and he has a special status.

In fact, Xue Guoqing hoped from the bottom of his heart that he would not have an operation, so as not to cause trouble.

However, in order to go further, he could only bite the bullet, go to the medical department, find other directors, and make advance preparations for Ning Ling's continued operation.

If Ning Ling wasn't a professor at Xiangya Hospital, he would definitely be a lunatic who was hung and beaten.

Chen Xuehua said: "Professor Ning, you thought before that this patient is likely to be neurologically damaged, so I deliberately kept Director Su and Director Ling here. Professor Ning, can you tell me about your thinking?"

The words of Chen Xuehua and Xue Guoqing caused Zhou Cheng, who was sitting next to Ning Ling, to change his face slightly.

Good guy!

When he first came in, he always thought that Director Zhang of the medical department was the one to blame, and thought he was trying to do something wrong. It turned out that he went around, but it turned out that there was something wrong with Ning Ling.

It was Ning Ling who insisted on the surgery, and Director Zhang, including Professor Li Neng and others, did not recommend surgery on such patients.But Zhou Cheng didn't think there was anything wrong with Ning Ling's choice.

Ning Ling took a deep breath, and slowly said: "Professor Li, and directors, let me first explain my thoughts."

"First, first of all, we can clearly rule out the central nervous system injury of this patient, because we can see that the patient has no organic lesions, whether through MRI or physical examination."

"Second, the patient's current sensory function is present, but motor function is absent."

"This looks a lot like dissociative sensory disorder!"

"However, dissociative sensation refers to the partial loss of pain, temperature, rough touch or deep and fine touch in the same part. The difference in deep and superficial sensory conduction pathways is the anatomical basis of dissociative sensory disturbance."

"This patient still has no organic changes."

"Third, in fact, the current fracture situation of the patient is considered to be a good one, and surgical treatment can be chosen. I believe that both Professor Li Neng and Director Chen can easily solve it."

"Since we are fully prepared for performance diagnosis, fracture-based skill reserves, and the patient's physical condition, we can fight for the quality of life of the patient!"

"Next, let me talk about the current guesses about the patient's muscle dysfunction."

"The first one is that the patient's descending motor neuron function is absent, but the segment is just in the right lower limb, because the family members have said before that the movement of the right lower limb is intact."

"Moreover, the patient's pudendal contraction function exists, which proves that it is not a large-scale damage to the descending motor neuron area. So we can rule out this diagnosis for the time being."

"Secondly, I think it may be that the inner part of the nerve fiber is torn, which leads to concussion damage to the motor nerve fiber."

"This is unlikely, but our hand surgery has such a possibility, and what if such a situation occurs?"

When Ning Ling said this, he frowned slightly: "It is such a nerve stripping and precise suturing of nerve fibers. Under normal circumstances, a professor from Huashan Hospital may be invited to come to perform the operation."

In Huaguo, the hand surgery in Huashan Hospital is absolutely top in the country, and even far ahead in the world.

But when Ning Ling said this, everyone turned their heads in unanimous agreement and turned to Zhou Cheng's direction.

Huashan Hospital, is Ning Ling inviting Zhou Cheng over now, is he just trying to catch such a line?

But?

Why didn't Ning Ling send an invitation letter for consultation directly to Huashan Hospital?

"Doctor Zhou, can you see the specific diagnosis of this patient's muscle dysfunction through the MRI reading?" Ning Ling asked.

Hearing this, Zhou Cheng felt a little bitter in his heart, brother, you finally thought of this level, I have been waiting for you here for half an hour!

You just asked me what I'm here for.

"You can try it. If you have similar damage, you should take a look at it." Zhou Cheng didn't dare to finish his words.

Even a perfect level of MRI reading can't see things that can't be visualized by MRI.

Moreover, as Ning Ling said, inside the nerve, only the motor fibers are broken, but the sensory fibers are not broken, such a special case.

The chances of it happening are extremely small.

Ning Ling laughed when he heard the words: "Professor Li, Xiao Zhou should still be Xiao Zhou!"

Ning Ling's words made Li Neng and others frown slightly.

