Nineteenth Century Medical Guide

Chapter 122 119. "Matryoshka-style consistent injection method" and "Dream back to the medieval retro-style hemostasis method"

The method used by Carvey is not the first. As early as 30 years ago, doctors used intravenous infusion to correct the fluid imbalance in cholera patients. 【1】

At that time, ordinary saline was used. Although the simple NaCl solution would cause the disadvantages of "hyperchloremia caused by excessive chloride ions" and "hypokalemia caused by severe diarrhea still cannot be corrected", it can be injected directly into the vein. The water solution at least prevents death from dehydration. 【2】

In the days without antibiotics, the death rate from cholera was very high, and the infusion gave people hope.

It is a pity that this method of infusion did not become popular, because blood has always been a nuisance in daily medical practice except to deal with severe dehydration.Supplementing fluids is the opposite of bloodletting, and is a cumbersome process that is quickly forgotten.

Carvey used the infusion method used in the early days of cholera, and the liquid that was mixed was a super low-end version similar to modern balance liquid. 【3】

Hemorrhagic shock trio: hypothermia, coagulation abnormalities, and acidosis.

There is no way to solve blood coagulation, because it is an ever-changing thing that needs to be monitored, and there is no corresponding drug, so it can only be luck.But hypothermia and acidosis are not difficult, just boil water to increase the temperature, and then add a small amount of sodium bicarbonate to increase the alkalinity.

What really made him feel awkward was the way the rehydration fluid was injected.

In modern times, infusion bags + pimps are used, and the liquid is pressed into blood vessels by atmospheric pressure and gravity.Kavi didn't have such a thing, and only a syringe was available at hand, so he could only inject it into Olgi's body slowly by the syringe.

Although the speed is not slower than the infusion pimp, it is really labor-intensive.Moreover, the four of them are not proficient in the use of syringes, and it is easy to make mistakes when changing syringes.

Nurses are not like nurses, doctors are not like doctors, and their hands are clumsier than those undergraduate interns.

It's just too messy.
Kavi stood aside, and the left outer lobe of the liver in his hand had reached the final stage of dissociation.He has been distracted by Olgi's heart rate and blood loss, and now looking at the hectic rehydration screen, he can only think of new ways for rehydration: "You only have this kind of syringe here?"

"Yes, only 1ml."

As a surgical emergency doctor, Carvey has a strong on-the-spot response ability.

Now all he has to do is to inject all the water into the blood vessel, and changing the syringe back and forth can indeed accomplish the goal, but the reality is much worse than he imagined.Moreover, when switching back and forth, there will be problems such as "blood backflow" and "air entering the syringe" [4]. Carvey must find another way: "There is no syringe, but there must be an enema."

Nurse A: "Enema device? Yes!!!"

Nurse D: "There are many in the ward, I'll get them now."

At this time, Lockard put down the syringe and walked to the desk, and opened a drawer in the corner: "Here is the enema device used by Mr. Olgi himself."

"Find all the enemas that you can find, and rinse them off." Carvey has long since ignored whether they are dry or not, and said directly, "First compare whether you can put it into the syringe, and find the most suitable one to fill it up." water, then wrap it tightly with a bandage to seal the interface as much as possible, and finally push the water into the blood vessel."

Things have been explained to this point, and it is simply a matter of IQ if they don't understand.

What Kavi wants is a stable channel for injecting liquid. Even if the channel is a little leaky, it is not clean, but now this is the only way to save Olgi's life.At the same time, this matryoshka-style injection method can also free up one or two hands for him. It is difficult to complete the subsequent left lateral lobe cut with only two hands.

"Where's Nurse B?" Carvey separated the root of the left hepatic vein and made a suture with two sutures. The entire left outer lobe of the liver was completely freed. "Where's the iron rod I want???"

"Come here~"

Hills walked to the door and looked out, and saw that Nurse B, who ran out to find the sticks just now, was holding several iron sticks in her hand, panting heavily: "Here are things, thick ones, thin ones, long ones , I found all the short ones."

"so many"

"What should I do next?"

"Choose the thinnest and shortest one." Carvey looked up for a moment, then bent over and found the scalpel in the box next to the equipment, "clean one end of it, and then put it on the stove to bake." , let me know when it turns red."

"it is good."

