Mrs.
Luo asked Xiao Zhi with a smile, "How did you come up with the idea of letting Pearl call the door?"
”"Luo Tian and I went to call the door, Dou Dou will definitely not open the door.Only if Pearl calls the door, Dou Gang's stupid boy will open the door. ”Mrs.
Luo looked at Xiao Zhi lovingly and said, "Next time, don't talk about calling your father uncle, it's Pi Jian who wants to be beaten."
You have to say that you saw Aunt Luo's hand hurt too badly and your sister cried too pitifully, so you went to find the Dou family sisters and brothers to vent their anger for the two of them.You know?
”"Mom, you're going to teach bad kids like that."
Professor Luo held back his anger for a long time, and muttered dissatisfaction to his mother."
Have I taught your brothers and sisters badly?
Which of you didn't teach you with my own hands?
Xiaozhi, this kid is good, he is a good example.Xiaozhi, I'll take your sister down to play when I have time in the future.Your grandfather Luo and I like smart kids who are willing to use their brains. ”Xiao Zhi has never heard anyone praise himself for being smart since he can remember.He hurriedly left himself a step back: "Grandma Luo, I'm not smart. ”"Oh?
Why aren't you smart?
What is the lowest ranking in the class in the exam?
”Xiao Zhi blushed and said proudly: "I'm in the top ten."
There was no countdown. ”"That's a smart kid.Remember what I just said?
”"Remembered.If you want to say that Aunt Luo's hand is seriously injured and her sister is crying pitifully, she went to vent her anger for the two of them. ”"That's right.The memory is good, and the children can be taught.Luo Tian, what about you?
”Luo Tian leaned over to his grandmother and said eloquently: "I just saw that my mother was seriously injured, so I followed Xiaozhi to fight." ”Director Luo was so angry that he slapped the dinner table and said, "It's not right to fight." ”Mrs.
Luo immediately pushed her daughter: "Do you have a better way to solve this matter except for the child giving you a fight?"
Hum!
Are you stupid and stupid?
Okay, take the child to Dou's house at night to apologize. ”"Grandma, why do you want to apologize?
We're not wrong. ”"If you two don't apologize, the whole hospital will have to say that your parents can't teach their children, which has nothing to do with what you did wrong, but to show the neighbors in the dormitory area of the provincial hospital.We are reasonable, and we have to be reasonable.I definitely have to say why I did it, but I can't forget to say that it's wrong to do it.Come, Luo Tian, you show Xiaozhi first. ”…… Wang Qiuyun looked at Luo Tian, and then looked at Director Luo, whose face was twisted to the side, and the smiling old lady Luo opened the door to another world in her eyes.No wonder the Luo family is living so well!
Learn more on your own.
*Director Qian sighed and said, "That patient has been diabetic for more than ten years.In the past, when endocrine was not separated from digestion, he always came to me to prescribe hypoglycemic drugs.In the past few years, new problems have been added one after another, and I began to have high blood pressure and atrial fibrillation, so I have lived in the circulation for a few months.But after the patient was discharged from the circulation, I found that he did not correct the habit of not taking medication on time, and every time I had to remind him to take antihypertensive drugs and anticoagulants on time. ”"He didn't take anticoagulants on time, did he?"
Chen Wenqiang asked.Director Qian nodded helplessly: "If he is willing to take anticoagulants on time, it won't be like this."
He was willing to take the blood pressure medicine because he had a headache and dizziness.Even blood sugar control is not good. ”This is a patient who does not follow the doctor's instructions!
The so-called cure of the disease is another specific manifestation of not being able to save lives.Anyway, this kind of person has such a belief: why should I take medicine if I am so good!
But once something happens, it's a big deal.Because patients have atrial fibrillation, the atria are very prone to blood clots.The purpose of taking anticoagulants is to prevent the formation of atrial thrombosis and prevent the increase of blood clots.Otherwise, once these blood clots fall off, they will flow down the blood to all kinds of parts of the body.- Cerebral infarction when it flows to the brain; Bleeding to the arteries of the extremities causes ischemia of the extremities; If the arteries flow to each organ, there will be embolism symptoms in the corresponding parts.Such as renal artery embolism, superior mesenteric artery embolism and even hepatic artery embolism.No matter where it is bolted, it is a big deal that kills you."
