Nineteenth Century Medical Guide

Chapter 126 123. Three Answers
Since Carvey successfully completed the cesarean section last time, the Lakeside Theater has been preparing for the next cesarean section.

The main goal of the work is Carvey, and the price and the success rate of the operation have become important bargaining chips in the conversation between the two parties.After several contacts, the Riverside Theater recognized Carvey's ability and promised to give 5% of the share as long as Carvey's cesarean section was successful.

5% is neither high nor low. After all, Kavey is too young to give too high a ratio at once.

But for Carvey, this is not a matter of more money and less money.The value of one's own surgery is life-threatening and should not be measured by money.If you really want to use money to give a certain value, then 5% is really too low. After all, this is not a modern day that is about to become an assembly line operation.

He didn't get entangled with the other party. Anyway, he didn't sign any written agreement with the theater from the beginning to the end. After the cesarean section was over, Carvey would suggest to the hospital again that the hospital should open a surgical theater by itself.

As for whether the hospital management will support Carvey or stand on the side of the theater and maintain the original state, it depends on the result of this operation.

The lower the success rate of the operation, the economic value brought by it once it succeeds cannot be calculated by simple mathematical formulas.The ticket price has already explained part of the problem. If Carvey's surgery is finally successful, then his value should not be a poor 5%.

The Lakeside Theater is not an idiot, and has also changed after seeing the huge income of tens of thousands of crowns in just a few days.

The venue of the theater cannot be changed, but the internal facilities can be updated.The candle lamps on the walls had all been replaced with wall-mounted oil lamps, and the candlesticks used to illuminate the chief surgeon had also been replaced with more advanced portable lamps.

The types of food sold have also changed, from simple snacks to staple foods such as fried bacon, roasted pork knuckle, and veal steak.The food is pre-cut into small pieces, and small forks are provided, which is more humane.Corresponding desserts, fruits, and fine wines will certainly not be missing.

This time, the theater also considered the experience of the audience in the back row, and specially placed a temporary sales point for high-power telescopes dedicated to surgical theaters at the entrance.

It is not expensive, the price is 150 crowns, and if the operation is successful, you can use the telescope to ask the surgeon for his signature. 【1】

These are all changes in the audience experience. For the surgical center area, the theater has not forgotten Carvey's habit.They specially made changes to the rest area, freeing up a space for disinfection preparation by the running water, with salt, baking soda, kettle and stove.

In addition, the operating table was remade according to Carvey's intention.

There is no embedded fixed relationship between the table legs and the table top, but the height can be adjusted, so that the operating table is no longer a simple horizontal plane.The upper end has a movable cushion close to the acromion clavicle, and the lower end can be bent downward to place the patient's legs. 【2】

These changes have firmly attracted the audience's attention from the very beginning, achieving the brightest moment since the completion of the Lakeside Surgery Theater.

At 11 o'clock in the afternoon, the host slowly walked into the venue wearing a gorgeous dress, and calmed down the noise in the venue with his unique smile and posture: "Ladies and gentlemen, welcome to the most famous surgery theater in Europe. one
Today we are honored to invite the youngest surgeon in Vienna, a young man who is well-known in Vienna because he has successfully performed several abdominal operations.

His reputation may not be comparable to that of famous surgeons such as Ignatz, or Waterman, Olgi, Massimov, etc., but his cesarean section is destined to bring a completely different exciting experience to everyone. "

As soon as the voice fell, the door opened, and Carvey walked into the theater wearing his black coat.

"Good afternoon everyone, thank you for taking the time to join us."

Carvey asked the little assistant on the side to put on a surgical leather skirt for himself, then stepped forward and patted the host on the shoulder, saying, "It's getting late, and everyone is an old audience, so there's no need to be polite. The assistant is still the old one." Faces Hermann, Bergett, Melen and Sarsson, let's introduce today's patients as soon as possible."

Just when Carvey got the right to speak and attracted all the attention, the four assistants filed in and began to prepare for the preoperative work that had been discussed before.

