My medical skills can add experience points Chapter 108 Myoelectric attenuation, a breakthrough diagnosis
Because Dr. Gao, the youngest and promising doctor in the Department of Neurology, when he saw this emergency doctor, the expression on his face was not only surprise, but also respect.
The hospital is also a small society. If you have a future or strength, others will respect you.
On the contrary, it is the dust in the corner.
Tuya Hospital has thousands of employees, most of whom are ordinary people.
"I can tell you that Dr. Zhou is the most promising doctor in the emergency department. Getting along with him will only do you good, not bad." After Gao Jian finished speaking to the nurse, he looked at Zhou Can again.
"Could Dr. Zhou come to see me? Haha! I'm a little narcissistic!"
Although Gao Jian and Zhou Can are competitors, when they met, they were very enthusiastic.
The nurse girl looked at Zhou Can again in surprise.
There is no contempt in the eyes.
There is a little flattering smile on his face.
It's a pity that Zhou Can didn't look at her again.
"I'm here to ask Director Yin some questions, do you know where he is?"
"Director Yin is my teacher. Do you think I know where he is? Let's go, I'll take you there. The teacher mentioned you two days earlier. You are lucky today, the teacher happens to be working overtime today. Normally, on weekends, Director Yin does not go to work. There have been a lot of patients recently, and the teacher is worried that his expert account will be fired by scalpers, so he chooses to work overtime."
At Director Yin's level, many basic tasks no longer need to be undertaken.
The main thing is to guide students, attend consultations, hold meetings and so on.
If you are a chief surgeon, you will need to perform surgery in addition to attending consultations.
From this point of view, physicians have a natural advantage in academics.
Surgical attendings and above, basically half a day for consultation and half a day for surgery. There are also ward rounds, leading students, leading groups, leading projects... There is really not much time to study and recharge.
Many people think that surgeons earn more than internal medicine.
This is very one-sided.
Surgeons can of course earn surgery fees and overtime wages through surgery. But physicians also get a lot of commission on medicines.
In terms of hospitalization, internal medicine can crush surgery.
A daily ICU of 10,000 to 20,000 is a gold-swallowing behemoth.
Even so, many hospital leaders often scold the ICU as a money-losing department.
Under the leadership of Gao Jian, Zhou Can went straight to the neurology clinic.
There are still many patients sitting in the aisle outside.
There are actually quite a lot of specialist clinics in Tuya.
The cheapest expert number is 50 yuan, and the most expensive special-needs expert outpatient number is more than 1,000.
This world is very strange. Not many people want cheap expert accounts. On the contrary, there are hundreds or thousands of expert accounts, many of which are instant.
It's a little better now, and I am required to register with my ID card.
Scalpers have much less room to operate.
In the past, there were no self-service registration machines, and when it was all manual operation, the better expert accounts were all monopolized by scalpers.
If you want to see a doctor, you have to find them to buy.
It doesn't matter if you don't buy it, there are plenty of patients who are willing to pay more.
Because the patient can't afford it.
"Liu Yan, how many patients have Director Yin left?"
Gao Jian asked the guiding nurse.
The role of these nurses is to guide patients in line, maintain order, and call numbers.
As long as patients hand over their medical records and registration slips to her, she will call their numbers one by one in order.
This prevents someone from jumping in line.
Patients and their families only need to sit on the benches in the corridor to rest and wait.
"There are three patients in total."
"OK!"
Gao Jian nodded and looked at Zhou Can.
"There are three more patients. You will have to wait for about half an hour. I have to go to work in the inpatient department, so I can't accompany you."
All the regular trainees in the junior college are very hard-working.
Taking care of patients, writing medical records, working night shifts, and doing various chores...every day, I am so tired that I fall asleep when I touch the pillow.
"Go do your work! Thanks!"
Zhou Can waved to him.
Fortunately, I met Gao Jian today, otherwise it would not be easy to find Director Yin.
After watching Gao Jian leave, Zhou Can found an empty seat and sat down.
He found that many patients came for consultation with various examination reports done in other hospitals. They couldn't find out the cause at the local hospital, or the treatment didn't work, so they went to Tuya Hospital for expert diagnosis.
Zhou Can glanced casually, and the outpatient rooms inside were basically specialist outpatient rooms.
In Director Yin Hua's room, there is the sign of Special Needs Specialist Clinic No. 1.
