Nineteenth Century Medical Guide

Chapter 39 38. He Needs Air

Naya's shout was like pouring a whole bottle of "Venice Carnival Night" [1] into his mouth. The strong stimulation that went straight into the depths of his brain made Ignatz instantly refreshed: "Miss Naya, there is something going on inside! What's the matter?"

He tried his best to restrain his impulse and knock on the door with the demeanor that a gentleman should have, but there was no other reaction in the room except for Naya's cries and some discussions.

Ignatz raised the volume again, and his hands were a little heavier: "Doctor Fatorade, it's me, Ignatz. I'm back, please open the door and let me in! Mr. Laszlo must be suffocating!"

"."

"Only I can save him!"

It wasn't until then that the door was opened, and there was a faint smell of blood, a patient who was restless due to lack of oxygen, and a few helpless faces.

The situation in the room is already very obvious, and the bloodletting therapy for humoral disturbance and mucositis has completely failed.

The course of the disease was exactly as Ignatz had expected. After the redness, swelling and itching of the skin and mucous membranes appeared, the tongue began to swell, and then he could not speak well, and finally developed into airway occlusion, dyspnea and even suffocation.

Internal medicine failed.

The amount of bloodletting approached the limit, and emetics and laxatives were tried, and even the new treatment of whiskey mixed with quinine powder was found to be ineffective.Now that the swelling is getting worse, it is beyond the scope of what they can solve, as evidenced by Laszlo's up and down body and hands that have nowhere to rest after breathing hard.

Physicians are either rich or expensive, and this is especially true for these big shots standing at the top of the pyramid.They are proud and elegant in their usual attitudes. Even if they encounter difficulties and setbacks, they will suppress the humiliation in their hearts and keep the surface calm.

Of course, these are not absolute.

Those who don't have confidence in their medical skills can't face the fiasco, and generally choose to escape in order to prevent being crushed by failure.

As soon as Ignatz, Bergett, and Carvey entered the door, several doctors declared that they could not be treated in the same room as the lowly surgeon and barber, and left the room angrily.For them, this is the most direct way to maintain their dignity. Anyway, they don't know the year of the monkey will be the next time they meet.

In the eyes of Fatolad and Bosa, they have long been famous in the world, and they are well aware of the boundaries of medical treatment. Treatment failure is a common occurrence.

The ineffectiveness of bloodletting stimulated their desire for knowledge.

You won't get anything by escaping now, and you'll be the laughing stock of others, and you'll lose the opportunity to observe the skills of the strongest surgeon in Austria up close.It's not easy to get this guy's live ticket in the first place, and sometimes money alone may not be able to buy it.

Ignatz can't care about the small thoughts of these guys.

The swelling of the airway is like being stuck in the neck, and it will kill people at any time. He directly crossed the crowd and told the importance of Bergett and Carvey preventively: "These two are my assistants, I need them to assist me Perform surgery, please give us some wiggle room."

Fatolad and Bosa were both sober, and quickly let the rest of the people disperse, leaving the bedside area free.

However, Naya, already panicked, was not sober: "Surgery?"

"Actually, it can't be regarded as a formal operation. It's just to make a channel to send air to the lungs."

Ignatz spoke very lightly, but after flying into Naya's ear, his appearance changed completely.

The more than 300 ml of blood in the basin had already stimulated her nerves, and at this time, the operation was completely frying her on the fire: "It was said just now that bloodletting can cure the disease, but now the bloodletting and medicine are taken, it doesn't hurt at all. No good! How can I feel relieved if we are still talking about surgery now?"

"Your father is in danger now, he needs air! [2] So I'm helping him!"

It was difficult for Ignatz to explain the various anatomical structures to a little girl, so he just said something casually and asked Bergett and Carvey to come forward: "Come and hold the body, don't let him move around! "

Naya became even more anxious when she saw it: "My father is very uncomfortable now, why do you want to hold him down? Do all doctors in Vienna treat patients like this?"

Ignatz did not expect that at this time, he would need to dismantle the process step by step to the family members.

