Nineteenth Century Medical Guide

Chapter 238 234. Litokwa's Portable Diary【2】

Litokwa came from the outskirts of Graz, his father was an ordinary clerk in a government agency, and his strong learning ability allowed him to enter the Medical School of the University of Graz.After graduation, he entered the largest local hospital and became a surgeon there.

From the perspective of the 19th century, his surgical ability should be at an upper-middle level.

Although not as good as Hills and Herman, he can also preside over amputations and some common facial operations.After all, Graz's medical level is a level lower than Vienna's, and his teacher is not Ignaz, so the basic skills must be worse.

After a brief training, he also failed Carvey's surgical assessment and is now a doctor with the army.

The life of the Kravov Infantry Battalion was not only monotonous but also very short. He was sent to the rear hospital within two weeks after joining the army.But luck is not bad, at least the shell on the morning of the 27th did not take away his hands and feet, otherwise, I am afraid that he will have to say goodbye to medicine in this life.

In this regard, the young military doctor was very sentimental, and praised the surgical level of the Fortress General Hospital in his diary. 【1】

In today's surgical environment, amputation is still the first choice for limb surgery, but the Fortress General Hospital often performs limb salvage surgery, and the success rate is still very high.While praising this operation method, as a surgeon, Litokwa said that it is absolutely impossible for him not to be surprised or moved.

Especially Ronagne that night completely refreshed his understanding of surgery, and all of these were written in his diary:
[It was an astonishing rescue, which directly interrupted my description of the battlefield yesterday morning.

为了能准确记录下抢救的全过程，我必须停掉9月27日的日记，直接给9月28日开了个头。现在是9月28日晚上11点48分，罗纳涅被送进了我的病房。

The damned Prussian shot right through his head, cracking the skull and breaking the brain.

This is almost a fatal situation, not to mention that I have never seen this kind of trauma, even if I did, I don't know how to deal with it.Cut off the broken parts?Perhaps the only way to do it is to resect it. After all, the professors of medicine at the Graz Faculty of Medicine teach surgery in this way.

But can you live after removal?There may be only one answer, but the operating room of the Fortress General Hospital rescued this guy from death.

Now, part of Ronagne's head is missing, part of his brain may have been cut off, and his entire face is swollen out of shape.Just now, less than an hour ago, Dr. Carvey was at his bedside addressing his blood pressure and putting him on a tube.
To be honest, I can't imagine why a traumatic brain injury requires a puncture tube in the waist.But this operation lowered his blood pressure very well. This heroic soldier who charged for the empire survived. Although he was not awake, I knew his heart was still beating.

I have never seen such a surgical operation, and I don't know what made him survive?
Is it his strong and unyielding will to survive?
No, I've seen traumatic brain injuries, and it's hard to survive even normal trauma, the head has always been the deadliest part of the human body.

Is it those new medicines in the medicine cabinet?Or superb surgery?
I asked the nurse who was taking care of it, but they only said they didn't know, and I asked the ward assistants here, and they also said they didn't know.The doctors who were able to go on stage to see the whole process of the operation are either sleeping or busy, no one can answer me!
hateful!It's really disgusting!
Why did I fail that test?If I passed the assessment, I might have learned it by now Oh, no, I shouldn't be so brazen, at least I can see the operation!
I really want to go into the operating room and see how Dr. Carvey and his assistants operate! ]
This is the text written by Litokwa at 9:29 on September 0.

Not long after Ronagne's craniotomy and debridement surgery, severe cerebral edema was caused, and his blood pressure rose from 140/84 to 155/98.If nothing else, Ronagne would have died of cerebral edema and brain herniation that night, just like other traumatic brain injuries.

But Carvey temporarily solved the problem with a lumbar puncture and a lumbar drain.

At that time, Litokwa couldn't see clearly what was going on in Ronagne's hospital bed, surrounded by doctors and nurses.Even if he finally stood on his hospital bed, he could barely see the arched posture of Ronagne sleeping on his side and the back of Kawi.

