There are many young and timid colleagues like this. Dr. Liu lost his temper after realizing what was wrong with this partner.
In any case, Dr. Liu has been in the industry for one year longer than Li, and has had an extra year of experience, so he is more tolerant towards young people with less experience than himself.
Two people worked together to examine the patient.
Doctor Li Qi'an said anxiously, "That's strange. It seems to be fine."
When it comes to symptoms of abnormalities in a patient's brain, the most familiar basic examination item is to check the patient's pupils.
Is it true that all brain patients must have problems with their pupils?
First, let’s talk about the anatomy of the pupil.
The size of a normal person's pupil is about 2 to 5 millimeters, except for some special people, who are born with strange pupils.
The pupil changes dynamically with the intensity of light and the fluctuations in the excitability of the sympathetic or parasympathetic nerves.
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The parasympathetic nerve that controls the pupillary sphincter comes from the ophthalmic nerve. The sympathetic nerve circuit that controls the pupillary dilation muscle is more complicated. The center goes to the hypothalamus, and the nerve path sent out must pass through the brainstem to the spinal cord to the cervical nerve circuit. When returning, it will pass through the cavernous sinus in the skull and finally reach the ophthalmic nerve.
From the above circuit, we can know that the pupil abnormalities in the brainstem accident cases mentioned in the previous article have anatomical basis. What most people don’t expect is that problems with this cervical nerve circuit can also lead to pupil abnormalities.
Just saying this can make people imagine that pupil examination is a very complicated technique. Don't be fooled by the fact that many clinicians examine the patient's pupils at every turn. In fact, doctors who are not specialists don't really understand it.
For example, when the two neurosurgeons standing at the door looked at their two colleagues who were shining flashlights into the patient's pupils, Dr. Song's expression was: he couldn't bear to watch.
Class monitor Yue Wentong almost wanted to grab classmate Li's head: Go back to school and repeat your studies, don't embarrass me as the class monitor of neurosurgery.
The doctor uses a flashlight to examine the patient's pupils. The textbook says that this is a pupil light reflex test. This test uses the pupil's reaction to light intensity. When light shines on a normal person's unilateral pupil, both pupils will contract symmetrically, which is a pupil light reflex.
The pupil light reflex is divided into direct light reflex and indirect light reflex, and the anatomical basis is the light reflex pathway.
as follows:
When light shines on the retina of one eye, it triggers the photoreceptor cells to transmit information to the retinal ganglion cells. The information then passes through the optic nerve, the optic chiasm, and the optic tract. The nerve fibers then pass through multiple parts of the brain and finally return to the bilateral oculomotor nerves, enter the ciliary ganglion of the orbit, and control the pupillary sphincter, causing bilateral pupil contraction.
Based on this basic theory, the doctor should perform the following operation: first shine the flashlight on one eye of the patient to observe the direct light reflex of this eye, and at the same time observe the indirect light reflex of the other eye.
How did student Li take the photo?
Shine the flashlight back and forth between the patient's pupils.
Is there anything wrong?
Can't be wrong.
There is an advanced pupil examination called RAPD examination, which is done like this.
But if you ask Li, does he know that this is a RAPD test?
Student Li said: "This patient has a direct light reflex."
Please forgive Mr. Li. He has never been to the neurosurgery or neurology department for internship, so he confused the various specialized operations.
Not to mention, if you find it difficult to tell whether there is something wrong with the patient's pupil, you should at least have some intelligence to know that you can try turning off the interior headlights and checking again.
Squad Leader Yue was so angry that he couldn't speak.
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