Nineteenth Century Medical Guide

Debridement of burn wounds is very painful, especially for deep burns with large wounds that have experienced fires. It is necessary to remove all surrounding necrotic tissue to reduce the chance of infection.The procedure is tantamount to surgery and can almost only be performed under general anesthesia.

Severe pain will accompany the wounded for nearly a month, and if the wound is not healed well during this period, the time will continue to prolong.

Whether the debridement is complete or not determines the speed of wound healing, so it is a process in which long-term pain is not as good as short-term pain, and it is very tangled.However, the most troublesome thing is that this kind of entanglement is actually the same for doctors.

As long as you are a normal person, you will have empathy.

It is an extremely painful thing to use a sponge to rub the wound back and forth, to trim the scab with scissors, and to remove the necrotic tissue while others are crying, which is difficult for many people to accept.In the treatment of burns, debridement and dressing changes are almost always carried out, and the physical strength and painstaking efforts of doctors are another kind of suffering.

If you want to hone into a cold mentality like Kavey who ignores the feelings of the wounded and focuses on wound recovery as the primary purpose, it is impossible to rely on ordinary surgery alone.

"Haven't you been on the battlefield?" Carvey's age is in sharp contrast to what he said, "It seems that I am used to using ether, and I have forgotten what it looks like to operate without anesthesia. Hard, give me hard, necrotic tissue Why don't you remove it and keep it to make the wound fester?"

"But."

The pain made the wounded tremble all over, and just the slightest touch of the sponge to the wound caused screams, and ordinary residents couldn't do it at all.

The wounded were brought into the debridement room one by one. Carvey really didn't have time to dawdle with others, and demonstrated what real cold-bloodedness was.He approached the wounded and said, "As long as you hold back the debridement now, there is a high probability that you will survive. Do you want to live or die?"

"Are you going to, amputation?"

"Of course not. I will try to keep your leg as much as possible." Carvey said, "But debridement is painful, and the dressing needs to be changed every day. You should think about it carefully."

"Yes, can you keep my leg?"

"The wound is not big, and you didn't go into shock. The chances are very high." Carvey pointed to the two wounded behind him who had no chance to debride the wound and said, "Look at them, they can't even do debridement now, can they heal later? depends on luck”

The slightly provocative tone greatly enhanced the opponent's will to survive. If he could save his life and his legs at the same time, it didn't seem to matter to be patient.

"That's fine then."

Carvey's words worked, and he knew it would work. He often used this kind of words similar to parents coaxing children.It's like a psychological booster.One injection will be more or less useful, after all, human beings are animals that need hope to survive.

"Give him some morphine, the effect will be stronger, debride the wound quickly, don't delay."

Kavey's attitude is not good, even a little impatient.

This is a manifestation of high pressure, because there are not many wounded who can be directly debridement, and there are more shock wounded with larger wounds and excessive fluid loss in the debridement room.

There are three major causes of death from burns, and shock is one of them.

In modern times, because of the corresponding first aid measures, the number of burns who died of shock has been very low.But in the 19th century, the awareness of burns was extremely lacking, and shock has always been the main cause of burn deaths.Many wounded lost their lives unknowingly, and the doctors didn't know what the problem was.

The smooth passing and barely passing of shock have a great impact on the later treatment.How to deal with the volatile shock period of severe burns directly reflects the skill level of burn doctors.

There are only two days to determine the success or failure of the shock period. During these two days, there is no need to consider whether the debridement is clean and complete.If the shock is severe, the debridement work can be put aside. There is only one problem that doctors need to solve at this stage, fluid resuscitation. 【1】

Kavey's method of fighting burn shock is very simple, strict fluid infusion + sodium bicarbonate anti-acid + methylene blue anti-infection.

The structure of rehydration during the shock period of simple burns is very simple, and does not require high sugar and nutrients, nor other therapeutic drugs, and even hemofiltration and hemodialysis are not necessary. 【2】

What the wounded body needs now is simplicity and stability.

The shock patient was placed in another room

"The burn area is .23%, and the infusion on one side is not enough, and your rubber tube is too tight." Carvey found something wrong just by looking at the physical signs, "What's her blood pressure?"

"91/66." [3]

"The lips are chapped and the blood pressure is unstable." Carvey only gave the most basic explanation, "Give her another channel immediately, and you are too slow in giving the fluid. Don't tie the rubber tube too tightly, loosen it."

"understood."

"Wait, where's the catheter? Why didn't you insert it?" Carvey looked at the empty sheets, "Didn't Kallen teach you to insert a catheter?"