He took the toolbox from Kavi, took out a long black metal tube with a specific arc at the end [3], and said, "Your father has obstructed airway, the first thing we need to do is to put the newly developed I put an artificial airway deep in his nose to help him breathe. I can't guarantee success if I don't hold him down."

"But."

"Don't do it!" Ignaz emphasized, "I am the best surgeon in Austria, not to mention Mr. Laszlo, even if the Hungarian prince comes here, I will deal with it in the same way. Time is limited, please Don't interfere with my work."

This explanation was full of momentum, and it finally overwhelmed Naya's nervousness.

Bergett and Carvey took their positions, and with Earl Moraso's lessons learned, they quickly suppressed Laszlo's hands and feet.

However, Carvey still has his own views on this tube, and he is skeptical about the choice of approach: "Teacher, the tip of the nose is a little far from the throat. Is the tube too short?"

"There is still a protruding part inside, and you can go down after entering." Ignatz pushed forward from the end of the tube, and the front of the tube protruded a full 5cm. "Actually, I also want to enter through the mouth, but he My tongue was so swollen that I had to try the longest nasal cannula first."

After Ignatz explained, he approached the patient while preparing the long tube and said, "Mr. Laszlo, please relax as much as possible. I need to put the long tube into your nose. You will definitely feel uncomfortable and even a little painful." , but there is no way, please be patient!"

While speaking, the black long tube slowly penetrated into the nasal cavity with Ignatz's hands【4】.

The tube is made of metal, and the operation must be much rougher than modern nasal endoscopes.After entering the nasal vestibule, the tube will continue to stimulate the soft tissue in the nasal cavity, and Laszlo's reaction is very violent.

"There is no ether, it seems that the stimulation is a bit big"

Ignatz gently stirred his wrist back and forth, but he still couldn't detect the passage into the throat, and Laszlo's condition did not improve: "No, it seems that the nasal cavity can't get in, and the lower part is blocked. Try it from the mouth again."

"Come again?" Naya looked at the worried Naya with tears in his eyes, "Father, he is very sad."

"I know he is very uncomfortable, so I have to save many unnecessary procedures, such as anesthesia. If ether anesthesia is used now, he will indeed feel comfortable all over, but I am afraid he will never wake up again."

This time, Ignatz's hands were replaced with another white artificial airway [5], which was thicker and had a larger arc, and two metal pressure plates were taken out at the same time: "Come on, one piece for each of you, Open his mouth, move fast!"

Carvey knew what he was going to do, and it was nothing more than the endotracheal tube thing.But as he said just now, Laszlo's oral condition is not good, his tongue is swollen badly, and he doesn't have the aid of an intubation mirror. Whether he can enter the glottis depends entirely on luck.

This time even Bergett on the other side also saw the problem: "Teacher, the mouth is too swollen, can I get in?"

Ignatz was a little displeased: "Of course I know it's swollen. I tried the nasal cavity just now and it didn't work. Now I can only insert it here. If I don't try, how will I know if I can get in."

Seeing that Bergett had been slandered, Carvey did not dare to challenge his authority, but asked reflexively in accordance with modern precautions before endotracheal intubation [6]: "Is the patient's teeth all good? "

This is a very strange and funny question, because at the age of Laszlo and a wealthy man, a lot of sugar and tobacco will cause immeasurable damage to the teeth, and it is good to keep half of it up.

So everyone's answer is simple: "Of course not."

They didn't know why the young assistant asked such an absurd question at such a tense moment, but Ignatz's reaction quickly caught up with Carvey, realizing that this was a very serious question: "You Is it because the pressure plate will damage the teeth, and the fallen teeth will be sucked back into the airway?"

"Correct."

Ignatz glanced at Carvey and nodded: "It's a good suggestion, I will pay attention to it next time, but I can't care so much at this time."

Two metal plates forcefully opened Laszlo's mouth, and a silver metal catheter was inserted through the middle.The difficulty is obvious. Even if Laszlo's head is raised, there is still no way to make room for the throat. The swollen tongue is like a huge oyster that has just been eaten, and the catheter is pushed out of the mouth several times.

"Don't worry. I'll try again." Ignatz was obviously in a hurry, and asked, "By the way, let's see how much his pulse is."

