Nineteenth Century Medical Guide

As long as the amount of simple incision and drainage is large enough, quantitative changes will become qualitative changes.Moreover, wanting to form such a large abscess cavity in a short period of time indicates that the patient should have some underlying diseases, which also creates conditions for qualitative changes.

There were many incisions and a large amount of fluid flow. A large amount of inflammatory substances stimulated the incisions, coupled with the stimulation of intrusive items such as saline and gauze, which made Amor's already stretched anesthesia management even worse.

Blood pressure, heart rate, and respiration are the only three indicators that can be used to judge physical condition.

Any mess up will make Carvey feel uneasy, for fear that a careless patient will die on the operating table.

But the other surgeons in the audience were not in the same mood.They have always regarded anesthesia as a high-probability gamble.As long as there is no accident, there will be no accident. If there is an accident, the patient can only admit that he is unlucky.

Their cognition is the same as that in Vienna half a year ago. Doctors are bystanders of anesthesia, and those who do not know are fearless.

For this aspect, Carvey tried to say as little as possible or not at all.The main reason is that there are too many horizontal involvements in internal medicine, involving many theories of physiology, pathology, biochemistry, cell biology, and histoembryon that have not yet been discovered. It is almost impossible to explain clearly, and he does not have the ability to demonstrate and explain clearly.

What Carvey has to do is to confess the facts, become a discoverer, and then let those bigwigs who are willing to delve into the theory slowly study.

"Heart rate is fast, blood pressure is low, the patient is likely to be in shock." Carvey stopped the scalpel in his hand, waiting for Amor's retest, "I brought a medicine from Vienna that can stabilize blood pressure , and can also be used for local hemostasis.”

"Blood pressure. I have never understood the meaning of blood pressure. Can Dr. Carvey tell me?"

"The heart needs to pump blood to the periphery, which requires a pressure, which is blood pressure." Carvey simply explained, "Once the pressure is too low, the blood cannot enter other tissues of the body smoothly, so it cannot."

The next step is that the blood carries oxygen, and the body tissue consumes oxygen to metabolize energy to generate energy, and then it takes away carbon dioxide, and completes blood circulation and respiration.

This phenomenon had been discovered a long time ago, but just like what happened in Vienna, these Parisian surgeons were still unable to understand the true function of blood, and even did not know that what humans need is oxygen.

"Blood pressure is up, 123/77."

"Test every 5 minutes."

"it is good."

Carvey picked up the scalpel again, and made incisions along the skin lines one by one, with an interval of about 5cm between each other: "Without blood circulation, a person is no different from death. Facts have also proved that excessive blood loss and cardiac arrest Both lead to death attractors."

Still the same steps, incision, drainage, lavage, trimming of necrotic tissue, and finally hemostasis.It's just that the pus cavities in the legs are not big, so it's a bit troublesome to rely on suction alone, and more often use gauze to absorb and wipe.

Overall, under reasonable anesthesia management, the operation is almost without difficulty.Especially for emergency surgeons like Carvey, as long as the vital signs are guaranteed, drainage of pus is as simple as turning on the faucet.

The real key lies in the recovery after the pus is drained.

The so-called retractable, able to cut and recover, this is modern surgery.

"I don't know if you have seen hydrogen peroxide, that is, hydrogen peroxide solution." Carvey asked Herman to fetch a glass bottle from the preparation table, "This is what I asked for at the Paris Institute of Chemistry this morning. The concentration is 3 %. The wounds cleaned by it can greatly reduce the chance of ulceration.”

Kawei brought a brand new "drug", and everyone came forward to take a closer look at the magical power of this potion.

Herman opened the glass bottle cap and poured the pungent-smelling hydrogen peroxide on the patient's wound.In an instant, large and small bubbles and even foam appeared on the surface of the skin, as if the metal had been corroded.

"Is it really okay to use this thing?"

"What an exaggerated reaction."

"Don't be nervous, it's just a normal chemical reaction." Carvey didn't explain the doorway, but explained, "Hydrogen peroxide is unstable and can inhibit the growth of bacteria, thereby reducing the formation of ulcers."