"Dr. Carvey, Dr. Olgi's heart rate has gone up again, now 135"

Nurse C finally knew the nature of her work and reported her heart rate to Carvey immediately, but the reported number was really disappointing.Kavey turned to look at Olgi, and touched his arm with the back of his hand. His skin was clammy and pale, typical of hemorrhagic shock.

However, because the bleeding was stopped by laparotomy on the spot, the rescue was timely enough, and the degree was not serious.At least the lips are not severely cyanotic, and it is still possible to save before the time of real hypoxia.

There are rescues and rescues, but the subsequent surgery is also full of variables.The technique of removing the liver had to be meticulous enough, and the amount of bleeding needed to be minimized as much as possible, because any bleeding would push Olgi to death.

"Here comes the enema, here comes the enema"

Locard yelled twice, and he and two nurses brought more than a dozen enemas into the office: "Try the size quickly and find the most suitable one."

"it is good!"

Seeing that the rehydration solution was about to be put in place, Carvey asked Nurse B who was roasting an iron rod beside him: "How is the stick burning?"

"It's not red yet."

"Let me try it first."

The electric knife cuts and coagulates tissues by generating heat from high-frequency alternating current. In fact, it uses high technology to drastically improve the medieval soldering iron hemostasis method, making its usage more precise and controllable. 【5】

There are a lot of small blood vessels inside the liver. When the liver is cut off, they have to face them. It is unrealistic to suture them one by one with catgut alone.

Every minute the abdominal cavity was left open brought more danger to Olgi, the loss of blood and the bacteria in the air could kill him.Carvey doesn't have that much time for suturing, not to mention the poor quality of the current sheep gut and the thick needles, half of whether he can really stop the bleeding depends on luck.

Therefore, the most direct way is to simulate the effect of the electric knife to speed up the operation.

He carefully took the iron rod from Nurse B, and under the horrified eyes of everyone, he touched lightly the left outer lobe of the liver that was about to be cut off.

Hey~
"Kavi, what are you doing???"

Compared with a room full of doctors and nurses who are closer to the medieval soldering iron to stop bleeding, Kawei, a modern person, is more familiar with this scene: "It's okay, I just make a judgment in advance. The temperature of the hemostasis must be controlled well, otherwise the liver section is easy to burn, which is not conducive to healing. ”【6】

The surgery in front of them greatly exceeded their imagination. The nurses were originally from the bottom of the society and had not received systematic medical education. They were surprised and had nothing to say, so they could only continue to work hard.

Unlike Hills and Lockard, Carvey embraced the medieval soldering iron and completely overturned hundreds of years of medical progress.
"Are you using a soldering iron to stop the bleeding?"

"You turned the clock back on history? It's horrible to go directly to the soldering iron."

"It's a good way to stop the bleeding, what are you in a hurry for?"

The iron rod that was not completely reddened still had a faint scorching mark on the surface of the liver envelope, and Carvey handed the stick back to the nurse: "Move the stove to my feet, and stick the stick inside to burn. "

"it is good."

Carvey found another scalpel from the pile of instruments on the side, and began to cut the left outer lobe of the liver: "Hills helped his liver."【7】

Hills hesitated, but seeing Olgi's open stomach, he still stood up.The medical theories he had studied for more than ten years collided fiercely with the reality before him. He didn't want to believe that Carvey's approach was correct, but now no one can take over the position of the chief surgeon.

And he also really wants to see how the dense liver tissue should be removed.

What Carvey did next was much rougher than the modern left lateral lobectomy. In order to speed up, he had to treat the liver tissue on the left and right sides differently.

The scalpel starts at about 2cm from the edge of the injury, and cuts from the lower edge of the liver from bottom to top.

He needs to be as careful as possible with the right section that remains in the body.Slight and meticulous cautery is first performed on the disconnected blood vessels and hepatic ducts to achieve temporary coagulation, and then the final ligation is performed with sutures.

For the discarded left outer lobe on the left side, he used a hot iron rod to perform carpet ironing. 【8】

Scalpels, sutures, and fire sticks, accompanied by billowing smoke and the smell of charred liver, made the operation scene very exciting: "Dr. Locard, why are you still standing there? Get the suction device. Take the smoke away! There is smoke in front of my eyes, how can I go on?"

Although soldering iron oil is a traditional advantage item of European surgery, both Locard and Hills were born late and did not catch up with the good times, so they have never seen such a big scene.

"Is this considered surgery???"

