Nineteenth Century Medical Guide

Chapter 250 246. Should I Seek Stability or Seek Greater Victory
[Just after stepping down, there were five departments down, and I was on duty again. Fortunately, there is nothing else to do. . .When I finish editing, I delete this sentence, sorry]

Severe hemorrhage during an operation like this requires not only medical knowledge or so-called surgical techniques, but more profound experience in trauma treatment.If there is no experience and only theory and technology, even the operation will end in failure.

And the experience in question here encompasses both of these things.

Internal medicine may still require a lot of logical deduction and theoretical knowledge, so even an ordinary person who has never received medical education can become an independent surgeon after experiencing dozens of such surgeries.

Of course, the types of trauma that such "surgeons" can deal with are very limited, and the cost-effectiveness of devoting strength training to them is also very low.

But Ignatz was different.

He was the holder of the title of "genius" in Austrian surgery before the emergence of Karvey. He has two generations of surgical inheritance from his father and son. He is also the chief surgeon of the Municipal General Hospital. Any title is enough to reassure patients on the operating table.

The growth that can be obtained by instilling experience into such a surgical elite must be much greater.

This is also the main purpose of Carvey asking Ignatz to help clamp blood vessels, which is similar to giving young people the opportunity to use mobile phones before he traveled here.

However, there are prerequisites for giving other people the opportunity to use mobile phones, and it is impossible to give them randomly. At least you must ensure that you can still control the scene when something goes wrong.However, if you want to control the undetermined scene, you need to judge the bleeding situation and make a simple assessment.

Conditional factors are limited, and Kawei is just an ordinary person and not a machine, so it is impossible to see the bleeding port clearly.If you want to do an evaluation, you need to engage in some special little tricks.

During the period of stabilizing the blood pressure, he did not simply press the bleeding point like a piece of gauze, but constantly and finely adjusted the blocking position and strength of his fingers to create a feeling for the evaluation.

The first thing to do is to repeatedly wash the abdominal cavity that was soaked in blood just now, to wash away unnecessary blood stains, and to make the field of vision clearer.Only when the field of vision is clear enough can the bleeding after the finger change be seen immediately.

The second is to control the pressure of the finger.

In fact, the amount of pressure Carvey gave was not small at all. I can clearly feel that the reason for stopping the bleeding is not simply to compress the breach, but to close the entire artery. As long as you relax a little, a lot of blood will come out Come.

Finally, by moving your fingers to find out the approximate range of the breach, you have a basic understanding of the extent of the breach.

Now Kavey has almost stuck his entire finger on it to completely seal the bleeding. Any movement will cause blood to ooze out, indicating that the scope of the breach is very large, and the diameter may have exceeded 1cm.

As for whether the blood vessel is simply broken or there is a worse situation, Carvey can't make a judgment, so he can only take one step at a time:

"Mr. Ignatz, there is no anatomical separation around the aorta and branch vessels, so the blood vessel itself is invisible to the naked eye, and what can be seen is only a simple bleeding point. My current oppression makes it impossible to perform clamping, so Later, you need to judge the location of the blood vessel rupture through the bleeding point, and then clamp the rupture with a hemostat."

"Well, I understand what you mean." Ignatz concentrated on looking at the surgical field surrounded by several retractors, and the hemostat in his hand was already hanging in the air. "I will clamp the wound as soon as possible."

"How's your blood pressure now?" Carvey asked Amor again.

This is already the No. 17 blood pressure measurement: "It is stable at around 110/60, and the heart rate fluctuates greatly, which should be the result of the effect of drugs."

"No time, just now, you need to keep an eye on his blood pressure."

"Well, don't worry."

Kavi looked at Ignatz: "Listen to my countdown, 3, 2, 1!"

He quickly moved his finger away, and the pressing position quickly rebounded, exposing the bleeding point in front of the eyes of the two of them, and at the same time, a bright red gushed out instantly, quickly covering the bleeding point just now.

Ignatz is also a surgeon who has experienced many life-and-death operations. The more tense the scene, the more concentrated his attention and the more extraordinary his performance.The hemostat went straight to the bleeding port without any hesitation.

