Nineteenth Century Medical Guide

Chapter 258 254. The most critical part of maxillofacial injury is not in the maxillofacial area

In the case of limited medicines and equipment, the order of treatment of wounded soldiers will definitely be sequential.It is often to try to stabilize the situation that is slightly better, and then try our best to rescue the poor situation.

The vital signs of the wounded soldier who had just been sent to the operating room were not stable, his blood pressure was low and his heart rate was high, and he was already in hemorrhagic shock.If you don't perform surgery to stop the bleeding, suture blood vessels, or directly choose amputation, you will definitely die in the church in the end.

In comparison, the lieutenant and deputy company commander named Opper seemed to be much more relaxed.

From Mendelstein's dictation, it can be seen that he was accidentally hit by a stone and injured his face.According to this logical thinking, the injury is a one-off, at most there is a single fracture and skin and muscle cuts, and generally there will be no serious problems.

But when Opal was carried into the church, Carvey knew he had been cheated.

Whether it is in the 21st century or the 19th century, the rhetoric of "family members" is important, but you still need to maintain a certain degree of vigilance when obtaining this information.

"It was smashed too hard!" Carvey blurted out, but immediately realized that this was not a good topic, and quickly returned to the wounded himself, "It looks like it was smashed seven or eight times, the nose, left ear, left eye , lips are lacerated, mandibles are shattered"

The content of his soliloquy is very simple, but it already represents the seriousness of it being able to be spoken by Carvey.

Opper's nose collapsed again, and blood still oozes from the left nostril.The left eye socket was bruised and swollen. As I breathed, the cracked skin under the eye socket still fluttered. The outer canthus (outer corner of the eye) of the left eye could still see pits smashed by stones. Active oozing was seen.

In addition, the top of the left auricle was broken again, the skin of the upper and lower lips was lacerated in several places, and the upper and lower jaws were obviously broken.

With such a serious maxillofacial trauma, the first thing to pay attention to is not the amount of bleeding, but the consciousness of the wounded and some more unexpected things.

Consciousness represents the possible damage to the cranial brain. In the absence of imaging examinations, a simple inquiry, inspection of pupils, and some pathological reflex physical examinations can make a rough judgment.The judgment may not be 100% accurate, but Duoduo can see some problems a little bit.

"What's your name?"

Seeing that it was a doctor, Opal quickly moved his lips, but unfortunately the pain and some invisible factors made him unable to speak properly.

"Does your head hurt?" Carvey added just after asking, "It's not the pain of the wound, it's the inside of the head."

Opal shook his head slightly.

"Are you dizzy? Vomiting?"

Opal still shook his head.

Carvey looked at his pupils as he asked, and then at his shattered upper and lower jaws, and immediately realized a very bad situation: "Are you feeling out of breath?"

Opper's breathing can't be called shortness of breath, but the frequency is faster than usual, from 20 to 25 breaths per minute. Even he himself didn't realize that he had any discomfort.

After all, the resting state of lying down for a long time does not need much oxygen.

Opper shook his head at first, but after taking a few conscious breaths, he switched to a nod: "Kindly."

Knowing that his injury was getting worse, Kavi turned around and found Damirgang who was still doing "examination and treatment" for the original patients: "Damir, bring my equipment box over here."

"it is good."

Mendelstein had never seen this kind of questioning method that could predict symptoms, and he always felt that the young man in front of him was very different from the surgeons he knew: "Dr. Carvey, what's the situation with Opper now? Why is he panting?" Not angry? I think he's pretty good."

"The airway is blocked." Carvey said the reason directly, "The injury will not only cause the skin to bleed, but also the inside of the mouth to bleed. Look at the upper and lower jaws are broken. The bone is broken, and the tongue will lose its support." Falling back into the airway, combined with the influx of blood causing blood clots to stagnate”

Mendelstein seemed to be listening to heaven, and Carvey stopped talking and said, "I have to cut his trachea."

"Cut the trachea?" This sounds painful, Mendelstein looked at his comrades, and continued to ask, "Where to cut?"

"Here." Carvey pointed to his neck. "A small incision, and then a tube is inserted, and the breathing can be improved."

Carvey's preventive tracheotomy is definitely the product of a lot of experience in emergency surgery, and it belongs to the branch of otolaryngology.

