Nineteenth Century Medical Guide

Chapter 109 106. The Three-Axe After Drowning

Both Carvey and Ignatz are busy surgeons, working almost every day, either in the ward or the theater, or in the dissection room cutting up the corpse.Carvey has one more place to go than Ignatz, and that is two laboratories for oxytocin experiments.

Count Moraso got married today, and the two busy people were away, so the surgery department of the Municipal General Hospital became an empty shell.

Except for the removal of an unattractive sebaceous cyst in the morning, the rest of the operations were postponed for a day. Herman, Melen, and Sarson stayed in the ward with nothing to do after completing the operation and rounds.

Usually they will perform surgery with Ignatz, even if they don't go on stage, it's good to stand on the sidelines and watch.If there is no operation, I will soak in the dissecting room with Ignatz, anyway, I can always find something to do.

But the corpse is precious, and the dissection has always been dominated by Ignatz. The destruction of the anatomical position due to random cutting is equivalent to wasting a corpse.Without him, no one dared to touch the body, not even the key to the door of the dissection room.

There is one word around the heads of the three of them: boring.

"Mr. Heman, or the two of us will go back first."

The three of them didn't have enough fun last night, today Sarson and Melen played again, and they were going to the concert hall to enjoy the opera after lunch.But before leaving, he still had to say hello to Herman, so as not to be said to be leaving early.

"Is everything done?"

"It's all done."

It's rare for Herman to be the boss, and he feels a heavy responsibility. Of course, he doesn't have the aura of a boss, and he doesn't want to embarrass these juniors. It's really meaningless to stay in a daze in a boring ward.However, for the sake of safety, Herman still wants to ask a few more questions, so that he can make a report tomorrow morning:
"How is Li Ben in the postoperative ward?"

"The temperature has dropped."

"How much is the incision bleeding?"

"Fortunately."

Herman nodded: "What about the three women who are about to have cesarean section?"

"Things are all stable."

"There's a placenta previa inside, how's the bleeding these days?"

"There has been very little bleeding in the past few days, and the fetal heart rate is normal."

Herman compared these answers with the ones in his mind one by one, and waved his hand when he didn't see the problem: "Okay, if you feel bored, you can get off work."

"Thank you Teacher Herman~~~"

However, things did not develop according to the direction the two of them had preset. The happy time in the afternoon was cut off at the gate of the ward before it even started.As soon as the two of them went out, two nurses came outside, pushing a flatbed cart in their hands. An eight or nine-year-old child was lying on the cart, followed by a group of anxious parents.

"Come, come, pick up the patient soon."

"Patient?" Sarsen looked at the child with a pale face, and asked quickly, "What happened?"

"Fell into the river more than half an hour ago and just got out of the water."

The nurse didn't know the specific process, but only heard the general idea from the driver and the child's parents.The two felt very strange, how could the drowning be sent to the surgeon: "The child's hands and feet are broken? Did he hit something?"

"No, I'm fine." The nurse said, "Hurry up and send him to the postoperative ward."

Not to mention that the postoperative ward is a place for surgical patients to recuperate after surgery. Since they are drowning and have no trauma, and they are still awake, they must be sent home.

Both Sarson and Melen have learned about drowning. The treatment process in textbooks is based on waking up. As long as a person wakes up, he is alive, and there is no need for further treatment: "Go home, we have nothing to treat when we come. .”

When the parents heard it, they were anxious: "It was the doctor Kawei who said he would send it back."

"Kavi?"

Everyone is friends, and with Kawei's current status, the two dare not mess around.However, even if they obediently sent the person to the postoperative ward, they still didn't know what to do next. Could it be that they just put the person in the room and didn't care about anything?
The child's condition is passable, he seems to be breathing a little fast, he coughs occasionally, and a trace of severe cyanosis can be seen between his lips.But this is a typical performance of surviving after rescue from drowning. As long as you go home and rest for two days, you should be able to recover.

"Just should, not absolutely!"

At this moment Herman came over.

He has several years of clinical experience more than the two, and he is more aware of the horror of drowning: "I think Mr. Carvey should have considered pneumonia after drowning. Many people will contract very serious pneumonia after being rescued from drowning. Consider whether Inflammation after water irritates the lungs."

