Nineteenth Century Medical Guide

Chapter 226 223. Surgery "Successful"

The caliber of firearms in the early 19th century was exaggerated. The main reason was that the airtightness inside the barrel was not good enough, and the energy of black powder was limited. Only by increasing the caliber could the power be maintained.However, the exaggerated recoil and the barrel without rifling make it difficult to guarantee the initial velocity and accuracy of the bullet, and the power is out of the question.

But in the mid-19th century, the Minie bomb was born. 【1】

This conical bullet is paired with a few simple rifling lines, and the rotation not only improves the accuracy but also improves the power.Infantry no longer need to be close to 300 meters to shoot, but can conduct accurate sniping from two to [-] meters away.

When it comes to the Prussian-Austrian War, we have to mention the Franco-Austrian War seven years ago.

In the battle with France, Austria was defeated quite thoroughly, destroying their imperial power to dominate Central Europe.

From some research conclusions of later generations, the Minie bombs equipped by France and the loopholes in the training and command of the Austrian military have become the main factors that determine the success or failure of the battle.It's just that fans of the authorities, whether France, Austria or other European countries, believe that the infantry's bayonet charge won the final battle victory.

Even the Three Emperors and their country's military experts regard the morale generated by their own fighting spirit and courage as the iron rule of victory on the battlefield.

This kind of misunderstanding and determination to insist on implementation caused France to pay an extremely painful price in the following Franco-Prussian War and World War I.

In fact, from the perspective of a military doctor, even if he couldn't see the chaos in Austria's command in the last war, he could still see the power of the weapons used by the opponent from the various wounds. At least he could tell whether the key to France's victory was the saber or the bullet.

At this point, Watman, who became the chief surgeon at that time, had already begun to study the management of the military surgical team. He didn't care about such details and didn't mention them, but Ignatz, who stepped up from the grassroots to the front But have their own opinions. 【2】

It's just that because of his low status at the beginning, the books he wrote have been eating ashes in the library, and have not been valued by the high-level military.

Seven years later, Austria began to follow the example of France, equipping the Lorentz front-loading rifle developed by itself with Austrian-made Minie bullets (there were errors and omissions in the previous writing, and Austria had long used rifled guns) [3].At the same time, the infantry commanders also began to use the assault tactics that the French were proud of.

It's weird.
The Minie bullet has a long range and high precision. The lead bullet used makes the bullet roll when it touches the internal structure of the human body.If it is in contact with a bone, the bullet will not only break the bone, but the soft bullet may also burst in the body, greatly increasing the lethality.

However, the Prussian Dreiser breech-loading pistol went a step further.

Its power is slightly smaller than that of the Minie bullet, but the integrated post-loading design of the bullet and gunpowder greatly increases its loading speed.The lead acorn-shaped bullet can also produce a similar roll and burst effect, and the lethality is not small.

In front of Carvey was a soldier who was shot by a Prussian breech-loading gun.

Judging from the injury report, it should be that he encountered the opponent's cold gun during field investigation, and the doctor accompanying the team sent him to a temporary ambulance.The doctor working in the ambulance sent him all the way back to the fortress hospital based on the judgment of the situation.

The injury was on the left side of his head as Bill Roth said.

Commonly known gunshot wounds to the brain are often a single straight line penetrating injury.But in real headshot wounds, the penetrating wound of the bullet often presents a worse and more complex picture.

"Soldier of the 11th Rifle Regiment of the Third Army, Ronagne." Bill Roth pointed to his head, and made a brief introduction of the injury, "The bullet should have been ingested from his left forehead, passing through a part of the brain tissue , and shot out from the left temporal region, shattering the entire skull it passed through, like a cracked biscuit."

Carvey looked at the bulging brain tissue and asked a few indicators.

The result is not bad: "When I came here, the blood pressure was only 80/40. After using a lot of adrenal gland extract, the blood pressure is now maintained at around 100/60, and the heart rate fluctuates between 120-140. I control my breathing at 20 times per minute. The left pupil is 3mm and the right pupil is 3.5mm."

"What about the infusion?"

"I lost 500ml of normal saline at the front line. This is the second bag of 500ml, half of which has gone in."

