Nineteenth Century Medical Guide

Chapter 261. 257. Postoperative Preparations

Craig is indeed the most serious of these wounded soldiers, with a lot of bleeding from the wound, and his mental state is not very good.

Mendelstein has seen too many wounded soldiers like this. Without the help of a doctor, they will die in a short time.So in his eyes, the operation is just to save the person, and he has no hope at all whether the leg can be kept.

Even if he really took Craig back to the temporary ambulance station of the military headquarters, their military doctor would amputate his limb when he saw this kind of wound.

But when Craig was carried out of the confessional, Mendelstein could clearly see that his right leg hadn't disappeared, but was paired with his left under the blanket.

This sudden surprise made the battle-tested captain speechless for a while, but Kawei, who came out with him, stepped forward and spoke first: "Captain, the operation is over, your soldiers are lucky, At least the leg was saved."

Mendelstein didn't turn his head around: "What about people? How about others?"

Carvey was a little confused: "Human? He's pretty good, his blood pressure and heart rate are normal. Speaking of which, your blood saved him in time, otherwise we don't know what will happen during the operation."

Mendelstein stepped forward and lifted the cloth blanket, saw that the cleaned thigh was covered with a piece of gauze and tape, and fell into deep thought.

He had never seen this kind of surgery before, that kind of exaggerated gunshot wound could save his thigh?

"Really keep it?"

"You also know that his thigh is bleeding badly, and all the blood vessels are broken. It is not easy to anastomose these blood vessels, and it depends on his recovery." Carvey explained, "It will take longer than Lieutenant Opper. If As long as nothing happens for the next four or five days, you'll be fine."

"Five days." Mendelstein asked, "What if something special happens during these few days?"

"It's really bad luck and something goes wrong. I can't guarantee it 100%. I can only see what happens and find a way."

"Can you survive?"

Carvey looked at him and realized that the captain in front of him was not Ignatz and his assistant. Not only did he know nothing about surgery, but he was also very unfamiliar with surgery that abandoned amputation.Carvey patted him on the shoulder lightly, and said with a smile: "People are fine, the probability of accidents is very low."

"Great!!!"

From the previous blocking battle, Mendelstein was full of guilt for his command mistakes.

An encounter that should have ended easily, instead lost more than 20 men.After the battle, revenge occupied his heart, and he didn't start to doubt his decision until he saw the wheat field in front of the small town of Otaka.

He was afraid of leading the remaining soldiers into a dead end, and he was even more afraid of encountering various uncontrollable situations.

When he entered the small town, he had prepared for the worst. If he really encountered a large number of enemies, he would cut the rear by himself and let the soldiers take Opper to evacuate first.

Of course, the current results have greatly exceeded Mendelstein's expectations.All the wounded soldiers brought in had been healed, and as long as the first army continued to advance the front line, they could join up with their own troops.

Everything is going in the right direction.

"You settle the wounded soldiers, and then go to the houses to find some food, we still need to rest here for a while." Mendelstein gave the order, and then asked, "By the way, how long has the orderer been gone? ?”

"It's been a while, but it takes a long time to fight back and forth on the road."

"Now the wounded soldiers are all safe and sound. We don't need to worry. Just wait for the messenger to pass the news to the military headquarters and tell us where we are. What you have to do now is to guard the wounded soldiers and observe their situation. If you find If there is any abnormality, notify the doctor as soon as possible.”

The soldier stood up straight and shouted "Yes", and then asked another question: "But Captain, no food was found in the house."

"No?"

"We started searching as soon as we entered the town. There were indeed none. They should have been taken away, or they had eaten up all of them themselves."

Mendelstein pondered for a moment, and said, "Then why are you still standing there? If you don't have food, go look for food in the surrounding woods."

"But we all carry three days of dry food, which is enough."

"We've had enough, what about them?" Mendelstein said, pointing to the doctor who had just come out of the operating room, "They left all their food in the carriage. Well, by the way, you bring four or five people back to the original place, and bring back the food from their wagon."

"Yes!"

"If you don't have enough food, look along the road to see if there are any wild rabbits or the like. If it's really not enough, give them our dry food."