He had incomplete embolization of the superior mesenteric artery at the beginning of the month and came to the hospital in the middle of the night with abdominal pain.This person is not my old sick number, I know his past medical history and medication habits, so I am worried that he may have a plug falling off.Early the next morning, I begged Lao Hu and gave him an abdominal CT scan + enhancement, and sure enough, I found the site of the superior mesenteric artery embolization, which was fortunately incomplete.Lao Liang took an embolus for him in an emergency.Because I was familiar with me, I was transferred to the gastroenterology department on the fifth day after surgery.I also asked Dean Shu to adjust his medication and told him to take anticoagulants on time. ”"The outpatient phone said that he embolized the cerebral blood vessel this time, did he do a brain CT scan last time?""
Nope.I haven't arrived for so long, so I may have gone to the CT room first. ”Director Qian seems to be explaining to himself and Chen Wenqiang.Chen Wenqiang looked at his watch and said, "It's better to go to the CT room first, otherwise we don't know where the intracranial embolism is, and we still have to do a CT scan when we send it over."
Now it's useless for us to be anxious, we have to see the film and see the talent to formulate a treatment plan. ”Lu Qing sighed: "Then you don't have to rest today."
Hey, Dr.
Li, I heard that your parents are here?
”"Hmm.We had a big ward round on the 2nd, and it was inconvenient for me to go back, so I wrote to them early to celebrate the holiday. ”"That's a good arrangement.Anyway, you have a place to live and cook there. ”"yes.But looking at it like this today, my mother cooks a meal, and I can choke enough to go back to eat.The operation is expected to start at noon. ”It's half past ten, and the patient hasn't entered the ward yet.After waiting for a while, Chen Wenqiang waited impatiently, so he said to Director Qian: "It's useless to wait here."
Let's go to the CT room. ”He spoke, and Director Qian and Li Min naturally followed.In addition, there are more than a dozen people such as interns who have nothing to do, and they all follow behind Chen Wenqiang and Director Qian.Because of the scarcity of patients in the holiday corridor and the medical staff of various departments have been on vacation one after another, they have suddenly become a scene in the provincial hospital.
*This is the only patient in the CT room who is doing emergency examinations, and Director Hu personally started it.Because the patient's family already knew him when he had an abdominal CT scan last time, they went directly to him this time."
Lao Hu, the outpatient clinic said that there was a cerebral infarction, and he sent you here for a CT scan?"
Director Hu nodded and said, "Just after I finish it, I can launch it."
But this time, I'm afraid that you won't be able to take the embolus well.The emboli is larger, between C3 and C4 on the left, near C4, and worst of all over the C4 bifurcation and then incarcerated there. ”When Director Qian heard about the embolism, his expression was awe-inspiring.Pretended: "Wouldn't that be difficult to remove?"
”He hadn't paid much attention to neurosurgery for many years, but because patients had known him for many years, he couldn't help but worry about it.Chen Wenqiang nodded and said to Li Min: "You tell the intern about internal carotid artery segmentation." ”Tell me."
The internal jugular vein is divided into four parts.C1 cervical segment from the common carotid artery to the external carotid artery orifice; C2 petrosal segment carotid artery canal to cavernous sinus; C3 cavernous sinus segment from the cavernous sinus to the dura mater that passes out of the cavernous sinus parietal; The upper part of the C4 bed process originates from the internal carotid artery into the subarachnoid space and ends at the bifurcation of the internal carotid artery, i.e., the anterior cerebral artery ACA and the middle cerebral artery MCA. ”"The blood supply of ACA is mainly in the caudate nucleus, the anterior lenticular nucleus and the anterior part of the internal capsule; MCA primarily nourishes the lateral surface and insular lobes of the cerebral hemispheres.The branch from the C4 segment to the front of the bifurcation has an ophthalmic artery, and the donor site is not detailed; There is the anterior choroidal artery AChA, which mainly nourishes the lateral geniculate body, the posterior lower part of the hind limb of the internal capsule, the middle 1/3 of the cerebral soles and the globus pallidus.
