Nineteenth Century Medical Guide

Chapter 249 245. Sudden Shock

Carvey's surgery is over.

According to the practice of modern surgery, the gallbladder will be taken and sectioned for pathological examination.The stones will be cleaned to count the number and size. If the chief surgeon has a collection habit, these things may become a member of his exhibition room after careful selection.

Carvey has no such eccentricity, and he prefers to promote surgery these days.

This is the first cholecystectomy in the world, and it is a cholecystectomy that takes less than one hour. If the education is in place, it can become a routine operation next to cesarean section and appendectomy in the future.

Based on this purpose, the scissors-cut gallbladder and the gallbladder stones scattered around it were lucky to be his postoperative spoils.

If there are trophies, there is capital to show off. Carvey's way of showing off is very rude, that is, he walks into the operating room with a metal tray for everyone to watch.This is gangrenous cholecystitis, a severe acute abdomen that requires repeated deep breaths to stabilize the mind even if the general surgeon is on the stage.

With Luo Jialuo as a patient, he could give a lively lecture on hepatobiliary surgery to everyone present.

However, as soon as Carvey walked in the door, he felt a little strange in the operating room.

The originally noisy operating room became much quieter. The operating table where Ignatz was located had changed to a surgeon. It looked unfamiliar, but Carvey remembered that it should be Ignatz's assistant during the operation just now.The wounded person lying on the operating table was also changed, from being shot in the abdominal cavity to debridement of trauma to the right upper limb.

As for Ignatz himself, he went to another operation.

If it's just watching, there's nothing wrong with it. Carvey likes to wander around in the operating room. It's always right to watch and learn more.But now the chief surgeon left his wounded and went to someone else's operating table, holding gauze and tissue forceps with both hands, and the atmosphere was extremely tense.

"Mr. Ignatz, this is the gallbladder of the patient just now." Carvey walked up to him with a metal tray and said, "You have never seen an unprecedented gallbladder."

"Um"

Ignatz was intrigued by the gallbladder removal, but looked away only after glancing back.And Carvey's attention was also attracted by the surgical incision in front of him: "Huh? Spinal surgery?"

"The bullet hit the spine from the lower back. I wanted to open it to see if I could take out the bullet and do a simple debridement." Ignatz looked at the former surgeon in front of him. I accidentally injured a blood vessel and bled a lot."

bleeding a lot
There is already a lot of bleeding in the spine, and the anatomical position is full of various large blood vessels.Whether it was carelessness during the operation, or whether the bullet injured the blood vessel in the first place, it is hard to say without imaging conditions.

What needs to be more concerned now is the situation of the wounded, and the situation is by no means better.

"Find a place to bury it." Carvey directly stuffed the metal plate into the hands of a nurse, and then continued to order, "Go out and turn left and there is a temporary operating table, let those people come over to help as soon as possible."

The nurse didn't know Carvey, but it was not difficult to tell from the tone of his speech that his status would not be lower than Ignatz's, and he had to follow orders: "Oh, good."

Carvey beckoned to another nurse at the side, asking for a new leather skirt and gloves, and then looked at the nurse at the operating table and the assistants who might be the anesthesiologist as usual: "Come on, someone report the blood pressure and heart rate. .”

"."

"what happened?"

"They don't have the habit of measuring heart rate." Ignatz seems to have gotten used to the frontline operating table, "and they don't have a blood pressure monitor."

"Heart rate is a vital sign that is strictly required. How can we not do it. And I remember that there are sphygmomanometers in the division-level rescue center, and there are three of them." Carvey is very strange, "This should not be the two infantry divisions of the Seventh Army. The vanguard of the formation? Why should such an operating room be equipped with a sphygmomanometer?"

"It was there before, but now I can't find it anymore." A nurse said, "And the doctor who used to use the sphygmomanometer also lost his life in the previous battle, so I just"

"Okay, so who will report the heart rate." Carvey had already put on his gloves, and said to the two nurses who were still in a daze, "He is bleeding very badly, and I need to know how he is bleeding now."

Having said this, they carefully pinched the wounded man's wrist.

In fact, it wasn't that the two nurses couldn't do a good job of measuring heart rate, it was just that they were almost suffocated by the tense atmosphere, and their reaction was a little slower.What they want is actual combat experience, not abuse, but now the situation is special, and Kawei can only choose to let them leave.