"Teaching is teaching."

"After teaching, insert it quickly, don't be afraid of bleeding. By the way, remember to be careful when pulling back the water bladder, calculate the distance, and don't burst the urethra."

Accidental disasters are just like wars. Although they are cruel, they can forcibly exercise the abilities of doctors.In such a high-pressure environment, as long as you bite the bullet and do it, no matter how bad your skills are, you can become proficient.In a relatively more relaxed medical environment, as long as there are no problems of principle, other small mistakes can be forgiven.

Just like the more advanced urinary catheterization technology, the rubber quality and technology are not mature enough, and the operation specifications are only taught orally, and it is difficult to do well without practice.

Pain and bleeding are unavoidable during the actual operation of the intubation, but this is a trivial matter in the face of calculation of intake and output of shock and rehydration. As long as it is not severely torn, it will heal on its own in a day or two.

"Dr. Carvey, someone here is out of breath!"

"coming!"

The second leading cause of death from burns is suffocation.

The high temperature burns not only the surface skin, but also the respiratory tract inside the body.Every time you breathe, a large amount of hot smoke powder will mix in the air and enter the respiratory tract of the wounded. This is why it is necessary to cover the mouth and nose with a wet towel during a fire.

Many burn patients have no serious problems, and the proportion of wounds is not high. They just inhaled a large amount of high-heat gas. The throat damage caused rapid tissue edema, and eventually blocked the airway and was suffocated to death.

The cause of suffocation is actually similar to that of shock, which is due to massive necrosis of cells and overflow of interstitial fluid.

Shock is when the water leaves where it should be and the blood does not perfuse.Asphyxiation is when the water goes where it shouldn't go, resulting in local or even systemic edema.

At this time, it is impossible to relieve the edema. What can be done is to re-open the blocked airway: "Where is my instrument kit? Prepare the scalpel, gauze and syringe."

"The syringe is out."

"Forget it, cut the airway directly, quick!"

"Huh? Do you want to cut the airway?"

"Cut it straight? Is it too hasty?"

The success rate of tracheotomy in France is very low, and it is usually only used for severe diphtheria patients, so it is not easy to use.When encountering a truly life-threatening airway obstruction, it is already very remarkable to be able to see that it is an airway obstruction. The general treatment method is to start with nasal and oral tube placement.

In fact, the method is almost the same as that of Ignatz at the beginning, but the real throat edema is racing against time, and there is no time to make other choices.

The wounded with edema now has more than 30% burn area and is extremely weak, not the healthy Laszlo who is in his prime.He was already in shock, and his blood circulation had problems. If the oxygen couldn't get in, he might die in an instant.

Carvey didn't have time to put on his coat and gloves, and didn't even need meticulous disinfection. After soaking his hands in carbolic acid lotion, he picked up the scalpel he was handed over.

Without waiting for other doctors around him to raise objections, he found a place to insert the knife directly, and at the same time began to give orders: "You, go to the equipment box and find the airway horn tube and bandages; you, go find ether; is there anyone else? an assistant!"

"."

As of 11:60 p.m., more than [-] wounded people had been sent to the main palace hospital, and most of them were concentrated in the vacated special ward and this room for debridement.The entire surgery department was overloaded, and even the internal medicine department was brought in to help. The two physicians who did the tracheostomy for Kavey were physicians.

Carvey's ears were full of crying and noise, and everyone was so busy that they wished that one person could be used as three people.

There must be no idlers, but the wounded are still being sent to the ward in a steady stream.

"The car is coming! Someone help me!!!"

"Why are you still here?" Carvey seemed to have found the state of emergency surgery at that time, and when he heard that someone was still coming, he quickly turned around and said, "Tell the people over there that there are not enough people here, let them go to other hospitals to try." Try, don’t send it here again!”

"But this car is full of patients from other hospitals."

"Are you kidding! Is it so casual to transfer?"

Carvey just turned around and wanted to scold the street, only to realize that he was in France in the 19th century. Not to mention transferring to another hospital, having such an efficient carriage is already a good idea: "Forget it, let's stay. But the room is full of people. Well, let them stay in the garden for a while"

"it is good!"

Kawei looked up at the wall clock, and couldn't help cursing inwardly: "It's already past 11 o'clock, what's going on with Cedijo?"

At this time, Cedieu was sitting in the living room of the Deputy Chief of Staff of the Logistics Support Department, listening to him keep talking about various reasons.In fact, it is nothing more than "I don't have enough power", "it is not appropriate to use military supplies privately", and "ministers are very serious and easy to misunderstand".

