Xiao Li is a young doctor in the department of anesthesiology, so he can only make up for the lack of experience with extra care.
No, a careful preoperative visit a few days ago, let him find a big problem: when he touched the patient's pulse, he was surprised to find that the patient's hand color was very abnormal. Overall, blue and purple. Look closely at the white part, very regular, mainly concentrated on one side.
With daylight, the red part looks similar to other places. Thinking about it, red should be the cause of contrast. But why are the white parts so white? He couldn't figure it out for a moment. So, he pretended to go to the computer to check the blood pressure record, and took out his mobile phone to check the relevant information.
This investigation made him very nervous. This is because patients behave very much like a disease , Raynaud's syndrome. If this is the case, the perioperative period requires great care. In case of lack of care, complications such as finger necrosis are not ruled out.
However, the patient's presentation does not appear to be fully consistent with Raynaud's syndrome. In general, this disease is symmetrical onset of both hands, and there will not be only one hand to manifest it.
Could it be that her illness was secondary? Thinking of this, he continued to look for the cause of the secondary.
Finally, the answer was found in a high-quality article: vascular diseases or nerve entrapment in the corresponding limbs can lead to the manifestation of Raynaud's syndrome in one limb.
With these materials, Xiao Li has a lot of confidence. So he went back to the ward again.
After carefully asking the reason, Xiao Li finally found the answer: it is very likely to be carpal tunnel syndrome. Because when asking her if she had any symptoms on her hands, she looked at Xiao Li in surprise and seemed to be saying: This doctor is very powerful!
So, what is carpal tunnel syndrome?
Carpal tunnel syndrome is a sign and symptom of the median nerve being compressed in the carpal tunnel. It is characterized by numbness, pain, and weakness of the fingers.
If you don't quite understand, you can think of the carpal tunnel as a "tunnel" through which the median nerve and tendon pass. The median nerve controls the sensation and movement of the thumb, index finger, middle finger, and part of the ring finger. When the "tunnel" becomes smaller, or when the contents increase, it will compress the median nerve and cause abnormal function, causing numbness, pain, weakness and other hand problems.
Due to the nutritional problems of the nerves themselves, it also directly leads to abnormal nerve regulation of blood vessels. The disease thus becomes a factor that predisposes Raynaud's syndrome.
Her hands, on the one hand, were the low temperature in the ward, and more importantly her carpal tunnel syndrome.
Subsequently, Xiao Li told the surgeon about the situation. The surgeon immediately consulted an orthopedic surgeon.
After consultation, it was agreed that carpal tunnel syndrome precipitated Raynaud's syndrome.
When the doctor told the patient about the situation, the patient asked if it could be solved surgically.
Her surgery was just a lipoma, and we had planned to give her a small venous general anesthesia. The sudden addition of carpal tunnel surgery can only be directly changed to brachial plexus anesthesia.
In principle, after the implementation of brachial plexus anesthesia, the blood supply to this arm will be improved due to the removal of the function of sympathetic vasoconstriction. Thinking of this, Xiao Li couldn't help but look forward to it. He wanted to verify whether the cold environment of the operating room and the anesthesia of the brachial plexus could alleviate the ischemia of the hand.
Since the lipoma also happens to be on one arm, the surgeon also agrees with Xiao Li's suggestion.
On the day of the operation, after the brachial plexus anesthesia, although the big white hand did not recover the expected rosiness, at least a little blood color could be seen, and it was no longer so scary.
Finally, let's give you another science popularization of Raynaud's syndrome:
Raynaud's phenomenon is also known as "intermittent change in skin color of the fingers", "spasm of the acromegadi", "secondary acral artery spasm". Intermittent changes in the color of the skin at the ends of the extremities due to paroxysmal spasms of arterioles at the end of the fingers (toes).
It is more symmetrical to the left and right, with cold numbness or tingling, and the arterial palpation is normal. Each episode resolves spontaneously after about a few minutes, but some patients may be in a persistent state, resulting in skin atrophy, longitudinal curvature of the finger (toe) nails, and gangrene at the end of the fingers (toes).
Raynaud's phenomenon can also be secondary to certain disorders, such as other connective tissue diseases, drugs or poisons, arterial structural abnormalities, carpal tunnel syndrome, thoracic outlet syndrome, or hematologic diseases.
【Warm tips】Point to pay attention, here is a lot of professional medical science, for you to decipher those things about surgical anesthesia ~