Nineteenth Century Medical Guide

Chapter 311 307. "Intermediate sobriety period"

Just as Peon left the theater of surgery, Cediyo got out of the auditorium and somehow became Kawi's assistant.

He had mixed feelings, feeling like a ball of string messed up by a cat, all messed up.

As the director of surgery at Zhugong Hospital, unless it is for teaching purposes, he should never give up the position of chief surgeon.This is the minimum professional self-esteem. If you can't even do this, you don't need to be the director of surgery.

But the problem is that the operation is completely in the blind spot of his knowledge, even if Kawei really asks him to let him, he can't accept it.On the contrary, it is best for Kawei to not say anything or ask anything, just occupy the position of the chief surgeon and let the flow take its course, which can be regarded as giving him a step.

If someone asked afterwards why he wasn't the chief surgeon, Cedieu would blame everything on his gentlemanly attitude.

Success can be said that he wants to give up opportunities to Austrian doctors who came from afar, and it can also be said that he is cultivating talented young people.If you fail, you can say that you are too gullible in Kavey's talent, and you are not strong enough in your choice.

No matter what, he can get some light.

But soon, the situation on the operating table was changing, and the mood he had just smoothed out became complicated again.

It feels like the ball of thread that I just rolled up and was snatched back by the cat before it was stuffed into the drawer.It's just that the cat's appearance has changed this time, more like a tiger with its head downhill.Because of this incident, the whole operation has risen to a whole new level, which is unbelievably new.

"Yes, Mr. Director."

In fact, the skull is still completely covering his head. No matter how he moves, there will be no other accidents except that the scalp will swing back and forth due to the lack of fixing measures.

"Where am I?"

"That's good to finish the third hole." Carvey let go, looked at Cedieu next to him, and handed the jackhammer over, "Is the professor interested in playing one?"

"The pain of the operation only exists on the scalp. It's inhumane to be awake now, but at least it's better than amputating your hands and feet 20 years ago." Carvey asked the nurse to find ether, but the key thing was missing. It’s not anesthesia, but the method of anesthesia is different. By the way, is there a watering can here?”

"Oh hiss." Xie Basto felt a headache and wanted to raise his hand to touch his head, only to find that Kawei had quickly tied him to the operating table, "This is."

But in the eyes of others, Carvey's reaction did not reflect this kind of surprise, because he did not immediately ask the nurse to go to ether to re-anesthetize like other surgeons, but instead called his name directly : "Mr. Sebasto, Mr. Sebasto, wake up!"

Hematoma compression of brain tissue caused by subdural hemorrhage often occurs hidden, showing progressive aggravation, and it is too late when it is discovered.Therefore, subdural hemorrhage can hardly see the middle waking period, because once the coma occurs, it will only become more and more serious, and it will not wake up at all.

Theoretically speaking, the intermediate lucid period is only seen in epidural hematoma.

This is a great craniotomy!
"I remember that the skull has a double-layer structure. After breaking through the barrier in the middle, there is another layer underneath."

"Don't worry, it's nothing serious." Carvey said with a smile, "It's just a protective measure to prevent you from moving around."

The orbital depression reflex was very strong, not only frowning but also limb swinging, which was much more obvious than when he first entered the hospital.

If Xie Basto has been in an unstable state and shows no signs of calming down, he will immediately choose general anesthesia to maintain the basic operation of the operation.

"Yes, you must be careful when handling the lower bone plate." Carvey picked up the wire saw and the metal guide plate [2], and said, "Of course, don't pay too much attention to it, and close it in time when you feel a breakthrough." Just hand."

A tourniquet was placed over Shebasto's head. 【1】

Kavi nodded, putting down his ether mask.

The stimulation just now made Xie Basto wake up in an instant, and the pain in the scalp also came like a tide.He yelled loudly, hoping from the horror of his heart that the nightmare in front of him would end immediately: "I'm not sick! Why are you doing this? Why are you cutting my head off?"

It was not Cedieu who first noticed the change, but the nurse with a blower on her foot, monitoring her heart rate and breathing at all times.She rested her right hand on Xie Basto's wrist, watching the rise and fall of her chest and abdomen with her eyes.

