Nineteenth Century Medical Guide

Chapter 229 226. Seminar on Surgical Cases at the General Hospital of Olmitz Fortress 【2】

Both of Delvaux’s two wounded patients developed typical compartment syndrome (5p, introduced at the beginning) after the operation. Once it develops to this stage, it means that the limb injury and operation have caused muscle swelling and oppression to the Bone, interosseous membrane, intermuscular septum, and deep fascia form the osteofascial compartment. 【1】

Blood vessels and nerves run in the bone fascia compartment, and the blood supply is naturally cut off after being compressed by the swollen surrounding tissue. At the same time, various symptoms will appear when the nerve is compressed, first pain, then sensory disturbance, and gradually loss of consciousness.

This situation has always been the enemy of limb salvage surgery, and it is also something that Carvey has emphasized in training before.

Delvo must have heard of it and memorized it. He must have passed the final assessment of the training, otherwise he would not be able to stand here.

Some people regard the Fortress General Hospital as a starting point, a platform for learning, and stay here to better learn technology.Some people regard it as the end point, a haven to avoid front-line work, and stay here just to ensure their own safety.

"Even your assistant thinks there is something wrong with their calf, and you know how to write it down in the notebook. You must have never read the medical records, but you can say this is common sense." Carvey asked, "Where is your common sense?" From it? Innsbruck University School of Medicine?"

"No!"

Hearing his alma mater being ridiculed, Delvo felt bad, and quickly refuted.It's a pity that his rebuttal is very broken because of his weak memory of theoretical knowledge: "I have paid attention to this concept you mentioned, but the result is not always bad."

"Aren't you talking nonsense? Soldiers don't always die in battle, so there's no need for military doctors. Let them fend for themselves."

Delvo knew that he had made a mistake, but he still hoped to find a reason to excuse himself: "According to what I said before, when encountering such a situation, it is necessary to make a small incision on the calf in time to reduce the pressure inside. But at that time, there were many wounds on their calf. , if such a small incision is made again, wouldn’t it be”

"There was no need for stitches."

"Who could have foreseen this kind of thing? They behaved very normal when the operation was over!"

Carvey nodded, but he didn't agree with him in his words: "Of course it is impossible to foresee, but after you find out that they have abnormalities, you can completely open the incision you just made again. I personally think that cutting a few sutures should There's nothing wrong with a good surgeon, unless he doesn't want to cut it, or doesn't bother to do it."

Delvo stared solemnly at the medical records in front of him, not knowing how to answer.

It was his first mistake, and both soldiers lost their only remaining calf almost at the same time.It's just that before this loss could be realized, the two passed away together.

Carvey then said: "It doesn't matter, everyone is a surgeon. Without a surgeon, you can't make mistakes. If you know your mistakes, you can correct them. But knowing your mistakes can't change the fact that you have deducted points. Your points will be deducted by 4 points."

"4 points? Shouldn't one bed and one mistake be 2 points?"

Delvaux thought that he attributed the death of the wounded on the two beds to his mistake, and quickly explained: "I was in the operating room when they died unexpectedly, and I didn't participate in the rescue, let alone receive the notice."

"Let's not talk about this for the time being." Carvey still aimed at the calf, "Their legs should be saved. If you didn't keep them, points will be deducted. The assistant wrote these descriptive paragraphs and specifically told you that you ignored them, and deducted points." Points. So 2 people make 2 mistakes each, and 4 points will be deducted first.”

Delvo is a little concerned about points, after all, low scores will bring a series of unpredictable consequences.But if only four points are deducted, it is still within the acceptable range.Besides, he also knew that he had no way to refute, so he could only respond: "Okay, I admit it, so it can be over."

After speaking, he threw down the stack of notebooks and prepared to leave.

"Don't worry, it's already here, why don't you stay a little longer." Why did Kawei let him leave, and asked quickly, "Have you not forgotten how the two wounded soldiers in beds 37 and 122 died? "

"As I said just now, I was not there when the two of them fell ill and had an accident."

"You must at least say something about the final diagnosis?"

Delvo looked at the short diagnosis written in red pen at the end of the medical record, and said it verbatim: "brain contusion caused by traumatic brain injury"

"Do you know what it means?"

"Probably the head was hit so hard that it damaged the brain."

"Since you know it, why don't you save it?"

Delvo looked at Carvey in surprise: "I've made it so clear just now, I wasn't around when I got sick, 'not around' understand???"

"But that's your patient."

"This is too difficult. It is impossible for me to leave the patients on the operating table and go back to the ward to give them the next step of treatment, not to mention how effective these treatments are."

"You didn't understand what I meant." Carvey shook his head, very dissatisfied with this explanation, "They are your patients, as the chief surgeon, you should be able to basically grasp their physical conditions, at least know what risks there will be after the operation .”

Delvaux propped his hands on the edge of the podium, with an inexplicable wry smile on the corner of his mouth, with an unbelievable expression on his face.

He had also trained as a military doctor and must have known Carvey's concept of the perioperative period.But at that time, he didn't pay much attention to it, thinking it was just a gimmick made by utopians, and no one would take it seriously.

Who would have thought that this concept has been followed by Carvey for more than 30 years, and it has been written into the military medical manual by him.

Delvaux didn't buy it, and tried to refute Carvey with his more than ten years of work experience: "You don't really think that the treatment after the operation can change the result of the operation?"

"You still haven't learned to understand the concept of 'perioperative period' and the meaning of naming it." Carvey said this not only to Delvo, but also to other doctors in the audience. The act of medical treatment is not to patch up the operation, but an important link to allow patients to safely pass through the dangerous period after the operation."