There are also the posterior communicating artery PComA, the perforator artery, and the superior pituitary artery.PComA is anastomosed with the vertebrobasilar artery, the vegetative part of the vertebral artery region.The difficulty of removing the thrombosis in this surgery is not only due to the fact that there are multiple curvatures between C3 and C4, which are S-shaped.Rather, it is because the embolism is close to C4 and is incarcerated in ACA and MCA after the C4 bifurcation.How exactly is the incarceration, let's watch the film later. ”As she spoke, Li Min drew a simple schematic diagram for the intern on a sticky note."
The most important thing in our neurosurgery is the anatomical and cerebrovascular blood supply range."
This schematic diagram is simple and clear, the interns understand it, and Director Qian is also quite embarrassed.This internal carotid artery dissection has been abandoned for I don't know how many years.The patient rolled out.In his 60s, in a coma."
Let's go back to the ward.I'm going to see a CT scan too. ”Chen Wenqiang took the CT report that Director Hu had just finished writing and spoke.The CT film was sent over quickly, and Director Hu pinched a corner and pointed out the embolism to Director Qian and his family.Chen Wenqiang took the film, left with the people, and went back to the twelfth floor.* When I arrived at the director's office, Director Qian spoke on behalf of the family.He stopped Li Min, who was leaving, and said to Chen Wenqiang: "Dean Chen, there is no thrombolysis in this place.I'll have to rely on the two of you to help me remove the plug. ”However, "Chen Wenqiang asked the family members about the onset of the disease and the symptoms of onset as early as when Li Min gave an autopsy lecture to the intern.He groaned and said: "Old Qian, we have known each other for 30 years, and the Ming people don't say dark words, this situation is not optimistic." ”The patient was happy last night and went back to his room to sleep after dinner.His wife packed up a large table of dishes yesterday afternoon to entertain the children who had gone home for the holidays, old and young, who had dragged their children and had already separated from each other.Then I washed and washed for a long time, and it was dark before I packed up my rope.I got up early today to go to the morning market, and I didn't see anyone come out to eat after breakfast.The old lady called for help from her neighbors and broke down the door, only to find him lying on the ground.No one knows when he fell, let alone how long he was unconscious.The old lady felt very guilty, took Li Min's hand and said, "Girl, I didn't expect him to be like this."
Look, look, alas, save him.Alas, he always disliked me sleeping and turning over, which affected him, so he moved to the hut to sleep.Otherwise, how can it be......
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I knew that it would be okay to sleep without turning over for a year or ten years. ”The children on the side persuaded the old lady: "Mom, I don't blame you for this. ”"yes.Only then did the operation remove the embolus of the supraabdominal blood vessels, and this time the cerebral blood vessels were plugged again.It's all my dad who doesn't want to take anticoagulant drugs. ”"Eat, eat, eat.I ate it every day after I was discharged from the hospital. ”But this anticoagulant does not work immediately.The emboli that have formed will not disappear because of the regular medication of this week.This prognosis ......
Not only them, but even the family members know badly.But when they were asked to sign off the treatment, they refused.Not only did he refuse, but he also strongly requested surgical thrombectomy.
*"Xiao Li, you should make preoperative preparations. ”Chen Wenqiang hugged his elbow and looked at the CT film without saying a word, Li Min took everyone out of the director's office and went to prepare for the operation first."
Old money, this operation is really a dead horse as a live horse doctor, and I won't say that if I hope for 1%.Do you understand?
”Director Qian nodded again and again: "Dean Chen, I understand.Do you understand?
”He asked the family.The family also responded: "We understand.Surgery to remove the blood clot is our best to save him as children.In any case, we can't just give up.That's our father. ”"Surgery can remove the thromboide.I won't talk about the problem of embolus in his veins and adhesion to the blood vessel wall.It is mainly the site of the embolism, which causes the area of the brain to be affected too widely, and the left brain is the dominant hemisphere.It's been at least ten hours, and I told you that 5 minutes of ischemia will cause irreversible damage to brain cells.Therefore, in this case, the possibility of waking up after surgery is very low.You have to be mentally prepared for him to become a vegetative state after surgery. ”The old lady wiped her tears and said, "The vegetative person also operated on him."
Doesn't it mean that there are vegetative people who can wake up?
”"Old Qian, you and the patient's family do a good job of explaining.Such a large area of brain tissue cannot be supplied with blood in time, and there are too many dead brain cells, and the possibility of awakening is not even 1 in 10,000. ”The old lady was more serious: "Dean Chen, have you done 10,000 such surgeries?"
”*Dr.
