Nineteenth Century Medical Guide

Chapter 231 228. Seminar on Surgical Cases at the General Hospital of Olmitz Fortress 【4】

Sarson is the son of a capitalist. Although he is not as strict as Bergett, the resistance he encountered on the road to becoming a surgeon is the same. Their father disagrees with choosing surgery.

The two top students in the medical school could have easily entered the ranks of physicians, but their master and doctoral teachers turned out to be professors of anatomy.

If you quit internal medicine and went to work as a knife surgeon, not only the income is bad, but the status is also much lower.

If the Bergett family originally hoped that he could inherit the family's political assets, the gap between surgery and surgery would not be too large.Sarson, who was born as a commoner, his family relied on his status as a physician to bridge the upper class, so there was a big difference between medicine and surgery.

Under such pressure, the young man in his early 20s survived and walked on the path he chose.

Different from Bergett's admiration for Ignaz, and also different from Melen's desire to show off his abilities in front of everyone, Sarson's attitude towards surgery is not mixed with other factors, and is more pure. Is simply like.

This kind of purity also made him more determined when choosing his own path.

In comparison between the two, the father-son relationship between Sarsen and his father is much sharper, far less harmonious than that between Bergett and Chrissy. The relationship between the two pairs of father and son can be seen on the issue of enlisting in the army. gap.

On Bergett's side, the two fathers and sons hold the same opinion. Since it is unreasonable not to go to war if he is the heir to the title, the i insurance in the army can also mention his status for the future succession to the title.

On the other hand, Sarson had a big quarrel and ran away from home. The current ward is his home.But the young man is fearless. In his eyes, family and parents are important, but what really excites him is surgery.

Interest was his driving force, but the four months of training and the few surgeries he performed with Kawi became a real accelerator.

"Everyone starts from ignorance and ignorance. Opportunities are equal to everyone. It depends on whether you can seize them."

Carvey showed the opposite side to Ignaz. He has great confidence in this young man and dares to hand over power: "In the point reward system, even the emergency doctor who simply bandages Ronagne No exception. His name has already been recorded three points by me, and the three-pointed one is the director of surgery of the Third Army, Lockard."

It is not easy for doctors from the non-fortress general hospital to return to the hospital. There is a need to consider the establishment of the military medical office, which cannot be changed simply by saying a word.

Therefore, those doctors who cannot leave the hospital will receive an expensive bonus when they leave the army. As for how much they can give, Carvey has not yet determined the number: "These things are not important, the important thing is Ronagne So, do you know the method of measuring cerebrospinal fluid pressure by lumbar puncture I just mentioned?"

From symptom judgment to pure numerical judgment (80-180mm water column height), the judgment standard is more specific, and the difficulty of understanding should be reduced.

But these doctors who have no research on neurosurgery in the audience have more question marks on their foreheads.

It has always been said that the abdominal cavity is a restricted area for surgery, simply because they have actually been there, found too many difficulties and withdrew.As for the brain, many people don't even have the courage to open it, and the concepts are not on the same level.

After all, only places where you can walk can be called restricted areas, and places like deep sea and volcanic magma should not be called restricted areas.

It’s true that I have never touched it at all, and I don’t even understand the most basic concepts: “If intracranial pressure is really the cause of death, why should the measurement be done at the waist? The difference between the cranial cavity and the lumbar spine is really Can they be linked together?"

"I also find it very strange. The brain is the brain, and the spine is the spine. Even if they are both called nerve centers, there should be obvious differences between them."

"Unless the brain and spine are connected, that would explain why fluid pressure in the spinal cord can be used to determine intracranial pressure."

"This is ridiculous, how could it be connected together?"

This is probably the difference between ordinary people and high-achieving students who have studied in institutions of higher learning. A question raised by a clinical examination was turned into an anatomical problem by them.Carvey was happy to discuss with them, because he couldn't hold up the seminar by himself.

As for whether the brain and spinal cord are connected, the conclusion was already reached as early as last night.