Melen was puzzled: "Shouldn't pneumonia be sent to the internal medicine department? We don't have anything to treat here."

"Actually, the treatment of pneumonia is not difficult. It doesn't matter whether you send it to an internal medicine department or not." Heman is also familiar with the road, and wrote a few doctor's orders for the child, "First bloodletting 50ml, once a day; then routine enema and laxative, once a day; three meals a day Reduce to one meal a day, just give it at noon, reduce heart rate and congestion level”【1】

Hearing the treatment plan in his ears, the father who was guarding the child remembered something, hurriedly took out a note from his pocket, and handed it over: "Oh, I almost forgot, that doctor Ask me to bring you a message, saying that it should be treated according to the method above."

"Note."【2】

The reason why drowning became the number one cause of accidental death in the 19th century is that, in addition to the messy on-site first aid measures, there is also a lack of post-drowning supportive treatment.

Compared with the golden treatment interval, drowning has a rapid and slow development process on the pathophysiological changes of the whole body.Often after being out of danger for the first time, it takes at least a week of treatment to fully recover.

The whole body hypoxia caused by some severe drowning will cause lesions involving multiple organs in the whole body, which is very dangerous.

The first is the damage of alveolar walls and capillaries caused by hypoxia, plus the acute pulmonary edema caused by water entering the lungs.Secondly, inhalation of a large amount of fresh water will cause alveolar perfusion, and the surface active substances will be washed away. At the same time, a large amount of fresh water will enter the blood, and the blood volume will increase. 【3】

Although this is related to water entering the lungs, it is still not advisable to control water upside down in first aid.

Because the water will be absorbed as soon as it enters the lungs, the water in the digestive tract can only come out if the water is controlled upside down.Doing this kind of thing during the golden time of rescue is undoubtedly losing the watermelon and not being able to pick up sesame seeds, and the spilled digestive tract contents will cause aspiration and aggravate lung lesions. (This paragraph is very critical, I will not put this chapter)

For the first two attacks after drowning, modern hospitals generally use scopolamine to fight pulmonary edema, and then use diuretics to fight blood volume increase.

After the two waves of attacks are stabilized, the patient will have different degrees of infection on the second and third days after drowning.There are a large number of bacteria and fungi in the water inhaled into the lungs, and they will colonize the lungs. Generally, antibiotics are routinely used to fight infection in advance from the time of admission.

The drowning treatment will not be declared over until the three axes are swung, and the patient can be said to be completely cured.

And where there were so many supportive treatments in the 19th century, coupled with the ambiguous misconceptions of doctors, it would have helped a lot if it didn't make things worse.

In such an environment where there is no need to care after waking up, it is impossible for Kavi to leave the king and the earl to care for a child who has already woken up.So he could only take care of the child's parents first, send him to the hospital first, and then attach the note with the treatment plan written on it.

Ignatz was not interested in patients other than surgery, and Herman had almost obeyed Carvey.If in doubt, he would do it.

And just now, Kawei's first aid operation has established a good image in the hearts of his parents. Since it is the request of the savior, they will naturally follow suit.

Herman looked at the strange treatment method on the note, feeling an indescribable feeling in his heart.

But when he thought of Carvey's superb operation before, he was not a physician himself, so he could only do as he wanted: "You look at the child, I will go to the internal medicine ward first."

"Why do you go to the internal medicine department?"

"Get the medicine."

The drowning rescue of Morazo and Carvey became the biggest talking point at the wedding lunch.

Needless to say, the earl, such a brave act of kindness, maybe this report will appear in the evening paper.Coupled with the newlyweds and proper headlines, Moraso is undoubtedly the well-deserved protagonist today.

Compared with Kawei's rescue, it is not so eye-catching.

He was surrounded by a group of passers-by, and apart from the count, Ignatz, and Bergett standing beside him, not many people would put his rescue first.After all, if the person is not rescued and goes ashore, even if there is a real hand of God, he can't do anything to the child.

Carvey is very calm: "Mr. Laszlo is joking. My job is to save people. Most people who save people don't have applause. If I always think about other people's applause, how can I work hard?"

"." Laszlo lost his temper by his professional outlook, "Are you really 17?"

"If it's a fake replacement."

"It would be great if Naya was half as mature as you, and I can save a lot of worry."