Dou has just finished his ward rounds in the Department of Cardiovascular Medicine.It was Dean Shu who organized the holiday rounds today, and everyone cheered up for twelve points.Because Dean Shu will immediately solve the siege for anyone who can't answer the question, but anyone who is relieved will then have a deep sense of guilt, and they can't wait for themselves to be able to hand in the correct answer smoothly.But before Dr.
Dou took the intern to complete the course record of the ward round, a call came from the emergency department.The head nurse was taken aback when she answered the phone, and hurriedly relayed: "Doctor Dou, your two children have been hit with bleeding heads. ”Dr.
Dou felt his heart stopping.He hurriedly explained and ran to the emergency room, not caring about the daughter-in-law who was chasing after him.The two of them went to the emergency room on their backs and feet, and saw that their son had just started stitching.A large chunk of hair on the top of his head was cut off, and he cried tears and snot all over his face.But the daughter covered her forehead with a towel and refused to let anyone touch it."
What's going on?"
Dr.
Dou was so anxious and heartbroken that he felt like he was twisted.Dr.
Wang, who was on duty in charge of the emergency department today, answered Dr.
Dou's question while stitching up the son of the Dou family: "The father of Dr.
Li and Dr.
Yan sent the two children over, but I haven't asked yet."
I saw your eldest daughter's injury, and you hurriedly called Dr.
Li on the twelfth floor of the ward to save her from going home, and you have to go home to find it.Let me tell you that the sheep intestines in your outpatient clinic are still too thick to be used on the little girl's face.You go to the operating room to get the thinnest line.10 zeros are fine.The little girl's family, you ask Dr.
Li to sew it for her.Use small needles and fine threads to avoid scars later.Your son's wound is in his hair.Boys have dense hair, and when the hair grows out, it is blocked.When you look back, you should remember to give your child a tetanus injection and a few oral acetylspiramycin tablets.Remember not to let the child's wound get wet, don't get infected, the child has a strong healing ability, and the stitches can be removed in six days, and there is nothing wrong. ”Dr.
Wang muttered a lot of broken words, and every word was good for the children of the Dou family.Although the sisters and brothers of the Dou family are quite annoying, there are many comrades in the emergency room watching it.As the chief doctor of the surgical emergency department, the child of the comrade in this hospital was injured, and it was natural that he should treat it.If he doesn't go to the Dou family's sisters and brothers, he has to be careful.So he didn't dare to discount what he should have done at all, and he couldn't say less than what he should say.When he is so sensitive, he must not make the slightest mistake.But he really didn't expect that the initiator was his precious son.
*Dr.
Dou saw that Dr.
Wang had finished stitching up his son, and then he noticed the two men in their fifties standing next to him.One is Li Min's father who I met yesterday, and the other should be Yan Hong's father who is downstairs from him.He hurriedly thanked the two of them."
Don't be polite to us, hurry up and take your daughter to stitch up the wound.We also looked at it just now, and the opening is not small and irregular. ”Li Min's father persuaded Dr.
Dou."
This towel is your son's head cover, and it can be used to wipe things after washing."
Yan Hong's father had seen the scene of the Dou family just now, and he put the towel on the boy's head and stuffed it into Doctor Dou's hand.Only then did the child's mother run to the emergency room.Her nurse's hat was on her hair and the nape of her neck, and she looked like she was about to die in the next second.Looking at her son whose face was covered with blood, she was so distressed that she immediately scolded: "The one who killed a thousand knives, how can he hit his head."
Oh my son. ”When she cried, the few patients and family members in the emergency room gathered around.Everyone thought they were dead.Dr.
Dou grabbed his daughter-in-law and stopped her from crying: "What about this emergency room?"
Xiaogang, who hit it?
”"It's Xiao Zhi and Luo Tian."
When the boy saw his father and mother coming, his courage immediately grew.It is no longer the same as when he was first sent to the disposal room and his head was plucked by Dr.
Wang.Dr.
Wang was immediately embarrassed."
What do you mean by that?
Xiao Zhi went to his grandmother's house at noon yesterday.I heard that Luo Tian went to her father's the night before.How can you get together and fight?
”The father of Li Min and Yan Hong looked at each other and smiled, and exited the disposal room on their feet."
Let's get out.""