As for how he had a lumbar puncture and drainage, Litokwa couldn't see it at all.

Closing the diary, his first half of the night was quite difficult, and the content of Carvey's teaching to the surrounding doctors was repeatedly scrolled in his mind:
[The exposed position needs to use the side lying position of "holding the head and bending the knees", and the waist should be perpendicular to the bed surface]
[Maintaining the patient's body position is critical and will affect the success of the procedure.For example, Ronagne was lying on his back without a pillow just now, and now he must be given a pillow to prevent his head from affecting his body posture when he is doing the puncture]
[Disinfection must pay attention to the range, the range should be large, to prevent one gap from entering, another gap can be used]
[Pay attention to the sliding of the skin when inserting the needle, and fix the fingers well. If the skin and soft tissue are not fixed well, the needle tip will go crooked.It's not that your needle insertion posture is crooked, but the internal structure is crooked, remember! ]
[If the first needle puncture is unsuccessful, you must not try repeatedly in four weeks.There are other tissues and blood vessels around, and doing so can easily cause damage.The correct way is to withdraw the needle to the subcutaneous area, and then make an accurate positioning and insert the needle]
[There is a sense of breakthrough after the needle is inserted, but it cannot be entirely relied on, because some patients and wounded feel differently.sometimes.]
Carvey talked a lot during the operation, from the preparation to the needle insertion to the final drainage, he said the main points again.However, because Ronagne's condition was different from that of ordinary patients, and the surrounding doctors were also asking questions, there was not much that Litokwa could really record.

These are only a small part of it, and it is very detailed, but what Litokwa really wants to know is not these details.

It cannot be said that these details are not important. It can be seen from Carvey's wording and expression that details are very important for lumbar puncture.But before pursuing the details, he wanted to know one thing, that is, where did the puncture go?

Does it go through the ligament and enter the spinal canal?

Litokwa heard the cerebrospinal fluid, and also heard the exclamation of the bedside doctor after the puncture:

[Squirted out, cerebrospinal fluid sprayed out! ]
[It’s so powerful that it can be sprayed out, the pressure is the same as the blood in the blood vessels! ]
[This pressure may have exceeded 300mmHO, after releasing some, I will make a simple measurement. ]【2】

Litokwa knew about cerebrospinal fluid, a medical term that had been established in the 19th century [3].The relationship between the brain and cerebrospinal fluid is also taught in anatomy courses in medical school, but not many medical students can remember it after an understatement.

After all, brain dissection does not affect brain surgery, and no one will cut open the brain to study the cerebrospinal fluid of a living person.

And the most critical point is that Litokwa couldn't figure out why the cerebrospinal fluid was released from the waist?He didn't even understand why the blood pressure dropped after the cerebrospinal fluid was released?Why does Carvey say that Ronagne is safe now, and Ronagne is really safe as he said
why? ? ?
There is also a measurement method similar to that of a sphygmomanometer. Can the pressure of cerebrospinal fluid really tell the severity of traumatic brain injury?

Although Litokwa memorized all these contents, it did not affect the pile of question marks in his mind.After experiencing the mental devastation left by tossing and turning and ruminating in the first half of the night, he reluctantly fell asleep.

However, after six hours of sleep, when he woke up, the pile of question marks did not get any explanation, but became more.

Because Rogerini, who had just undergone surgery, was sent in by the nurses.

Originally, his bed number should be a little later, but because of the shortage of beds, a lightly injured person in this ward was allowed to leave the hospital, so he was able to live in.

This time the injured part moved from the brain to the chest cavity and heart, another place where surgeons couldn't do anything.Litokwa still vaguely remembers how the director of surgery in his hospital dealt with heart trauma, "Just do a simple bandage, try to stop the bleeding, and wait for the heart to heal itself, if it really wants to."

This inherent approach is common throughout the world, at least in Europe.