Delvaux couldn't understand: "I don't understand. Surgery is surgery. After getting off the operating table, it's the physician's business. What does it have to do with me?"

"You asked a physician to deal with your postoperative patients?" This time, Carvey couldn't understand, "You don't have too many surgeries these days, and your response is starting to become dull?"

Delvaux put it bluntly: "I don't accept such criticism, because those professors have taught me this way since medical school. If you want to blame, blame those professors, it has nothing to do with me."

Carvey sighed, facing the brown candy, he didn't answer immediately, but quickly found a medical record at the bottom, and suddenly said without beginning and end: "Your words are inconsistent."

"Contradiction? Where is the contradiction?"

"You said the patient shouldn't be in your care after the operation is over?"

"Of course, I have to work 10 hours a day, and the number of operations is no less than anyone else. I don't have time to take care of the post-operation matters." Delvaux seemed to want to mobilize the crowd, and said to the audience, "Do you think that in After receiving his own surgical treatment, is it necessary for the patient to continue treatment in the ward?"

"Then let's take some time to look at the wounded." Carvey shook the medical records in his hand, and then searched back and forth for the number that each wounded number should have. "The wounded doesn't seem to have a bed number, okay Strange"

Delvaux realized right away who he was talking about: "You don't have to."

"It's not necessary?" Carvey gave up looking for the bed number and looked at him again, "I think it's quite necessary, let everyone see how you skillfully use the concept of 'perioperative period', and then give them some clinical refer to."

"He has the rank of major general!" Delvoy didn't hide his desire to curry favor with him at all, "The son of Earl Cram Glass."

"So only the earl's son is qualified to let you perform medical work according to the military doctor's manual?"

Carvey didn't bother to wait for him to talk, so he said first: "On the afternoon of the 26th, Major General Maciej, the son of the earl, was shot in his left leg. According to the description of the triage surgical assistant, the escort who escorted him The stretcher team is really dedicated, if it was later, the blood from the wound would have dried up."

Delvo stood awkwardly in front of the podium, and could only let Kawei play, not knowing what to say.

"After hearing that Major General Maciej had arrived at the hospital, Dr. Delvo, an excellent representative of our surgical team, left a wounded man who had been shot in the abdomen on the operating table, handed him over to his assistant, and left quickly. out of the operating room."

Carvey didn't know how to characterize this behavior, so he could only complain: "At any rate, you also have the rank of lieutenant colonel. If you really want to express yourself, you should find a lieutenant general to be good enough."

Originally, Carvey was reluctant to put this more personal choice on the table of the seminar. After all, ordinary soldiers in the 19th century really had no status at all, and it was reasonable to choose officer treatment.

But at least you should not delay the treatment of soldiers, let alone engage in double standards.

"Just one hour after Major General Maciej entered Olmitz, this unique and difficult debridement operation was performed in a yard outside the General Hospital." Carvey described, "It was a wealthy family. The 'operation' was completed smoothly, and Dr. Delvaux patiently explained the matters that need to be paid attention to after the operation, and returned to this courtyard again that night."

"Okay, stop talking!"

"Since the operation ended on the afternoon of the 26th, you have visited the temporary residence of Major General Maciej six times, and each time you have left a large section of medical record text [2]." Carvey looked at the medical record and sighed, "Would you like to do this for me?" A major general with a slight injury to his calf spends so much time, he is actually unwilling to give some of it to the wounded soldiers."

"I'm just following orders."

"No, you are disregarding the lives of the wounded soldiers, and you are responsible for the deaths of those two wounded soldiers."

"Don't be kidding. When they came to the hospital, they were not doing well. Death was already doomed."

"Oh?" Carvey pulled out another medical record, "Then let's take a look at a lieutenant of the Dragoons in bed 321. He was also shelled, his lower limbs were injured, and he was also injured when he fell. The afternoon before yesterday It was sent in the same condition as 37 and 122, but now he is lying on his hospital bed."

"321" Delvaux seems to have some impression of this patient, "I remember he seems to be called."

"The name doesn't matter," Carvey emphasized. "You just need to know that his operation was performed by his assistant. Just because he said at the operating table, 'It's the same patient again, let's do it. , I'll go to Major General Maciej'."

"You are slander!"

"But I have records here." Carvey smiled and flipped through the notebook in his hand, and said, "I have to say that your assistant is very good, and recorded almost everything that can be written in the medical record."

Delvaux swallowed, seeming aware of the storm he was about to face.

"Four points were deducted before, and two points were deducted for each soldier's death. Two points were deducted for leaving the operating table for two violations and giving up surgery. You have deducted a total of 8 points. Now you only have 12 points." Kawei announced that he came to the fortress The first punishment order after the General Hospital, "I now announce that Dr. Delvaux will be withdrawn from the ranks of surgeons and demoted to a surgical assistant."

"Hey, hey, there are not enough surgeons, why are you still downgrading me?" Delvaux patted the desk lightly, and asked, "You said before that the surgeons will be relegated to exchange with assistants. I have 12 points now. , which assistant can exchange with me?"

"Let's not talk about the relegation exchange, this is something I decide on my own, and I can change it however I want."

Carvey looked at a young man sitting in the corner of the audience, and said: "As for the exchange assistant you mentioned, I have already found it for you. It is your former first assistant, Sarson Frayo Somler. He won the praise and now has 13 points, which is more than you."

[I've been too busy recently, I don't have time to finish this chapter, so I can only owe it temporarily.After I finish the tasks at hand, I will start to speed up this book]

(End of this chapter)