Laszlo glanced at his daughter who was sitting in the distance laughing and playing with the lame cat, couldn't help sighing, and when he looked at Kawei again, his eyes became different: "Forget it, we still Let's talk business."

The business he was talking about was naturally building a factory.

Carvey hopes to mass-produce oxytocin first, no matter how troublesome the process is, at least it is better than doing it alone.The second is to build a surgical instrument factory that can be used by him, so as to provide relatively high-end hardware instruments for the backward shell environment, and the difficulty of surgery will also rise to a higher level.

At any rate, he is also an old director who has experienced level [-] surgery, and he really doesn't have much motivation to go back and forth for the main surgery.

"The boy's tone is not small."

Although Laszlo regards him as a benefactor, when it comes to his field of work, his tone will become extremely harsh: "If the effect of oxytocin you mentioned is true, it will indeed have a very large market. Don't say it for it. It’s not bad to open a pharmaceutical factory, even if you open ten. But the equipment factory.”

"I have drawn some simple design drawings." Carvey took out a notebook from the box, "The drawings inside are definitely better than the current surgical instruments."

Laszlo shook his head: "The quality of the equipment is second, and no one cares. The key is that you have no evidence. Without evidence, who will believe it? No one believes how to make money?"

Different from the mature model of modern medical device manufacturers who research, design, develop, experiment, provide data and promote themselves, the medical device industry in the 19th century was blank. Carvey did not change his mind for a while, and the idea was indeed a bit ahead of his time.

"If the equipment factory can't do it, then" Carvey abandoned the car to protect the handsome man, "I hope Mr. Laszlo can contact the steel factory to help me make a set of samples first."

"Do you really need this set of equipment?" Laszlo felt very strange, "I think the pliers scalpel in your box is also quite good."

"It is very necessary." Carvey explained, "When doing fine anatomy, some special structures on the instrument can bring a completely different experience to the surgeon."

"Ok."

Carvey put away the notebook: "The drawings are not accurate enough. After Mr. Laszlo has contacted the manufacturer, I will come to the door and chat with them in person."

"no problem."

Now that Laszlo denied the equipment factory, the production lines that Carvey had thought about before, such as thermometers, sphygmomanometers, stethoscopes, and artificial prostheses, need to be put on hold.Anyway, these things are expensive for today's medical system, and they are tasteless in the eyes of many hospitals.

Carvey knew that he couldn't become a fat man by eating in one breath, so he couldn't be in a hurry: "I mainly talk about these two things. The experimental report of oxytocin will be delivered in a few days, and I am also rushing to work on the paper. Besides, I I still have three caesarean sections in my hand, two are expected to be performed at the end of this month, and the other one is more troublesome, and I estimate that it will be performed in the middle of the month."

"Hopefully the powerful effects of oxytocin can be demonstrated again during surgery."

"You won't be disappointed."

Laszlo poured a sip of wine into his mouth. Seeing that Carvey was about to leave the table to get close to Franz, he quickly got up and grabbed his sleeve: "Young man, you left too quickly."

"Oh." Carvey thought he didn't have an empty glass and was insincere, so he quickly turned around and drank the wine, "Happy cooperation!"

"What a pleasant cooperation, I still have something to do!"

Laszlo pulled him to sit beside him, and whispered, "I told you before that I wanted you to come over and be my personal doctor, but you said you were not available."

"Yes." Carvey nodded and explained, "I still hope to learn more when I am young."

study?
Do you still need to study?

Laszlo was a bystander, and he didn't know how to complain about the word "learning": "I am old friends with you now, and I have accepted the order from your pharmaceutical factory. My friend is in trouble now, do you have to help me?" ?”

Kavey showed a sad face, knowing that this is not a good job, but thinking of the mass-produced oxytocin and brand-new surgical instruments, he still agreed: "No problem, as long as it is within my ability, I will definitely help."

"Definitely do what I can!"

Laszlo smiled very happily, pointed to the daughter holding the lame cat in the distance, and said: "You also know Naya's temper, she is too curious. The last time I saw you doing the gas cut, it seemed that I was interested. I just hope to learn anatomy. If you are free, come and teach for an hour each time, and the price is satisfactory to you.”

(End of this chapter)