Nineteenth Century Medical Guide

Chapter 310 306. Punctate Hemostasis
Modern neurosurgery requires drilling 4-6 bone holes during craniotomy, especially when a small amount of non-clotting blood is found in the extreme part of the temporal lobe, a large bone flap is used to remove the hematoma.

Carvey is now facing such a situation.

Xie Basto's intracranial hemorrhage is not rare, and it has spread from the frontal lobe to the temporal pole.Judging from the scope, the hematoma has already compressed the brain tissue, and the bone flap must be cut to remove the accumulated blood clot, so that the brain tissue can return to its original position.

But Carvey lacked the tools to cut the skull -- a craniotomy cutter. 【1】

In fact, apart from the craniotomy milling cutter, he does not have high-speed drills, scalp clips, flap fixation hooks, and periosteal glassware. It is really too difficult to carry out neurosurgery in this era. 【2】

But compared to the latter things, the milling cutter is indeed more important.

Carvey had considered this situation before the operation began. When the milling cutter had become the standard equipment of neurosurgery in major hospitals, modern young neurosurgeons rarely saw the instruments and methods of craniotomy in the early years.

Even Kavey himself had forgotten a little.

The neurosurgery craniotomies in modern hospitals are made by electric pneumatic drills, and then cut by milling cutters, saving time, effort and worry.But there are always some hospitals in developing countries or poor areas that do not have these things, and they can only choose older and cheaper cutting tools-wire saws.

Compared with the milling cutter, the wire saw is much more troublesome, because there is no protective measure similar to the milling cutter protective sheath, and it is easy to damage the dura mater when passing through the lower end of the skull.

It has been nearly two hours since Xie Basto entered the main palace hospital.

He really didn't know whether such a guarantee was a blessing or a curse.

If Paion still has the title of baron, even if his status is becoming less and less valuable, he can still get the respect of these people, then this nurse from the bottom will have no such opportunity at all: "What do you mean? What do you have?" Are you qualified to push me?"

"Then the others... are they all preparing this thing?"

"The hot air balloon just rose into the sky with the airflow, far from achieving the purpose of flying." Boluodo didn't believe Edward's nonsense at all, but out of basic respect for the diplomatic ambassador, he still maintained restraint in his words, " Dr. Carvey is so young, how could he be stronger than Professor Cedieu."

They waited anxiously outside the operation theater, discussing why such an important person's operation was performed by an unknown young Austrian under the moonlight and oil lamp.At the same time, they also hope to hear some good news from the bloody operation theater. At least someone has to come and tell whether Xie Basto is still alive.

"Surgery is urgently needed!"

"The Assistant"

"Is it."

"It's better for you to take a trip." Carvey glanced around, and there was indeed no one available. "It's not always possible to ask patients and their families to help. Even if we are kind, they don't have permission to enter the warehouse to get things."

In particular, the subdural hematoma itself has severe bleeding, and after the hematoma is removed, it is necessary to face the trouble of how to accurately coagulate the blood.

Peon sighed, and wanted to explain a few more words to them, but when he thought of the tourniquet that Kavey asked for, he didn't dare to waste time: "The operation is very difficult, but Dr. Kavey and the professor are working hard, please rest assured Don't be impatient."

Carvey looked at Cedieu: "I don't know if the professor is interested in coming down to help."

This includes the differential diagnosis in the ward, the continuous improvement of the preparations by the nurses and Paion, and the drilling exploration before the operation.In the medical context of the 19th century, it was already very efficient to be able to do this.

"That's it, but if that's the case, the replacement must be Dr. Kevin."

Now that Carvey does not have the pituitary gland extract in hand, it is obviously unrealistic to ligate the blood vessels that supply the brain.After all, the brain is different from the uterus. The blood vessels are buried under the skull. What Carvey needs to do is not to remove the brain, and there is no room for manipulation.

Leos took half a step back, patted his chest when the nurse touched him: "Why are you so anxious to boil the water?"