The water has been boiled and sterilized in the morning, and now it needs to be heated before it can be used.Among them, according to the ratio of Kavey, 1L of water + 9g of salt.Sodium bicarbonate was not used this time, because the mother is usually in good health, and now there is no hemorrhagic shock, and there is no risk of acidosis.

But what happened next confuses many people.

"On stage today was the brave Ms. Brenda, a baker's wife, who underwent a cesarean section. She had bleeding three weeks ago and was diagnosed with placenta previa by the obstetrician at Graze Hospital.

The operation was so dangerous that the surgeon at Graze Hospital refused it.

This is normal and not something to regret, because there are not many doctors who actively choose surgery knowing that the operation will fail.

As we all know, cesarean section is a problem all over the world, and placenta previa is a big problem in cesarean section.Today I will use some new devices and new drugs to try to solve this problem, hoping to not only bring you a visual experience, but also pave the way for future cesarean section operations. "

Brenda sat quietly in a wheelchair and was pushed into the venue, but everyone's focus was not on her, but on an iron frame next to the wheelchair, or more precisely, an iron frame filled with Glass bottle for liquid.

The bottle enters her arm via a long brown tube and a connection. 【3】

Carvey is no longer a surgical assistant who has just joined the job for two days. Several successful operations and successful surgical regular meeting speeches have gained him a lot of popularity and prestige.

The young medical students immediately took out pens and paper, hoping to learn some new knowledge from this operation.And those doctors prepared the difficulties, problems and causes of death that may arise during the operation early, hoping to get answers during the operation.

And the glass bottle and rubber tube on the wheelchair is the first answer given by Carvey.

"What is this?"

"I don't know, maybe it's another gadget newly invented by foreign countries."

"I saw that the rubber tube was stuck into the arm. Could it be that the medicine in the bottle is going to be poured into it?"

"Pouring water into the blood? Can this work?"

"In fact, it has been around for a long time. It was done when the cholera broke out more than 30 years ago."

Carvey cleared his throat and briefly explained how the infusion set works.The principle is very simple, but what is really important is the purpose of the infusion, because it is strange to infuse normal saline directly into a normal person's body no matter what age it is.

"Cesarean section with placenta previa can lead to massive bleeding and death. I have been thinking about a problem since I performed the operation for Dr. Olgi's abdominal hemorrhage."

Carvey helped Brenda onto the operating table and explained: "In the face of massive bleeding, since we cannot change the amount of bleeding, can we increase the remaining blood volume in disguise by infusing some fluids in advance to increase the total blood volume after bleeding?" the goal of."

This is a long, mouth-wrenching sentence, but anyone who understands it will seem to have opened the door to a new world, and write down all their thoughts in a notebook.

"I have injected 500ml of saline into Brenda's body, the concentration is 0.9%, please remember this concentration." Carvey tapped the glass bottle on the infusion rubber tube with his finger, "I have used various The concentration of saline is infused into the blood vessels of voles and rabbits, the safest concentration is this concentration, too much or too little will not work.”

Concentration is actually related to plasma osmotic pressure. These knowledge points will be integrated into the paper by him and published in the end, so I will skip it for now.

"0.9%, must this concentration be?"

"Please make sure to maintain this concentration." Carvey said, "This is supported by actual experimental data."

After explaining the preoperative infusion, Brenda was already lying on the brand new operating table.Half of the clothes were lifted, revealing a round belly.

"This is my improved operating table. It no longer uses the conventional horizontal plane operation method, but uses a height-adjustable table foot combination to achieve the purpose of changing the patient's position during the operation."

Carvey introduced: "There are pedals at the end, and the knees can be folded to place the legs. There are also several grooves at the front end, with detachable soft cushions, which can support the patient's shoulders according to their height and prevent them from slipping."

If you are a rich person without a medical background, you will only take a fresh look when you see the improved operating table, and you may forget it at a glance.But those surgeons who often come to the stage are different. The brand-new operating table immediately attracted their attention, and many sketches have appeared in many notebooks.

After the infusion bottle, the operating table is his second answer.

While giving the answer, he did not forget to continue to throw out his own views.Of course, Carvey concealed many physiological and pathological concepts, and brought the filter of the times to these views related to shock.

