Nineteenth Century Medical Guide

Chapter 301 297. Command Tower

Ectopic pregnancy causes fallopian tube rupture and bleeding, just like male foreign body in the bladder. It is not common in clinical practice, but one or two cases will occur from time to time, reminding the doctors on duty not to forget it.Because once you forget, there will be serious consequences.

The girl in bed 97 had vague symptoms at first, with abdominal pain but only abdominal pain.There were no tests to determine pregnancy, and menstruation was unclear.

Because ectopic pregnancy will have signs of miscarriage in the early stage, that is, a small amount of bleeding.In the 19th century, only the few doctors who were at the forefront of obstetrics and gynecology who really understood the menstrual cycle, and some of them were not even involved in clinical work.

Now with the continuous development of ectopic pregnancy, the symptoms are becoming more and more obvious, the most typical one is internal bleeding.

When Kavi and Peon rushed to the maternity ward together, the girl had no blood on her face, her heart rate exceeded 100, she was fast and weak, her limbs were clammy and cold, her hair was wet, and blue-purple ecchymosis could be seen around the navel. 【1】

Even if it is impossible to draw a conclusion on the cause, the conclusion of "heavy intra-abdominal hemorrhage plus shock" is achievable.

She had abdominal pain, hemorrhagic shock, and no history of trauma. Considering her gender, age, time of onset, and conditions, Carvey could only think of ectopic pregnancy and aortic dissection.

The chances of acute hemorrhagic pancreatitis and tumor rupture are negligible.

Although the types of diseases are different, the way to deal with them is the same, open the abdomen.

The girl's condition changed drastically in a short period of time, and Hu Jier finally realized the seriousness of the problem.

Fortunately, he has enough surgical background and served in the army when he was young, so he knows what it looks like when he loses a lot of blood.Therefore, he did not choose bloodletting, which is still regarded as one of the methods in internal medicine, but only used some fumigation and massage items. After tossing for a long time and found that there was nothing wrong, he agreed to Kawei's request.

Of course, on the bright side of the operation, it must be Hu Jier who is performing the surgery.

The patient had been classified as an obstetric patient, but the chief surgeon was a young Austrian who had just arrived in Paris for two days, and he couldn't face it.Kawei has no such worries. He is not afraid of showing off when he is the chief surgeon, and he has no problem being the first assistant.

In the eyes of the watching medical students, Hu Jier was indeed performing the operation, but in fact Hu Jier was just a "decoration".

It can't be said that he is useless. The old man's basic surgical skills are very solid, and he knows the rules of surgery, but he is not clear about the detailed steps of abdominal surgery.Or to put it another way, Hoogier's attention to detail is almost non-existent.

This seems to be fatal to the chief surgeon, but as long as he has completed this part of the work, he is still a qualified chief surgeon.

This kind of disguise can only deceive beginners, and it is impossible to deceive experts. The three doctors with rich surgical experience immediately saw the relationship between Kawei and Hujier.

"The old guy's technique is really rusty."

"A laparotomy is not easy. He hasn't had surgery for so many years, and he only relies on the technique of dissecting the corpse to stabilize it. It's already very good." Even after he had just quarreled with the other party, Cedieu still remained objective, "You Don't ask too much."

"That's right." Kaushik put out his pipe and began to concentrate, "But it's too embarrassing to let a young man in his 20s lead me by the nose, or even help him lay the groundwork step by step. Alright."

Cedieu sighed: "Can you blame him? You will be dragged when you go up."

Kauschk had never been a partner with Kavey, let alone had abdominal surgery, and was not familiar with the process.However, it is not difficult to compare the hand speed of the two. Kawei's hand speed is faster than Hu Jier's. This is not only the difference in age and reaction, but also the familiarity with the operation.

"...Indeed." Kaushk didn't care about his own praise. He stared at the operation area and nodded uncontrollably, "This kid cooks the stove, prepares the ingredients, cooks the food himself, and puts the food on the table by himself. I think it's almost time to pick up a spoon and put something in the old man's mouth."

"You're exaggerating too much. There's no such exaggeration."

"It's a bit too much, but it's not too exaggerated." Kaushik said, "Not only did he do a good job as a first aid, but he also helped deal with some troublesome places, and at the same time he had to coordinate the work of Albaran and Paion. It's amazing, this kid is still so young."