Because Professor Pasteur lives in Paris, and his theory is also based on the growth of bacteria, the doctors in front of them have a fairly good acceptance of the subject of "the relationship between bacteria and wound ulceration".

At least it was much easier than it was in Vienna.

Herman followed Carvey's instructions and poured a whole bottle of hydrogen peroxide into the patient's incision and abscess cavity.Then use diluted methylene blue to do a second rinse, and after repeating it twice, finally choose normal saline.

The entire operation area is like a heavy rain just now, and the operation has reached the final stage.

"I don't know if you understand negative pressure drainage." While the assistant was cleaning the patient, Carvey showed everyone his homemade vsd, "Choose a natural sponge to cover the clean incision, and cut out several small The rubber tube of the hole is the connection, and the exudate in the incision is introduced into the glass bottle which is pumped into negative pressure."

"Is this to keep you dry?"

"Yes! It's also the best way to seal the incision from the air."

Sedieu covered the incision with the sponge handed by Kavi, adjusted the position of the rubber tube, and then Kavi covered several layers of gauze: "The gauze needs at least three layers, the bottom layer is clean gauze, and the middle layer is coated with gauze. The ointment keeps out the air, and the top layer is impregnated with vegetable oil for further protection."

After the three layers of gauze are covered, wrap it with oiled paper, and use a lot of oil to make an isolation cavity: "Exhaust."

Bergett shook the hand rocker, and the gauze, which was still somewhat bulging just now, began to shrink inward.After the rubber tubes start to deflate, connect the tubes into a simple negative pressure bottle made by Damirgang with a fixed syringe.

"If you find that there is air leakage around the gauze, you can add a few more layers of gauze, or use tape around it to seal it."

Carvey said: "Don't think that this is a waste of materials. The most expensive part of the whole device is the sponge, not the gauze. Now that you have done it, you must do your best. The success of the next step has nothing to do with us."

The operation process was not long, and it only took more than an hour from incision to finishing.

Carvey used up all the jars, and the dozen or so rubber tubes mentioned earlier were simply not enough. Even if all the stocks were put in, it was still the result of Carvey's sparing use.The only thing that can be left is the sponge. After all, the incision length of the lower limbs is limited, and the number of incisions is not too many.

But the cost of the entire operation is also staggering enough.

"What? 2580 francs?"

When the dean of the main palace hospital saw the list of items sent by Cedieu, his whole face turned green: "It really doesn't include labor costs?"

"Certainly not, he has never charged such a fee, as if his skills were learned innately and are worthless at all." Cedieu shook his head, not knowing whether he admired or disliked Kawei, "To be honest, he is so It's his freedom to do it, but it's also demeaning the huge cost of medical education."

"This is his private matter, we have no right to ask."

The dean's hands were trembling, and he still couldn't believe his eyes: "When did surgery become so expensive? Isn't this a very common anal fistula incision?"

"He chose new materials and new care methods. The natural sponge inside is more expensive." Cedieu pointed his finger at the natural sponge, "It cost 2000 francs alone."

"It's too exaggerated. These are ordinary people. Why do you need such good materials for surgery? Do you really think that the hospital's money comes from random?"

The dean took out a handkerchief and gently wiped the sweat from his forehead: "Just for this pg, he paid an ordinary doctor's salary for a month!"

Cedieu nodded, agreeing with the view that treatment should not be too extravagant and wasteful.But now that the money has been spent, it is impossible for him to pay for it himself: "Dean, you also know that the materials are not cheap, and I paid for them in advance."

"I know"

After a long sigh of relief, the dean finally calmed down: "He has been tossing back and forth in the main palace hospital for more than a week, right?"

"Well, it's been eight days."

"Such a powerful talent, such a wonderful operation, should be shown in other hospitals." The dean stuffed the list into a drawer, looked up at Cedieu, and then sat back firmly on the office chair. "What do you think of this arrangement?"

how about it?
Of course it's not so good!

Cedieu definitely didn't want Kavey to leave. Although he didn't like this person very much, the surgical technique was innocent.He had just let go of the director's shelf after an ideological struggle, and suddenly let Kawei leave, which was not good for his own study.

But it is impossible for him to say that he wants to continue to watch Carvey's surgery more, and he can't get rid of this old face.