Let's go.Go home. ”When the two of them got out of the hospital, Yan Hong's father said, "The girl's forehead hit me very badly."
I don't understand about their surgical sutures, can a small needle and fine thread leave no scar?
”Li Min's father shook his head and smiled: "He's digging a pit for my daughter."
If there is a scar in the future, people will have to resent my daughter in this life, saying that my daughter has a grudge and did not sew the little girl well. ”"yes, that's it.That Dr.
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Wang is not very good-hearted.Why don't you go and warn the girl?
”"No, this kind of thing is just a good time to hone her.I'm sure my daughter will sew it for the little girl. ”"Well, you're right.A child whose heart is too small will not be productive. ”*Dr.
Dou and his wife were both looking at their son, who had been stitched and bandaged, and the eyes of the daughter standing next to him gradually changed.She has changed from being stubborn and worried about her brother to resentful and angry at her father and stepmother to greet her brother.Dr.
Wang noticed the change in the little girl and reminded Dr.
Dou: "Hurry up and take your daughter to treat the wound."
Let me tell you, the best stitch in our provincial hospital is Dr.
Li.Facial wounds are highly vascularized and generally do not become infected.As long as you are careful to sew and get the skin right, there will be no scars.Wait until I get off work tomorrow. ”"Wait for tomorrow?"
Dr.
Dou's daughter-in-law exploded: "Look at the two of them who were beaten and their faces were covered in blood." ”Dr.
Wang said as he packed up his equipment: "Then I can't help it."
The emergency department is on duty 24 hours a day, and you want me to leave my post and go home to take care of the children?
Then you have to go to Dean Shu and ask for a leave of absence.Your son said that Xiao Zhi beat it, I believe it.It's not the first time he's fought with your daughter.But you'll have to ask the kids why when I'm off work.Do you say it's Dr.
Dou?
”Dr.
Dou nodded.From hearing his son say that Xiao Zhi and Luo Tian fought together, he knew that it was a continuation of yesterday's incident.So he said to his daughter-in-law: "You take the child back to Corey tetanus serum, and I will take Doudou to treat the wound first and then go back to Cory." ”Dr.
Dou's daughter-in-law was reluctant, but it was useless to stay in the emergency room and quarrel with Dr.
Wang.She muttered and followed behind Dr.
Dou, went out of the emergency dressing room, and without asking her stepdaughter, she took her son to the internal medicine inpatient building.Leave the disposal room.Doctor Dou calmed down and first called the twelfth floor with the emergency phone, he was afraid that Li Min would leave after work."
Dr.
Li, she just went to the operating room.There was an emergency cerebral infarction patient who went to have an embolus removed. ”Dr.
Dou immediately called the operating room."
Looking for Dr.
Li?
She went to the stage for surgery.I don't know if I step down.I heard Dean Chen say that this operation is not easy to do.Director Hu of the Department of Radiology and Director Qian of the Department of Gastroenterology are here.Do you want them to answer the phone?
”Dr.
Dou put down the phone stupidly, what is the use of them listening to the phone.She had no choice but to take her daughter back to the emergency room."
Wang, I went to the operating room to ask for ten 0's threads, and my daughter has to sew them here.Dr.
Li underwent craniotomy to remove the thrombus. ”"Hey, I just thought about the fact that the child's forehead can't be scarred.Why did I forget to send a patient with acute cerebral infarction to the ward?
Then you hurry up and ask for the line.But I said ugly things to you in the front, I didn't sew as well as Dr.
Li, and then I really had a scar, don't blame me. ”Where can Dr.
Dou still care about talking these nonsense with Dr.
Wang.He said a few words to Dr.
Wang, and told his daughter not to leave the disposal room, so he hurried to the operating room to ask for sutures.The head nurse of the operating room had not left yet, and when she heard that Dr.
Dou was coming to ask for sutures, the boss was reluctant to ask people to find sutures for him.After Dr.
Dou left, she said to Sister Feng, the nurse beside her, "This Dr.
Wang has a lot of work."
He opened an order when there was no line in the outpatient clinic. ”"When he came back to the ward for surgery, let him pick a patient to get the line out.It's a few dozen pieces bigger.All sections are costed.He can't sell favors, let's pay for him to fill the hole in the operating room. ”"Yes.That's it.You can help me remember something. ”"Okay
.
"() The distance is a bit far