Nineteenth Century Medical Guide

Chapter 357 353. Difficult Surgery

November 12th, 4 am

University of Paris meeting room

Hult, the president of the Surgical Association, was sitting alone in the empty auditorium, with his legs in a comfortable posture, watching the news reports of the past two days. 【1】

If yesterday's report is objective, it is only a simple statement on the cause and result of the fire, and doubts and speculations are only a minority. 【2】

Then today is a day when gods and demons dance wildly. There are all kinds of data and all kinds of hypotheses can be said.Anyway, as long as the official has not confirmed it, they dare to state it in a vague tone between certainty and uncertainty, just like stating the facts that have been clarified. 【3】

Holt knew them well enough to dismiss the reports.

Compared with other news, he prefers to read them as a joke before the main topic begins.

And the topic he values ​​is not the truth, what is the truth is not important, what is important is how to save those lives that survived.And the emergency burn meeting, which the reporters never mentioned or understood, is the basis for rescuing the wounded today.

At the same time, he also believes that this will be an important meeting for a major upgrade of the world's burn response measures.

"You are so early."

"I happened to see a few patients in your hospital, and the time is almost here." Holt continued to lift up the newspaper and read, "Aren't you at home to catch up on sleep, why did you come so early?"

"I've been in the hospital for the past two days, and when I close my eyes, there are those burnt wounds." Cedieu sighed, and said, "I can't sleep, so come over and have a look first."

After the fire, Huot went to the main palace hospital twice as the president of the association, but both times Cedillo was absent.One time was to borrow a tent, and the other time was three hours ago, Holt wanted to hear his opinion: "What do you think?"

"Huh? How about what?"

"The new technology you use."

The burn treatment plan made by Carvey is the most basic method for modern hospitals to deal with burns, but at the beginning, it greatly exceeded everyone's imagination in terms of concept, debridement, equipment, drugs, and final dressings.

If it was just a single breakthrough, it could be explained by inspiration or some kind of attempt, but Carvey directly overturned the original treatment method and re-established a set of burn first aid mode completely created by him.

Even if France is more open to scientific discussions and more willing to pursue new things, it will be skeptical of this sudden innovation.

Carvey, who has been tempered by the conservatives in Vienna for a long time, did not give much response, but slapped all doubters in the face with the death rate of the first-aid wounded within the first 24 hours after the disaster.

Holt is one of those people.

In the early morning of the 3rd, after learning that the opera house had been burned, I went to several hospitals that received the wounded.Holt immediately expressed doubts about Carvey's first aid strategy based on rehydration, and his tone was full of distrust.

He admitted that there was a bit of resentment and resentment inside.

The main reason is Karvey's identity. A young man of non-French origin trampled all the top surgeons in France under his feet. To say that he doesn't care is simply deceiving himself.Although Holt's education allowed him to readily accept Carvey's toughness, there was still jealousy hidden deep in his heart.

Carvey did not respond at the time, only saying that the results would be given within 24 hours, but Holt's face was swollen.

But what made Holt feel strange was that he was surprisingly sober after being slapped in the face. It seemed that the fatigue caused by collecting data these days was also wiped away by this slap.

In public, he suggested that an emergency meeting be held this morning to bring together all the relevant persons in charge of the hospital involved in the treatment of the wounded in the fire, and pass on Kavey's successful experience.

"Where's Kavi?" Cedieu looked at the venue and asked, "He didn't come?"

"Should be sleeping." Holt smiled and handed over the newspaper, "You don't look very pretty, why don't you read the newspaper and relax, some of the reports in it are very interesting."

"It means that Kavey has superpowers?" Cedieu coughed lightly, and took out the same newspaper from his suitcase, "I read it when I was eating breakfast, anyway, it's just... well, don't say it This is it."

"You've been helping with the burns, what do you think of Carvey's approach?"

