Nineteenth Century Medical Guide

Chapter 313 309. I am really interested in antiques
In general, the amount of Cerebral Hemorrhage of Xie Bastou is very small, and the estimated value is only between 10-15ml.According to modern standards, as long as conditions permit, you can choose to rest and wait for the blood clot to be absorbed.

Of course, the requirements are absolute rest and long-term monitoring of vital signs, and repeated imaging examinations are required to confirm that the hematoma is not getting bigger and is indeed being absorbed by the body.

Once the vital signs are unstable and the hematoma further increases, surgical intervention is required.

None of this existed in the nineteenth century.

There was no sphygmomanometer in the main palace hospital, let alone requiring nurses to measure heart rate day and night.The imaging examination was even blank. No one knew whether the hematoma would increase. Even the location of the operation was guessed by Karvey with a little luck.

In the eyes of Peon and Cedieu, Xie Basto was indeed in a coma before, but he was awake after the skull was opened.The intracranial hemorrhage is what they saw with their own eyes, and they understand the principle of the fixed volume of the skull, so it is easy to associate cerebral hemorrhage with coma.

So Carvey's surgery did save Xie Basto's life.

If it had been someone else, it would probably have been quite satisfied with having performed this difficult craniotomy in the 19th century.Even if there are some flaws in the middle, it cannot be made up by manpower, not to mention that the operation itself was successful, and Xie Basto survived.

But from an objective point of view, especially after adding Kavey's modern medical philosophy to examine the entire treatment process, the timing of the operation is not so accurate.

The harsh demands made him very dissatisfied with his own judgment.

The operation was a success, and the patient was a success, but his decision failed because, no matter how you looked at it, it was better for Sebasto not to have the operation.Even if his cerebral hemorrhage has a tendency to worsen completely from the rupture of the vein found during the operation, the operation should be performed after the deterioration, rather than risky surgery in the early stage.

This includes errors in differential diagnosis, possible omissions in physical examination, and deficiencies in various hardware conditions.

For no reason, a big hole was opened in the human brain, and 12 thin screws and 6 pieces of iron were screwed in.Not only that, but you have to bear various risks of craniotomy after surgery, including possible bleeding, edema, and infection after surgery.
Carvey really can't be as free and easy as Xie Bastou.

Therefore, on the premise that the hematoma was cleared, there was no follow-up bleeding, and the patient's condition was stable, Carvey began to close the skull while reflecting on the entire diagnosis and treatment process.

Putting aside other symptoms and possible diagnoses, Carvey himself is satisfied with the surgical treatment of cerebral hemorrhage.In particular, all kinds of surgical preparations for cerebral hemorrhage have been called "perfect", and it is difficult to find better alternatives at the current level.

Before the operation, the patient was given concentrated sugar water to ensure osmotic diuresis. During the operation, cotton pads were placed on the head and shoulders to ensure the position of the head high and the feet low. The blower was used for moderate hyperventilation. All three methods tried their best to achieve the effect of brain relaxation. 【1】

As for postoperative external ventricular drainage, which is common for intracranial hemorrhage, Xie Basto is in good condition and does not need it.

The entire operation was performed without ether inhalation anesthesia, which preserved the human body's own cerebral blood flow-cerebral perfusion pressure regulation mechanism. 【2】

The mastery of surgical conditions has reached the top level, even the best director of neurosurgery in the hospital where Carvey worked at that time may only be able to do so.Because of this, Carvey is more concerned about the timing of surgery.

One error in judgment wiped out all the preparations for surgery.

Xie Bastou's body came second, clinically, it was full of luck.The main reason is that he has no way to judge whether these measures are really useful through surgery.If he encounters the next traumatic brain injury operation, his successful experience this time may not be successful.

"Is the bone flap ready?"

"Okay." Paion brought the bone flap, and there were already eight small holes on it, "I also added the two in the middle."

"it is good."

Carvey used scissors to cut off the suture between the dura mater flap and the skin flap, then passed the suture through the bone hole in the center of the bone flap, and sutured: "The outer side of the dura mater should also be suspended from the edge of the bone window. ”【3】

"What about the dura mater? Continuous intermittent sutures?"