Not to mention the current surgeons, even in modern times, if surgeons who are not usually exposed to ear, nose and throat injuries do not have several years of experience in emergency surgery, they will not make a judgment on tracheotomy at this stage.

Mendelstein has nothing to rely on now, and he is willing to trust the doctor's judgment, but his preconceived ideas still build an invisible wall in front of "belief".

Oppo's face was smashed by the soldiers of the blocking team. No matter whether these people were Italian or Austrian, he couldn't fully trust each other, and he would silently wonder whether the other party was out to retaliate: "I see his Breathing is pretty good, why do you need this kind of surgery?"

"He admitted to being short of breath."

Carvey got the equipment box, and according to his usual work habits, he ignored Mendelstein's suggestion: "The blood is starting to block his throat, and he needs to do a tracheotomy immediately."

"Aren't you going to do intubation?" Damir was also sincere, and directly asked a question that shouldn't be asked at this time.

Carvey turned his face and glared at him, and quickly explained: "For intubation, you need to raise your head and open your mouth. His upper and lower jaw bones are broken, his tongue has fallen back again, and there is still blood in his mouth. There is no way to do intubation."

Damirgang immediately realized that he had said something wrong, and nodded again and again: "So that's the case, I learned it."

After finishing this, Carvey looked at Mendelstein again, and began to use some "intimidating" words in accordance with the method of dealing with family members: "Maxillofacial injuries are not uncommon. I have seen with my own eyes three hours after being smashed, suddenly A patient with difficulty breathing. He died within an hour because the doctor who did not see him did not perform a tracheotomy in time.”

Mendelstein frowned, apparently taken aback.

Opper is his old comrade-in-arms, and they slowly climbed from the soldier to the current position together.Being injured already made him very uncomfortable. If he lost his life, he would absolutely not accept it.

In just a split second, the Prussian captain's eyes changed in a way that is hard for ordinary people to notice, but Carvey can still detect this change from the tone and attitude of the other party: "Well, I am willing to believe you, I will make the decision for Opal , agreed to do the tracheotomy that you just mentioned."

"Damir, give me the scalpel"

"Don't worry." Mendelstein interrupted him, "Before the operation, I need to clarify one thing with you."

Carvey:? ? ?
"I have no other request, I just hope that you can deal with Lieutenant Opper's trauma." Mendelstein patted his old comrade's leg lightly, and said to Carvey as if to comfort him, "He is mine. Old comrade-in-arms, I don't want any accidents to happen to him."

Carvey had to lament that in the early days of modern medicine, the relationship between doctors and patients was quite good.

Although the other party was a hostile officer with a gun in his hand and threatened death face to face, compared with the various sneak attacks with knives, direct beatings, numerous court summons and even threats to his family, Mendelstein Because at least it is straightforward enough.

Carvey, like an old monk who has experienced all kinds of hardships, shows no fear of this threat: "I will do my best."

"please."

"But I can't do anesthesia." Carvey said, "The wounded soldier is in a more serious condition, and I can't save ether."

"It's okay, as long as you tell him it's for Opal, he can bear it"

Seeing his comrade-in-arms talking like this, Opal raised his arm with difficulty and grabbed his sleeve, and then shook his head repeatedly.At this time, the shaking of the head was obviously much larger than before, for fear that Mendelstein would not notice it: "A little. Nothing. Nothing."

Perhaps it was due to muscle strain and difficulty in speaking. After gaining the initiative in anesthesia, Opal's breathing rate became faster than before.Simple breathing after lying down can no longer satisfy your lungs, and you need to breathe hard.

Needless to say, Carvey could also see the rise and fall of his chest and abdomen: "It must be painful to cut, but you still have to bear it."

Opal nodded: "Come on"

He is also worthy of being a soldier fighting on the front line. The same tracheotomy, Laszlo's body and Opper's body showed the opposite reaction.Although individuals feel differently about pain, when the pain reaches a certain level, the gap is actually not that big.

Laszlo almost passed out from the pain at first, but Opal relied on his tense muscles to endure the cutting of the scalpel blade, without making a sound.

"Fortunately, the neck is not injured, and the midline can still be touched." With the help of Damirgang, Kawei quickly separated the muscles, exposing the tracheal ring, and cut it off without thinking about other things. "Gauze, hemostatic forceps."