But the real reason is actually the fear of taking responsibility.

"Sedillo, it's not that I don't want to help. I'm just a temporary job in the logistics support department. It's good to be able to get mixed up until now." Mansa explained after eating dessert, "You also served in the army , False positions are useless, and the actual power does not belong to me at all.”

"The opera house is on fire, it is important to save lives now."

"The opera house, what a pity." Mansa was very fond of this century-old building, "But I heard that His Majesty was going to build a new grand opera house, and I have always had such an idea, but I just suffered from no chance. "

Sedieu glanced at his pocket watch and said, "We are talking about people now, Chief of Staff."

"Wrong, it's the deputy chief of staff!" Mansa picked up a cup of black tea to finish the three-hour traditional French dinner, "Professor, please allow me to call you that. If you want to enter politics like me , the necessary political sensitivity is still necessary. A slight change in the title will have a completely different meaning."

Cedieu did have the idea of ​​developing in this direction before, but unfortunately he has no interest now: "I don't understand such troublesome things, I want a tent now!"

Seeing that the other party's tone started to be tough, Mansa was not used to it, and his attitude became more and more indifferent even though he seemed calm: "I said, this thing is out of my control."

"Who cares then?"

"My superior."

"Who is the superior?"

"Anyone who can order me." Mansa put down his teacup and wiped the corners of his mouth with a clean handkerchief, "I know what you're going to ask next, but I don't know who is in charge, and I don't want to know."

"You are an old friend of mine. You have the highest rank in the army. Can't you help me with this?"

"It doesn't matter whether you are friends or not. The army has regulations, and I just want to keep my current golden job." Mansa said, "As for other things, what does life, property, and political ambitions have to do with me? Set them on fire After that, a new opera house will be built soon, and there will still be people going to see the performance.”

Cedieu is a typical aristocratic class. Even if he lost some privileges after the turmoil, he still has a deep class concept in his bones.

But such old-school European nobles dare not agree with Mansa's indifference: "Forget it, I'll find someone else to find a solution."

"Please, I won't send you off." Mansa got up and walked up the stairs when he suddenly remembered something and looked back at Cedieu who was about to leave, and said, "I still want to advise you, doctors should have doctors Look, don't do things that are not helpful or even harmful to yourself."

"I'm just saving people."

"As I said before, in this case, it is better to go to the surrounding hotels and residences, why come to ask for military tents."

"I've also answered you before. Now that the hospital is seriously short of manpower, it's much easier to get military tents in place as soon as possible than to negotiate slowly door to door."

Cedieu repeated his point of view, but Mansa immediately choked back: "Do you still think it is simple now?"

"It's really not simple." Cedieu looked at his old friend walking on the stairs and sighed, "It's just that I don't know why Paris has become like this. Does human life seem so insignificant?"

Hearing that he raised the question to such a high level, Mansa's face became more serious, and he asked, "What do you think is the probability of survival from severe burns? Is it 10%?"

Cedieu shook his head slightly.

"I have also studied medicine, and I also want to save people, but the reality is not that simple. Today the army gives tents for free, but tomorrow they may have to give medicines and food. When the day after tomorrow, the target is probably not just the army, but Your Majesty. Do you want His Majesty to give relief money to the living, or pension to the dead? Or both?"

Cedieu: "."

"You held up the banner of saving lives, saying that saving lives is the most important thing, that human life is more important than anything else. I'm sorry. I'm really sorry."

The more Mansa thought about it, the more amusing he became, but in the end he forcibly endured it: "You throw such a stupid question to me in a hurry, and as a friend, I naturally have to stop it. If you don't stop it, why don't you just watch you do it again?" Kick it to my immediate boss?"

Mansha has Mansha's considerations, and after explaining, Cedieu also realized that the request that Kavey made casually is actually very difficult to solve in Paris.This stems from the gap between the age and the country. It is difficult to say a few words, but as long as a little mention is made, Carvey can still understand.

After all, he himself is in such a social environment, and his status is much more noble than ordinary people.

And what really made him unable to understand was definitely not political considerations and decisions, but the two people who appeared at the door of the debridement room at 11:14 in the evening.One tall and one short, one fat and one thin, one with a broken leg and one with an arm.

"What are you doing?"

"Cure me quickly, oh no, it's us!" Alphonse's right hand and Li Ben's left hand were tied together with a hemp rope, "When it's cured, I'm going to have a legitimate duel with him! A duel that has been postponed for more than 9 months!"