"Yes." Carvey said, "Use the thinnest silk thread, and the needle distance is 2mm."

"so fine"

"Ensure the watertightness of the meninges," Carvey explained. "Any remaining cracks in the meninges may produce valve action, causing cerebrospinal fluid in the brain to overflow in one direction, resulting in fluid accumulation." [4]

The suturing of the meninges is time-consuming and laborious, and even Cedieu, who has repeatedly practiced suturing for abdominal surgery, is troubled in his heart.

"Come on." Carvey didn't have much to say, "Dr. Paion, bring all the nail plates, and fix the bone flap immediately."

In fact, the bone flap can be fixed with the thickest silk thread by ligation.However, in the 19th century, the silk thread was not fast enough and it was difficult to prevent slipping. Carvey still preferred to use screw iron sheets.The next step is the fully mechanized operation, the suturing, the hemostasis, from the bone flap to the galeal fascia to the scalp. 【5】

"Teacher Sediyo, I'll come next." Carvey said, "The family members outside are waiting, and someone needs to explain."

"I go?"

"You are the director of the main palace hospital." Kavi tapped Pion's hand with the hemostat, and said, "When you are a suture assistant, you must help align the incision margins, and push the two sides together to facilitate the operation." Knot."

Normally, Cedieu would definitely accept it, but today he couldn't let go of his old face: "Farewell, you are the chief surgeon, and the chief surgeon is qualified to report the results of the operation. I'd better sew my scalp with peace of mind."

"Then" Carvey said, "In this case, let's go out with Mr. Xibasto after the operation is completely over."

Shebasto's ending is naturally satisfying.

It's just that the operation itself was so smooth that the mother and son had more or less doubts about the operation itself.The point of doubt is that Shebasto is just like a normal person: "How did you wake up after the operation?"

"Is it okay if I'm awake?" Xie Basto, who was lying on the plank bed, was obviously more energetic than the people around him, "Do you know what I went through just now?"

After finishing speaking, he symbolically pointed to the still tingling scalp, making his wife think it was just an ordinary scalp trauma: "It turned out to be a broken head. To be honest, my dear, you look really good with your hair shaved off." It's strange, like a different person."

"Hair, oh yes, hair!!!" Sebasto became excited suddenly, "I have no hair now!"

Fortunately, Carvey controlled it quickly enough, and immediately held down his hand: "The operation went well, but at the same time, I hope Mr. Director can restrain himself as much as possible. The hair will grow back soon, but there is only one head. Touch it." The bad is gone."

"That's right, Mr. Xie Basto, now is the most critical recovery period after the operation, so don't move around."

The two exhorted a few words from left to right, and then began to describe the operation process in detail.

Carvey is relatively "honest", or in other words, he has no interest in describing some details, but only briefly talked about the process, emphasizing more on the state of the patient before the operation.And Cedieu's performance was even more indifferent. The whole article only talked about the success of the operation and Kawei's boldness, and hardly mentioned anything else.

But in fact, any discerning person who has participated in the operation knows what this operation means.

The eyes of the two nurses and Paion looked at Cedieu one after another, and their eyes became strange. Although they quickly retracted their gazes, Edward saw all this:

"Professor Cedillo, as the first close-up oh no, you should be the second. As the second French surgeon who witnessed Dr. Carvey's operation at close range after Dr. Mosier, do you think his How is the level?"

"Very good." Saidi Yue cherished words like gold.

"Can you be more specific?"

"Specifically?" Cedieu was a little embarrassed, but he quickly thought of a statement that could "take into account the overall situation", "If Dr. Kavey is interested, I am very happy that he can come to Paris for further studies. With his talent, he can definitely Become a leader in the surgery of the main palace hospital in the future."

It is true that they are all praising Kawi, but they are all praising themselves behind their backs.

Because it is not difficult to become a surgeon in the main palace hospital, but if you want to become the head of surgery, that is, the chief director, you must be appreciated and taught by the current director.In other words, Cavey had this opportunity only after Sedieu's teaching.