"understood!"

Mendelstein seems to no longer doubt Kavey's identity and is willing to share dry food, but in Kavey's eyes they have not turned the corner.The guards just escaped the first wave, and they are likely to encounter more and more difficult troubles soon after.

The escape plan that was originally considered must not work.

The other party also came on foot, without horses.It is impossible to deal with each other one by one. My side has been being watched all the time, and the number of people is even more disproportionate.All they can do now is to stand still, one word: wait.

But waiting is the most troublesome thing in itself, and time is not good for the guards.

The Prussian First Army, which was fighting fiercely with the Austrian army ahead, was superior in terms of strength, morale, and weaponry, and Lamin's Sixth Army would undoubtedly be defeated.Kawei, who doesn't understand military affairs, can see that the battle is settled, and the only thing that can become suspense is how long they can resist.

If luck is bad enough, the Sixth Army may be defeated tonight, and their "neutral" medical team may be invited to Prussia to help.If this is the case, Kawi has no way to resist. The only advantage is that the guards disguised as civilians can leave safely.

Although Aleister has been monitoring him, but at the same time he and the members of the escort are indeed performing the duty of protection.

The battlefield is ruthless. Even though Kawei has conflicts with him, deep down in his heart, he still focuses on gratitude, and this time he is considered a favor.

As for whether Mendelstein really believed in himself, Carvey is not sure, this is not a person who will put his thoughts on his face.Moreover, he couldn't remember whether there was anything with the Austrian mark on the carriage, so he could only take a step to see.

Fortunately, Prussia in the 19th century was not Germany during World War II. It really exposed its identity. They should also be able to let the medical team survive for the sake of the Geneva Convention and the surgery just now.

Regardless of the way forward, his life was finally saved.

Carvey followed behind the soldiers carrying stretchers, briefly sorted out the current situation, and then focused on Craig again.

Operations on the operating table are only a small part of surgery, and postoperative recovery is a more important part.Although the technique of this blood vessel transplantation operation is innovative enough, it is still much rougher than the formal procedure. If it is not handled properly after the operation, it is likely that the previous work of the operation will be wasted.

The problems encountered after autologous blood vessel grafting are nothing more than poor reflux, thrombus and infection.

They exist independently, and they can also be causal to each other, forming an endless loop after complementing each other.Breaking the cycle and making Craig fully recover will require actively fighting complications.

The first is lower extremity swelling, which is the easiest to deal with.

Surgical trauma will naturally cause swelling of the limbs, and the swollen limbs will compress the lumen of the blood vessels, increase the resistance of blood flow, slow down the blood flow rate, and increase the chance of thrombus.

At the same time, after the blood flow slows down, blood stasis will form, the tissue will become more swollen, and the compressed cells will gradually die.Necrotic cells will not be removed immediately, necrosis + blood, the lower limbs will become a petri dish for bacteria to grow.

Compared with artificial blood vessels, the incidence of lower extremity swelling with autologous vascular grafts is not high.But considering that there is no magnesium sulfate in hand to reduce swelling, the preventive work that should be done still has to be done, so don't be lazy.

"This folk house is not bad." Carvey glanced at the room and found the hook for hanging the candlestick on the wall. "Don't rush to put him on the bed. Move the bed first."

The two soldiers only obeyed the orders of Mendelstein and Opper, when a young man suddenly came and pointed at him, feeling uncomfortable: "What do you mean?"

"Move the table here and put the bed here." Carvey also saw their thoughts and said, "If you want to restore him to health, just listen to me, I am a doctor."

The soldiers glanced at each other, and had no choice but to follow suit, but Kawei's request didn't stop there: "Take down the curtains on the windows, too."

"What is this for?"

"He hurt his leg badly, and I had to lift his leg up," Carvey explained. "Don't waste time, just do as I tell you."

The soldiers had never seen a doctor who asked so much, but this guy saved people first, and Mendelstein's attitude towards him was second, so they couldn't say much: "OK, you saved Craig, we believe you .”