Obviously, before Zhou Cheng came, Ning Ling took the initiative to tell them something. Of course, now is not the time to go back to the past.

However, before Li Nengcai frowned slightly, he still said, "Professor Ning, I don't mean to doubt Dr. Zhou's level, I just think that even a film review can confirm the diagnosis."

"There are still big doubts about the current treatment method of this patient. It is not the safest choice to directly consider surgery." Li Neng, who looks rough, is relatively conservative.

"But the safest option may not necessarily be the best option."

"When hand surgery first appeared, it was an impossible miracle. Professor Li, what do you think?" Ning Ling was still increasing his persistence.

Ning Ling had reached this point, and Li Neng obviously couldn't say anything more.

"Doctor Zhou, the MRI reading system has been turned on over there. Go over and read the films first, and I will discuss the treatment of this patient with Professor Li." Ning Ling knew that what he said before was still insufficient. To support Li Neng to agree to the operation.

So let Zhou Cheng watch the film first, and then talk about his other considerations.

After Zhou Cheng left, he sat in front of the computer screen, and Director Ling of the spinal surgery department, an old man in his 50s, went over to help Zhou Cheng and taught Zhou Cheng how to flip the MRI layers up and down.

Although the MRI reading systems of different hospitals are similar, there are also some subtle differences, such as the display ratio and the adjustment scale.

Ning Ling continued: "Professor Li, Director Chen, the reason why I insist that the patient needs surgery is mainly based on the following considerations."

"First, we should abandon the patient's age, high risk, and limited life expectancy, regardless of his subsequent quality of life. The effective survival time is more meaningful than the invalid survival time period!"

"Second, this is a rare case. If we can make a more refined diagnosis and analyze a special treatment plan, it will be of great reference value for the development of hand surgery and the revision of treatment guidelines for rare diseases! "

"Third, in terms of skill reserves, the directors may not know that Dr. Zhou is not only very particular about MRI reading, he is also second to none in neurotomy and suturing in our hand surgery department, so when encountering such I only thought of Dr. Xiao Zhou when I saw the case."

"So, if a diagnosis can be made, I can cooperate with Dr. Zhou to solve the patient's neurological problems and complete this seemingly impossible operation!"

"Fourth, it is risk-taking. First of all, the patient's current surgical contraindications have not yet reached the level of absolute contraindications, and there are many anesthesia options to choose from."

"If spinal anesthesia is not easy to do, you can do nerve block anesthesia! This can reduce the risk of patients."

"Fifth, the problem of fracture treatment. The patient currently has an intertrochanteric fracture. The treatment of this fracture does not require a large wound. I believe that Professor Li can easily solve it."

"Sixth, the problem of cognitive reserve. Our country is currently far ahead in the world in terms of orthopedic hand surgery, purely technical reserve."

"However, the reason why our development of trauma surgery is temporarily restricted is because we are too conservative and dare not break into it, and even if it is possible to break through, we are still conservative. But in fact, we also have the same pioneering spirit as foreign countries. Precedent conditions and technological foundations."

"So we have to take the initiative to deeply understand new things, new cases, and analyze rare cases."

"In the end, no matter how bad it is!"

"The patient is just continuing the current state of paralysis, that is, muscle dysfunction!"

Ning Ling's words were resounding.

Although what he said was reasonable, Li Neng only pointed out one point: "But? Professor Ning, we should also consider the burden of the family members and patients themselves, and we should not do it for the development of our discipline."

"To bring greater burdens to patients and their families, the principle of no harm is the first principle of medical procedures!"

No matter how bad Ning Ling said, he would just continue to be paralyzed, but you performed the operation, and it was still a meaningless operation.Surgery that can be expected in advance.

Moreover, Li Neng also hid a sentence: At present, the relative contraindication of orthopedic surgery is poor muscle function before surgery!

Of course, this is only a relative contraindication. Large teaching hospitals and tertiary hospitals can reverse the relative contraindication. Otherwise, the development of medical treatment will be bound to death.

The reason why absolute contraindications are established is to break the word absolute and become relative, turning relative into non-contraindications, and expanding the scope of treatment of diseases!

Ning Ling fell silent after hearing the words.