This is also an important reason why Carvey chose to perform awake surgery at this time.

Suddenly, the wrist she was pinching moved.

"Oh." Xie Basto has no real feeling about the operation, and the only thing he feels now is a headache, "...I feel some pain in my head, can you help me look?"

Even Xie Basto, who had been on the front line in the early years, was a little uneasy when he heard these words.His hands and body reacted immediately, and he instinctively wanted to break free from the operating table, but the head clips and several straps fixed on both sides of his head told him that it was pointless to do so.

"Let them salivate slowly in it, you have half an hour to rest."

Cedieu's mind was still at the time of making the decision just now, still thinking about the feasibility of ether local anesthesia and the significance of awake surgery.Carvey's question can be regarded as popping his thought bubble, and brought him back to the operation again.

The operation began to speed up. Carvey quickly punched the hole while taking care of Xie Basto's mood: "How do you feel now?"

Carvey spoke quickly, but Shebasto seemed to understand: "My head hurts, I'm afraid."

After the watering can is washed, it is like watering flowers and plants, and it quickly relieves the tingling nerves on the scalp.Coupled with the extremely familiar tincture of ya flakes, Xie Basto's reaction quickly cooled down.

At first, she didn't pay much attention to it. After all, it is very common for ether to fail, and she just needs to add some anesthetic: "Dr. Carvey, the patient is about to wake up, and now I'm going to get ether."

"It really doesn't hurt much." He looked at the dangling scalp, still hesitating whether to accept Carvey's proposal, "To be honest, I've never heard of a craniotomy while awake. It all happened so fast and so suddenly."

This is definitely the best news of the whole operation. On the surface, it means that Xie Basto has woken up from a coma.However, if the interference item of alcoholism is considered, whether it should really be labeled as a coma before requires further consideration.

Logically speaking, he shouldn't have taken over, not even the assistant position.But who told him to be a surgeon? By the time his brain came to his senses, he had already clenched the handle of the drill bit tightly in his hand, and he still couldn't resist the desire to try it out.

Xie Basto slowly shook his eyelids, only to feel that there was a hazy golden light curtain in front of him, and the light made it difficult for him to keep his eyes open.His whole body was weak, and he couldn't move when he wanted to, just like an old machine that had been sitting on the ground for more than ten years was refilled with a shovel of coal.

Vomiting can be attributed to alcohol, and incontinent convulsions are common symptoms of intracranial hemorrhage compressing the frontal lobe.Urinary incontinence itself may also be overflow incontinence after a large amount of fluid intake, which Carvey has no way to judge.

"Don't move around." Carvey patted him on the shoulder and continued, "Moving your mind is easy to cause trouble."

"Well, I know." Carvey didn't understand the meaning of others at all, and continued to call his name, even in the name of a certain girl, and slapped his face while shouting, "Shebasto! Mr. Director! Sarah Miss Na came to see you with brandy, wake up quickly!"

"This"

"Oh, that's where your scalp hangs after it was cut."

Sebasto looked at Kavi and Cedieu standing on both sides, reminiscing about the smell of alcohol left in his mouth, and made the biggest decision in his life: "I accept, please cure me!"

In any case, Xie Basto's awakening is definitely great news.

".Um. Hiss"

Carvey recognized Xie Basto's reflection to the light, and continued to shout: "Mr. Director, wake up, Mr. Director!"

"how do you feel?"

"Drill or not?"

Maybe Carvey's advice worked for him, or maybe he regained his original intention of surgery, or he had confidence in drilling. In short, Cedieu is now back to his original appearance.

"I understand, I understand everything." Carvey held a hand drill in one hand and an ether mask in the other. "But the operation has been delayed for a long time, and the meninges that were cut just now began to ooze out again. Please make a decision now."

The epidural is often caused by a traumatic car accident, and the previous coma may be just a concussion caused by a huge impact.In the middle stage of the disease, there will be a period when the concussion subsides and the bleeding is not enough to cause neurological symptoms, that is, the middle sobriety period.