It's a pity that although the forceps clamped the tissue around the bleeding, the bleeding didn't stop, or stopped completely.

"Still bleeding!"

Carvey went to touch the position of Ignatz's clamp with his left hand, and quickly picked up a hemostat with his right hand and plunged into the pool of blood, trying to help clamp the bleeding hole together.But at this moment, Amor's voice came over: "The blood pressure has dropped, now it is 85/44, and the heart rate is over 120!"

"Medicate, increase the amount of infusion."

Carvey said the same thing, because there was really no other way to do it, and at the same time his right hand hemostat made another pinch above Ignatz's.

When there is no liquid around the blood pool, the bleeding seems to be stopped, but after the aspirator removes the blood, you can still see a lot of leakage around it.

The area pressed by the fingers is much larger than the forceps, but it is rare for two hemostats to stop the bleeding. Carvey realized that this is not a small breach, and hemostats alone may not be able to completely stop the bleeding .

Of course, this may also be caused by the clamp not being in place.

Because there are many sheaths and other tissues around the blood vessels, errors may occur in the blind-field clamping done in a short period of time, and the teeth may slip.In comparison, finger pressure is more direct and effective.

He pressed the artery with his left hand again and felt a slight pulse: "First draw out the blood here and wash it twice. Amor, let me know as soon as the blood pressure stabilizes."

"it is good."

The two suction devices worked hard again, and the color of the blood flowing into the glass jar seemed to be slightly lighter than before.But now no one cares about this issue. As long as the wounded soldier is still alive, it is necessary to continue the rescue.

Carvey and Ignatz on the side discussed how to deal with the breach again.

"Clamps probably won't work."

"What should I do?"

"Let's do the suturing directly."

"Needle and thread? Is it feasible?" Ignatz frowned. "Also! You originally said you wanted to save the limb, but now you want to sew off the right common iliac artery? What's the difference between this and amputation?"

"It's just a short-term upstream suturing, and the anastomosis is done after finding the lower rupture." Carvey said, "Stopping the bleeding must be the top priority now, and the bleeding can be stopped before the next operation can be performed."

Ignatz has no experience with such massive bleeding: "I am the first assistant now, and you are the chief surgeon. You can decide the direction of the operation yourself."

"Then do this, sew silk thread for me!"

Carvey stretched out his hand to the equipment nurse beside him, and soon a needle holder with suture thread was delivered to him.

The blood vessels are in the retroperitoneum, and there is a large amount of abdominal content in front, that is, the intestinal tube. The surgical field created by the retractor is inherently small.Now there are two hemostats around the cut, plus Carvey's fingers, there is no room for the needle holder to enter.

So this time the roles of the two were reversed, and Ignatz counted down, and Kavey was preparing: "As usual, 3, 2, 1!"

The two hemostats were loosened almost simultaneously in Ignatz's hands and moved away quickly, and Kavey's left hand also quickly penetrated into the abdominal cavity, pressing the blood vessel by relying on the position and feel in memory.

This step of exchange gave him the confidence to make the next step. Carvey also heaved a sigh of relief, and tapped the hooks on both sides with a needle holder: "The hooks on both sides are stable, and the lights are a little closer. A little more. Okay, that's it!"

Ignatz's hands completely withdrew from the operation area, and the next suturing work basically had nothing to do with him. All he could do now was to keep the hemostat at hand, and prepare to give Kavey the bottom line at a critical moment.

"Come here with the suction tube." Carvey gently tapped the tissue above the left index finger with a needle and thread, "Put it here, and suck it away as soon as the blood comes out."

"understood."

Damirgang took half a step forward and took the position of Ignatz just now, which is convenient for attracting.On the other hand, Kawei gently moved his index finger away, probably less than 3-4mm away, and blood gushed out again.

Ignatz was very nervous, and the hemostat was already waiting at the incision: "Do you want to help clamp it?"

"No need." Carvey quickly inserted the needle next to the bleeding site, bypassed the blood vessel with experience, and passed the needle tip out from the other end, "Mr. Ignatz."