Herman and Damirgon lead Kavey's surgical team into the operating room.

This includes Amor and two experienced nurses who have been with Carvey, one is dedicated to passing equipment, and the other is mainly responsible for helping Amor and Bergett with other chores.

"How is Rogalo now?"

"Very good, you should wake up soon."

"Let's change people." Carvey shook his hand, and let his team come to the stage one after another, "Leave a few nurses, and the others will treat other wounded people. Don't waste time here. Teacher Ignatz and I will take over." gone."

Immediately, the doctors and nurses around the operating table began to disperse. Amor habitually found a chair and sat on the head of the wounded. .”

"Well, after the heart rate is measured, you can watch the medicine."

"it is good."

Five months ago, Amor was a very ordinary surgical assistant, fresh out of medical school with no experience.But now, he has learned the technique of adjusting the dosage of drugs to stabilize the patient's vital signs.

What Carvey taught was only the technique of ether anesthesia, not much about it, because the composition of the contents of the two extracts was too complicated, and even he himself couldn't grasp the difference between the dose of body weight and the changes in vital signs. The relationship between them, it is all due to his own careful trial and exploration to achieve this step.

There will inevitably be some surprises at the beginning, but as long as you get through it, you can turn them all into experience.

Carvey glanced at the wounded lying on the operating table. The incision on the spine was still there, with gauze pressed on it, and the bleeding seemed to have stopped.But this hemostasis is just an appearance, and the real situation of the wounded is far worse than what the naked eye can see.

"The face is pale, and the abdomen is swollen." Carvey touched the belly bulging from both sides, and lifted the surgical drape, exposing his legs, "Cut his pants off!"

After the nurse quickly cut the trouser legs, several ecchymoses could be clearly seen on the right lower extremity.

"Have you had these bruises before?"

"I don't know."

"If not, it should be ischemic ecchymosis, and the shock is a bit severe." Carvey found the key to the problem, and naturally touched the dorsalis pedis artery of his right foot with his hand, "The pulse has disappeared, and we are in big trouble!"

He quickly screened the lumbar blood vessels, and the only one that could cause this level of shock was the aorta in front of the vertebral body: "It should be that there is a problem with the abdominal aorta. Turn the person over first, and open the abdomen urgently."

Only a simple suture was done on the back wound, and the wounded body changed from prone to supine under the joint efforts of the three.

"The belly is big enough." Carvey looked at the nurse who was already taking the blood pressure measurement, "How is the blood pressure now?"

The nurse shook her head slightly, with a dignified expression: "Press up to 79, down to return."

"understood."

As soon as the words fell, the nurse took off the stethoscope: "I'm going to find someone for a blood transfusion."

This situation is also extremely difficult on the modern surgical operating table, and generally requires a large number of imaging examinations to clarify the location before making a judgment.Sometimes it is necessary to do vascular intervention to find the bleeding site, and then do emergency closure.

But the abdominal aorta is bleeding violently, and the third-class operating room is not bad, and everything can be done. If the conditions are more ordinary, it needs to be transferred from the ordinary operating room to the interventional operating room.Transferring this little time is enough to change many situations, and it may be impossible for a person just off the operating table.

"Severe shock with massive blood loss, the amount of bleeding must have exceeded 1000ml, maybe 1500ml." Carvey can't judge the amount of blood loss, so he can only give a simple inference, "The bleeding site should be in the right side of the abdominal aorta." Lateral iliac vessels, which resulted in severe ischemia in the right lower extremity."

The nurse has already handed the scalpel to Carvey: "Open the front abdominal wall, and the bleeding is in the retroperitoneum. Damirgang, go and prepare two suction devices, I will use them soon."

"it is good."

The situation was urgent, and Carvey even forgot the disinfection towel that he had been emphasizing all along, and directly cut open his stomach with a knife.

He and Ignatz are old partners and assistants to each other, so they are very skilled in the operation. Leaving aside some innocuous bleeding points, they entered the abdominal cavity in less than 3 minutes.In this short 2 minutes, Carvey basically explained what might happen next, and hoped that Ignatz could cooperate with him as soon as possible.

