Nineteenth Century Medical Guide

Chapter 336 332. Outpatient Records—[II]
"Herman, he's dead, his blood pressure and heart rate are gone, and he can't be saved!"

"."

"Herman!!!"

"But."

"I'll say no."

Herman looked at the patient who was no longer breathing, and helplessly let go of his hands: "He looked okay just now, why did he suddenly fail?"

"This kind of patient is like this. The huge abdominal pressure has already caused circulatory failure, and the liver, mesentery, and omentum are all severely ischemic." Carvey pointed to the liver and asked, "Even the portal vein has embolism. Do you know why?"

Everyone shook their heads.

"It's all air here." Carvey explained, "Because when the stomach ruptures, the pressure in the stomach drops sharply, the blood vessels expand suddenly, and a large amount of gas in the stomach enters through the broken ends of the blood vessels, causing an air embolism in the portal vein. The liver ischemia is too severe. , Even if you get off the operating table, you will die from liver failure.”

He has seen several cases of such acute gastric dilatation combined with gastrointestinal rupture and food spillage. Even with the support of modern medical methods, the effect of forced surgery is often very poor.

Most will, like this one, experience severe hypotension and difficult-to-resuscitate cardiac arrest during surgery.Even if he survived the operation in good health, he would die within 24 hours due to abdominal infection and prolonged circulatory ischemia.

After a narrow escape, the lucky ones who have truly passed through the gate of hell will bid farewell to their stomachs forever.

"Dead is dead. Surgery is not a panacea." Carvey took off his gloves and ran to wash his hands in the sink beside him. "If you have time to toss this corpse, it's better to think about what to do next."

"Leave the rest to me." Sedi asked him to wash his hands, so he stopped being polite, and directly asked for the right to be the "chief surgeon", "Just try the distal gastric resection + gastrojejunostomy you just said .”

"I'm afraid the anastomosis is not so easy to do, the stomach wall is too thin."

Carvey lifted a piece of stomach wall and said, "It's probably less than 5mm, and a large piece of jejunum at the lower end is necrotic. If you really want to practice, you can try the ileum or colon, but the effect is really not very good."

"It doesn't matter, I will continue to practice along with the previous operation ideas."

Cedieu didn't care about these details. It was every surgeon's dream to avoid the cadaver storage procedure and directly enter the practice stage: "Dr.

"It's enough to have them with you, I'm not interested in dead people."

Carvey shook his head and left the theater of surgery.

It was already ten o'clock in the morning when we returned to the garden again, and the scene of entering and exiting became deserted in an instant.It was also because the situation of the visitor was too urgent, and Kavey forgot to take care of the follow-up matters.Perhaps because of the long operation time, all the original tables and chairs have been removed, and the sign for free money is gone. This is still the original garden that no one cares about.

But no matter how slim the hope is, there will always be someone who can persevere.

They were three people, two men and one woman, and they lined up at the original consultation position very religiously. When they saw Karvey appearing, they all smiled and walked forward: "Dr. Karvey, you are here."

"The operation was delayed for a while and everyone else left?"

"It's all gone, we'll keep it."

"This is the number we took before."

If you can wait at the gate for more than an hour without seeing the result, there is a high probability that there is something wrong, and it should not be for money.The free clinic was originally something that Kawei did casually, since it's gone, let's go.

"It's not convenient here, follow me to the ward."

Patient G
"Uh, actually, I just wanted to ask if you could operate on me." The girl in the first place was a little excited, and after saying this, she remembered that she didn't introduce herself, "By the way, my name is Laura, Laura Patty, Mr. Liben's friend, he should have mentioned me to you."

Carvey: Li Ben. Who is Li Ben?

Uh, I remembered a little bit, it was the LSP, the big liar who was left behind by Mick.It's been a long time since we met, how did I meet such a beautiful girl and say we are friends
An unfamiliar name + a familiar name that shouldn't be here + something that never happened.