As soon as the words fell, some bloody secretions in the trachea spurted out along with the airflow.

"Captain, don't be nervous, it's okay!" Carvey immediately stabilized Mendelstein, who was extremely worried, and quickly sucked up the secretion with gauze in his hands, and then carefully separated it with hemostats amidst the blood red. Notch, "croissant."

"Here." Damirgang watched the operation under Kawei's blind vision, protected the incision with one hand, and brought the tracheal tube with the other.

Compared with the horn tube that Ignatz used on Laszlo's neck before, the tube in Carvey's hand has an extra silver sleeve.If Ignatz's tube becomes clogged with secretions, it needs to be replaced with a new one because it cannot be cleaned.

But with the inner tube, cleaning is easy and less painful to replace the tube.

Opal's situation is different from Laszlo's, far from suffocation, but severe pain without anesthesia still needs to be considered.Carvey's hand speed is already very fast. The incision that originally took about 15-20 minutes was completed in less than 10 minutes under his operation.

"It's okay, you should be able to breathe smoothly now, right?"

Opper could feel a foreign object stuck in his throat, and the surrounding tissues were uncomfortable and painful, but if these were put aside, the originally strenuous breathing was indeed much better: "Yeah"

"Okay, the breathing has stabilized, and the next step is to deal with these wounds."

There is no need to take a radiograph, just a simple examination of the wound shows that Opper's nasal bone, upper and lower jaws are fractured, and they are comminuted fractures.What he can do to deal with these fractures is very limited. It is very irresponsible to cut open and reset in such harsh conditions.

"Clear first?"

"Well, we can only do debridement first." Carvey pointed to the two lacerations on the scalp, the laceration of the left ear and the damage around the eye socket, and said to Damirgang, "You debride the wound first, and suture these movable wounds." Bleeding wound."

"it is good."

"Pay attention to the hemostasis to be clean."

"Ok, I know."

"The nose can't be dealt with, first use a simple cold compress to reduce the swelling." Carvey said, "As for the upper and lower jaws, you should suture first to prevent the open wound from infection."

"And what about the broken bones?"

Just as Karvey was about to continue talking, he heard a familiar voice in the distance: "Kavi, Mr. Yi Chino called you over."

As soon as Carvey heard it, he knew that the matter was not simple, and Ignatz in the operating room over there probably couldn't stabilize: "I'm dealing with patients? What's wrong with the teacher?"

"The wounded man was seriously injured just now, and I need you to come and help." The man may have seen Mendelstein, and immediately added, "I can't keep up with the speed of the teacher, so you have to come."

"Okay, I'll go over right away." Carvey still followed the procedure and had to inform the captain of Opper's current situation first, "Lieutenant Opper's injury is not serious, but the airway has been opened now, and the superficial trauma The problem is not too big, the main thing is to stop bleeding, suture and detumescence.”

His answer was still as conservative as ever, which made Mendelstein always feel weird: "The superficial trauma is not a big problem? Then, what about the deep one?"

"As you can see, there is a shortage of doctors and medicines here, and if there is a problem in the depths, I can't deal with it." Kawei glanced at Damirgang's skilled operation, "I don't have a perspective eye, so I can't guarantee that his internal wounds will happen. What kind of changes, including his brain and some other soft tissues."

Mendelstein couldn't hear those proper nouns, he only felt that Carvey's words were full of uncertainty: "So, his life is still in danger?"

"I can only say that there is no such possibility now, but in the future, this possibility cannot be said that there is no such possibility." Carvey saw that he was a little anxious, and quickly gave him an approximate time, "Let him rest in the church for two days. If there is a problem, I can deal with it immediately.”

"Two days."

"Yes, if there is nothing wrong in two days, then it will be fine." Kawei pointed to Damirgang and said, "This is my junior, named Damir. He is very skilled in debridement and suture. You can rest assured about the suturing of the wound."

Seeing that he didn't say anything else, Carvey left Opal and prepared to run to the operating room.

"Are you going to the operating room?"

"Yeah, the soldiers sent in just now seem to be seriously injured."

Opal looked at Carvey: "I'll go with you."

(End of this chapter)