Nineteenth Century Medical Guide

Chapter 228 225. Seminar on Surgical Cases at the General Hospital of Olmitz Fortress 【1】

Everyone makes mistakes, especially in surgery, where every action has to be chosen. Even Kavey is no exception.

In order to keep improving, the emergency surgery department where Carvey used to work will have routine meetings every week, mainly discussing the gains and losses of those emergency operations.

Each surgery is dissected from the surgical notes through to the discussion of the patient's postoperative complications and physical recovery.There are praises and criticisms, but more I still hope that I and my team can learn from it.

Before in Vienna, he was at best a surgeon who could perform operations, and he didn't have that much authority.

But the super surgical ability, coupled with the outbreak of war, let him now regain this special "power".

At 9:29 a.m. on September 7, he sent almost all the surgeons in the fortress hospital into the meeting room except the chief surgeon who was still in the operating room.It sounds like the scale is not small, but there are only more than 20 people who can really be targeted by him.

There is only one purpose, to review the work situation in the past few days by discussing the cases, and prepare for the upcoming war.

The meeting focused on case discussions, mainly analyzing several seriously injured soldiers, and some educational reviews will be interspersed during the meeting.

"At that time, I will ask some surgeons to come on stage and describe the operation process in detail." Carvey looked down at the medical records and list in his hand, without any expression on his face, and said coldly, "You don't have to worry about the follow-up wounded soldiers. The treatment, because I can allow to go to the operating room, are those doctors who do not need to go on stage."

The first thing to discuss is Ronagne's headshot trauma.

The main reason is naturally that his injury is the most troublesome in the past few days, but even if there is no Ronagne, Carvey will choose some other craniocerebral gun injuries as teaching examples.It's just that doing so will lack a sense of reality, and the teaching meaning and effect will be worse.

Because except for Ronagne, those soldiers who could become examples are all dead.

Brain gunshot wounds are not uncommon in the battlefield. Bullets and shrapnel have no eyes. Once they hit the head, the outcome is often not very good.In addition to luck and his own physical fitness, Ronagne can survive until now, but also benefited from the first debridement of the frontline ambulance station and the second debridement of Kavey last night.

Since the first Ronagne can survive, Carvey hopes to have the second and third
"Craniocerebral gunshot wounds are divided into three categories, scalp soft tissue contusion, extracranial penetrating trauma and penetrating craniocerebral injury." Carvey made a brief introduction, "The first two cases are not serious, usually minor injuries, Just simple debridement and dressing.

What I want to focus on is penetrating craniocerebral injury, which is divided into tangential injury, blind pipe injury, rebound injury and penetrating injury. Ronagne is a typical penetrating injury. "

A white cloth was pulled out in front of the conference room, on which were drawn general images of injuries and operations, including the entrance and exit of bullets and the fragmentation of bones.

"The bullet entered from the left forehead and was ejected from the top of the left temporo, and a large amount of fragmentation occurred on the lateral skull along the way."

Carvey gave the general situation: "The injury was very serious, and there was brain tissue spillage at the time. When encountering this kind of wounded, the doctors in the army, the surgeons in the ambulance station and the surgeons in our central hospital have different things to do. We What needs to be completed is a closed loop of treatment, and no mistakes can be made, otherwise the wounded will die at any time.

The case of Ronagne illustrates this point well.

I need to focus on the military doctor on the front line. This doctor played his role very well and knew what to do at this time. Seeing that there was no atmosphere in the audience, Carvey began to ask, "Do you know what he did?" "

".Give him a hemostatic drug?"

"It must be bandaged to stop the bleeding. When I came here, I saw several layers of bandages."

"It should be a booster drug. This kind of patient can easily lose blood pressure and die in a short period of time. I have encountered a few cases, and the blood pressure could not be measured when it was delivered."

Carvey listened to these answers and said: "It is true that a bandage was given to stop the bleeding, because such a severe head injury has a lot of bleeding. Seeing the blood on the wounded head, anyone would do bandages, but..."

