Nineteenth Century Medical Guide

Chapter 40 39. Twists and turns

Tracheotomy [1] is indeed not a difficult operation. It is simple to operate, has few steps, and does not require high requirements for medical equipment.The reason why it is positioned as level 2 in the modern surgical classification is entirely because of the complexity of the anatomical structure of the neck and the danger of failure.

Air cutting was originally used as a bare stub metal tube, but it was quickly transformed into what it is today because it cannot be fixed.

In fact, the silver horn-shaped artificial airway used by Ignatz already has a modern prototype. It only needs to open a hole and put the tube into it, and then pull the ropes on both sides to fix it around the neck. 【2】

The replacement of tubes in modern times is actually only for the convenience of the operator and to reduce the risk. The really important surgical step is the opening of the tube before intubation.

The neck is one of the key points of the human body. In the eyes of people who have never used it or have little knowledge of anatomy, this area is too special and has a low error tolerance rate.It is inevitable that there will be a sense of fear when cutting the knife, because I really have no idea.

Ignatz certainly wasn't that type of guy.

In terms of the number of autopsies performed on the corpse, he is absolutely top-notch, and he already knows the structure of the neck well.Even if he has not actually practiced it, his years of surgical experience will not be deceiving, and his rich experience will help him make a correct judgment.

In this case, he may be a little nervous and agitated, but he will be more focused than usual, just like he was with the inguinal hernia.

That's how Carvey judged.

He stood aside with a blood-stained pillowcase in his hand, seemingly concentrating on it, but he was inevitably annoyed when he saw the fleeting opportunity slipping through his fingers.Because as long as there is no accident, Ignaz can successfully save Laszlo's life.

Accidents, however, have always been a matter of probability.

When one low-probability event gathers together, as long as there is a little more unlucky, things that should never have happened will happen immediately.

Under the dual effects of long-term fatigue and drunkenness, Ignatz's hand has become a little unsteady, and Laszlo's continued lack of oxygen, the time left for him is passing by.

The earliest tracheotomy generally uses a longitudinal incision [3]. The operation is rough and very direct, directly piercing the skin and the front wall of the trachea with one knife to make room for the artificial airway tube.

But haste makes waste. His first cut was too hasty, and the location he chose was a bit off. After penetrating the skin under the Adam's apple, he didn't hit the trachea directly.When I tried to find the position of the trachea again, my field of vision was covered by the gushing blood, and I couldn't see anything.

Carvey quickly wiped off the blood with a pillow towel, and exposed the muscles and deep cervical fascia that needed to be completely separated as much as possible.

The incision made by Ignatz was indeed crooked, which violated the requirement that the tracheotomy must be kept in the middle, but there is still a chance of remedial action.Kavey used the pillow towel to cover some unnecessary places, and secretly helped to adjust the position of the field of vision.

"teacher"

"Well, I know, the position is crooked."

The sudden knife made Laszlo tremble in pain and screamed.Naya's crying continued behind her, and the surroundings were full of cold gazes from her colleagues.

Against the pressure, Ignatz clenched the scalpel again, and pressed the skin on both sides with his fingertips to stop the bleeding as much as possible. He needed to make a new incision.

second knife
This time the position was correct, the tip of the knife was completely submerged in the midline of the muscle fascia.Judging from Ignatz's reaction to the touch, it seems that the trachea has been cut.

However, the scalpel used by Ignatz is very small, with a blade width of less than 1cm. Such an incision is obviously not enough.In order to allow a catheter with a diameter of more than 1 cm to pass into the trachea smoothly, the incision needs to be enlarged, at least 2 cm.

Success is imminent, and there is only one last step left in the incision.

But at this moment, a lot of alcohol accumulated in the body, fatigue and a slightly relaxed attitude after successfully passing the first step made Ignatz make a small mistake that only appeared in the 19th century.

He did not change the direction of the blade to pick up the trachea, but chose to continue cutting the trachea directly downward.

The lower the position is, the richer the blood vessels around the trachea are, and there will definitely be a lot of blood when the knife is cut.Carvey wanted to persuade, but the reaction couldn't keep up with the speed in his hand.Before the words came out, the knife had already been drawn down.

But after thinking about it, he also felt that it was nothing.

After all, it was the 19th century, and tracheostomy was a new type of surgery, so there was no standard operation [4].