Any small mistake will prolong the operation time and let the wounded die on the operating table.

"First of all, its bleeding site is in the right common iliac artery, and the blood accumulates in the retroperitoneum. When I reveal the bleeding site, there will be a lot of blood gushing out." Carvey looked at Ignatz, "At this time, it is necessary to The teacher quickly found the bleeding point and clamped it accurately."

Ignatz thought that Carvey would do it by himself, but he didn't expect that this burden would be on his shoulders: "Me? I don't have this kind of experience."

"I will first block the opening of the blood vessel with my fingers, and then guide you to do the clamp."

"It was so"

"I estimate that the continuity of the entire arterial vessel has been interrupted. Suturing the wound and restoring the blood flow of the right lower limb as soon as possible will be the key to keeping the right lower limb." Carvey said, "I can't tell you how difficult it is to repair the damaged area of ​​the blood vessel. Evaluation, but I know that if the ischemia is too long, the whole right lower limb will have to be amputated."

Ignatz nodded: "This may be a good result."

"Well, the worst outcome is that the heart stops beating during the operation, and the wounded die." Carvey looked at the original surgeon who was still standing aside, "Death on the operating table requires a written report to the medical committee. Is it an operation?" The mistake is that the injury was serious in the first place, and we still need to wait for the follow-up autopsy."

"I, I understand."

"Don't be too nervous, maybe there will be so many things going on that we won't even have time to do the autopsy."

Carvey opened up the peritoneum when he made a joke, and the entire abdominal cavity was swollen, and the retroperitoneal hematoma pushed the abdominal cavity upwards without any space.Continuing to open the small intestine, you can also see a large amount of congestion in the small intestinal mesentery.

"Mr. Ignatz."

"I know."

Ignatz held a pair of tissue forceps in one hand and helped push open the small intestine with the other.On the other hand, he prepared at least three tissue forceps, and further away was a stack of thick gauze in Herman's hand, as well as two suction devices from Damirgang.

"How's your blood pressure?"

"The blood pressure has gone up, but the heart rate is very unstable." It was the first time for Amor to encounter such vital signs as if he was on the verge of death. "I'm trying my best to increase my blood pressure."

"Just come up a bit, this leg can't be dragged anymore."

everything's ready.

Carvey gently opened the right side of the peritoneum, and in an instant, the accumulated blood gushed out like a spring.

First, there were two sets of suction devices for Damirgang. The nurses and assistants beside the table kept pumping outwards, but they couldn't fully suction, and there was always active bleeding.Then came Heman's gauze, the blood quickly drained through the white gauze, as if it was blocking a spring, there was no way to do it.

The operation of the two was just to give Kavey and Ignatz the time to operate, and it was wishful thinking to rely on the suction device and gauze to stop the bleeding.

"Kavi!"

"I'm touching, don't worry."

"I'm not in a hurry, the bleeding is too much!"

"Infusion speeds up the flow rate!"

"It's already the fastest speed."

"Squeeze it!"

Carvey seemed calmer than anyone else.

His hands were already submerged in a pool of blood, and his vision was full of intestines and the bright red that soaked them.He could only use his experience and the slight sense of blood flow on his fingertips to go straight to the suspected bleeding point with his bare hands and press hard.

“Should be around soon”

Suddenly, the turbulent bleeding seemed to slow down a lot, which fully verified his previous judgment. The bleeding point was on the right common iliac artery: "I found the bleeding point, and I suppressed it. How is the blood pressure now?"

Amor also broke out in a cold sweat. During the three measurements, his blood pressure went downhill like a roller coaster: "Now the upper pressure is only 62, and the lower pressure cannot be measured."

"Speed ​​up the infusion, the transfusion person didn't come so fast, Damirgang, go for autologous blood transfusion!"

"it is good."

"Mr. Ignatz and I can't do anything now. We can only stabilize our blood pressure before proceeding to the next step."

Both autologous blood transfusion and allogeneic blood transfusion are much slower here than in modern times, and Kawei can only choose to wait.But as long as the breach is blocked, there is still hope, and there is still room for manipulation in the next suture.

Over time, the amount of autologous blood transfusion reached 800ml, and the blood pressure rose slowly from the original 62/- to 103/58.

The second step of clamping and suturing begins.

(End of this chapter)