Nineteenth Century Medical Guide

Chapter 225 222. Ward Inspection
A good surgeon is a combination of a physician and a surgeon. Without good basic skills in internal medicine, accidents will happen sooner or later.

Of course, the development of modern internal medicine is based on the common development of other disciplines such as profound basic medicine and complex pharmacology and toxicology. It was difficult to lay these foundations in a short time in the 19th century, so Carvey’s requirement is to be a good surgeon first.As for those things in internal medicine, they can only be subtly instilled in them.

Because these things are difficult to understand for a while, Kavey needs to use some mandatory requirements when instilling them.

For example, when using alcohol carbolic acid, Carvey will not explain their disinfection mechanism, but can only say that the experiment is very effective.The hydrogen peroxide and suture methods used for debridement in the wards are also based on the same principle. The standard is established first, and the principle part can only be filled in slowly.

For the concept of perioperative period, Carvey will not emphasize the concept, but will only teach them a series of standards and let them strictly implement them.There is quite a helpless feeling of being unable to speak clearly when teaching children to read.

The postoperative 24 hours in the perioperative period is the peak period of death, and the 1st to 3rd postoperative days are the key to judging the success of the operation.

It is impossible for Carvey to see the progress of each operation, and he can only complete the evaluation work through the operation records they wrote down and the current situation of the patient.

The hospital has 1400 beds, plus several temporary tents and other rooms outside the main building, the number of beds has reached nearly 2000.Compared with the chaos in the Granseny Central Hospital in Prussia, it is much more orderly here, and of course the wounded soldiers are much more serious.

Prussia's frontline battlefield is almost ungraded, and anyone may move to the rear.

But Austria is different. The professional evacuation system has filled the fortress hospital with 2000 seriously injured patients.This means that there are more wounded soldiers in the front-line temporary ambulance, and it also verifies from the side how powerful the Prussian breech-loading pistol and the new Krupp artillery are.

Although the army commander has been yelling to charge, since firearms have been used instead of cold weapons on the European battlefield, cut injuries from swords have basically faded out of the sight of military doctors, and various complicated firearm injuries have become the mainstream.

Carvey is not a military doctor, and he only occasionally saw some gunshot wounds in the past. The scene of the ward rounds can only be described as "spectacular".

"1 bed, Second Lieutenant Lars of the Kravov Infantry Battalion, shot wound, 11 projectiles in the left arm, comminuted fracture of the humerus. 2 projectiles in the left abdomen, ruptured spleen."

Talking about the patient's condition was a 33-year-old surgeon. Although he had been working as the chief surgeon in his hometown in Graz, he failed the examination by Carvey.According to the assessment requirements, he had no way to stay in the central hospital, he should be a doctor with the army. Although it was dangerous, at least he had autonomy, but he chose to surrender his status and stay here as an assistant.

"What surgery did you do?" Carvey asked, looking at the wound.

"The trauma to the left arm was serious, and the ambulance station only did simple debridement and bandaging. When it was delivered." Gorham was not very familiar with the new word "blood supply", so he said it awkwardly, "When it was delivered The blood supply to the forearm had been cut off, so Dr. Hills chose to amputate it."

"What about the abdominal cavity?"

"Splenectomy."

Carvey glanced at the rubber tube leading out from the wounded soldier's stomach: "How about the intake and output?"

"In and out?"

Gorham didn't understand what he meant for a while, so Carvey had to explain again: "There should be in the record, how much fluid was infused, how much blood was produced, how much urine was excreted, and what was in the drainage tube. How much blood came out. Didn’t military doctors have been trained before entering the job? Forgot?”

Gorham has indeed forgotten, but it is not an easy task for a doctor in his 30s who has formed an inherent medical concept to change his past habits in a short period of time.

"I'm sorry!" He quickly reported the data, "1000ml of fluid was infused during the operation, the bleeding exceeded 1000ml, and there was almost no urine on the first day. After the operation, Dr. Hills gave him another 1000ml, and the urination was around 1100ml on the second day , the discharge volume of the drainage tube is 50ml. Today’s words.”

"Okay, I see."