And Chen Xuehua and the others basically didn't dare to fight Ning Ling...

But Li Neng is at the same level as Ning Ling. There are gaps in his cognition and direction of choice with Ning Ling.

And just when Li Neng and Ning Ling were arguing endlessly.

Zhou Cheng stood up with a strange expression: "Professor Ning, does this patient have any other medical history?"

"Ok?"

When Ning Ling heard this, his pupils shrank suddenly: "You mean? Are the family members of the patient still hiding something about the patient's medical history?"

Ning Ling's complexion changed slightly. The patient's family members are originally the kind of relatives. If they leave holes everywhere, then his fight will be meaningless!

"Do you have the patient's medical record? Can I have a look? If I read it correctly, the patient should have undergone partial genital nerve dissection or other operations before." Zhou Cheng said.

"There are medical records, here they are." Chen Xuehua hurriedly handed the medical records to Zhou Cheng.

However, Ning Ling knew about this matter: "Yes, the patient is an elderly person. He underwent hemorrhoid surgery a year ago. He was afraid that the postoperative irritation would be too strong, so he performed a bilateral pudendal nerve block."

"It is used for postoperative pain relief. Can this be seen on the MRI?" Ning Ling was very surprised.

Obviously, the patient's family members had talked about this operation before.

Zhou Cheng didn't answer, but first looked at the medical records on the medical records, among which hemorrhoid surgery was recorded.

However, the internal pudendal nerve block to relieve pain is just an operation, not an operation, so it was not recorded in the medical records.

However, it may have been told orally, so Ning Ling still remembers.

After being so sure, Zhou Chengcheng said: "That's almost like this, Professor Ning, Professor Li, and the directors. Come and see!"

Holding the medical records, Zhou Cheng returned to the MRI computer screen.

A group of people immediately became commotion.

This thing is really new. On the MRI, traces of nerve block can still be seen. What kind of skill does this have?

How can it be so miraculous?

Zhou Cheng pointed at the computer screen: "Professor Ning, look, here is the place where the internal nerves of the pudenda originate, and through this deformation, we can see that there is a scarring performance of the muscles after block surgery." .”

To be honest, if Zhou Cheng hadn't pointed it out, no one would have noticed that little scar!

Ning Ling nodded: "Yes, it looks a little different here, but Doctor Zhou, is this the reason why the patient's lower limbs cannot move?"

"The internal pudendal nerve, it seems? Even if it is mutated, there is no way to mutate to be continuous with the motor nerves of the lower limbs?"

"This is not, Professor Ning. This nerve block is more complicated and troublesome. Even if it is operated under the supervision of color ultrasound or other imaging examinations, it cannot be done overnight."

Zhou Cheng looked around and found that there were only experts inside, so he said, "But on this MRI, we can find that there is a keloid here, that is, in the femoral nerve outside the pudendal nerve."

"And there is also a small amount of scarring, so I consider the possibility that when the nerve block was performed, I made a mistake at the beginning, or during the puncture, the drug was misplaced and directly penetrated into the femoral nerve."

"So within this nerve, there is a compressive change in the femoral sheath."

"Look, it's here, and then the upper part of this nerve distributes the tibial nerve. The lower part is the area innervated by the common peroneal nerve, and there is compression right in the middle."

"There is no special change in the diameter of the lower limb muscles of the patient, which proves that there is no nutritional damage. If there is only sports damage, it is estimated that the descending motor neuron has been compressed. This compression can be removed. It is possible Restoring the patient's motor function."

"It's not a tear of the motor neuron."

"And I guess, the patient's muscle dysfunction is gradual, not immediately after the operation." Zhou Cheng raised his head like this, his voice was very low.

This problem is still a medical injury, not a trauma or degenerative organic injury, so it cannot be made public.

And this point, if it is not someone with excellent film reading ability, they will not be able to discover it!

It's just that it's unbelievable to understand a patient's past medical history to such an extent through reading the films. Moreover, the reasons Zhou Cheng said are all based on modern medical theories, not inscrutable guesses.

This is kung fu!

Chapter 475 Ningling's Panic Crisis

"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."