Chapter 608: Unsolvable Dilemma
“As for the cortex, it controls the nerves and muscles on the opposite side.
"Once a lesion occurs, the brainstem can no longer control ipsilateral gaze, which will cause both eyes to gaze to the opposite side. When there is a lesion in the cortex, it is ipsilateral hemiplegia."
As Xu Qiu finished speaking, everyone present was slightly startled. It was only after a few seconds of silence that they suddenly woke up.
Enlightenment!
This is their first feeling.
The complex and complicated neurological signs were summarized by Xu Qiu in a few sentences, and the outline was two sentences... Moreover, according to Xu Qiu, from the perspective of anatomy, any brain surgeon can have a photographic memory!
"What a clever memory method..." The director of the brain surgery department couldn't help but sigh.
He had spent several years on and off reciting these functions and signs. It would have been much easier if he had Xu Qiu's guidance at that time.
However, after a brief surprise, the director of brain surgery became worried again.
He glanced at the patients on the bed, then looked at the aggressive group of family members not far away, hesitated, and then pulled Xu Qiu aside.
"Dr. Xu, I'm afraid we can't accept this patient..." The director's eyes were a little dodgey.
Xu Qiu nodded and motioned for him to continue.
The director then sighed and said:
"Dr. Xu, you are also a clinical practitioner, so you should be able to understand our difficulties...
"The patient's condition is very poor, and the prognosis is definitely not good. If he continues to be treated, it is possible that both people and money will be lost. Even if the patient is rescued, there will be considerable sequelae.
"But unfortunately, the expectations of the family are too high. If we admit this patient, we will definitely spend the money like water, but the final treatment effect will not be good, and they will definitely make trouble..."
Xu Qiu didn't argue.
Based on the performance of these family members, the treatment effect is not good. Even if it is him, the other party may not give him a good look. In the end, his next trip will definitely be ruined.
"besides……"
Seeing that Xu Qiu did not refute, the director continued: "DRGs..."
Xu Qiu raised his head. Ever since the superiors implemented this system, every hospital has been frowning. He has heard complaints from frontline doctors no less than ten times in the past month.
The director said: "After DRGs, overly complex diseases will 100% exceed the maximum limit set by the Medical Insurance Bureau for the department, and the excess... As you know, Dr. Xu, will definitely be borne by the hospital, and will eventually fall on every doctor in the department. superior.
"A disease like theirs would conservatively cost 20,000 to 300,000 yuan, which may not even be enough. Of which, nearly 100,000 yuan may be borne by our hospital!
"One patient costs our department a hundred thousand yuan... Dr. Xu, you may not be short of money, and you may not be short of money for medical treatment, but Greentown No. 1 Hospital does not have direct provincial financial support, and we all have to eat..."
These words are word for word, and anyone who has done clinical work understands the pain and sorrow in them.
It’s not that I don’t want to save, it’s that I can’t save!
Once the rescue is carried out, the department will definitely deduct nearly 100,000 yuan to make up for the shortfall; and if the treatment fails and the patient dies, the family will not let the hospital go. Even if the hospital takes care of it, the department will be in a state of uproar; even if the patient dies, the department will be upset; Even if it succeeds by chance, failure to achieve the recovery effect expected by the family will also lead to disaster...
In contrast, as long as no patients are admitted, everything will be fine.
It is actually very simple to solve this almost unsolvable dilemma.
As long as the family members tell the hospital that they have money, they will pay for it themselves without taking out medical insurance, and then put hundreds of thousands into the hospitalization account; or they may tell the family members that they will be treated as living horses regardless of whether they can be saved or not...
Of course, these are extreme cases.
In fact, as long as the family members are a little easier to talk to and more reasonable, instead of being like today, where the family members suspect that the hospital is seeking money and murder before the doctor even opens his mouth... ordinary doctors will do their best to save lives.
Today, however, none of these effective methods work.
Xu Qiu couldn't make a decision for a while.
If he were in a clinical hospital, he would definitely help without hesitation... After all, clinical doctors are really rich. DRGs can't cover it, so the hospital can make up for it. Two or three in a month won't be a problem.
But most of the other hospitals are operating at a loss. Their finances are already short of money. To treat a patient, the hospital has to make up tens of thousands or hundreds of thousands, and it really cannot afford to treat them.
After thinking briefly, Xu Qiuyi smiled and said, "I will bear the part that exceeds the medical insurance limit."
"Doctor Xu!"
The director of brain surgery was anxious. When he was about to persuade, Xu Qiu interrupted him directly and said: "Prepare for surgery... I happen to have some insights in the field of brain stem injury, and maybe the prognosis will be better than expected. You can also come on stage and take a look. , learn from each other.”
After that, Xu Qiu returned to the ward and made various arrangements before the operation.
"Do a cerebrospinal fluid replacement first." After the evaluation, Xu Qiu made a decision.
Nowadays, patients have large amounts of bloody cerebrospinal fluid in their brains, which is a huge risk factor.
What cerebrospinal fluid replacement requires is to release it through lumbar puncture, and then inject an equal amount of normal saline to reduce intracranial pressure and relieve symptoms such as confusion and headaches.
Moreover, this operation also has certain benefits for subsequent surgeries - it can reduce the occurrence of hemocephalus and reduce the probability of vasospasm.
This operation is not difficult, but in order to accurately understand the patient's condition, Xu Qiu performed it himself. A total of two lumbar punctures were performed. After replacing 30ml of cerebrospinal fluid each time, the patient's consciousness recovered a lot and the headache symptoms were greatly reduced.
At this point, everything is ready.
Soon after, an emergency aneurysm clipping operation was performed at Greentown No. 1 Hospital.
"This time we are doing the keyhole clipping technique." Xu Qiu said.
The keyhole clipping technique is actually a variant of microcraniotomy, named because the bone window is very small and looks like a keyhole.
Everyone in Greentown First Hospital was a little confused... Keyhole? Is there such a microsurgery technique?
The director was about to ask a question, but Mo Wan immediately said, "Don't worry about whether you understand it or not."
Tong Yan added, "Just watch it!"
After that, the two looked at Tang Yunshu at the same time.
Tang Yunshu was hesitant, but in the end, he was forced by the coercion of the two women and gritted his teeth and said, "Doctor Xu, six six six!"
Mo Wan and Tong Yan nodded with satisfaction... This is a qualified trio of supporters. It doesn't matter if they don't know anything else, but they must shout 666 loudly.
On the other side, when Xu Qiu's voice sounded, the scalpel had already fallen.
Swish——
The tip of the knife cut an incision, and a blood line slowly formed.
This step is one of the most important basic skills in microsurgery.
With the title of master of brain surgery and solid surgical skills, Xu Qiu was very fast.
After using indocyanine green to identify the frontal and temporal sylvian veins, Xu Qiu used a gemstone knife to open the outer arachnoid membrane and separate the sylvian fissure towards the skull base.
When the director and others saw this scene, their breathing became heavy.
