On Monday, Dr. Liu was going to the ward to check on the patients who were operated on the next day. She was surprised when she checked the patient’s medical records on the computer.
We are all wondering: how many years of anesthesia, what kind of patient can surprise her so much?
After surrounding the past, everyone seems to have noticed something unusual. It turned out that not only did the diagnosis column read “Fracture of the left lower extremity”, but there were also large and small fractures in the past history. For a moment, everyone even thought about domestic violence. For a 6-year-old child, such frequent fractures are simply unimaginable. In addition to domestic violence, and then the glass man, there is almost no reason to find out.
However, looking at the inspection, it’s not like the glass man.
The so-called glass man, generally referred to as brittle bone disease, is a hereditary disease of connective tissue, which is familial. Mainly due to mesenchymal tissue hypoplasia and collagen formation disorder, and due to lack of osteoblasts, both periosteal and intraosseous osteogenesis are hindered, resulting in systemic osteoporosis and increased fragility, which often occurs clinically due to minor trauma. Fractures, such children are also commonly known as “glass dolls”.
However, neither from family history nor from looks, this child does not look like a glass man. Apart from the scars, nothing was noticeable.
No matter the cause, surgery for a broken bone must be done. So, with a puzzled look on his face, Dr. Liu went to the orthopaedic department.
When she saw the child, she did not have a routine consultation, focusing on investigating how he was injured.
Parents are also bewildered by this situation. However, the parents provided a message: this child did not cry when he was a child, and he never cried when he was injured so many times. Such a strong character once made parents very worried. The parents pondered in their hearts: How ruthless this child will be in the future!
Generally people will be surprised and laugh when they hear “not afraid of pain”. However, Dr. Liu felt that it was not so simple. Not just curious about the case, but also directly related to anesthesia. Because, fear of pain and not fear of pain are related to how and how much analgesics are given during anesthesia.
After a while, Dr. Liu took a quick look at the child’s other examinations. After not much discovery, she hurried back to Corey.
As soon as she returned to Corey, she told everyone about the special findings during the preoperative visit, and asked everyone to help her find some information quickly.
It can be said that no one has experience with such a rare case. Thus, a large case search began.
After a few minutes, a colleague shouted: Found it!
Following the sound, everyone saw “Congenital Painless Anhidrosis” written on her phone.
For a while, the anaesthetists, who thought they were well-informed, lost their voices.
After a few seconds of silence, everyone urged her to scroll down quickly to see what kind of disease it was.
It needs to be objectively stated here that the “informed” of anesthesiologists is not a lie. Counting from the school stage, during the university, not only have to study all clinical subjects, but also specialize in more than a dozen anesthesia majors; after graduation, I can see the conditions of various departments in the operating room almost every day. Compared with orthopedics, gynecology and other departments, the cases seen are too rich.
After seeing the true face of Lushan with congenital painless anhidrosis, everyone turned around and asked Dr. Liu: Does this child have a fever?
The reason why everyone asks this is because the main clinical feature of this disease is that it is not afraid of pain and often has fever.
Dr. Liu said: On the temperature list, the child’s body temperature is indeed a little higher, more than 37°C. However, considering the influence of the heat absorption of the child’s fracture, and the low white blood cells, it is considered a normal phenomenon. After asking the parents, the parents also reported that the child had a fever as normal. In addition, no antibiotics are required each time, and physical cooling is enough.
When Dr. Liu said this, everyone said, “Yes, yes, yes, that’s what happened, that’s the disease”.
Dr. Liu also suddenly realized: No wonder this child never cried when injured, so he didn’t know it hurt!
After a short academic discussion, everyone could not help but sigh: The reason why he was injured so frequently was directly related to his ignorance of pain. You know, pain is the best gift from God to mankind. It is precisely because of pain that people avoid hurtful stimuli and accumulate the experience of not being hurt.
After a sigh, everyone also discussed the anesthesia plan together.
Because the child is not sensitive to pain, the dose of analgesics was deliberately reduced in the anesthesia protocol. Although it is theoretically possible not to even give any analgesics, some moderate-strength analgesics are reserved just in case.
In view of the high possibility of the child’s body temperature rising during the operation, I also specially called the nurse: the coverage should be reduced during the operation, and a cool room should be selected for the operation.