Carvey looked at the wounded soldier's surgical incision and drainage tube, smiled gratifiedly, and said to Ignatz beside him, "Teacher, Hills can now have a splenectomy."

"It's really not easy." Ignatz also glanced at the incision, "At the beginning, he learned for a long time from simulating the bullets into the corpse."

Splenectomy can only be regarded as a moderate difficulty in the existing Austrian surgical team, and any surgeon who can be the chief surgeon in a central hospital will do it. This is a basic requirement during surgical training.But the real trouble is not the splenectomy itself, but the blind cavity after the bullet is fired.

Hills strictly complied with Carvey's requirements, and the incision was injected along the bullet. When suturing, he tried his best to ensure the tension of the incision, and at the same time, he paid attention to removing some cauterized and necrotic tissues.

The surgery was really beautiful.

Carvey nodded: "The drainage tube only outflowed 5ml today, and the tube can be removed tomorrow morning without any problems."

"Okay." Gorham wrote in the notebook, "The second bed was also shot wounded, also from the Kravov Infantry Battalion, Lieutenant Feito. A total of dozens of projectiles were shot into the left and right legs, and the right leg was injured. Three fractures, one in the left leg."

"Operation?"

"The right thigh was amputated, and the left calf was amputated." Gorham looked at the second lieutenant who was leading the charge with a gun a few days ago, and said cold numbers, "The fracture of the right leg is serious, and the left calf still had a chance, but .But the blood supply is not good. A total of 24 iron pellets were taken out during the operation, and some remained in the body."

Compared with the first bed, Feituo's situation is much more serious. It is not known whether the shotguns were shot crookedly or rebounded, and almost all of them went towards his lower body.Most of the wounds were concentrated on the right thigh and left calf, but some went to his vagina.

"How did you deal with it here?" Kavi asked, lifting Feituo's quilt.

"I took out some of the projectiles after cutting them open." Gorham replied simply, "Some of them were shot too deep, we didn't dare to move."

"You? Are you also on stage?"

"I'm Dr. Hills' first assistant."

"How is Gao Wan?"

"After entering the vaginal sac, we saw that the right one had been shattered, and the left side had been hit by two bullets. It was very swollen, and the vas deferens was also broken." Gorham looked at Feituo again, and said helplessly. , "We can only do resection."

Kavey nodded, this is a very correct choice.

The gao pills that were shot basically lost their function, and there was no benefit in staying inside, it would only aggravate the subsequent infection.And this kind of infection will not subside because of the low-efficiency antimicrobial drug methylene blue because of the stimulation of the projectile. In the end, repeated infections are likely to affect the whole body.

This is not the top three in the modern first-tier cities. At that time, it will be too late to think about surgical rescue.

"Good job." Carvey replied, and then looked at the patient, "How do you feel?"

Feito is 25 years old, has been in the army for three years, and spent three years in the Klavov infantry battalion. He is also a veteran of the army.This battle didn't come suddenly, maybe it could bring him a lot of honor, but it's a pity that this shotgun came very suddenly.

Both legs are crippled, and there is no gao pill, and now there are many wounds on the lower body that are drained with gauze strips, looking like a disabled person.

Feito was very frustrated, and now he heard Kawei's cold question, and his mood was even worse: "I feel very bad, I have no legs, no gao pills, what is the difference between me and a cripple? Why don't I just die on the battlefield Come on, so you can leave a good name on the tombstone!"

"Don't worry about your legs, I will help you get a set of prosthetics after you return to China." Carvey checked the wound on the amputated limb, "You will definitely not be able to run by then, but you can still walk with a stick, that is. Go slower."

"Prosthetics will allow me to walk?"

"The Municipal General Hospital has the best prosthetic rehabilitation technology in Austria." Carvey said vaguely, "However, in the end, it still depends on your own rehabilitation."

This news gave Feito a little more energy: "What about the gao pill?"

"I really can't do anything about that." Carvey shook his head and started walking to the next hospital bed.

"I heard that if you put cow's gao pills in, the function might be even stronger?"

"Who did you hear?"

"Newspapers, those famous surgeons, and that ogre Fernand."

"Sorry, I don't have this ability."

Carvey has no time to talk to him about these topics now, and after a few words, he has come to the bedside of the third bed: "What's the situation with him?"