Watching Carvey turn the precision cutting and stitching into a barbecue stall, Sears' brain was shaking uncontrollably.But in fact, the cutting of the left outer lobe of the liver went very smoothly, there was not much bleeding on the left and right sides, and the section was very clean.

Crow beak forceps, scalpels, fire sticks, and suture needles lined up in sequence, and entered Kawei's hands in turn, flying over the liver section.

Lockard was busy sucking the smoke and maybe he didn't see the specific operation carefully, but Hills was standing opposite and he did see clearly.This is the first time he has really observed Carvey's operation up close, and it is also the first time he has experienced Ignatz's mood.

He finally knew why his teacher was so protective of this guy, and why he was indifferent to his departure.With such superb skills, not to mention Sears, even two Ignatzes can't compare.

Is this the difference between ordinary people and geniuses?
Hills went from being curious at the beginning to being surprised, and then to questioning, but now there is only a deep sense of powerlessness in his heart.He was at a loss, and he didn't know how much effort it would take to catch up with this gap.

ten years?

20 years?
It is recognized that Ignaz, who is the most powerful in Austria, should not have such skills. Hills thought over and over in his mind, and couldn't find a way to catch up with Kavey.However, after half an hour of his bewilderment, the left outer lobe of the liver was finally completely removed and moved out of Olgi's abdominal cavity.

The bullet hit the middle of the upper abdomen, shattered the outer vest, and then entered Olgi's body with the rags of his shirt.After penetrating the abdominal muscle, the lead bullet entered the left lateral lobe of the liver.

Fortunately, it was a pistol, and the bullet did not penetrate the liver, because the largest arteriovenous vessel in the abdominal cavity was behind it.

Carvey tried to slowly release the blocking band of the first hepatic portal. The sutures were very tight and clean, and there was no sign of bleeding.So far, the left lateral hepatic lobectomy has basically been declared a success.

"Give me sutures." Carvey removed the liver and began to suture the remaining liver on the right side. "How's your heart rate?"

"132."

"Okay, very good." Although the change in the number is not obvious, Kawei can feel that the rehydration has started to work, at least the shock has not aggravated, and he is in a good mood immediately, "The next section can't just be open like this, It will affect the healing of the liver section."

After speaking, he folded the front and rear edges of the liver section, and then sutured it with needles and threads, hiding the section inside. 【9】

If it was normal, he would choose to let the young people around him come forward to practice at this time.But the situation is different now, Olgi does not have the support of many modern maintenance drugs, and will deteriorate at any time.He glanced at Hills, and chose to finish the rest of the liver suturing by himself.

After the suturing is over, the rest is the finishing work after the liver is cut.

For example, cover the sutured wound with the ligament that was separated just now, and then use the greater omentum for a second wrap to do a good job of protection.

"Next we'll move on to the laceration hematoma on the spleen."

The operation has entered the final stage, the most serious liver damage has been removed, and the spleen bleeding is not serious.Although Olgi's vital signs are still a little unstable, but overall it is developing in a good direction, and Carvey is a lot more relaxed: "The liver was successfully cut, don't be so stern."

"And the spleen."

"The condition of the spleen is okay." Carvey took away the gauze lining the hematoma of the spleen, and the blood was not obvious. "Look, this kind of wound doesn't need to be cut at all, it just needs to be sutured. Where to cut it, see if it can be remedied, if it cannot be remedied, then it will be too late."

Although the office is very busy, the atmosphere is still like a pool of stagnant water.

Seeing that the two just nodded, Carvey suddenly asked, "I'm curious, why did that man rush in to murder Dr. Olgi? Did the operation fail?"

"The operation is not considered a failure, it can only be said that there were complications." Hills changed his explanation for the failure, "but that guy insisted, first he asked the teacher to waive his medical and operation fees, and later he blamed the teacher for ruining the operation. He fell in love with him. You heard it at the gate just now, he is a guy with a brain problem."

"Destroyed love?" Carvey suddenly began to gossip, "Can you tell me the details?"

Hills was a little embarrassed to speak, but Lockard on the side had no worries, and said directly: "The teacher told his fiancee two days ago that he would not be able to have children in the future, so his wedding was ruined."

　There are a lot of things to talk about in the operation, and the writing is slow. It is also far from simple to rescue the rupture of the liver and spleen in reality. Surgery is always accompanied by risks. I need to make some trade-offs in details. Here I can only downplay it for the sake of the plot.Go on stage.
　　
　
(End of this chapter)