Nineteenth Century Medical Guide

Chapter 137 134. Copy Surgery
Humans are not machines, and have many shortcomings. If the chief surgeon wants to have machine-like precision, he has to make up for it with years of proficiency.

People are not machines, and they have many advantages. There will be quite a lot of emergencies during the operation. In addition, each patient is different, and various critical treatments brought about by each indicator require the cooperation of the operation team. and the decision-making ability of the chief surgeon.

Where did these things come from?

Of course, it is the result of constant surgical practice.

Modern surgical medicine has a relatively complete practice system. It starts with the practice of medical students, enters the regular training, and then professional training, and then formally enters the surgical team, and finally becomes the real chief surgeon.

There must be differences in the actual results, but the written regulations are the same, and each step has a set goal.When completing these plans, there will always be a senior doctor by his side to help guide and teach. 【1】

This is just a single training line for specialized surgeons to train existing or mature basic techniques and surgical procedures.

When a surgeon wants to try some new surgical methods on the same kind of patients, he needs to learn through surgical videos and communication with each other before proceeding.

If he wants to take this attempt into a new field, watching videos and simple language communication may not be enough for doctors to have the confidence to operate. At this time, further study is often required to increase clinical experience.

Lower-level hospitals go to higher-level hospitals for further training, and higher-level hospitals go to hospitals that have developed these new surgical methods and new fields for further training.Of course, there are also those who are brave enough to get on stage without further study, know all the theoretical knowledge, and have enough professional titles, but the work in hand is messy, which belongs to the category of irresponsible poor performance.

Olgi certainly can't be called a bad show. He came on stage only half a month after he was injured by a knife and a gunshot wound. It has already shown that his goal is to get the cesarean section as soon as possible.Hills can't be called bad. Being able to get rid of Ignatz and start again from another hospital also shows that his goal is to prove his strength with an independent surgeon.

These are the main reasons, but the secondary reasons cannot escape the word "name".

They need this "name" to justify themselves, and at the same time, they can attract a lot of business for the hospital, and patients are the tools to become famous.If it fails, sacrifice the next one.

This practice was common in the haphazard medical environment of the 19th century, and it was actually done by Ignatz and Wattman.It's just that they had Kawei as an assistant behind them, and the operation went smoothly, but the two from Graze Hospital didn't, and the operation failed.

This time, Carvey also imagined that he could teach one by one.

But because of his "name", it was impossible for Olgi to put down decades of experience and status, and humbly go to Kawei for the so-called "training".Even if Kawei gave up the position of the chief surgeon, he still felt that it was awkward to have to follow the opponent's request every step of the way.

Hills finally got his current position. If Kavey is allowed to step in, he will be forced to the second assistant position again, which is more disgusting than turning back.

The above is the pressure from the hospital, and the bottom is the inner persistence of the two. It is not difficult to understand such a result.

Kavey also knows the feeling of being inferior to others, and trying to persuade him by force at this time will definitely have the opposite effect, and even cause fire.Since others were determined, he could only sit in the auditorium and watch slowly, taking the opportunity to collect more operational errors.

After the operation is over, write them into the main points of cesarean section operation, and then change the current situation of high mortality rate of cesarean section.

Cesarean section was originally a very lucrative program. The process was complicated and dangerous. The operation process was fast in and fast out.After being set a benchmark by Carvey, it could have brought more audiences, but the Municipal General Hospital suddenly came to draw its salary from the bottom of the pot, and the theater had no choice but to let go.

I thought I could maintain the original market by relying on confidence, but this entry and exit will not only reduce the income, but also the audience who came for the cesarean section.It was also a cesarean section, and the theater in the city general hospital was overcrowded, but it was much quieter here.

At four o'clock, the host entered the venue on time.

"Emmm, it seems that there is no lady here, so good afternoon, gentlemen. The performance that will be performed today is the very famous elite surgical team in Vienna."

The host was still wearing a dark red coat, packaging the upcoming doctors brightly: "The team members are all from Graze Hospital, and they are all surgeons who can handle complex operations on their own. Today they gathered in nearly a hundred doctors. Under the oil lamp, I challenged again, a cesarean section operation that can only be completed with the gift of God.