Carvey looked at the simple respirator [4] in the nurse's hand, and sighed: "The fortune is saved temporarily, but the person is still in a deep coma, which is a bit troublesome."

Soldiers are seriously injured. Even if they are placed on a modern battlefield, they need to rely on modern medical equipment and active and rapid rescue and transportation to receive effective treatment.Now the soldier named Ronagne was able to reach the fortress general hospital alive. In addition to luck, he also benefited from the fact that the front line was close enough to the rear and the battlefield management principles brought by Karvey.

"You said just now that it was the third army. The doctor in charge of the army should be Locard, right?"

"Yes, Dr. Locard."

"The handling is quite in place, boosting the pressure, infusion, and opening the airway. If there is no such tube and respirator, I am afraid that the person would have died on the road." Carvey glanced at the tracheostomy tube on the soldier's neck, and turned his head Said to Ignatz, "Locard has also grown a lot."

"The stitching is a bit messy." Ignatz seemed to be more demanding.

"It's probably because he's not familiar enough with needle holders, so he and Damirgang have to study hard when we go back." Kawei made a brief comment, and then continued to focus on the wounded head, "The left forehead is 1*1cm Bullet hole, 3*2.5cm scalp defect in the left temporoparietal occipital area, 5*4cm skull defect, comminuted fracture of the surrounding skull, the area is about 11*8cm"

The assistant at the operating table quickly took notes. Although these numbers are not useful for treatment, they can easily determine the damaged parts and brain tissue defects when the bullet passed through.

Bill Roth was quite confident about abdominal surgery, but he was really at a loss for this kind of complicated brain injury.What he lacks is not extravagant surgical techniques, but the principles of treatment of craniocerebral injuries.

The treatment principles are based on the basic principles of surgery, and are slowly deduced through the analysis of the cause of death of the wounded and the postoperative recovery situation, and cannot appear for no reason.Without a lot of surgical treatment, lack of samples and experience accumulation, and no theoretical knowledge of modern surgery, Bill Roth would naturally find it tricky.

But where did Carvey learn the principles?

Bill Roth asked him several times, and the answers were nothing but father, father's old friend, short-lived, dreaming and other unfounded answers.

Carvey undressed, washed his hands quickly, changed into a clean leather skirt, and asked, "What was the cause of death in the headshot wound?"

"Brain tissue damage?"

"Impaired breathing?"

Carvey shook his head and walked onto the operating table: "No, hemorrhage is the deadliest cause of death and has the highest proportion! Now he can still see active bleeding in some small arteries in his wound, which shows that the extract of the posterior pituitary gland The haemostatic effect of the patient is not good, the bleeding is still severe, and our priority is still to stop the bleeding."

Billrot responded immediately: "Take the brazier, the wire, the hemostat, the scalpel."

"it is good!"

"Then what's the next cause of death?" Goram asked suddenly, "Is it because of impaired breathing? Because you just said that Dr. Locard's tracheotomy was beautiful."

Carvey looked back at him and replied, "The central nervous system in the brain controls breathing, but judging from the location of the injury, the injury did not involve that part."

"But he still has impaired breathing." Goram was puzzled.

"Yes." Carvey affirmed his judgment, and at the same time threw the question back to him, "So here comes the question, what caused the impaired breathing? I mentioned it briefly when I was training as a military doctor before. It's a whole chain reaction."

This knowledge point is very important, but Goram forgot.

It's not that he's not easy to learn, nor is it that he has a bad memory. After all, he is also a doctor who graduated from a serious medical school, and his learning ability cannot be poor.The main problem is that there is too much training content in that month.

All they have to do is to recite all the rules and regulations in the entire military doctor's manual and keep them in their heads.

Most people's memory needs to rely on understanding, and the basis of understanding is the result of basic theories and a series of logical relationships interspersed.However, the content of this military doctor's handbook has no logical relationship, let alone a theoretical basis, and some are just a series of practical operations.

For Ignatz, Herman, and Sarsson, it may not be that difficult, because they all watched Kavey's surgery all the way here.Bill Roth hadn't seen it before, but he watched it many times in the next four months, and he also had his own understanding of debridement and disinfection.

But for a doctor like Gorham, who didn't work in Vienna and basically had no contact with Kavey, he just heard such a name from some colleagues.