Carvey felt strange at first, and didn't know how to reply to her, but his magical brain connected these elements with the note received yesterday.

Could it be that she was the person mentioned in the note?
Considering the existence of Alphonse at this time, it makes sense for Li Ben to hide his head and show his tail.Since the background is complicated, Carvey didn't say it directly, but greeted the liar who had found him before: "Oh, thanks for waiting until now, by the way, where is Li himself?"

"I don't know where he went." Laura looked uncertain, "Doctor Carvey, are you willing to accept mine?"

Kawei didn't rush to answer, but wanted to confirm her basic situation first: "Which side is it?"

"The left side." Laura's left hand unconsciously covered the left side of the chest, and said helplessly, "In order not to attract attention, I put a lot of sponges and fabrics inside. In fact, if you look carefully, it will be a bit unnatural, and I also It feels weird."

"When was the surgery done?"

"Two years ago, Professor Cedieu was the chief surgeon."

"Even the muscles inside were cut off?"

"I don't know. The operation took an hour, and now it feels a little sunken."

Carvey made a simple palpation through the clothes, and continued to ask: "Is there any pain or lump now?"

"No." Seeing him asking around, Laura was a little worried, "Will you accept me?"

"No problem, but the operation requires some preparation time, and you have to stay in the ward for at least two weeks." Carvey warned, "Because I need to evaluate the healing of the incision after the operation, if there is a problem, I must solve it as soon as possible. Otherwise, the whole operation will be in vain.”

As long as you work hard enough, you can bring Laura at least 500 francs in two weeks. The subsidy given by Carvey is definitely not comparable.

But once I think that what has disappeared on my body can grow back again, a little loss of money is not so important: "No problem, I have thought about it, let alone two weeks, even if it is a month, I will live."

"Well."

Carvey took out a stack of sticky notes from his clothes pocket, wrote two lines on it, tore it off and handed it to her: "Take this piece of paper to the next ward and give it to the nurse there, just say I asked you to go of."

"oh oh."

Laura happily accepted the note, but her feet didn't move, and her eyes kept glancing at Carvey's pocket.

Seeing that she hadn't left, Carvey remembered something, then took out his wallet and sent 100 francs: "I still need to do a comprehensive examination before the operation, because the reconstruction requires good muscle and skin measurements."

"no problem."

"It is best if the operation is successful. If there are problems such as incision ulceration due to our problem, then we will give free treatment and send an additional 200 francs as compensation."

"Okay, thank you."

Patient H, male, 56 years old

"what happened?"

The man let Laura pass, looked at the stool and hesitated for a while, still supported the table with both hands, and sat down slowly: "I'm sorry doctor, my butt hurts, I can't sit down quickly, if I hurry up."

As soon as he finished speaking, he stood up as if sitting on a nail: "I think I'd better stand, the stool is too small to sit on."

"A painful lump in the butt? Or hemorrhoids?"

"It should be considered a lump, it was next to the gang gate from the beginning."

"At the beginning? Now?"

"It's more like a full bladder now, kind of soft, but still very painful."

"It seems like a long time."

"It's been more than a week."

"Do you have a fever?"

"It was a little bit at first, but now I don't know."

"Okay, come with me." Carvey pointed to the examination room on the side, and asked the nurse for some gauze and linen gloves, "Come here, take off your pants, and let me see."

In fact, the examination is not difficult. A little palpation can diagnose periganglinal abscess, and the specificity is very high.The location is on the left side of the gang port, and the pain is very obvious after touching, and the range is not small, and it has spread to the rear and right rear.

In addition, what was more serious, and the main reason why he was willing to come to see a doctor this time, was that the abscess had burst.It may be due to pressure extrusion, but it should be more caused by the friction of the pants.

"When did it break?"

"Last night. Take it lightly, it hurts too much."

"Have you squeezed yourself?"

"No, hiss. Don't dare to touch it, it hurts too much!"

"It's very swollen." Carvey continued to pull his pants down, "Does your left leg hurt?"