"But" came late, and what Carvey wanted to emphasize was not just bandaging to stop bleeding, but how to bandage to stop bleeding.

"So, bandaging to stop the bleeding, how do you bandage, how to stop the bleeding? Is it the same as bandaging the limbs? Press the bleeding point tightly to make it stop bleeding?"

This is a very serious question, because no matter how good the surgical ability in the rear is, the first hurdle for the wounded is the frontline army doctor.If the army doctor did not treat the wound properly, there would be no need for follow-up treatment.

The problem stumped them.

"General traumatic brain bleeding needs to be stuffed with gauze for pressure treatment." Carvey cited a few examples, "bed 65, the scalp laceration caused by shrapnel, it seems that there is only a long wound, but the bleeding volume exceeds 500ml The front medic had a loose packing, so the bleeding was quite profuse.

But let's look at the 112 bed again, the same scalp tear, the length and depth are comparable to the 65 bed.But because the filling had enough pressure, the wound had basically stopped when he came to the hospital.At this time, the surgeon only needs to do simple sutures, or even take care of other wounds first, without doing any treatment for the time being. "

After the audience listened, someone asked, "So Ronagne's head was bandaged tightly?"

"But I heard that he was still bleeding when he came here. If it wasn't for the rehydration, he might have died."

"That's the problem," Carvey said. "A loose bandage can cause bleeding, but what if it's too tight?"

There is no basic knowledge of neurosurgery in the audience, and there is no sound at all: "."

"First of all, we need to be clear about two things. After the first brain tissue is severely traumatized, two things will inevitably occur, one is swelling, and the other is bleeding." Carvey explained, "The second brain tissue is very tender, and any damage may Destroy its functionality."

These are the two preconditions given. As for why these two situations occur, why the function of the brain tissue is destroyed by a slight touch, and what function is destroyed, Carvey did not give a clear reason.

What he wants to do is to make these doctors react logically under the existing conditions.

"You guys are military doctors now, and there are such wounded people around us. After knowing this, what should we do? How should we bandage them?"

"The bandage can't be too tight or too loose?!"

The first one to respond was Hills's first assistant, Gorham, who answered well, but he lacked confidence in himself.Carvey nodded, affirming his answer: "I'd rather not stop the bleeding, but also ensure that the bandage is not too tight. Because the bleeding can be maintained by infusion, but too tight a bandage will further compress the swollen brain and form a cerebral palsy." hernia!"

This is a concept briefly mentioned in training, and Carvey brought it up again.

"I said at the beginning that if a head injury is combined with severe headache and severe vomiting, the skull needs to be cut to decompress the brain. This is also the best and most direct way to maintain stable blood pressure and breathing. There is no one."

Carvey took two related cases from his hand and continued: "During the training before, I didn't have any examples in my hand, and you may not understand. But now, there are 122 beds that were just announced dead this morning, and yesterday morning. 37 beds, I have read the medical records, it is because the decompression surgery was not performed in time."

From the seriously injured to the dead cases, and the cases with a clear bed number, the atmosphere in the conference room turned sharply, and even the surrounding temperature seemed to drop by a degree or two.

They all knew Karvey's current temper more or less. After all, he was the youngest, most capable, and most powerful surgeon in Austria, so his temper was naturally not much better.But compared to Ignatz, chief surgeon of the same status, and Edinson, director of the military medical department, Carvey's approach is even more merciless.

"Doctor Delvaux."

The light voice was like a road sign, drawing everyone's attention to the rear right of the venue.Sitting there was a doctor under the age of 40, wearing a military uniform and driving a pair of black-rimmed glasses, who didn't seem to respond much to the title.

"I am."

"Are you the chief surgeon for the two wounded patients in beds 37 and 122?"

"Yes." Delvaux stood up and answered very concisely.