After getting in touch, they realized that a month was too short, leaving very little time for themselves.

"Don't worry, think slowly, let's do the surgery first."

With the surgery to this extent, Carvey is not very sure.

Because in craniocerebral injury, what surgeons can do is not to treat, but to provide a good environment for healthy brain tissue.This includes extremely thorough debridement, and good control of bleeding and intracranial pressure.

To put it simply, the surgical procedure is to turn an open traumatic brain wound with bleeding, pollution, brain fragments and various foreign objects into a wound with thorough hemostasis, clean interior and completely closed surface, so as to achieve decompression and prevent trauma. purpose of infection.

The real difficulty lies in how to preserve the surviving brain tissue as much as possible, which is extremely important for the wounded to resume their daily life functions in the future.

Now he can only do it according to the principle of craniocerebral injury: "Although brain tissue is important, what everyone is seeing is the brain that has been impacted by high-speed projectiles and baked at high temperature. What we need to do is to expand the operation on the basis of hemostasis." Range, remove things that will affect the recovery of the brain. Come, give me the hemostat first."

Carvey temporarily ignored the brain tissue smashed by the bullet, first, with the help of the suction device, he used the hemostat to stabilize the two small arteries that were bleeding, and sutured to stop the bleeding.After the suturing was completed and the iron wire of the brazier was in place, he began to use spot burning to assist himself in the next step of debridement.

There is no need to do CT, just from the extent of the injured skull, it can be guessed that the left half of the brain tissue of the wounded soldier is not much usable, and the cerebellum in the rear is probably also partially affected:

"We proceeded to remove the foreign objects, which included broken brain tissue, scattered hair, pieces of cloth from the hat, bone fragments, and metal bullet fragments. Give me the scalpel, and I will expand the surgical area."【 5】

Carvey's action was more brutal than Billrot's treatment just now. He cut off some useless scalps, and tried to keep the intact skin and the larger bones connected to the dura mater to prepare for the subsequent closure of the wound: "Get ready for the hydrogen peroxide. And methylene blue rinse, pay attention to the ratio, I will use it later."

Hemostasis, hair removal, simple rinse, hemostasis, removal of bone fragments, rinse and hemostasis, removal of two bullet fragments.
Carvey repeats these processes at the operating table, and he needs to be more careful and gentle than those diners who want to keep the integrity of the dishes and pick out the pesky garlic.

The lengthy operation lasted for more than two hours, and Kavi was slightly relieved after seeing all the foreign objects removed: "The remaining brain tissue still has slight bleeding and swelling, but it has not been affected by the impact of bullets." Destroyed, the filling degree of the cerebral blood vessels is also good, and the wound can be closed. Give me the debridement and flushing fluid that I asked you to prepare just now.”

"What about sutures?" Bill Roth was thinking about a more realistic question, "There's not enough scalp."

Carvey made a simple measurement and found that the remaining scalp and skull could not completely cover the wound.If it is forcibly covered, it will only compress the remaining brain tissue, which is a taboo for neurosurgery.

"Sew up the galeal aponeurosis of the forehead, and the skin will not be sutured first."

"Open?"

"Make a simple covering first, and I will think about it after the operation is over." Carvey handed the suture to Bill Roth, asked about his vital signs, took off his leather skirt, and got off the operating table.

During the entire operation, Ronagne's blood pressure fluctuated violently twice, and his heart rate remained above 120. He might die on the operating table at any time.

Adrenaline, pituitary hormone, methylene blue, normal saline, and the blood provided by some doctors and guards after matching, Kavi used all the means available on him, and finally woke up Ronagne Tenacious will to live.

He survived surgery.

But surgery is not only about the operation on the operating table, but also the troublesome postoperative recovery, which accounts for a higher proportion of traumatic brain injuries than any other surgery.

Especially for such a large-scale craniocerebral injury, the violent debridement and large-scale surgery during the operation will severely stimulate the brain.Cerebral edema and intracranial hypertension will definitely occur after surgery, and weak anti-infection measures will definitely bring infection and high fever.

So Carvey never said "the operation was successful" from beginning to end, but left the operating room silently after getting off the operating table.

Whether for him or for Ronagne on the operating table, the real danger posed by traumatic brain trauma was only now beginning.

(End of this chapter)