Rebirth of Medicine Practices the World

One Monday afternoon, Zhuo Yiming admitted a patient to the outpatient department. Liu Yulan happened to be at work that day, so this patient naturally fell into Liu Yulan's hands.

This is a young man who suffered from "epileptic seizures". He has been treated in the outpatient clinic for a period of time, and has undergone various examinations and used many drugs, but he cannot control the seizure well.

What Zhuo Yiming meant was that he wanted to be admitted to the ward and adjust the medication under the doctor's observation.

Since the last time she dealt with a patient with "status epilepticus", Liu Yulan once told Lin Lin that she was afraid of treating patients with epilepsy and always felt that the treatment of epilepsy was very complicated and difficult to control.

Liu Yulan was afraid of epilepsy, but this epileptic patient happened to fall into her hands.

After Liu Yulan asked about the medical history, completed a physical examination of the nervous system, and took all the information the patient gave her, she returned to the doctor's office.

She repeatedly looked through the outpatient medication, not knowing how to start. After thinking for a while, she simply did not change the current treatment plan and wrote the outpatient plan unchanged on the doctor's order.

Her idea is very simple. Since the patient is hospitalized, she can adjust the medicine while observing her. If it doesn't work, bring it up and discuss it with the whole department.

Liu Yulan felt neither sure nor confident.

For the next three days, the patient had seizures every day, all of which were tonic-clonic seizures.

This kind of attack is characterized by tonic twitching of the patient's limbs, loss of consciousness, eyes turned up, throat sounds, foaming at the mouth, and a purple face. The whole process makes people who don't understand medicine feel very scary and worried when they see it.

Patients who live in the same ward as the patient see such attacks every day, and of course they feel scared and worried.

On Thursday, Liu Yulan saw that no other doctor had discussed the patient she was in charge of, so she took the initiative to discuss this epileptic patient as a difficult case to be discussed in the general practice tomorrow.

The next morning, the discussion of difficult cases began on time, and Liu Yulan introduced the patient who gave her endless headaches.

"The patient is a male, 31 years old, teacher. Due to paroxysmal twitching of limbs, he has been unconscious for 3 years and was hospitalized for 2 months at home." "The patient suddenly developed twitching of limbs, unconsciousness, and vomiting 3 years ago without any inducement.

Foaming and cyanosis."

"After the attack, we had electroencephalogram and head CT examinations at Yingzhou People's Hospital and our hospital. There were no abnormalities in the head CT examination. The ordinary electroencephalogram showed mild abnormalities. After adding the 'sphenoid electrode'

, indicating a moderate abnormality, with scattered sharp waves and sharp slow complex waves visible."

"In the outpatient department of our department, drug treatments such as carbamazepine, phenytoin, phenobarbital, and sodium valproate were used successively, but the symptoms were not well controlled. There are multiple attacks every year."

"In the past two months, the patient's attacks have become more frequent, with attacks occurring almost every day, and the nature is the same as before."

"Currently, all anti-epileptic drugs in our hospital pharmacy have been used on patients without any effect."

"After admission, the patient's blood routine and liver function tests were normal, and other biochemical tests showed no abnormalities. Because the treatment effect is very poor, I would like to ask all teachers for their valuable diagnosis and treatment opinions."

Liu Yulan's report was very detailed, describing the patient's current predicament and the predicament she was in.

"Let me say a few words." A voice that no one expected sounded. Jian Sandie spoke first for the first time since entering the Department of Neurology to participate in difficult cases.

"I think there is no doubt that this patient has an epileptic seizure diagnosis. However, epilepsy is actually just a set of symptoms that appear when the brain is stimulated. Behind this set of symptoms, there must be a reason for it to occur."

"For this patient specifically, the treatment effect is not good and the seizure is difficult to control, which means that the brain lesions are relatively obvious. Therefore, I suggest that in the absence of better drug treatment, further examinations, such as CT

Enhance the scan to see the condition of the brain, hoping to find out the lesions that caused the attack."

"This patient's electroencephalogram can also support my point of view. The ordinary electroencephalogram only showed mild abnormalities, but after adding the 'sphenoidal electrode', obvious epileptic waves were found. This shows that there should be

A definite lesion."

It seems that Jian Sandie has done some research on neuroelectrophysiology. He has also put in a certain amount of effort on this patient, including consulting books, checking on patients, etc.

Among the doctors here, except Ma Shuiyuan, all of them are no strangers to epilepsy. Jian Sandie's opinion can be said that he knows very little about epilepsy.

"As the doctor in charge, I would like to express my opinion."

"First of all, this patient has had epileptic seizures for more than three years, and the control has not been ideal. I think it can be classified as refractory epilepsy."

"In addition, I do not agree that this patient has clear lesions visible on CT in his brain. If there is such a lesion for more than three years, the patient's symptoms should not be limited to epileptic seizures."

"I remember that Dr. Lin successfully treated a patient with stubborn status epilepticus before, and I learned a lot from it. Regarding this patient, could repeated attacks cause an acid-base imbalance in the brain?"

"Because the acid-base balance of the whole body is still maintained at a very good level. If there is, it can only be considered locally in the brain. If this problem exists, it can explain to some extent why this patient's seizures are so difficult to control.

."

"What I'm most confused about is, if this is really the case, how can we solve this problem? In this regard, I would like to ask the director and Dr. Lin for guidance." Liu Yulan's original intention was to ask Lin Lin for advice, but she was afraid of offending Ling Xiaoyun and would give her up.

It's tied up.

"I think what Dr. Jian and Dr. Liu said are very reasonable." Li Yun'e's opening remarks left people speechless.

Liu Yulan denies Jian Sandie's point of view, but Li Yun'e thinks that both people's opinions are reasonable. They are obviously trying to make peace with each other, and neither party can offend.

"Dr. Li, Dr. Liu's speech just now has refuted Dr. Jian's point of view. Now you think they are reasonable. What exactly do you want to express?"

Now that the skin has been broken, Ling Xiaoyun's character will never show mercy to Li Yun'e.

"My point is very clear. Dr. Jian's point of view may be right, and Dr. Liu's point of view may also be right. In this patient, both situations may occur at the same time." Li Yun'e said in order to support Jian Sandie

, already desperate.