"Please come to the stage." Carvey's request was also very concise, so concise that the other party did not respond. "I didn't make it clear? Or do you not understand German?"

"I don't know what's the point of being on stage?" Delvaux pointed to the door, "I have nearly a hundred beds in my hand, and I didn't even do the ward rounds early this morning."

"You don't usually do ward rounds, and someone is already doing it now." Carvey asked an assistant to move a small chair from the audience, took the documents in his hand, and sat on it, "Don't worry, It's not some random surgeon, it's Mr. Ignatz, the Chief Surgeon."

The Surgeon General's job is to coordinate all the surgeons, rate their performance, and preside over some very difficult surgeries.

According to the routine, he should appear in the rear, such as drinking tea with Edinson at the military medical office in Vienna and reading the telegram.Or appear at the army headquarters, that is, stay with Brecht, the commander-in-chief of the Northern Front, and coordinate and direct all surgical and medical dispatching work.

But appearing here now, in addition to wanting to see how the general hospital established by Karvey works, I also want to give her a platform.After all, an outstanding surgeon like Carvey also has a weakness, that is, "too young".

"The chief surgeon is doing ward rounds just to let me, a little surgeon, take the stage." Delvo seemed to have heard something, and took the lead in attacking, "I can't compare this relationship, I can't compare it."

"This is not something you should care about." Carvey pointed to the podium, "Please! You! Get on stage!"

Delvaux also seemed to have his own confidence, objecting on the spot: "What if I say no?"

"Then you will deduct all your basic points of 20 points, and immediately take the army transfer carriage and roll to the front line as an emergency doctor." Carvey buried himself in the point system he created, "In this case, your salary will start from 1 krona a day down to 30 hel a day and have to deal with those bullet bombs all the time.”

Points are a system similar to "rewards and punishments" that Kavey came up with to improve their skills and postoperative management capabilities.

The chief surgeon has 20 basic points, and the assistant has 10 basic points. One point will be deducted for every wrong thing done, and three points will be awarded for every praise.If the assistant surpassed the surgeon by some point, their jobs could be interchanged.

Of course, this exchange is not mandatory, and it also depends on the assistant's qualifications and accumulation of surgical procedures.

Military doctors and front-line first aid don't have this kind of treatment, but relatively, they also have easier access to front-line commanders.The commanders can recommend qualified doctors to Carvey by means of letters of recommendation, but how many commanders are willing to transfer outstanding doctors who they think are qualified is a matter of luck.

"Okay, okay, I'm on stage." Delvaux finally stepped onto the podium, opened the familiar medical records in front of him, and said, "The two wounded soldiers fell on the ground after being shot or blasted. land, a blow to the head."

"Have you done the inspections in the order written in the manual?"

"Do" Delvaux shook his head again, "Several neurological examinations need to be done through the legs, but they are all amputated."

"Only one leg was amputated, didn't the other one be saved?"

"After the operation, their legs felt very painful, and they couldn't do the examination."

"You don't know that their sore leg ends up not hurting anymore."

"It doesn't hurt anymore?"

According to his previous work experience in Innsbruck, Delvaux only presided over the operation and did not participate in the postoperative rounds, so he was not clear about this matter.But since it doesn't hurt, that's a good thing, there's no need to follow up and ask: "I don't know, the assistant didn't tell me."

Karvey nodded, as if he didn't pursue his negligence, but he didn't miss any of the questions: "Do you know why it doesn't hurt?"

"Why?" Delvaux smiled and looked at the surgeon, who was much younger than him, and really didn't understand why he wanted to target him. "After the operation, pain is painless. Isn't this the most basic common sense?"

"common sense?"

Carvey read a description in the medical record, which should have been written by an assistant: "'The patient's operation is over, his right leg is very painful, and I can see that the whole leg has become extremely pale. I checked the pulse of the dorsalis pedis artery according to the requirements in the military doctor's manual, and I found that the pulse seems to have disappeared.', you call this change of condition common sense?"

(End of this chapter)