The curtain was taken off and tied in a knot, and hung on the candlestick hook. Craig's head was facing outwards, and his calf was suspended from the curtain. The gravity of the blood itself increased the amount of blood returning to the heart, preventing congestion and swelling of the lower limbs.

After the swelling is resolved, the next step is the thrombus.

Swelling can form thrombus, and vascular suture itself will make the intima of the blood vessel uneven, which will increase the incidence of thrombus.In addition, after trauma and surgery, the blood is in a hypercoagulable state, coupled with the dual stimulation of infection and limb swelling, the incidence of thrombosis further increases.

Among the three major complications, thrombus can account for more than 90%, so "preventing thrombus" is the most important task throughout the entire perioperative period.

During the operation, Carvey had expanded the diameter of the grafted vessels as much as possible, but the clinical situation was impermanent, and what could be called complications were all force majeure.He now lacks anticoagulants such as heparin in the body, and the possibility of thrombus formation is still high under the two-phase offset.

"Let him drink more water after he wakes up." Carvey said, "Our people will come over to give him rehydration later, so as to dilute his blood and reduce its viscosity."

"What about pee?"

Carvey also thought about inserting a urinary catheter, but just like the incontinence that may occur during anesthesia, the current urinary catheter lacks an inflatable balloon, and the opening cannot be fixed in the bladder.At the same time, urinary tract infection was also considered, so it was always ignored: "We can only rely on you to urinate and defecate. We have other wounded soldiers and patients to deal with, so we really can't manage it."

"Well, after all, he is a comrade in arms. As long as he can get better, these are trivial matters."

The second is infection.

The incidence of infection in autologous transplantation in modern vascular surgery is not low, and it can reach 10-20% even with the routine use of antibiotics.Now there is no carbolic acid, no alcohol, and no methylene blue. The operation is performed in a church in a rural town in Central Europe. If no measures are taken, the chance of infection must exceed 50%.

Infection can cause the entire root of the autografted blood vessel to be reimbursed, and the degree of harm is the highest.

It's hard for Kawei's clever woman to cook without rice, so she simply did drainage to cover the wound.The next operation space is very small, and the only thing that can be controlled is to replace the gauze.

"Go to the kitchens of other houses to see if there is any oil."

"Oil? What oil?"

"Any oil, it doesn't matter if it's palm oil, kerosene, lard, fish oil, as long as it's oil."

Now that the conditions are limited, it is impossible for Kawei to specialize in cooking oil like he did in the Municipal General Hospital, so he can only use local materials, whatever is available.There is a drainage tube to drain the exudate, and the surface can be safely covered with grease, which can also block infection as much as possible.

"Don't rush away." Carvey continued, "Check to see if there is any alkali soap. If there is any, bring all of them. It will be useful."

Alkaline soap has a certain bactericidal effect. As for the "certain" effect, no one can say for sure, everything can only depend on God's will.

At this time, the Sixth Army was still struggling to support the fierce Prussian artillery fire.

Lamin's offense was not good, but the defense seemed to have received the true pass of the old Marshal Ludwig, and he coped well.It's just that the huge gap in weapons caused him to lose many soldiers, and the medical system that was originally sufficient was instantly broken down.

However, Karvey's medical team had already left, and even if he didn't leave, his medical team of more than a dozen people couldn't deal with so many wounded soldiers.

What really bothered Lamin now was the awkward location of the barracks.

In front was the ferocious Prussian army, and Kischen was too far behind. The messengers went out several times, but it would take at least three or four days for reinforcements to arrive.This is the miracle that could only happen if the messengers and the Fifth Army stationed in Kischin rushed on their way desperately.

Laming was firmly stuck in this place, and he would definitely not be able to fight head-on. If he retreated back, he would be able to escape with the protection of a company of guards.

but these soldiers
He looked at the map in the command post and analyzed it all afternoon, but he couldn't think of a way to break the situation.Just when he was in a state of desperation, the guard at the door suddenly walked in with a panting soldier: "Deputy Marshal, the messenger is here!"

"The orderly? Didn't the orderly just leave in the morning, how could he come back so soon?"

"No, he's not our orderly!"

(End of this chapter)