Nineteenth Century Medical Guide

Chapter 233 229. One Bullet, Three Wounds
At dawn on September 9, Yodek Fortress on the Bohemian Front

The light rain that had been raining all night finally stopped, and the fog rose in the sky, and it didn't recede until the sun had fully risen.The Third Army has been stationed here for one night, and as the chief surgeon of the army, Lockard will definitely have a separate house as a private rest room.

However, considering the situation of the northern front, he needed to deploy the army's temporary field hospital as soon as possible. He spent the whole night dealing with tents, medical supply boxes, and the increasing number of casualties.

No one in the Austrian army thought that the Prussian army had slipped across the mountains of northern Bohemia.Not only that, but they also crossed the border, bypassing the Fort Yordek, which was the front line position in Bohemia, and inserted a small force between the Fortress of Olmitz behind them.

They would never have imagined that the imposing Third Army would suffer considerable casualties in its first encounter with the Prussian army.

On the first day alone, the entire Third Army suffered more than 4000 casualties, almost equivalent to a local battle.And the ensuing mountain pursuit battle expanded the number to 6000.Even if some stragglers, lost, and missing were removed, the casualties exceeded 5000.

This is not what Lord Cram Glass, the commander of the Third Army, wants to see.

The 58000-strong Third Army only encountered a small force, and so many people were killed or injured, it is difficult to say it without shame.But it's a shame, as the commander-in-chief of the first army, he must adjust his state in time to prepare for the next series of vicious battles.

He quickly found the answer from the captured Prussian artillery and guns, and immediately sent an urgent letter to Grand Duke Brecht and King Franz in Vienna. 【1】

It focuses on the superiority of the opponent's weapons in terms of firepower, and implicitly expresses the idea of ​​wanting to continue to receive reinforcements.

He knew very well that a letter alone could not accurately convey his thoughts, and at this time he should stand still and wait for news from the headquarters.However, out of consideration for avenging his son's injury and taking credit for himself, he sent a large number of reconnaissance posts to the mountainous areas near the border, and let the 6th and 7th Infantry Divisions continue to advance.

Departure time was set after lunch.

Lockard has seen all the way, knowing that he will definitely encounter trouble, so he can only integrate the medical resources in his hand.On the basis of maintaining enough surgical personnel at Fort Yordek, he added a considerable number of surgical assistants to the two infantry divisions.

The number of people has changed from only one doctor at the battalion level to a combination of one doctor and one assistant.

With three battalions as the basic establishment of a regiment, regiment-level troops can have a complete surgical team.However, if the brigade is used as a combat unit, it is not a problem to set up a simple medical team of more than a dozen people.

The short-term shortage of assistants in Yordek Fortress can be temporarily replaced by soldiers and surgeons in the villages around the fortress.

This decision was very wise. The two infantry divisions were blocked one after another in the ensuing mountain battles, and the frontline medical operations were barely maintained by relying on the expanded surgical team.

Of course, it can only be barely.

Because not everyone can understand the transshipment guidelines mentioned by Karvey like Locard, and no one can guarantee that everyone can understand Karvey’s military doctor’s manual. People like Doctor Delvaux.

Lockard couldn't leave Yordek Fortress, the quality of the doctors on the front line could only be maintained at the passing level, and the soldiers could only live in peace
At 28 o'clock in the afternoon on the 4th, four carriages brought a large number of wounded back from the front line to Yodek Fortress.Locard promptly formed several emergency surgical teams to respond one by one. When encountering operations that could be performed, they tried to complete them in Yodek, while those that could not be processed could only be sent back to Olmitz.

After all, there is a real rear hospital for the Austrian army.

After four months of meticulous preparation by Carvey, the staffing, hospitalization conditions, and inventory of equipment and medicines far surpassed the Legion Hospital that Locard temporarily deployed.And in terms of technology alone, Carvey's team is much stronger than Locard's.

The wounded soldier on Lucius' operating table was a captain of the 6st Mountain Brigade of the 1th Infantry Division of the Third Army.