Moreover, the dean's thinking direction must be different from his. The hospital has to bear the cost of the surgery demonstration, and the people who watch the surgery are completely free to other hospitals. No one wants to be taken advantage of by this.

The surgery alone cost the hospital more than 4000 francs, and this is just including the VSD. If this nursing method is effective, then the main palace hospital will probably face an astronomical figure.

"But several patients have already been admitted to our hospital."

"Why is the patient coming again?" The head of the dean immediately reacted after a brief downtime, "Oh, yes, he just had a free clinic yesterday. You said why he was so boring, he opened free free clinics for nothing, he How much money?"

"There must be a lot of money. I went to the auction two days ago. I heard that the sale was very generous."

"Then let him pay for it himself."

Sedieu looked at the dean, blinked, and said reluctantly: "But the problem is that we asked him to perform the operation demonstration, and the effect was good. If he is not willing to pay for this operation fee, once it is passed go out"

"Who asked him to come? Oh!!! Yes, the one from the Ministry of Foreign Affairs."

"It's Edward."

"Yes! That's right!!" The dean slapped the table, out of anger, "Let that Edward pay!!!"

Of course, Carvey didn't know about this conversation, and he didn't know anything about the attitude of the main palace hospital.

He only knew how many patients he had admitted, how many surgeries he was going to perform, and how Bizet's physical condition was following him to the ward.As for how much the operation would cost, how to allocate the materials, whether it could achieve a balance between income and expenditure, and whether it could achieve a balance between supply and demand, he didn't want to think about it at all.In fact, in the previous life, I thought too much and saw too much. There were restrictions and walls everywhere.

He didn't want to do that, but it was awkward anyway considering the circumstances and having to.

"This is the simplest laryngoscope." Carvey found a fairly primitive long-tube endoscope from the cabinet, and began to assemble a few small parts. "Because there is almost no curvature, it will definitely be uncomfortable when inspecting it." , bear with it."

Bizet frowned, and had already begun to imagine the feeling in his mind: "Why don't you forget it, and don't bother you."

"kindness?"

Carvey walked up to him, pressed his shoulders with his hand, and pushed Bizei who was about to get up back to his seat: "Just now you promised me to do an examination, why have you changed your mind now?"

"I have written more than half of the repertoire, and now is the time for a burst of inspiration."

"After I finish checking, you will have more inspirations!"

Carvey didn't have time to hang out with him. The inexplicable death of this talented musician is a pity for the whole world, and it is also a question he has been pondering these days.Examination is the best way to solve doubts, and among many chronic diseases mainly caused by cough, throat is the only place that surgery can treat.

"Open your mouth, it will be fine soon." Carvey stretched the tube in, "Say it."

"Ah~~~cough cough!!!"

"Come again! Bear with me!"

"Ah~~~~~cough cough" Bizei coughed violently, "this, cough cough, this is too difficult, cough cough cough, too."

Carvey sighed, looked at Bizet and said, "For the last time, I will go deeper this time, so you can hold on longer."

"No, no, no"

"I already have some clues, I saw something just now." Carvey wiped the lens with gauze, "Just for the last time, as long as I see what's inside, I will back out."

Bicai retched twice, spat out a few mouthfuls of saliva, and opened his mouth again to let the mirror enter his throat.What Kavi touched was the most sensitive part of his throat, but since it was the last time, just bear with it.

"."

"It'll be ready soon."

"."

"Well, it does look like there is something wrong with the throat." Carvey slowly pulled the tube away, this time instead of wiping it with gauze, he used a microscope slide instead, "There must be something wrong here, but I I don’t know if it must be related to your cough, but the correlation is about [-]% to [-]%.”

"Cough, cough, doesn't that mean you didn't check, cough cough."

"You have something growing in your throat. I suspect it's a tumor, that is, throat cancer." Carvey directly guessed, "Now I just took a simple sample, and the result is unknown."

Bizet froze in place, not believing his ears: "."

"If this sampling fails, we may have to do it a second time." Carvey scraped the mucus from the lens on the glass, "As a genius French musician, I, a genius surgeon, hope you can actively treat it. The world brings more beautiful music."