"You probably didn't watch the lumbar puncture last night, did you?"

"I didn't watch it, I was catching up on sleep."

"I was in the operating room and went to sleep afterwards. I just heard about it this morning."

"Me too, I've been really tired these days."

"That's such a pity, lumbar puncture, the world's first lumbar puncture! Who would have thought that a silver needle could directly penetrate the spine from that position, it is simply amazing."

The doctor spoke in high spirits, but to the others in the conference room, there didn't seem to be much to be surprised about: "Well, it seems that you have seen too many 'world's first', the word has not much impact gone."

"Can a simple puncture prove that the fluid in the brain communicates with the spinal cord?"

"I used methylene blue yesterday," Carvey said. "The stain is a good way to explain the relationship between fluid in the brain and spinal cord."

"That's right, it's methylene blue! I watched the whole process of lumbar puncture in the ward yesterday, it was amazing. Only a thin trocar was simply inserted through the skin at the level of 3-4 of the lumbar spine , the depth is about 2cm. After pulling out the needle, you can see the blue liquid flowing out drop by drop.”

Methylene blue has antibacterial properties and can be used as a tracer, so it works best at this time.

Everyone in the audience recognized the effect of the dye. Since the blue liquid can be punctured from the waist, it can basically prove that the liquid in the cranial cavity and the spinal canal are common.

The whole process of cognitive transformation is the same as when the No.1 lumbar puncture Heinrich Quick proved that the cranium and spine are connected, but the dyes chosen by the two are different. The neurologist who studied in Germany and abroad used Red mercury sulfide. 【1】

At this time, Quick was still a young man of 24 years old. He may have just graduated from the Berlin Medical School. As for whether he joined the army, it is unknown.

"Now that everyone has agreed with my point of view, increased intracranial pressure is a problem that Ronagne must face now." Carvey sighed, "His cerebrospinal fluid pressure is twice that of ordinary people, unfortunately , I have nothing to do about it, I have done everything I can, and then he can only recover slowly by himself."

"I heard that his temperature is also rising?"

"This morning's body temperature exceeded 39 degrees Celsius. This is a normal reaction after traumatic brain injury surgery, and almost everyone will do so." Carvey still has nothing to do. yourself."

"We'll be praying for him."

Ronagne revealed this, and what Carvey will talk about next is another kind of firearm injury.

"Bed 55, Bed 63, Bed 71, Bed 94. These are chest gunshot wounds." Carvey flipped through the medical records in his hand and said, "I saw from the medical records that your treatment is not bad. There's a total of 38 chest firearm injuries here, and the mortality rate is provisionally at 45 percent."

The number of wounded is not many, and it is not a pleasant ratio.Because the death rate of thoracic gunshot wounds is not lower than that of craniocerebral gunshot wounds, those who can really be transported to the fortress hospital for treatment are those who are lucky.

The chest cavity is not as good as the abdominal cavity. A closed chest cavity is the prerequisite for the lungs to breathe, so it cannot be opened easily unless it is absolutely necessary.

In fact, even if it is opened, the current surgical technology will only increase the damage, and it is difficult for Kawei to do much.Moreover, there are abundant nerves in the pleural cavity, which are very sensitive, and a slight stimulation will produce nerve reflexes. In addition to the serious physical injuries of the wounded, reflex shock may occur if there is a slight carelessness.

Naturally, the bullet cannot be removed without opening the chest cavity. What the surgeon can do is to simply bandage the bleeding, suture the wound, give a simple respirator, and apply methylene blue.

Those who succumbed to thoracic gunshot wounds often died from unstoppable bleeding or suffered fatal heart injuries.In this situation, when God comes, he can only silently say a few hallelujahs with a headache, and then go back to where he should go and stay quietly.

"More than half of these 38 cases of chest gunshot wounds survived, and a considerable part of them have even stabilized, all thanks to your hard work and serious work." Carvey gave a rare compliment, but the audience had not had time Hearing his extra points, he choked back, "Dr. Lucius, please come to the stage."