"Rogerini, 23 years old, had bullet wounds on his left chest and upper left arm." Lucius briefly introduced the medical history, "He was still awake when he came here, and he only said that there was pain at the gunshot wound and he had difficulty breathing. There are no other symptoms. I saw that the amount of bleeding was not too much, and I did a simple test. The blood pressure was 115/75, the heart rate was 113, and the respiration was 30."

"You guys rest for a while." Carvey stopped the seminar, simply packed up his things and followed him out of the meeting room.

rest?

If the time went back to an hour ago, they might all want to stay in bed and have a good rest.But now that the state has been adjusted to the work area, a sudden break is a kind of torture.And most importantly, a wounded soldier that Lucius couldn't handle was much more interesting than sleeping.

The people in the conference room quickly walked out in twos and threes behind Carvey.

"How did you get out?"

"Specially injured soldiers naturally need to observe and study hard."

"Yeah, it's better to study surgery in the operating room."

"So studious?"

It didn't matter to Carvey, he often encountered this kind of situation in previous meetings, and the seminar would continue in another form of surgical observation.It’s just that the content of the meeting that was originally prepared has to continue, so this approach will greatly prolong the meeting time, and it can be regarded as a double-edged sword for teams with tight time.

Doctors lined up in the corridors of the hospital area, just like the rounds of modern hospitals.

Occasionally, someone would be called away by wounded soldiers, and after answering a few questions, he would return to the team as soon as possible, for fear that he would fall behind everyone.

"Because the location of the bullet was not very good, I didn't strictly judge the sequence of operations based on vital signs, so I took him to the operating room immediately. I'm going to check his condition while doing debridement."

Lucius was a little unsure, and just pointed to his left chest wall with his right hand, "The bullet penetrated very well and did not burst. The diameters of the three wounds are all about 1.5cm. After shooting through the left upper arm from the outside, It went directly into the chest cavity, the position was near the midaxillary line, and the height... the height was exactly in the fifth intercostal space."

"It's where the heart is!"

"Yes, to be exact, it's the apex of the heart."

"This position is indeed very bad, and the wounded can easily die."

"If there is a blood pressure problem, it means that the heart has been damaged. But now the wounded's blood pressure and heart rate are not bad. Personally, I think it is pure hemothorax. The bullet just stopped at the lung tissue outside the apex of the heart."

This is a good judgment, and Lucius thought so at the beginning, but in Kavey's view, it is meaningless to go back to the process of judging the situation of the wounded now.

"These are meaningless." What Carvey wants to hear is not these, "Just tell me why you came to me."

"Because he said that he had trouble breathing and the wound was painful, so I gave him some medicine and performed a thoracentesis." Lucius gained confidence from Kawei, and the operation became more and more bold, "immediately About 500ml of non-clotting blood flowed out."

"Well, well done."

"I asked the nurse to put on the infusion, and at the same time started the blood matching, and prepared to give him the infusion as soon as he got off the operating table." Lucius is already very skilled in the treatment of hemothorax caused by chest trauma, but often at this time, special circumstances will come up, "But."

"But what happened?" Carvey seemed to have guessed the special situation, "Did he experience shock symptoms during the infusion? Then he became very irritable?"

After hearing this, Lucius couldn't believe his ears: "How do you know?"

The voices of other doctors came from behind the two of them: "Yes, how do you know this?"

"No one saw it, but guessed the symptoms after hearing a few words?"

"Before being surprised, do you have to ask the person involved first?"

Lucius nodded again and again: "The symptoms are the same as Dean Carvey said. The wounded showed some symptoms similar to mild shock. For example, the lips were bruised, the limbs were cold, and the body began to sweat. I had no choice but to continue to give him input. Rehydration, but I don’t know how to deal with it, so I came to you to ask about the situation.”

Unknowingly, the team of doctors left the inpatient area and walked into a small building in the distance.

There is the location of the first and second operating rooms, and a huge logistics postoperative observation button was built around the two, and the layout of the building area completely inherited the style of the Municipal General Hospital.

The operating room is a space that is relatively isolated from the outside world. In order to be able to do a good job in teaching in the operating room, Carvey should not be too strict with them. He can only tell: "Lucius and I wash our hands. It doesn't matter if you don't wash your hands. But don't get too close to the operating table, wear a mask and a hat."

"We understand, let's go in."

"Let's go, let's go and see if the wounded man is still alive."