Skull drilling is a basic operation in neurosurgery, and it is not difficult.In particular, Kavi had done it three times before, and Cedieu had seen it three times, and he already knew where the thickness of Shebasto's skull was.

"No wonder." Xie Basto looked back and forth at the surrounding environment, and found that he seemed to have no other serious problems except a headache, "I feel pretty good now, by the way, why is there a black spot on the right side of my forehead s things."

"No, it should be in the warehouse."

After a few words, there was a response to the shout, and Xie Basto's hands began to move, followed by the facial muscles, and then the eyelids.
Sedie looked at Xie Basto, who was about to wake up, and really couldn't understand this approach: "Dr. Carvey, don't you think that in this era, forcibly interrupting anesthesia is a very inhumane thing."

Because it was extremely difficult for Sebasto to remain calm while undergoing conscious craniotomy.After opening the skull, intense physical resistance may further aggravate the intracranial hemorrhage.

"It's okay, it's fine."

At this time, the door of the operation theater was pushed open, and the nurse and Paion walked in together, with the head tourniquet, rongeur, watering can, and oral analgesic tincture of ya tablets all in place.

Giving himself one last chance, he picked up the metal tub of douche: "There's blood in your head, and we've got to get it out, or you won't wake up. If you feel like you can't stay calm, I'll immediately Just put an ether mask on you, and if you think you can bear the headache and cooperate with me in the operation, then bear it."

The two nurses originally performed their own duties, and when they asked Paion to get the equipment, they said that it was impossible to take either of them.As a result, it took only a few minutes for Kavi to change his face.The nurses complained, but the operation was still going on, and they had to obey the deployment.

Carvey didn't expect him to become so sober, and realized that his impromptu idea was still too reluctant, and his "patience" also fell to the bottom.

This is a skull!Below is the brain!

"Dr. Carvey, the operation is still going on."

The cutting of the wire saw is based on the hole on the skull. The hole at the temporal pole has already been made, and now two more holes need to be made on the cutting line to facilitate the insertion of the wire saw under the skull.

As for the so-called coma before, in fact, the orbital depressive reflex, tendon reflex, and light reflex all exist, but the response is slow.These things are all human judgments, and there is really no way to serve as key evidence for a definite diagnosis.

Carvey took off his gloves, picked up the oil lamp next to the theater again, and checked Shebasto's eyes: "Go find it!"

"Surgical theater." Shebasto's brain finally had a response to the words, "Surgery theater? Are you operating on me?"

"I'm going to spray ether on the scalp and skull as a local anesthesia," Carvey said. "The sensation in the wound on the scalp is definitely there, but it's much more comfortable than it is now. You can still stay awake at the same time. When dealing with blood accumulation, you can also get timely feedback from your state."

".drill."

"The surgery theater at the main palace hospital." Carvey pulled several ropes and began to tie his hands and feet. "You fell at the masquerade ball, knocked your head and passed out, and slept until now."

"But I'm going to watch the leech."

"The surgical site is on the head."

Cedieu couldn't remember how many years ago it was the last time he practiced under the supervision of the chief surgeon.

There is a double possibility of alcohol poisoning and concussion in Xie Basto's body. It has been three hours since he came out of the dance, and it is indeed time to wake up.

"Don't get excited, don't get excited."

After hearing the news, Carvey was uncharacteristically surprised, as if he had changed himself.He was still sitting on the chair, looking at Shebasto's unmoving head, and pressed his eye sockets with his hands.

"woke up?"

Once a person regains his composure, he will choose to look back at what happened just now: "I don't understand one thing, why do you have to let Mr. Xibastou operate in an awake state?"

"Huh? Didn't I say that?" Carvey explained, "This will help give feedback on the operation, the brain is too tender."

This is what Cedieu didn't understand: "Since this is the case, there is no need to anesthetize him with ether in the first place."

Carvey threaded the guide metal plate with the wire saw through a hole in the skull and replied, "Did I mention that he was given general anesthesia? I don't remember it."

(End of this chapter)