When dealing with the dura mater, epidural bleeding may also be caused by various factors, so early hemostasis becomes particularly critical.

"Go and get it." Carvey remembered some craniotomy tools he had seen at the Municipal General Hospital, "just to see if there is any rongeur, after drilling + wire saw, you need to cut off the lower bone plate .”

"What I say is the truth."

Edward looked at the mother and child, as well as other people who were watching the play, and became more and more aware of the importance of tonight's operation to him.

"Yeah, if a young man in his 20s casually surpasses the best surgeon in France, then the so-called surgical center will be a joke."

After all, the burly elder brother was about to go up and smash the door.Unexpectedly, someone knocked on the door suddenly, and a fist as big as a sandbag almost hit Pai Ang's face.

Today, when the aristocracy is declining, the energy of the baron is extremely limited, but the long-term imprint still makes people fearful of the aristocrats.

"." Peon nodded, but he didn't move. "Doctor Carvey, if I leave, there will be no assistants here. How about letting me go?"

Just as he was about to speak, he saw the only two nurses in the surgical ward busy with work.

Poirot's voice was instantly silenced by the words, but it didn't mean he didn't respond: "Just now, my mother said that she trusts the Lord Palace Hospital. Of course, I have to respect her decision."

"OK."

It's a pity that this stability is only temporary, and it can be felt from their tone of voice.

Thinking is a bit simple and wishful thinking, but what I want now is this feeling of blood rushing straight to my head.

"Mr. Edward, what you said is as ridiculous as saying that Mr. Carvey can fly in the sky."

The more Leos spoke, the more excited he became: "So, since the operation is so dangerous, what are you waiting for, just go in and snatch your father back."

"That's the fact you saw, not the fact we think!"

"Mr. Edward, are you sure that this guy's operation will be successful?"

"I"

"How did I know it would be an Austrian who operated on him?!"

"Mom, you don't know much about this world. Humans have had hot air balloons for a long time."

One is in charge of monitoring the blower + heart rate and respiratory rate. If the respiratory rate is too low and shallow, she has to pump air into the patient's body to prevent hypoxia.At the same time, the heart rate must be reported at all times to prevent accidents during the operation.

The mother joked: "Don't be joking, Leos, there is a limit to trusting others. How can surgery be a certain success."

But when they arrived at the hospital, they found out that the bruise on the back of Xie Basto's head was the key.

"Okay, Dr. Peon, we'll take care."

At first they only thought that Shebasto had drunk too much. After all, an old alcoholic knew everything.Wake up and spit a couple of mouthfuls, and you'll be fine after a night's rest.

But the dark door opened and closed, closed and opened again, first the nurses, then Pai Ang, and other family members of the patients who helped, came and went so many times, no one could give an explanation.

The two nurses could not move.

"Come on, Polodo." Leos, who is two years older, ignored his mother, but glanced at his younger brother, "What's the point of saying these words now, why didn't you stop me when I entered the surgery theater just now?" with?"

The other has to deal with leeches. Although they may not be used, they are still very important because of the possible bleeding during the operation.

"That's right, even Professor Cedieu's operation still has a mortality rate of more than 30%. Surgery is such a terrible thing, and few people who go to the operating table end well."

"Everyone, please believe me, believe in my words who brought Carvey from Vienna to Paris." Edward caught everyone's attention with a loud voice, "I have always been Dr. Carvey's guarantor, and his surgery is indeed true. Like I said, never fails."

Now there are barely enough instruments, but there are too many surgical procedures, which will greatly delay the operation time.The longer the delay, the greater the chance of bleeding.In fact, as long as a large bone flap craniotomy is involved, intraoperative bleeding and brain injury will be put on Kavey's prevention agenda.

Carvey's surgery has indeed been successful all the time, no matter how bad the patient's condition is, it won't cause people to die on the operating table. This is the premise that he can stand here and deal with them.But now he is doing craniotomy, a craniotomy that almost no one can survive.

