Nineteenth Century Medical Guide

Chapter 232 229. Seminar on Surgical Cases at the General Hospital of Olmitz Fortress 【5】

Medical puncture technology has been around for a long time, and the instruments used are similar, but the purpose and effect of puncture in the 19th century are completely different from those in modern medicine.

The former is a helpless move that cannot be dealt with by surgery, and the blind piercing that cannot be seen directly is used, which often fails, and may even cause iatrogenic secondary injuries due to needle tip penetration.

The latter is different.

With perfect imaging positioning, puncture has become the best way for invasive diagnosis because of its small damage, simple operation and short time.And for those emptying fluids in the body, piercing can also play its role well.

Even without the aid of imaging, blind puncture in modern medicine will become much safer because of the operator's solid anatomical knowledge.

Lucius' puncture was indeed a helpless move at the time, because the wounded's damage was too severe, and there was no room for treatment at all.Seeing that his breathing rate decreased and the blood transfusion didn't work, his first reaction was that there was active bleeding in his lungs.

The chest cavity, where the lungs are located, is a closed chamber because the pressure provided by the closed chamber is required to regulate the contraction and expansion of the lungs.

When the blood vessels in the chest cavity bleed, the pressure can easily exceed the pressure of the lungs to expand. When the blood starts to squeeze the space of the lungs to expand, breathing will naturally become difficult.This was Lucius' judgment. Since the blood squeezed the lungs and the surgeon couldn't perform a thoracotomy, it must be a good way to use a puncture needle to drain the blood. 【1】

"I chose the bottom of the lung, that is, the position between the seventh and eighth ribs for the puncture." Lucius said, "The result of the puncture was good, a lot of blood flowed out, and the wounded recovered quickly. only"

"It's just that he was injured too badly and died not long after." Carvey asked suddenly, "Do you know the cause of death?"

Lucius shook his head: "This needs to be confirmed after an autopsy, but we don't have time to do it now. In order to free up space in the ward, the wounded who died will be moved away for burial as soon as possible."

"I remember that many of you became military doctors just to dissect corpses, why don't you dissect them now?" Carvey felt a little regretful, "Such a good material."

"We doctors who are the chief surgeons are so busy that sometimes we don't even have to eat."

"What do you mean sometimes? I haven't ordered a meal in the past few days. When I get over it, the food delivered is cold."

"Me too, I don't even have time to sit from morning till night."

"Dr. Carvey, you just came here yesterday, so I don't know the situation here. That is, there are few carriages in the morning, and in two or three hours, when it is close to noon, the carriages will send batches of wounded soldiers. We basically all had to wait in the operating room."

Now that Carvey started the conversation, the audience simply complained about their workload.The sudden excess workload made them very uncomfortable. After all, it might take two or three days to perform an operation in the original hospital, and they didn't need to work so hard at all.

"Be patient, the doctor reserve in the fortress hospital is much better than the battlefield central hospital in Italy on the southern front." Carvey explained, "As for the autopsy, I personally hope that you can do it, which will also increase your medical expenses. experience. Of course, I will not force you, if you don’t have time, you can ask an assistant to do it for you.”

Let an assistant do it for you?Isn't this called coercion?

This light and fluffy sentence seems to be fine. It is normal for the assistant to fill the vacancy for the chores that the chief surgeon does not do. They have always done this.

But if you think about the situation, something is wrong, because although the dissection is tiring, it is not a chore, and it is the main method for them to improve their surgical skills.

In these three days alone, nearly 1000 wounded soldiers died in the Fortress General Hospital.If the fatal injuries on their bodies and some limb defects are excluded, the quality of the corpses is actually not bad at all.Those are all strong young soldiers, and they are usually the source of corpses looted by major hospitals.

If all these anatomical tasks were given to assistants, wouldn't their skills be improved?

It is a good thing to improve the skills of assistants, and it can bring a lot of convenience to the operation, but now is an extraordinary period, and the competition brought about by the points system cannot withstand such technical improvements.
"Dr. Carvey, we really don't have time."