Carvey's left hand needs to block the blood vessel, and he can't do the ligation with only one hand, so Ignatz can only help.And he himself quickly took the second suture needle and thread, and after the ligation was completed, he slowly moved his finger away as before, and then pinpointed the location of the bleeding
Descend, pass, sew.

Go down, go through, and sew again
After six stitches, the breach was like a dam quickly closed by superpowers, sealing the turbulent river on the other side.

So far, there is no more active bleeding in the entire abdominal cavity, and the blood pressure has been raised from low pressure to an almost normal level by drugs and self-transfusion.Satisfied smiles filled the entire operating table. After all, being able to pull the wounded soldier back from the gate of hell has exceeded their expectations.

But in Carvey's eyes, all this is just the second step of the whole operation, and sealing the rupture only saved his life.

There is still a long way to go to achieve limb salvage like modern surgery, and the real trouble is the third step: how to save the ischemic right leg.

In the modern battlefield, as firearms become more powerful, the conditions for limb salvage surgery are becoming more and more stringent.In fact, in the front-line ambulance, it is rare to be able to perform limb-salvage surgery. The most important point is that it is difficult to ensure the blood supply.

Without a blood supply, nutrients cannot be sent in, metabolites cannot be sent away, and the preserved limbs are just a burden, which will soon be necrotic, infected, and then further attack their own master.So after seeing the bleeding in the abdominal cavity stop, Ignatz considered amputation.
According to the "Military Doctor's Handbook" and the medical level here, there is indeed no condition for further limb salvage, and it is highly likely that it is a waste of time: "Now the bleeding has stopped, the dorsalis pedis artery has not recovered, and the right lower limb is the same as you just said Severe ischemia, I recommend"

"I understand what the teacher means, but I still want to try."

For the first time, Ignatz heard Carvey objecting to his Surgeon's Handbook: "Try? How?"

"Since the bleeding has stopped, let's open the blood vessel sheath first to see what's broken inside." Carvey said, "If possible."

"You want to do blood vessel repair?"

"I think there is still a chance, you can try."

"It's too difficult, the blood vessels are too deep, and this kind of anastomosis is likely to cause bleeding again." Ignatz was very worried, "If bleeding happens again, it will make everything that was done just now come to naught, besides what you wrote at the beginning That's not what the Surgeon's Handbook says."

""Military Doctor's Handbook"?" Carvey smiled. "This is just the first edition written to save time. The content is not complete. Most of it is written for you."

Ignatz frowned even tighter, why did this sound strange.If he understood correctly, the implication should be that Kawei's technology is not restricted by this book?

Military doctors have to make a choice. Ignatz has been on the front line and knows that many times he has to make a choice: "There are still many wounded soldiers who need to be treated at the door. I still suggest that you amputate as soon as possible and choose to treat other wounded. Amputation is theirs." Fate, the most important thing is to safely save the lives of these soldiers."

"So those wounded soldiers depend on you, Teacher." Carvey smiled and let him off the operating table.

Ignatz was a little disappointed, but he was more worried about the failure of the operation: "If it fails, all previous efforts will be wasted!"

"But if he succeeds, he will be able to walk on two legs instead of using prosthetics and crutches for the rest of his life." Carvey briefly stated his purpose for doing so, and did not listen to Ignatz's suggestion, and replaced the first aid with Hercules Man, "How's your blood pressure now?"

Amor also breathed a sigh of relief: "It's basically back to normal."

"What about the blood transfusion just now?"

"1000ml was reinfused by autologous."

"Have the soldiers for the blood transfusion been found?"

The nurse dragged Bergett to the table next to him. While drawing blood, he made blood and glass slides: "We found four comrades from his company. We are already doing blood experiments."

"Okay, I'll wait for the results of the blood test."

Carvey let out a long breath, and said to the surrounding doctors and nurses: "If the operation is compared to a tough war, the heavy bleeding just now is the battlefield under a full-scale attack. Now that the bleeding has stopped, we have avoided the worst outcome. At least it was a tie with the opponent head-on.

But... but as Archduke Brecht said at the time, what war is about is victory, and the meaning of launching a war is to strive for the greatest victory while avoiding the worst.I think this sentence is a bit extreme, but if it is substituted into our war, it is especially appropriate to use it here! "

(End of this chapter)