He had never heard of a surgeon who dared to open the chest cavity, let alone a surgeon who dared to repair the heart. Can the heart really be repaired?That heart that beats more than 100 times a minute beats twice a second, how to do it?
Litokwa had never even seen the beating of the heart. He couldn't imagine the scene of the operation, so he could only focus on a piece of bread on the table with his eyes, and use his simple body to move up and down quickly to simulate what he might see.

No, my mind is even more confused!

"What exactly do you want to ask?" It was Goram who was in charge of this ward, and Rogerini and Ronagne were both his focus.

Litokwa was originally a doctor in the army, and his military rank was not much different from that of Goram, but he was very careful when he asked: "Can you tell me how Dr. Kavey treated Ronagne's traumatic brain injury?"

"do not know."

Gorham wrote down the medical records carefully, and answered very simply: "Without the arrangement of the chief surgeon, I couldn't enter the operating room at all. I didn't even see the lumbar puncture that night. I still want to ask someone else."

"That's it." Litokwa looked at Rogerini who was still awake, "What about him? How did he repair his heart?"

"It is to open the chest cavity, find the pericardium, and cut it open." Gorham pointed to his left chest, speaking very simply, "Then find the opening in the heart and sew it up with sutures."

"Are you on the operating table?"

"Yes, it's on." Goram was a little proud, "I'm really happy to be an assistant by Dr. Kavey's side."

Litokwa was very curious about how good a young surgeon was that the 30-year-old Gorham could praise so much: "How do you evaluate his operation skills?"

"The technology is very good, I can't compare it, even Dr. Bill Roth, the deputy dean of the School of Surgery." Goram said very bluntly, "But I think the relationship between him and us The difference is not just technical."

"Oh? At what level?"

"Surgical thinking." Gorham said while writing the medical records, "Dr. Carvey's surgical thinking is different from ordinary people, and he is not bound by traditional surgery and anatomy at all."

This is an extremely abstract statement. Litokwa is very clear about the meaning of this statement, but what he wants to hear is more specific content: "The constraints of traditional anatomy and surgery? How do you understand this statement?"

"It can be understood that he can do what we think can't be done, he can do what we think is difficult, and he is strongly opposed to what we think should be done." Gorham said a nonsense , "Probably that's what it means."

Knowing that it was pointless to ask these questions again, Litokwa tried to dig deeper into the specific process of this heart repair operation: "Can you explain the process in detail?"

"Process? What process?"

"Heart repair, how is it done? Does the heart really need to be repaired?"

"Didn't I just talk about the process?"

"But that's too simple, can you talk about the details?"

It seems that Gorham has said the whole process, but in Litokwa's cognition, these words are as if they were not said: "How did the chest cavity open? The distance between the ribs is so narrow, it can really expose Is there enough surgical field? Also, after entering the chest cavity, what about the bleeding from the rupture? Can it be stopped? That’s the heart, isn’t it?”

"Okay, okay." Goram didn't have the heart to answer these questions, "You are the wounded, the wounded should do what they should do, go back and rest."

"I know I'm wounded, but so am I."

"Of course I know you are a doctor." Gorham sent him to the bedside with a smile, and said, "Even a doctor has to heal the wound first, the infected part has just improved, and you can ask after the wound heals." It's not too late for these things."

If it was Goram two days ago, maybe he would have a good chat with Litokwa now.

But he saw the exchange between Delvaux and Sarson, saw the competition pattern in the general hospital and the possibility of his own promotion. At this time, exchanging surgical details with an army doctor was setting up a new competitor for himself.

Goram is not that stupid, why should he share experience equally with others when he finally got the chance to be on stage.

However, he was not so unfeeling. After seeing Litokwa's lost appearance, he still comforted him: "Dr. Kawei will continue to make ward rounds in the afternoon. This is a key ward, and he will definitely come. Then you can ask him again." Right. I’m a second assistant, and I’m doing cleaning and hooking almost the whole time, so I really can’t tell the details.”

[On duty, this chapter will be supplemented at midnight]

(End of this chapter)