"Yeah, I'm really exhausted after a day!"

Carvey just said casually, but he really didn't expect this level. After hearing their endless complaints, he was a little dazed: "Didn't I say that the assistant can do it for you, I just want to know the cause of their death. This is not only It is not only for the development of military medicine, but also to increase clinical experience for you, why not do it?"

Some people's answers are very veiled:
"Don't those assistants run off to do autopsies at that time, no one cares about the surgery."

"That's right. In the final analysis, the work of the hospital is more important. We must prevent this kind of putting the cart before the horse."

And some people put it quite bluntly:
"We are busy with surgery, they are busy with dissecting corpses to increase technology?"

"Made! I don't want to be robbed of the position of chief surgeon!"

When their core interests are violated, they will burst out with a more positive side.

But at this time, after considering their workload and rest time, Carvey still pressed the pause button for them: "I didn't think about this, and the assistant presided over the autopsy. It's really a bit sloppy. The autopsy must be done. Regarding the diagnosis of the cause of death, as for who will do it, I will discuss it with you later.”

It was rare that Kawei was willing to understand their hard work, and everyone breathed a sigh of relief.

"Okay, let's continue talking about other patients."

As soon as the conversation came here, there was a knock on the door, and a doctor in his 30s walked in after opening the door: "I'm afraid the front line is fighting again. Two cars of wounded soldiers have come, a total of 12 people."

"Lucius, Fausto, Fred, you three, bring your own surgical assistants to deal with it." Carvey called out his names, then stopped Lucius, "Ask Delvo to help you. , keep a close eye on him, and truthfully report to me his work attitude."

Lucius didn't like this kind of monitoring work, but it was impossible to refuse Kavi's order, so he could only nod in response: "Okay."

Downgrading from chief surgeon to assistant is a very frustrating thing. With Delvo's character and way of doing things, it is very likely that he will choose to lie flat and rot.If everyone did what he did, the hospital wouldn't be able to survive.

Therefore, monitoring and a one-to-one assessment system are very necessary.

"Let me reiterate that demotion is not only a punishment for making mistakes, but also for those who make mistakes to re-examine the wards and wounded under their jurisdiction in a different environment. But this is based on normal work." Carvey sighed, "If If you don’t even have the enthusiasm to continue working, then there’s no point in staying here.”

The content didn't seem that serious, but the environment at this time was not their respective hospitals, but military doctors.

If they are judged to be passive sabotage in the fortress general hospital, what awaits them is not as simple as being kicked out of the army, but a more severe punishment.

After Kavey warned everyone, he glanced at Sarsson who was sitting in the front row again, and said, "You are also the chief surgeon now, so follow along and go to the stage with your favorite surgical assistant. But you are now experienced Insufficient, can only do simple amputation."

"it is good!"

"Pay attention to the indications for amputation. As long as the distal limb is intact and the blood vessels pulsate well, it is necessary to save the limb." Carvey emphasized, "Also, pay attention to debridement!"

"I see!"

The four left the meeting room, and Carvey clapped his hands and drew back the attention of others: "It's just a small episode, let's continue discussing the case."

The seminar lasted for half an hour, and now the biggest winner is Sarsen. It is by no means an easy task to complete the class transition in three days.

For him, the job of chief surgeon is full of challenges, but more exciting.Just being able to preside over the amputation operation has already made Sarsen tremble with excitement, which is basically impossible in the Municipal General Hospital.

Although surgery is mainly amputation, the number of amputations in peacetime is not too many. In addition to Ignatz's strict regulations on the probation period for fresh graduates, Sarson and the others have no chance to practice as the main surgeon, and even the anatomy depends on others. Only the face of a person can do it.

However, there are such wounded soldiers everywhere in the field general hospital. Of course, Carvey's attitude towards amputation is much stricter than other military doctors.

After leaving the conference room, the four of them saw the wounded being carried off the carriage one after another at the entrance of the hospital.