Sediyo opened his mouth to say a good word, but was soon suppressed by rationality and hesitated. After a while, he sighed and said, "I won't talk about the benefits. The wards and patients are all in the hospital. No one is in front of the data." It’s okay to lie. But the disadvantages are also obvious, it’s too expensive.”

"Even the main palace hospital can't take it anymore?"

"Do you know how much I spent these two days?"

"Why do you spend money? Isn't it the hospital's money?"

Huot was very strange, and Cedieu was very wronged: "Look at the infusion tubes used, they were all picked up from the rubber factory. Look at the hydrogen peroxide used to disinfect wounds. Even if it needs to be greatly diluted, it can Can't hold up to crowds, it's like a full boozer showing off his wine."

"Forehead"

Huot has been in a semi-clinical state, and has been focusing on research and education, but he didn't expect this level: "However, you still didn't say why you are spending money."

"Because Carvey asked all the people who went out to pick up the goods to report my name, the arrears have accumulated to 3 francs! A total of 3 francs!!!" Even though the annual income exceeds 20, Cedieu still feels a heartache. "I'm not a goat that produces cashmere, just stare at me alone."

"Hehe, it's really expensive." Holt didn't expect so much money behind it, just smiled and comforted, "But the [-] francs saved many lives."

Cedieu must also admit that the rescue success rate of the main palace hospital, which is treated according to the Kavi process, is ridiculously high.At this level, the data can no longer be called a cliff-like lead, but a complete crush, just like the civilized war when the proud French army knocked on the colonial gate, it is as pleasing to the eye.

Therefore, the money was very painful to spend, and Cedieu had to admit that he was in pain and happy: "I will ask the dean to reimburse the expenses. This should be regarded as normal medical work."

"Don't worry, this is also a good time to solicit sponsorship for the main palace hospital, and you will not be missed."

Holt got up and walked onto the podium, threw the newspaper into the wastebasket, then tapped the podium lightly with his clenched fist, his face was full of excitement: "Cedillo, it's time for the mind of the unexamined surgical liberation to make a move." It's changed, it all started in Paris!"

Two hours later, the emergency meeting officially opened.

In fact, many people were similar to Hult's previous thoughts. While agreeing with Carvey's super surgical technology, there are still many dissatisfaction in their hearts.Therefore, there are not many people who are really willing to be there, and on the premise of hearing that the survival rate of the wounded is so different, the number of such numbers has not increased but decreased.

In the end, it was Holt's personal "invitation" that led to this emergency meeting with little preparation.

The process of the meeting was also kept simple, and only a little effort was made to limit the number of people. At least today, there were no medical students and interns, and all the leaders in the surgical field in Paris came.

Many people are good friends, but they don't look like they usually do when they meet.Such a big accident put a lot of pressure on everyone, and the wounded kept dying in front of them, their faces were really ugly.

The same is true for Kavey, who entered the venue last. He started with a big yawn, declaring that he was short of sleep: "I am very pleased that everyone can take the time to attend this meeting. Of course, it does not matter whether it is sincere, as long as you can follow my Doing what you say is the best reward for me.”

return?Not ashamed!

Why do you do what you say?
The data may be true or false, and the number of wounded may vary. This mysterious thing can only be used as a reference, and it is not the most important standard for measuring medical technology!
Kawei is eloquent, and the spittle that spews out from time to time can ignite their competitiveness.Everyone in the audience was full of complaints at the beginning, but they didn't dare to talk nonsense because Huot sat behind and supervised.

"Let's not be polite, let's just say the conclusion."

Carvey wrote five words in French directly on the blackboard, "shock", "breathing", "wound", "infection", "nutrition": "We are still in the stage of dealing with shock and breathing, and in the first 24 hours The wounded who died basically fell into these two categories."

"Why are you in shock?"

The speaker was Dr. Stanch, the chief of surgery at the Grande Hospital. He had a huge beard and wore a pair of gold-rimmed glasses: "Shock is a decrease in circulating blood. Burn patients have almost no trauma, let alone bleeding."