As he spoke, he looked at Cedieu meaningfully, his eyes full of some indescribable meaning.

"what happened?"

"Are you the surgeon for rectal cancer this afternoon?"

"Yes."

"Kavi's help?"

".right."

Kaushik glanced at the operation area: "By then, wouldn't you want to be like him?"

Cedieu finally understood what he meant, nodded and said: "Rectal cancer surgery is much more complicated, and he alone can't solve an operation of that scale. Besides, my ability is better than his Hujier, so there is nothing to be afraid of." of!"

"I hope that's true." Kaushik suddenly asked, "By the way, it will still be this theater by then?"

"After all, major surgery must be done here."

"Okay, I'll come over and take a look."

Carvey has indeed exploded a scheduling ability that he has never shown on weekdays.

The little girl was in shock and had lost a lot of blood. The usual hands were not there, so he had to hurry up from the source.While hurrying up, he also felt as if he had returned to the Municipal General Hospital half a year ago.

Nurses lacked awareness, assistants couldn't keep up with their train of thought, and the surgical steps of the surgeon were chaotic.

If this is an elective operation and the patient is still healthy, the doctor can take his time.Now that the situation is critical, he can only slightly expose his domineering temper to minimize the chance of the operation failing.

"Don't be in a daze. I agreed to report my heart rate every 3 minutes. My scalpel is almost cutting into the peritoneum. Can you be more diligent?"

Where did the nurse experience this kind of atmosphere before, she was stunned for a while before remembering to take her pulse: "Now... it seems a little fast now."

"What I want is data! Heart rate per minute, every 3 minutes!" The abdominal skin and muscles in front of him have been completely opened, and Kavi hurriedly said to Albaran, "Go and get a bottle of medicine in my box." , it says sodium citrate on the label, hurry up!"

"it is good."

"You can see that the patient's peritoneum is also blue-purple like her umbilicus. If you are lucky enough to see the inner mesentery, you may still see this color."

Cullen's sign is so obvious that Carvey basically guessed that the blood loss is not optimistic, but he still hopes to save the person by reinfusion of his own blood: "Mr. Paion went to prepare two jars, needles and matching rubber tubes. .”

Peon has long been caught in Kawei's speed vortex.

He didn't have time and didn't want to think about it at all. After hearing the request, he automatically said "hmm". After putting down the hook in his hand, his mind came to his senses: "Rubber tubes? I remember that there didn't seem to be any rubber tubes in the operating room."

"Paris is so big, you said there is no rubber hose?"

The rubber tube should connect the bottle and the needle, if not, you have to use other solutions.For patients who have lost a lot of blood, it is not ideal or even realistic to use the thankless injection or switch to a fixed metal pipeline.

"Wait, how did I remember it?" Carvey turned around and found Guyon on the stage, "Master, don't you have rubber tubes in your urology department? Mr. Mosier told me that he used them before."

"Rubber tube" Juyong was also mobilized by him, and quickly got up and got out of the auditorium, "Yes! I'll go get it now!"

"Is it this bottle?" Albaran rushed over from a distance, "It says"

"Sodium citrate, I use Latin!" Carvey saw that what he brought was methylene blue written in German, and shook the pituitary extract on the side of the operating table, "Like this Yes, take them all!"

"oh oh."

"113 beats." The nurse finally found a chance to speak, and said suddenly, "Her heart rate is 113 beats per minute."

"Okay, then it will automatically report every 3 minutes, and if it exceeds 120, you must tell me."

"understood."

"Mr. Hujier, we are entering the abdominal cavity now." Carvey pulled the skin with the retractor in one hand and the suction device in the other. "Albaran, are you alright?"

"I'm coming."

"Put the medicine aside for later use, come here and shake the stick." Carvey said more and more urgently, and omitted some negligible titles, "Nurse, take a washbasin and come here to collect blood."

"Blood?" The nurse looked confused, but her body and mind had long been separated, and her mind was still thinking about why she needed to receive blood, but she passed a basin of water on her own, "Here."