Lucius directly became the on-site commander, looked at the wounded injury report sent, and started the assignment of the wounded: "Abdominal injury, unstable blood pressure, send to the No. [-] operating room, Fred, you come. Chest and neck Injury to the head, operating room No. [-], I will come; left arm + left shoulder, blood pressure is not bad, send to operating room No. [-], Sarson, you do the amputation first, and I will do the rest; craniocerebral injury and neck injury, send one No, Forstall, you deal with it first."

Sarsen immediately got the opportunity for surgery, and asked Gorham, who is still working as an assistant, to help him: "Mr. Gorham, I'm sorry for the trouble."

"It's okay, let's learn from each other.",

Gorham looked calm on the surface, but he had already started complaining in his heart.And when he actually stepped onto the operating table and began to deal with the stump, he realized that Carvey's decision was not unreasonable.

The birth of surgical amputation is not to treat injuries, but to remove useless limb tissues, and also to prevent damaged tissue from festering and infection. By amputating irreparable parts, the remaining healthy limbs can be restored as soon as possible.

Therefore, it is very important to grasp the resection site. Too much cutting will affect the function, and too little cutting will not work.

This is the concept that Carvey put forward at the beginning, which makes those senior surgeons who are used to doing one-size-fits-all very uncomfortable.But young doctors don't have this trouble, and the speed of access to new knowledge is much faster.

Sarsen had been in the Municipal General Hospital as early as a few months ago, and he had already shed the childishness of a fresh graduate.His operation does not have the clumsiness of other new chief surgeons at all. Experience and technology can be felt in his technique, just like an old oilman who has already mastered amputation proficiently.

"Your technique is quite good."

Although Gorham felt uncomfortable, he had a good mentality and was not stingy with his praise: "In Grantz, young people like you don't have such delicate knife skills, and amputations are always rough and rough. of."

"It was Dr. Carvey who taught me well."

Sarsen also said this kind of praise, without much emotion, and he didn't show much joy on his face, but Gorham knew in his heart that no surgical technique could be accomplished overnight. (except, of course, Kavi)
"It seems that you have already made sufficient preparations for today."

"Because the new chief surgeon must start with amputation, so after I failed the military doctor examination in Vienna, I kept the relevant surgical indications and amputation operation requirements in my mind, and took it out to review when I had time." Sarsen He said, "In the past three days, he has also followed dozens of amputators. He has seen all kinds of lengths and positions."

"Diligent enough, Dr. Carvey is quite accurate in seeing people."

Under a solid theoretical foundation, the surgical experience is like running into a high-speed suction tube, quickly entering Sarsson's brain from the operating table.Now he is holding a scalpel and a hemostatic forceps in his hands, and by feeling the muscles and blood vessels, he truly transforms this knowledge and experience into his own.

"33 minutes, the operation was clean and neat."

Sarsen didn't pay much attention to the time, but took a closer look at the stitching technique he had done.The skin at the two incisions fit together very neatly, and the skin was wrapped very tightly without exposed muscle and fat tissue, which should meet Kavey's usual suturing requirements for amputation.

"Sure enough, it's a good idea to learn sewing from Mr. Damirgang"

"Huh? What did you say?"

"Oh, nothing."

After inspecting the wound, Sarsen did a simple disinfection, and was going to find Lucius to deal with other damaged parts.Not only did the wounded suffer severe shrapnel cuts to his left forearm, he was also hit by two bullets in his shoulder.

Although gauze and bandages were used to stop the bleeding, it was up to other surgeons to decide how to deal with it.

"Mr. Lucius, I'm done here"

Sarson turned his head, looked through the messy operating room, and looked at another operating table not far away.The wounded man with a chest injury was still lying on the operating table, and Lucius, who was the chief surgeon, had long since disappeared.

Sarsen was very surprised: "Didn't it mean that the chest wound only needs to be sutured and treated conservatively?"

"Dr. Lucius just left." Delvo said on the same stage.

"Where did he go?"

"I'm looking for Carvey." Delvo was full of hostility towards Sarsen, but now he was more puzzled, "The wounded has some unexpected situations, and we may not be able to deal with them."

(End of this chapter)