"I?"

A tall, thin man stood up under the stage, wrapped in a cotton coat, with disheveled hair and a lackluster face.It looked like he had just been woken up from the bed, and then followed others to the conference room inexplicably.

He pointed at himself in disbelief, then left the seat helplessly.

Lucius was ashamed, but he still wanted to resist a few words in order to show his dignity as the chief surgeon: "Dr. Carvey, if there is anything wrong with me, just say it, there is no need to make it so complicated." . If what you say makes sense, I will admit it, and I will also deduct points."

"You misunderstood, I didn't say you were wrong. Don't be nervous, I'm not a mad dog who bites anyone."

Carvey really didn't lie this time, the performance of these three days made Lucius a completely positive image.

Although the medical records are not as detailed as Sarson's, they are comprehensive and good at grasping the key points.Apart from the scribbled handwriting and the sloppy recording position, there are no shortcomings.In terms of surgery, he has nothing to criticize, at least he can be ranked at the upper middle level among the more than 20 surgeons.

And the most important thing is his ability to judge.

It is rare to catch a positive person, and Kavey has to use it anyway, making him a typical representative of the consolidation of the point system: "The wounded on the 1175th bed should have arrived yesterday afternoon, right?"

"Yes, yesterday afternoon." Lucius yelled something was wrong when he heard the bed number, "Dr. Carvey, Dean Carvey! I really tried my best yesterday. I cared about his condition while operating on bed 1324. The operation is over. I stayed by his bedside all the time after that, really"

"I understand, I understand, don't be nervous." Carvey continued to appease his nervousness. "It's just a case discussion. Death cases are also cases. Let's talk about the situation."

Lucius had no choice but to briefly introduce the wounded: "I don't know which unit he belongs to, and I didn't hear anyone mention it when he was sent. Anyway, he was wearing an imperial uniform, so he should be from a certain infantry regiment." Soldier. He was seriously injured. It is estimated that more than a dozen pieces of shrapnel directly pierced his chest and abdominal cavity, and the bleeding was serious.

At that time, the blood pressure was still around 80/35, and the heart rate was very fast, it should be above 130.I urgently asked for a blood transfusion because I knew the transfusion alone would not save his life."

Speaking of this, Lucius paused for a moment, and Kavi looked at him and asked, "What's the matter? Why didn't you continue talking?"

"Okay, okay, I admit, I admit that I was hesitant at the time!" Lucius sighed, and nodded his head for a while, "If I had been more determined then, if I had pulled him away immediately Go to the operating table to open his abdominal cavity, maybe there is still a chance."

Carvey blinked, listening to the slightly frightened whispers from the audience, he was speechless for a while: "You really misunderstood, being on stage doesn't mean you have to deduct points, and I didn't say that you did something wrong."

"Huh?" Lucius was taken aback, "Is conservative treatment correct?"

"No one knows what happened in the body of the wounded in that situation. The doctor's choice is based on experience and there is no right or wrong. If you really want to test your own judgment, you still have to rely on an autopsy." Carvey said, "What I want you to talk about on stage is an incident half an hour after he was admitted to the hospital. At that time, it was about 1175 minutes before Bed 20 passed away."

"Before death???"

Lucius took over so many wounded soldiers that no matter how strong his memory was, he really couldn't remember them.He quickly buried his head in the medical record book, and finally found a few simple sentences in the corner that recorded the handling method: "Oh, you mean the puncture?"

"Yes, it's a puncture."

Carvey said: "At that time, the patient did not respond to the blood transfusion, indicating that there was active bleeding and dyspnea. The bleeding was probably in the chest cavity. Analyzing along this line of thought, thoracentesis is indeed a good choice. , but it is also a very dangerous choice.

Of course, what I want to praise is not the result of your treatment. After all, the person is dead. What I want to praise is your courage to make this decision. "

(End of this chapter)