This has nothing to do with surgical ability and technology, it is completely a product of the involution of the medical circle.

Edward could understand, but Sebasto's two sons could not.Especially the eldest son Leos, whose stupidity is completely inconsistent with his handsome appearance: "Dr. Carvey is really good, I didn't expect my father, who had to sleep all day to wake up, only took four hours to wake up. "

"Dad is not drunk, but his head is broken!"

The younger brother Borodo immediately corrected his mistake, and at the same time threw an olive branch to Kavey: "Dr. Kavey is new here, if you don't dislike it, why not come to live with us. Anyway, it must be better than the messy hotels on the street."

Before Karvey could react, his mother also said, "Yes, so my husband can take care of me at home."

"Don't worry, Dr. Carvey, we won't treat you badly."

The three of them made Kavey speechless. Fortunately, Edward responded well: "Everyone, Dr. Kavey is not here for tourism, but for a tour of surgery. The director's home is several kilometers away from Medical Street, and he goes back and forth every day." An hour or two of tossing."

Seeing what else they wanted to say, Edward Lianman added: "Besides, I chose the best hotel in Paris, it shouldn't be much worse than your expensive house."

At this point, the meaning of the words is quite obvious, but Leos still rushed forward: "It doesn't count if you say it, it still has to be decided by Dr. Carvey."

"That's all right, big brother, everyone else has declined, so what else can we say?" Polodo quickly stopped him and said, "It's okay, father is fine now. If there is any problem, we will go to the hotel to ask for a card." Doctor Wei."

After a short greeting, Carvey, Edward, and Slang, the vice president of the Bank of Paris, left the main palace hospital.

In fact, the two of them took different paths from Carvey, and they got into the same carriage more because of the auction.Because no matter how you look at it, Carvey's attendance seemed abrupt, but it was full of topics.

Slang hadn't figured out the details of Carvey before, so he had room to speak.But now that the operation is in front of him, it is not fun for him to keep these leeway.

"I have already prepared a deposit and a VIP seat for Mr. Carvey, and you can just go there when the time comes."

Slang looked extraordinarily cheerful. What he didn't fully agree to at the masquerade just now, was actually done not long after.This made Edward can't help but sarcasm: "Mr. Slang's movements are faster than lightning. Could it be that I fell asleep just now and didn't see you going back to the bank?"

"Hahaha, Mr. Edward is joking again." Slang and him looked at each other and laughed, "Dr. Carvey really deserves his reputation, if you are too tight, this deposit will be considered as a gift from the bank. "

"No need, I just borrowed a loan for two days to pay for the quota of the auction." Carvey said, "After the funds are transferred, they will be returned to the bank immediately."

"At your request."

Edward did not expect that Carvey would be interested in antiques and artworks, and asked, "Did Mr. Carvey fancy something good? Or did he want to buy something for the girl he likes?"

"I do have an interest in antiques, especially oriental antiques."

"Well, Dr. Kavey really has taste. Those yellow-skinned oriental things are really exquisite." Slang introduced with a smile, "Of course the price is also very high, you have to be prepared."

"Well, I understand."

The two casual conversations made Kawei's face extremely ugly.

The two thought it was because Professor Cedieu didn't clarify the primary and secondary relationship of the operation just now, or didn't give the necessary respect to the chief surgeon of the craniotomy, so the words will focus more on Kawei's side: "The operation of staying awake throughout the whole process is over. For many years, I thought I would never see him again."

"And it's a craniotomy. Dr. Carvey's technique is really superb."

"Professor Cedillo doesn't seem interested."

"Indeed, the reaction was flat."

Slang and Edward repeatedly talked about the topic of surgery, hoping to arouse Carvey's interest.But seeing that he didn't have any intention of interjecting, he stopped talking.

The main palace hospital is not far from the hotel. After a few minutes, the carriage put down Carvey and drove away.

It seems that no one watched this operation, and even a reporter appeared, and Cedieu didn't want to over-promote it.But in fact, the French newspapers exploded across the board the next day, as if the reporters from the major newspapers had visited the scene of the masquerade ball in person, and even watched the operation all the way.
(End of this chapter)