There are at least six or seven consultation rooms for such specialist outpatient clinics.
Those who can afford the four characters of special needs experts usually have made great achievements in a certain subdivision field.
Only after a rigorous review can they be qualified to add the word "special needs".
Tuya's strength is still quite strong.
After all, there are already so many top experts in just a subdivision of neurology.
Adding up all Tuya's weighted departments, the number of top experts is probably more than one hundred.
The lifelong wish of many doctors is to become a top expert.
In fact, it is remarkable that three or four of a hundred doctors can become top experts.
As long as Zhou Can keeps working like this, sooner or later, he will be able to sit in the outpatient room of a special needs expert and treat patients as a top expert.
While waiting, he took out his mobile phone and looked at Qiu Jie's inspection report again.
One by one, look carefully.
He even read some inspection reports no less than ten times.
But there has never been much discovery.
Nearly five o'clock, Director Yin finally finished the outpatient clinic.
Zhou Can hurried to the door and knocked on it.
When Yin Hua raised his head and saw Zhou Can, he couldn't help but froze.
"Xiao Zhou!"
"Director Yin, you said last time that I can ask you anytime if I have any questions. I really have the cheek to bother you."
Zhou Can walked in with a smile.
"Welcome! Have you been waiting outside for a long time?"
Director Yin's attitude towards him is quite warm.
"It didn't take long, only about half an hour. But it's really not easy to find you. I'm not familiar with neurology, so I asked around where you work. Fortunately, I met Gao Jian, who brought me here."
Zhou Can didn't look out at all.
Walking over, picked up Director Yin Hua's empty teacup, and offered to refill the water for him.
A small move made him close the distance with Yin Hua in an instant.
Usually only the students will refill the teacher's teacup in time.
This is a kind of respect.
It also has the meaning of dedication.
"Come to see me next time. I'm here for the outpatient clinic on the first, third, and fifth. During the day shift on the second and fourth, I'm mostly in the office of the inpatient department, or the minimally invasive operating room. You only need to go to these three places to find me. If you can’t find it, just call me, do you have a number?”
Being courteous still pays off.
Director Yin Hua took the initiative to give him the phone number.
This treatment is not available to everyone.
"I don't have your number, please give it to me and let me remember it?"
Zhou Can took out his phone and got ready.
Director Yin reported his private mobile phone number, and Zhou Can wrote it down. It will be much more convenient to contact you in the future.
Famous doctors of their level, in order to reduce unnecessary troubles, generally would not give their mobile phone numbers to irrelevant people.
"What questions do you want to ask? I will go to the inpatient department for rounds later, hurry up!"
Director Yin is really very busy.
When others seek medical treatment from him, they not only need to pay 800 yuan for the registration fee, but also have to wait in line.
It was a great convenience for Zhou Can to be appreciated by him.
"I met a patient who had been paralyzed for several years because of a miscarriage. But after visiting famous doctors, the cause was still not found. You are a top expert in neurology and have a lot of knowledge. I would like to ask you to help look."
Zhou Can opened Qiu Jie's inspection report, and then put the phone in front of Director Yin.
"Here are some of her inspection reports."
Director Yin clicked on it, and a strange expression appeared on his face.
Zhou Can also noticed that Director Yin's expression was different.
"This patient came to see me three years ago. As soon as you said that she was paralyzed due to abortion, I guessed something. Because there are so few such patients, it is difficult for one case to occur in 100,000 cases of abortion."
Thinking about it, Li Luo and his wife lived in this city, so how could they not go to Tuya to seek medical treatment?
As long as he went to Tuya Hospital, Director Yin would definitely be consulted for such difficult neurological cases.
Although he had diagnosed Qiu Jie three years ago, he still opened up the patient's examination reports one by one for inspection.
He watched very carefully.
"The patient named Qiu Jie left a deep impression on me. She committed suicide the second day after she was admitted to the hospital. Fortunately, the nurse found it in time. Unexpectedly, three years later, she still failed to find out the cause."
Director Yin sighed.
Hospitals are actually quite afraid of the dead.
Even if it is a normal death, it will increase the fatality rate in the hospital. Let alone this kind of suicidal patient.
It will have a certain negative impact on the hospital, and it will bear the responsibility for inadequate management.