The afterglow of Dr. Carvey has come to an end, and now the three doctors of Graze Hospital, Olgi, Sears, and Lockard, will continue to shine, so let us invite three doctors to come on stage."

The opening remarks were obviously designed. Not only did Carvey feel weird, but many viewers also felt weird.What is the gift of God to complete?What is the curtain?What is the continuation of glory?

It seems that every sentence says that Carvey is lucky to get to where he is today, but he has performed 7 cesarean sections, and none of them failed.According to what he said, wouldn't God have to live in his own home every day?

Everyone came to see the operation, so it's not enough to complain about a host because of Carvey, not to mention that not many people in the audience remember him.

Three doctors opened the door and walked into the venue one after another. At the same time, there was a small team of four behind them, responsible for carrying surgical instruments and a lot of bottles and jars that needed to be used.

Olgi walked to the auditorium and nodded slightly: "The patient undergoing surgery today is a peasant woman in the outskirts of the city. She is 22 years old and gave birth for the first time. Because she had obvious vaginal bleeding a month ago, we concluded that she is a pre-existing woman. The placenta requires surgery to remove the fetus.

Two days ago, her vaginal bleeding increased significantly, and the hospital sent a special car to bring her to Graze Hospital for surgery."

While speaking, two nurses in the theater pushed the mother into the theater.

Like Carvey at the time, the mother had a hanging bottle in her hand, and 500ml of normal saline had been injected into it.The operating table was also set by Olgi with the head high and the feet low, in preparation for the possible bleeding during the operation.

These are all done well, the only difference is the people around the operating table.

For a country girl who entered the city for the first time, the spiraling surgical theater in front of her eyes, more than 30 gentlemen in uniform black coats, and the smell of disinfectant on the tip of her nose made her quite nervous.

"The operation will be over soon." Olgi drew her attention, and said to her with a smile, "It feels like I just fell asleep, and I can see the child when I wake up. There is nothing to be nervous about."

The woman rubbed her stomach with one hand, took Olgi's hand with the other, and nodded slightly: "You promised me that I would keep the child?!"

"I swear, it will."

Olgi comforted her and began to introduce the preparations before the operation: "We still adhere to the disinfection standard advocated by Dr. Carvey this time, first treat her abdominal skin with carbolic acid and alcohol, and clean the rubber on our hands with disinfectant water." Gloves before performing the procedure."

Olgi looked at the nurse at the side. The black mask covered the peasant woman's mouth and nose, and the ether vapor slowly diffused into the respiratory tract through the rubber tube, and then diffused into the blood.Soon the anesthesia reacted, first coughing, then increased saliva, the peasant woman began to swallow non-stop, and then slight vomiting began to appear.

"Bring a towel." Olgi turned her head to the side, "These are side effects of ether anesthesia, bear with it, it will be fine soon, it will be fine, it will be fine"

The nurse patted the peasant woman's face lightly: "The ether has worked."

"The disinfection here has also been completed."

Olgi glanced at Kavey in the auditorium and put on his gloves: "The operation is starting now, scalpel."

Considering that the peasant woman had placenta previa, the surgical incision did not choose the subabdominal incision that Carvey had been using for several games, but entered the abdominal cavity according to the earliest incision through the rectus abdominis muscle.After all, Olgi has decades of clinical experience, and his techniques are sophisticated. Judging from the coloring of the gauze, there is not much bleeding into the abdominal cavity.

"Cut the peritoneum and we're in"

After talking more than half of the words, the scene in the abdominal cavity in front of Olgi forced him to swallow the last tail: "If I read correctly, this should be the placenta that Dr. Carvey encountered last time. Implant it."

It was still a familiar large group of red and black blood vessels, which were intertwined and covered the wall of the uterus.

"The range is 5*6, maybe even bigger than that day." Olgi roughly measured the implant range with his fingers, and then said, "Bring the blocker."

A gauze strip 3 cm wide and half a meter long was placed in the lower uterine segment, and ligated and oppressed to block the blood flow into the uterus.But these are definitely not enough. Preparations must be made to collect blood for blood transfusion: "The suction device and blood receiving basin are ready, the jar is opened, and the anticoagulant is ready."

Lockard and another assistant had already been prepared on both sides of the operating table, as long as an order was given, they would step forward to deal with the surging blood.The midwife at the other end is standing a little further away, as long as she enters the uterus, she will step forward to help fetch the fetus.