He and Carvey are no longer separate individuals. In the hot land of Paris, they are a community that prospers and loses.If he succeeds, he might be able to return to Paris for a promotion.If it fails, the big deal is to stay in Vienna as your ambassador abroad.

"I didn't expect that the operation was not performed by Professor Cedieu, and he didn't even know that there would be this operation. How could the management of the main palace hospital be so unbearable? It's so puzzling!"

But these busy tasks seem to be useless in the eyes of outsiders, which only increases their anxiety.

"Tourniquet." Peon glanced at the director in the stands, and said, "I remember a tourniquet, it should still be in the warehouse."

With some fragmentary laughter ringing around, everyone didn't take what Edward said to heart.Surgical technology is indeed developing, and human beings are also making great strides forward, but it is obviously impossible for a surgeon to be immortal.

Just when Edward was trying to verbalize everyone, the door was suddenly opened again, and it was the nurse with the blower who rushed out just now: "Get out of the way! Get out of the way!!!"

Carvey did find the jigsaw in several equipment boxes in the theater, along with a metal guide to guide it under the skull.As for technical issues, he has actually used them before, but he gradually stopped contacting them after the country became stronger.

The nurse also seemed to be suppressed by blood, and she looked like she wanted to explode but couldn't exert herself.After thinking about it for a while, she still decided not to tell the truth, and lied to them for a while: "There is not enough water for the operation. I am going to boil hot water now. Can you make a way out?"

Edward didn't know what to do, it was nothing more than a rhetoric out of desperation.

"I just heard about it."

How to do?
Facing the possibility of massive bleeding, Carvey chose the same way as blowers and leeches, a unique treatment method in the 19th century: "Does the Main Palace Hospital have a tourniquet to control head and face bleeding?"

"Mother, don't blame the professor. He has been unlucky for the past two days and failed two operations in a row. I heard that a patient died, the kind that died directly on the operating table!"

Peon is just an ordinary surgeon, and his qualifications cannot be compared with professors and associate professors like Cedieu and Kevin.But being able to work in the main palace hospital is either rich or expensive, and Peon has the title of baron on his head.

"He is sprinting for the Surgical Technology Competition half a month later, and he is not in the hospital for the time being."

The development of the disease was beyond their imagination, and the person was in a coma all the time.The family members were suspicious of Carvey's judgment for a while, but fortunately Edward and the bank president stepped forward to temporarily stabilize the situation.

Peon didn't see what he was going to do for a while, he was carrying a heavy burden on his shoulders, and didn't think much about it, thinking that he just wanted to knock on the door, so he said: "Can you be quiet? The operation is about to enter a critical stage, and now Cedieu The professor took my place. You should know him, he is very demanding in the surgical environment."

As soon as this remark came out, everyone didn't know whether to laugh or be surprised.

What they said most was "wait", "it's not good", "we're just helping to move things", "I don't know" and so on. The two sons may have been unable to hold back for a long time.

Many of them are subordinates of the police station, including the theater owner who initiated the masquerade ball, and the bank president and Edward who participated in the masquerade ball together.After the news spreads tomorrow, there may be even more people coming.

The American Civil War on the other side of the Atlantic had just ended, and the direct mortality rate of craniotomy exceeded 60%, and most of the remaining half of the people would die within two weeks after the operation.

As the chief of the Paris police department, not only his family members, but also other people came to visit him.

Just like when the hysterectomy was done, the major arteries are ligated before the cutting, and the hemostatic effect of the pituitary extract will greatly reduce the risk of surgery.

"Enough is enough! If you are in a hurry to use it, you shouldn't be so rash, how can you do a good job as a nurse like this!"

The nurse didn't want to talk nonsense with them at all, and let them run directly to the ward.It wasn't hot water that forced her to leave the theater, but another big event.What she has to do now is to rush to the warehouse of the ward as soon as possible to see if there are any extra tincture of ya tablets and watering cans.

I don't know why, but the strength that was exhausted just now seems to come out again and again, supporting her to keep running forward.

While running forward, she couldn't help muttering: "It's crazy, this operation is so crazy."

(End of this chapter)