Hu Jier made a light cut on the peritoneum stretched by Kaviti, and then used his fingers to separate a small opening into the abdominal cavity, only to feel a bloody smell rushing towards his face: "Attractor."

Only now did the nurse know what the so-called blood collection meant.

A large amount of non-clotting blood is like an unscrewed faucet, and with the efforts of Albaran's hands, it keeps pouring into the jar.After a while, the first 500ml was filled: "Where's the jar?"【2】

"I'm coming!"

"Change the bottle, and then put the sodium citrate in." Carvey said for Hu Jier while controlling the suction head to move between the organs to suck out the remaining blood as soon as possible, "After the blood is pumped out, we will It is necessary to expand the peritoneum and find the bleeding point."

Hujill quickly opened the peritoneum as he asked, followed by Carvey's hand into the abdominal cavity.

Touch the uterus first, and then use the uterus as the starting point to move to the possible location of the lesion: "Then pull the hook with Dr. Paian, stretch the abdominal cavity a little more, and then prepare the hemostat."

Ectopic pregnancy is different from ordinary abdominal elective surgery, and everything is based on seizing the time.It is impossible for Carvey to do the separation slowly, and it is impossible to hand over this matter to Hujill. He has to do the separation of the appendages and surrounding tissues by hand at the first time, especially the adhesion of the rectal recess.

The situation of the girl was exactly as Carvey imagined. The right fallopian tube was enlarged, and a 5*6cm mass could be felt: "Sure enough, I guessed right, it was an ectopic pregnancy! The fertilized egg that should have entered the uterus got stuck in the fallopian tube." .heart rate?"

"Just measured, 117 beats/min."

"Where's the rubber tube?"

Carvey looked outside the door, but he didn't see Guyon, so he could only open the passage first: "How is the sodium citrate adjusted?"

"It looks about the same."

"Who can do an IV?" Carvey's rare request, but no one dared to answer, "No one can do an IV?"

The nurses at the Main Palace Hospital are still at the initial stage of simple bed care and delivery of items. In fact, their professionalism is better than that of the Municipal General Hospital when Karvey first arrived in Vienna, but they are no longer comparable now.

In the end, Paion, who was the second assistant, helped out: "Let me do it."

"The basilic vein, cephalic vein or the center of the elbow of the left and right arms are also acceptable."【3】

Carvey mentioned the location of the puncture, and Paion's technique was a bit clumsy, but relying on the experience accumulated in the experimental work, he stabbed in after a few more attempts.This is not easy for a general surgeon. After all, the patient is still in shock and the veins are all deflated.

"Dr. Carvey, the heart rate has risen again, 124 beats per minute."

"What should we do now?"

"Where are the salt and water I asked for earlier?"

"It's ready, but it will take time to heat up."

Carvey found the rupture on the fallopian tube mass, blocked the blood vessel with his fingers, pulled it out together, and then clamped it with a hemostat: "It doesn't matter, let's inject it first. Professor Hujill, we will" 【4】

Hu Jier didn't hear the shock, and just did the operation himself: "Dr. Carvey should take care of the assistant's work, and I will do the mass removal (I understand)."

While speaking, he also used the hemostat to cut around the mass, and after seeing Kavey nodded, he took over the surgical part, and Kavey could also free up his hands to deal with the problem of intravenous infusion.

Just when other people were wondering whether they should listen to Carvey's advice and do the injection directly, or whether it is safe to inject clean water into the human body, the door of the surgery theater was finally pushed open by Guyon: "The tube is here, the tube is here!!! "

Now is not the time to worry about whether the two rubber tubes have been cleaned, even if they have just been pulled from someone else's body, they must be used as they should.

Two 500ml jars sent blood into the girl's body again, and then added 500ml of normal saline to her body.

In fact, as long as you have survived the main battlefield of shock, as a sideways operation to directly attack the cause, it is not difficult and the operation process is not complicated.

Before the mass appeared, Hu Jier had no concept of surgery and could only listen to it step by step.But when the mass and the breach appear, the purpose of the operation is very clear, that is to cut off the fallopian tube where the mass is located, ligate the blood vessels, and stop the bleeding.

According to Hu Jier's dictation, the second half of the operation went very smoothly. In the end, it was only necessary to remove the residual blood in the abdominal cavity.

(End of this chapter)