For this reason, they have practiced hundreds of times, and everyone is confident that they can do their job well.

But the patient's body is ever-changing, and the situation on the surgical site is also ever-changing. Apart from practice, what they can really rely on is the decision-making power of the surgeon.

Olgi's scalpel avoided the implant site, just as Carvey had done then.In order to facilitate the extraction of the fetus, he made a long longitudinal incision on the uterus, reaching the fundus of the uterus and exceeding 10cm in length.

For the first time, Carvey watched someone else's cesarean section from the audience's perspective.

Olgi was also considered "obedient", and the disinfection and preparation work before entering the abdomen were done well, but the selection of the entry point for the uterus was a bit far-fetched.Carvey knew that he wanted to increase the error tolerance rate of fetal extraction, and he could also rely on this longitudinal incision to avoid the placenta coverage, or at least touch the edge of the placenta, and only need to peel off to have enough space without directly incision placenta.

This kind of long longitudinal incision also has disadvantages. The recovery will be poor, and there will be a considerable risk if you want to get pregnant again in the future.

But what really surprised Carvey was the peasant woman's placenta accreta.

The incidence of placenta accreta is not high, but within a short period of one month, there were two implanted women, which made Carvey think of Brenda who had just been discharged from the hospital.

"It's bleeding, catch the blood!" A loud roar pulled Kawei back from his thoughts.

At this time, Olgi's scalpel had cut open the uterus, and a large amount of amniotic fluid mixed with meconium and blood poured out of the uterus.Immediately after the fetal head was exposed, the midwife stepped forward, put one hand into the womb, raised the head, and gently pulled with both hands: "The baby is out!"

There was a lot of applause on the field, which was an affirmation of the success of the first half of the operation.

Then comes the truly thrilling time.

"I don't want this basin with amniotic fluid, just use another basin to catch blood." Olgi began to explore the inner wall of the uterus in his hand, "Come on, give me gauze first, I will do some oppression."

"Give."

The yellow and white cloth strips turned red shortly after entering: "...Give me the gauze again"

"."

"Give me a little more, a little more!"

"."

The gauze was continuously stuffed into the peasant woman's uterus, but the bleeding was still going on, with no sign of abating.

Olgi knew that this was the limit, so he asked Locard to find the oxytocin that he had just ordered from the pharmaceutical factory: "A bottle of 50 kroner, a real life-saving medicine that is more effective than the panacea in the pharmacy, put it all in Muscle layer of the uterus."

One, two, three, oxytocin was continuously injected into the peasant woman's body, but the uterus remained motionless.

"placenta!"

Suddenly, a voice suddenly sounded on the stage, and then quickly disappeared from everyone's ears.Olgi realized that he had forgotten the important process of cesarean section. No matter what the situation was, the fetus should be taken first, and the placenta should be taken second. If the placenta is not removed, the next step of hemostasis cannot be done, because it cannot be stopped at all.

".To take the placenta!"

Olgi suppressed his competiveness, and followed what he said on the stage just now: "Swapping the positions of the operating table, how about the blood from the blood basin?"

"It's almost 700ml."

Olgi slowly peeled off the placental tissue implanted in the uterus with his hands, while saying: "Prepare to start the autologous blood transfusion."

Without Olgi talking about the blood transfusion process, the two nurses have already carried out blood anticoagulation and filtration according to the most standard methods.The infusion bottle on the side was also taken off, ready to replace the original normal saline with fresh non-coagulated blood.

Perhaps Olgi's handling was still a bit rough, and perhaps the cooperation between the teams needs to be strengthened, but the surgery on the scene seemed to be proceeding at the same pace as before.

Carvey also hopes that the operation can go smoothly, so that Vienna can also have one more surgeon who handles cesarean section, so that he will not become a "holy obstetrician".After doing so many cesarean sections, I really vomited.

But the great God seems to be joking with everyone.

The work of stripping the placenta has just come to an end, and it is about to enter the final sprint stage.It may be that Olgi was too excited, or he was too focused on the blood loss of the peasant woman. He exerted too much force on his fingers, and with a puff, he directly pierced the uterine wall where the placenta was too deep.

(End of this chapter)