The wounded man named Rogerini was still lying on the operating table, and it seemed easier to take his life here than the bumps in the carriage.Because thoracentesis and disinfection are not too harmful, even ether anesthesia was omitted this time.

It’s just that after the anesthesia was dispensed with, the patient’s emotions seemed to be uncontrollable: “I’m a little uncomfortable, really, very uncomfortable! I feel like I’m going to die, I’m really going to die!”

"Don't worry, I haven't seen a dying person who can say the phrase 'I'm dying' loudly in such clear and standard German." The waking state gave Carvey a better opportunity to ask questions: "Where uncomfortable?"

"Here, here, and here. It hurts too much!" Rogerini raised his finger and pointed at the bullet wound, as well as his own chest, "It hurts badly!"

"Chest tightness? Shortness of breath?"

"Yes. Yes." He pointed to his head again, "I feel that my head was hit by a bullet too, why don't you check it too?"

"Head?" Carvey glanced at the scalp covered with dust and a few blades of grass, and shook his head after a brief inspection: "The head is fine."

"And what about my stomach?"

"Your stomach is fine!" Lucius replied, "You only have three wounds on your body, all from the same bullet."

"What bullshit bullet is so powerful?"

Rogerini's voice became louder, but the clarity was slowly declining, and at the same time, it seemed that his rationality was also falling: "I dare not join the army, what kind of shit captain, it's useless at all, and getting a military rank is also a job on the front line." Cannon fodder! Look at those officers, and then look at you doctors, hiding behind each other and doing nothing, so happy, so happy!!!”

"What are you waiting for?"

Carvey looked up, gently lifted his chin with the fingers of his left hand, gently pressed the liver with his right hand, and then looked at the jugular vein: "He is talking nonsense, give him anesthesia to calm him down."

"But his condition doesn't require surgery, it's just a chest injury, and he received a thoracentesis from Dr. Lucius, and the breathing problem has been resolved. And no matter how you look at it, the heart should be fine."

"Yeah, if the heart is really hit, you won't be able to live here at all."

"And the military doctor's manual clearly states that ether should not be abused because it has strong side effects."

Although the others thought this move was a bit strange, the nurse on the side still brought an ether inhaler, and put the mask on Rogerini's face under the signal of Kawei: "You guys, what are you going to do? 1th [-]st God Brigade Diro Niki Nisang bit, no"

The sound got weirder after mask processing.

Carvey looked at the captain who was slowly closing his eyes, and corrected their thinking: "Ether is not abused for postoperative pain relief, but if it is determined that surgery is necessary, it must be used. Of course, if there is chloroform as a substitute Not too bad."

"He's going to have an operation? I think people are quite normal."

"The newly measured heart rate is 118 and blood pressure is 103/66. Although there are some changes from before, the values ​​are still normal."

"A heart rate of 118 is not normal, and his lips are bruised, which is a manifestation of shock and hypoxia." Carvey's sensitivity to vital signs is much stronger than these beginners. "Blood pressure is a physical concept, which only represents pressure. The value of the environment does not mean everything, and sometimes it is necessary to look at these numbers more systematically and give me a stethoscope."

Taking the stethoscope from the nurse, he placed the tip in the fifth intercostal space where the apex of the heart is.

As expected, Rogerini had a typical Beck's triad. Combined with shock, fast heart rate, and weak pulse, the diagnosis was very clear: "Look at his neck, the veins are distended, and then consider this series of symptoms, I There is reason to believe a bullet had struck his heart and he had cardiac tamponade."

"Shot in the heart? He's still alive here?"

"I heard that the battle has advanced to the border, and it will take half a day's carriage to retreat from there to Olmitz."

Everyone couldn't believe their eyes, because they had never seen such a wounded person.

"Cardinal tamponade heart injury is not uncommon." Carvey explained, "It's normal if you haven't seen it, because the only symptom of this kind of wounded is cardiac tamponade. They will die slowly under your nose. If you don't An autopsy did not reveal the cause of death at all. Give me a syringe and prepare surgical instruments, I will use them later.”

[Sleep for a while, and finish this chapter when I wake up.If there are no accidents, there should be two more chapters today]

(End of this chapter)