"It was also a shotgun shot. A total of 13 rounds were taken from the left shoulder and the left abdomen." Gorham said, "The choice was amputation of the left arm, splenectomy and anastomosis of the descending colon."

"Oh? The intestines are broken too?" Carvey finally heard a patient worthy of analysis, but then he saw the incision picture and his emotions fell to the bottom. "Who performed this operation? Hills?"

"It's not Dr. Hills, it's Dr. Delvaux."

Carvey didn't have much impression of this name before, but after the scene in the office just now, he had already remembered the surgeon from Innsbruck Hospital: "It's him? Give me the operation record."

Carvey changed the way he asked just now, took the record and looked at it: "Why didn't you put a drainage tube in the abdominal cavity for such a major operation?"

"This..." Gorham was terrified by the sudden question, "Maybe it was because there were not enough tubes during the surgery."

"He came to the hospital at noon on the 26th, only 1 minutes later than the first bed, and this is used up?" Carvey glanced at the patient behind him, "Aren't there other patients still using the abdominal drainage tube?"

Goram lost his voice for an instant.

Because the earl's son was treated with a minor calf injury first, Carvey remembered the name, so the requirements became extra strict: "The surgical record did not include the amount of bleeding, nor did it write about the process of exploration. Look at this incision." Bar!"

After speaking, he put the back of his cold hand on the forehead of the wounded soldier: "Where's the temperature record?"

"It was measured this morning, around 38 degrees."

"Why is there no temperature record in the medical record?"

"Morning. A large number of wounded soldiers came again in the morning. We are too busy."

Carvey sighed, lowered his head and uncovered the gauze on the wound, and then gently pressed the surrounding skin with his fingers, causing the soldier a burst of pain: "He did a colon anastomosis, I should have said in the training, The abdominal and intestinal anastomosis must be cleaned, and it must be cleaned repeatedly before and after the anastomosis! Now that the incision has begun to be infected, there must be a problem with the cleaning during the operation!"

Goram stood behind him, not daring to say much.

"You followed this operation?"

"not me."

"Find someone for me!"

"Dr. Delvaux should still be sleeping in the lounge."

The high-intensity operation for three consecutive days made almost all the surgeons either sleep and rest or fight on the operating table.Although Carvey was angry, he was still young after all, so he wouldn't be so shameless: "When you wake up, pass on my message and ask him to come to the dean's office."

"OK, Got it."

"Forget it, no need, I have a meeting tomorrow morning, let him come to the conference room."

"Oh."

Carvey looked at the incision, then looked back at Ignatz: "Teacher, the doctors here are all busy, why don't you take care of it?"

Ignatz nodded: "Anyway, I, the chief surgeon, came here to help. The operation is not difficult, just re-cut and rinse thoroughly."

"We have to see how well his anastomosis is done." Carvey said, "A doctor who is so careless may have problems during suturing. If there is a tear or necrosis in the intestinal segment, then"

"Cut it off, and do the anastomosis."

"Yes, and pay attention to whether there are other pus cavities around."

"I understand this."

Just when Ignatz was about to appoint the assistant beside him as his first aid, a familiar voice suddenly came from the door: "I heard that Kawei is here? Where is he???"

"Mr. Billrot?"

Carvey put down the notebook in his hand, walked to the door, and saw Bill Roth who had just come off the operating table.At this time, he was still wearing the leather skirt in the operating room, and the gloves on his hands had been taken off, but he could still see mottled blood from the cuffs: "You are"

"It's fine if you come back, come with me to see the wounded soldier, it's about to die!"

"Another shotgun injury?"

Carvey and Bill Roth did have a lot of disagreements, but he still chose to refer to each other as "teacher".This is directly related to the name of the father of Bill Roth's general surgery. Facts have also proved that after training at the Military Medical Office, it is Bill Roth, who has a strong foundation in abdominal anatomy, who reassures Carvey the most.

Since even he is difficult to deal with, it shows that the situation of the wounded soldiers is very complicated.

"It's not a shot, it's a bullet, only one."

"One?"

Billrot pointed to his head: "It's really bad luck, it hit him on the head."

(End of this chapter)