"It's a bit of a touch if you touch it like that."

"It's a bit late, I might have to suffer a bit." Carvey's left lower limb in front of his eyes was already red and swollen, and the area even reached the popliteal fossa. "Come on, the pg is raised, I want to do another checkup."

"Forehead"

This time, Carvey put on thick cloth gloves to check the situation in the gang.The result was a headache. There was already a lot of pus in the rectum, and ulcers could still be found on the dentate line.

"The situation is very serious. You should stay here first. I will study it with Professor Cedieu." Carvey took off his gloves. "You may have surgery tomorrow as soon as possible. You have to be prepared."

"It's fine, it's fine if you can be hospitalized and have surgery"

Carvey was already familiar with their money-greedy psychology, and said with a smile after washing his hands, "Don't worry, the money will be given to you in a while."

Patient I, male, 28 years old

"You are the last one, tell me what's going on."

"Actually, it's not me, it's my father." The other party briefly described the situation, "My father has been bedridden at home. Recently, the skin on his heel and pg was broken, and he was bleeding a bit."

Carvey understood the appeal as soon as he heard it, and he probably wanted to ask if there was any way to deal with bedsores.

"Just started to break the skin recently?"

"Well, just last week, we went to the pharmacy to buy some plasters, but the effect was very limited."

"Then why do you think that surgery can help you?" Carvey was a little strange. Seeing that there was still a lot of time and it was the last patient, he became interested. "I remember that this kind of rotten sore seems to be treated by internal medicine."

"Didn't you have a cesarean section before? The woman lived very close to us, and she went home early this morning. She also showed me the wound, which healed well." The son said, "I heard My father has a wound, so he suggested that I come to you."

"Oh, I see"

"It doesn't matter if it's money or not. I just hope to help my father. There's no way to lie flat on my back like this."

"Well, then don't lie flat."

"what???"

"It's because the weight of the body has been lying down all the time, and the skin has been crushed." Carvey explained, but he didn't continue to ask about the rotten sores. "This happened recently, so it means The time in bed was not long."

"Just two weeks. I fell and broke a bone. The doctor advised us to stay in bed."

"Where is the fracture?"

"It should be here." The son pointed to the pelvis, "I can't stand up at all, and even sitting is very difficult. We don't know what to do, so we asked the doctor from the main palace hospital to help, and they only said to rest in bed , and didn’t say anything else.”

Judging from the description and the age of the person, it is likely to be a femoral neck fracture. Even in modern times, once the femoral neck fracture occurs in the elderly, it will greatly affect the follow-up life, which is a big killer.

Now that there is no X-ray, Carvey has no way to determine the fracture situation. Even if he can be operated on, the result will not be very good.With at least three months of bed rest after surgery, pressure sores are still the biggest obstacle in the way of recovery.

Besides, he currently lacks internal fixation equipment, so there is really no good way to deal with this kind of fracture.

Carvey tore off a note and handed it over: "Write down the address, I'll take a look when I have time."

"Thank you so much."

Carvey's outpatient clinic process was not smooth, and although the result was passable, there were two patients who could undergo surgery, but if it wasn't for Li Ben's recommendation, Laura would never come here to try her luck.

After all, the public is still not satisfied with the curative effect of surgery. Compared with internal medicine, which only needs to take medicine to complete the diagnosis and treatment, once the surgery is at full capacity, it will be a big battle.

Carvey sighed, and was about to end the outpatient clinic to have something to eat, and then after Cedieu and the others finished, they would discuss the operation of Laura and the patient with abscess around the gang.Both are big projects, especially the one with abscess may cause big problems, so we need to be well prepared.

After completing the preparations for the operation, he still needs to meet with the auction apprentice in the afternoon to discuss the storage and transportation of the auction items.

Just as he was about to get up and leave, there was a sudden commotion outside the ward.After a while, a nurse rushed into the ward covered in blood and shouted: "Someone vomited blood, a lot of blood, who can help?"

(End of this chapter)