"The important organs that keep the human body running are all in the abdominal cavity. After massive bleeding occurs, the organs will lose serious blood, and the human body will die. I know that you must have many questions, but the reason is very simple, because people with severed arms and legs can still live. No more People with internal organs will definitely not be able to survive.”

Many people didn't understand the true meaning of his words, and finally Ignatz and Watman in the stands realized the key.

"No wonder you want to use such an operating table because you want to change the place where the blood flows by changing your body position!"

"Currently, the head is high and the feet are low. The blood is hidden in the blood vessels of the lower limbs due to gravity. When the bleeding is serious, it is changed to the head low and the feet high, so that the blood stored in the lower limbs will flood into the trunk to protect the body. .Wonderful!"【4】

Just when everyone wanted to reduce blood loss during surgery by blocking blood vessels, no one had ever thought of changing the body position to reduce the changes in signs caused by massive blood loss.

The two answers in a row made many people excited and had a lot of confidence in the operation: "This may really be able to deal with the bleeding of placenta previa."

However, there are still many people who maintain their objectivity and do not think that these small routines can change the outcome of the operation: "I am still conservative. The blood loss of placenta previa is often thousands of milliliters, which cannot be corrected by simple 500ml fluid replacement." .”

"Don't forget the oxytocin you used last time. The effect of contractions is very good."

"That's only for ordinary cesarean section. If you really encounter an 'exaggerated' placenta previa, things are not that simple."

In the 19th century, there were very few women who survived cesarean section, and placenta previa was only a simple placenta previa, and it would not develop into the dangerous placenta previa that is unique to modern times [5].Brenda is a multipartum woman, but she had a normal delivery before, and there is no possibility of dangerous placenta previa, so in terms of difficulty, this operation should be relatively small.

However, due to the limitations of the times, Carvey lacks many supportive drugs for pregnant women, and general anesthesia such as ether is also a risk factor for children, so he dare not take it lightly.

The preparatory work is still done according to the established rules. After the abdominal disinfection is completed, the inhalation anesthesia will take effect, and the operation will officially begin.

"Sarson first prepares the oxytocin injection needle, and Melen prepares warm salt water at 30°C, aspirator, and a clean water basin." Carvey pointed to an area with his toes, "The water basin and aspirator are placed at my feet Come on, come and draw blood after the uterus is cut."

"okay, I get it."

Hermann had previous cesarean assistant experience, and this time he stood in the first assistant position, while Bergett was the second assistant, mainly pulling hooks and maintaining lighting and vision.

"Take out the child within 2 minutes, and control the bleeding within 5 minutes. I hope it will be successful."

"The blockade is ready."

"let's start."

Having said this, the scalpel has cut through the skin and fat according to the incision position of the classical cesarean section.After further separating the muscle fascia and opening the peritoneum, it took only 1 minute for Carvey to enter Brenda's abdominal cavity.

Don't look for it, the enlarged uterus is just below the incision.

The stage couldn't help applauding the speed of the operation, because apart from the speed, Carvey also minimized the bleeding at the incision, and the entire operation area could be described as clean.

But just when everyone felt that the operation was about to get down to business, Carvey stopped the knife in his hand.In front of him is a purple-red distended blood vessel like an earthworm, crawling on the uterus with twists and turns, this is no ordinary placenta previa.

Carvey sighed and reported the operation process to the audience on the stage: "I have entered Ms. Brenda's abdominal cavity. You can see that this is her uterus, and the placenta should be in front. It's just that the placenta is not the same. Not good, these wantonly growing blood vessels are deeply piercing into the myometrium. It's a bit troublesome."

Now what he is facing is not only the problem of placenta previa, but the real trouble is these blood vessels. Modern medicine has a term for it: placenta accreta.

It seems that the third answer must be moved: "Sarsen, bring me my medicine chest."

"The one with the oxytocin?"

"Yes, there is a small bottle in the corner." Carvey looked at the implanted placenta, frowning, "Mellen, prepare the gauze, stack each eight, prepare a few more, I will use it later. "

(End of this chapter)