"It's a bit fast." Bergert put his wrist on his wrist and said, "It's estimated to be over 100."

"I can still feel some gas flow around the mouth, we still have a chance, press the plate forward as far as possible to press his tongue, and give me a little more space!" Ignatz did not give up, still holding the artificial airway tube in Las Vegas Luo groaned in his throat, "Yes, just press here, okay, let me see if I can get in!"

"The teacher's throat is bleeding." Carvey noticed something wrong with sharp eyes.

"Well, it's okay, there's not a lot of blood."

Seeing that Ignatz didn't respond, Carvey didn't dare to act recklessly. After looking back, he wanted to find a helper, and found that they were all medical experts in expensive gowns.It was impossible for him to command these people, and it was impossible for him to line up with the anxious Naya, so he could only use the cotton pillow under Laszlo's head nearby.

Kavi didn't say much, and when Ignatz made some adjustments, he temporarily pulled out the pressure plate, quickly wrapped the pillowcase around the surface of the plate, and then stuffed it into Laszlo's mouth again.

Although it is not helpful for intubation, it can at least suck a lot of blood.

It has to be said that rich people even have the best pillow covers, the remaining blood is sucked up in an instant, and the vision becomes clear again, but the progress of intubation is still not progressing.Seeing that Laszlo, whose mouth was opened, made a whimpering sound in his throat, and his hands became weaker and weaker, but Ignatz's tube could not be inserted no matter what.

There is not much time for rescue after hypoxia, and the situation is getting more and more dangerous.

Carvey is also hesitating whether to stop intubation in time and switch to a more secure traumatic method.

Laszlo's status is obviously not low, and there are so many famous doctors standing around watching the show, plus the tracheotomy is not difficult for him, and the equipment is placed in the box, so he can try it.Once successful, it may be possible to completely get rid of the shackles of the existing identity.

The only thing to watch out for throughout the process is Ignatz.

Whether the apprentice persona that has been managed with great difficulty should be discarded, and whether he can gain a foothold in Austria without Ignaz's help in the future, these are all questions.

Just when Carvey was about to end the ideological struggle and was about to replace Ignatz, the famous surgeon suddenly stopped what he was doing, pulled out the tube, and asked the two of them to take out the pressure plate: "Can the nasal cavity go in?" Go, the mouth can't get in, there is only the last way to go."

This time he replaced a horn-shaped artificial airway [7], about the size of a thumb: "Miss Naya, I'm going to find the position of the trachea under Mr. Laszlo's Adam's apple, and use this knife to pierce the skin and the wall of the trachea, and put the tube in there."

This sounds very painful. Looking at her father who has gone from being irritable to a drowsy state, Naya covered her mouth with her hands and couldn't believe her ears: "Is there no other way?"

"I've tried everything, none, and it's dangerous."

"Dangerous? Wait a minute, doctor, can you?"

"I'm not asking for your opinion." Ignatz looked at Fatorade aside.

Although the two had conflicts between internal medicine and surgery, and they had different opinions on many diseases, they still had a tacit understanding that other colleagues could not match in the face of such a troublesome patient and family member.

Fatolad naturally stood beside Naya, smiled and comforted like a kind uncle: "Be strong, kid, I don't want to see you crying when your father wakes up."

"But, I... I can't do it"

"Dr. Ignatz is the best surgeon in Austria. He is even in charge of the operations of the princes of the Austrian royal family. Please give him the utmost trust."

Naya leaned against Fatolad weakly, sobbing softly with her eyes closed, not daring to watch the surgery at the bedside.In contrast to her, the other doctors in the room slowly leaned forward, hoping to see the truth of the tracheotomy.

To this day, this peculiar incision method of connecting the lungs to the outside world only exists in Britain and France, and conservative Austrian surgeons have never really practiced it.

Ignatz also knew the danger. He picked up the fine-bladed scalpel, his hands trembling slightly, and beads of sweat kept rolling down his forehead.At this point, he has no way out, he can only touch Laszlo's Adam's apple with one hand to stretch the skin, and carefully land on it with the tip of the knife with the other hand.

"Kavi."

"I'm here, I'll help wipe off the blood, don't worry."

(End of this chapter)