"The definition is well memorized." Carvey suddenly asked, "How do we define the reduction of circulating blood volume?"

"He is pale, flustered, and has a fast heart rate." Stanch is also considered a strong man in the Parisian surgical field. His skills are not as broad as Cedieu's, but at least he is specialized enough in his field. "When this happens, it can be suspected that something has happened shock."

"So how to quickly and accurately determine that the wounded have decreased circulating blood volume during these two days when they are busy enough to distract all the medical staff?"

This is a dead question that can't be answered, and Stanch is drumming in his heart: "No, my question is why shock occurs in burns, not how to judge shock."

Carvey knows that the smell of gunpowder is inevitable, and the necessary explanation is also conducive to the subsequent preaching.He himself doesn't like this kind of cramming teaching mode. Unfortunately, time is running out now, and he has to teach:

"Indeed, I was a bit off topic just now. The main reason is that the probability of shock occurring after a large-scale fire is very high. As long as it is a severe burn and the area exceeds 10%, shock will occur."

Carvey directly made a judgment, and also gave a certain number, which made several directors in the audience curious.

"10% burn area? How to calculate?"

"Also, what is a severe burn? How do you define serious?"

Carvey came here to explain these things: "Don't worry, let's talk about the burn area one by one. I don't know if you have dissected the skin. The experience of peeling off the skin completely?"

Everyone looked at each other in blank dismay, some shook their heads, while others remained silent.

"Then have you ever seen skin cells under a microscope?"

The second question came one after another, the audience's voice completely disappeared, and the entire venue was eerily silent.

"No one wants to take a look at something as good as a microscope?" Carvey couldn't help complaining, "Sometimes the cell structure of the skin is more important than identifying the color of the skin and linking it to IQ." interesting."

"."

"I know that dyeing technology is not mature, and the failure rate is very high when doing pathology, but what is damaged by burns is the skin, and severe burns have caused complete damage to the skin. We must understand it."【4】

After finishing speaking, Carvey drew a picture and two tables on the blackboard: "I was lucky enough to see the skin cell structure under the microscope, so based on these cell structures, I made a judgment standard for severe burns【5】

At the same time, my father also did the peeling work of the skin of the corpse, and made a corresponding calculation and segmentation method for the surface area according to the composition of the limbs and torso. "【6】

This is the basis of all burns. As long as they accept it, Carvey has the confidence to train them to be qualified burn doctors.

But in fact, these people are not as well-behaved as interns or regular trainees. Each has his own thoughts and ideas: "What is the significance of distinguishing the burn area? Is it to judge whether the burn is serious or not?"

"Is there really such a necessary relationship between the depth of skin damage and the severity of the burn?"

"What I care about is not these, but the impact of the distinction itself on subsequent treatment. Are severe burns and severe burns treated differently? If there is no difference, then there is no need to distinguish."

Faced with so many questions, Carvey lost his patience for a moment, and tapped on the blackboard directly: "I am not discussing with you whether these can become standards, but to tell you a fact. These are my standards. According to my If you follow the standard, you can achieve a 88-hour survival rate of 24%."

Data is the weakness of those people in the audience. If they could question the data in their own hospital, they are not qualified to do so in front of Hult.

After all, the data was calculated by Huot, and questioning the data is tantamount to questioning Hult's mathematical level.This has exceeded the level of controversy, and it can be classified as a humiliation in France, which has a strong folk style.

"The division of the burn degree and the calculation of the area are the basis of the treatment." Seeing that they had lost their voices again, Carvey explained, "The treatment of burns is a rather long process, after which we have to experience wound infection, nutritional support and surgery. Treatment. Not an irresponsible operation like amputation, but a very difficult skin graft operation!
But ask yourself, you can't even get them through the first 24 hours, so what other treatment is there? "

(End of this chapter)