"When I diagnosed this patient, she had just had a miscarriage. At that time, my diagnosis level was weaker than now, and my experience was also poor. Thinking about it now, I fell into a misunderstanding. I think she was in shock for too long, which caused The degree of damage is very large, coupled with complications such as co-infection, this caused natural paralysis."
"When she was examined at the time, it was found that the muscle spindles were more sensitive to stretch reflexes than normal, especially the muscle tension of the flexors of the upper limbs and the extensors of the lower limbs was very high. The resistance was high at the beginning, and then the resistance dropped rapidly, and the cliff-like decline That kind. At that time, based on the subtle results of these examinations, I diagnosed her as a natural paralysis caused by the lesion plus infection complications. I thought there was no way to cure it."
Three years have passed, and after re-checking the materials, Director Yin still has a clear memory of what happened back then.
Doctors are like this. When encountering some difficult cases, it is easy to remember them for a lifetime.
One is that difficult cases are rarely repeated, and the other is that the diagnosis process is exhausted, so the memory is particularly deep.
"Then do you have any new discoveries now?"
Zhou Can asked.
In the past three years, Director Yin's diagnosis level and experience have improved to a certain extent.
Maybe there will be new discoveries.
"There is still no major discovery. However, this inspection report from the Kyoto Medical College gave me some ideas. They conducted a myoelectric test on Qiu Jie's female patient. We Tuya can also measure myoelectricity, but because of the equipment It’s not that advanced, and the detection can’t be as accurate as theirs. You see, the electromyography test, the conduction ability gradually decays from here. There is still a weak signal when it is transmitted to the root of the thigh. I think if the patient’s lesion can be found, it will definitely be There is a turning point."
Zhou Can can understand common problems of EMG.
But it is difficult for him to see some places that are too advanced or require a combination of rich experience and medical knowledge.
This is a bit like a picture, some people can see two faces, some people can see seven, or even more.
According to the examination report and some clues of the patient's symptoms, you can see the abnormalities that other doctors can't find. This is the master, and this is the level.
Zhou Can had a very high talent in diagnosis, and when Yin Hua reminded him, his eyes lightened slightly.
"You mean, if the EMG signal can be transmitted to the root of the thigh, it means that the patient's nerves are not completely necrotic. It's just that the nerve signal is severely attenuated and cannot be transmitted to the more distal parts of the lower limbs. At the same time, because the nerve signal is transmitted to the root of the thigh, It's already very weak, so there's no possibility of a motor response."
As long as the nerves are not dead, there is still a chance.
Because nerve cells are the only non-renewable cells, once necrotic, it is difficult to cure.
"clever!"
Director Yin gave him a thumbs up.
This kid's talent and comprehension are indeed very high.
Just one point.
"The patient's myoelectric signal attenuation is gradual, not cliff-like. According to my experience, it is not much different from the result of nerve necrosis. It is like an aging wire, UU reading www.uukanshu.com it There is a serious problem with the conductivity of the wire. Unless you replace it with a new wire, there is no way to solve it."
Director Yin shook his head and sighed.
There is no cure for this patient.
The lower extremity neurons are quite rich, and I am afraid that no doctor can replace it with a new one.
Zhou Can, however, seemed to be dazed, frowning, staring blankly at the corner of the wall without speaking.
Director Yin noticed that Zhou Can didn't respond, and when he looked up, he couldn't help laughing.
This kid is quite the demeanor of his past.
When delving into medical problems, I often plunge into it, approaching the point of obsession.
Director Yin did not interrupt Zhou Can's meditation.
Instead, he lowered his head and continued to check the patient's information to see if there were more discoveries.
After more than ten minutes, Director Yin was going to make a ward round, and he was about to get up, leaving Zhou Can here to continue thinking.
At this time, Zhou Can had a result.
"That's right, yes, that's probably the case."
He was chattering, his eyes were bright, and his face was excited.
"You made a new discovery?"
Director Yin has seen Zhou Can's alternative diagnosis ideas, so he didn't despise him just because he is Gui Peisheng.
Speaking of which, Director Yin admired Zhou Can so much that he did not hesitate to open the door for him.
It is also because of Zhou Can's alternative diagnostic thinking.
"I think this patient can still be cured. Her EMG signal will decay all the way. Do you think it has something to do with blood supply?" Zhou Can asked, obviously having made a major diagnosis.
Why do paralyzed patients need to check the electrocardiogram?
What was actually checked was blood supply. +Bookmark+