Ignatz originally did not suture the surrounding small blood vessels, nor did he separate the muscular fascia and the thyroid isthmus at the entry point.After this series of operations, damage will be caused wherever it passes, and cutting down will only damage some small blood vessels, as long as it does not exceed the fifth ring of the trachea.

But what neither of them expected was that Laszlo's neck blood vessels were different from ordinary people, and had special mutations【5】.

Ignatz's finger sensitivity is very high, and he stopped his hand in time when he sensed something was wrong.The lack of clinical experience in tracheotomy made him very confused. He didn't know what he had cut, and he didn't know whether it was a success or a failure.

Suddenly, a strong stimulus forced Laszlo to break free from Bergett's arm, bent his body and coughed violently.

"Cough cough cough~~~cough cough~~"

Coughing and pulling the surrounding wounds, while squeezing the scalpel away, two injections of blood were sprayed out.Both the height and the color are telling Carvey that Ignatz's blade must have cut an artery.

In an instant, there was chaos in the room.

The physicians surrounding the outermost circle retreated one after another, fearing that their clean and bright gowns would be stained with blood.

Bergett, who was standing on the bedside, was shaken away by the powerful force, but his previous experience told him that he must control the patient immediately, so he hurried forward and pressed Laszlo's shoulders and head: "Be patient , it will be ready soon!"

Ignatz was the closest to the wound and must have borne the brunt of it. His eyes and nose were covered with blood, so he could only retreat temporarily: "I can't see, give me a cloth."

Naya behind her didn't know what happened, so she handed over her handkerchief reflexively.But when she saw her father from between the people, tears fell down again.If Fatolad hadn't been pulling her by his side, she might have jumped on her and cried loudly.

In the entire room, the only one who remained calm and thought of a remedy was Carvey.

He kept his eyes on the wound, avoided the blood injection, and immediately thought of the location of the bleeding【6】.While the others were still flustered, he had already pressed the entire wound with a pillowcase: "Teacher, I must have touched an artery, and it needs to be ligated as soon as possible!"

Ignatz wiped his face, and reached out to touch his surgical equipment box: "Needle and thread. Needle and thread are found!"

"Teacher, give me another crow's beak pliers."

"Pliers. Here!" Ignatz wiped away the blood and threw away the handkerchief. "Did you see the bleeding just now?"

"Well, it should be at the bottom of the incision, probably the artery supplying the thyroid gland."

Carvey took the pliers, and while ignoring Laszlo's shouts, carefully wiped the wound, while trying to pinpoint the bleeding area with the newly emerging blood.

The needles and threads of the 19th century were not thin enough to handle this artery well.Kavey could only use the crow's beak pliers to grab the eyebrows and hair, and simply wrapped the wound with the remaining fascia around it, and performed a one-time ligation.

"Fortunately, the breach is blocked."

The clamping strength of the crow's beak forceps is very low, and Carvey can only slowly lift it up at an angle for fear of slipping, freeing up a part of the space for Ignatz to do the ligation: "Teacher, as long as this tissue is sutured, the bleeding should be completely stopped."

The voice slowly fell, but there was no response from Ignatz in the noisy space.

"teacher?"

Carvey withdrew his attention and looked up at the opposite side of the bed. Ignatz, who was supposed to be standing there listening to his command, was holding his forehead and trembling: "Teacher, what's wrong with you?"

"It's okay, I'm just a little dizzy"

Ignatz wasn't just dizzy, there were countless small cold sweats on his cheeks, and the shirt in the dress was already soaked.

These all point to a common condition: low blood sugar.

"Didn't you eat much at the teacher's dinner?"

"Uh, I've been chatting with Mr. Laszlo."

"I've been tired all day, and it seems that I can't keep up with my physical strength." Carvey replaced "hypoglycemia after drinking" with a more down-to-earth statement, and then suggested, "Teacher, why don't you take a break first?" , I'll finish it next."

"No, I'm fine, and you have no experience in this area."

Still reluctantly, Ignatz wiped off the sweat on his forehead with his sleeve, and was about to sew with a needle and thread.

Karvey can't help it, he is just an apprentice, it is impossible to embarrass him in front of so many people.If he seized power without his approval, Ignatz would not have to come forward, and those physicians who valued the relationship between superiors and subordinates would be the first to stand up to denounce this disobedient young man.

However, there are no absolutes in the world, and it is not advisable to be too conservative, and risks and benefits coexist.Carvey still retains the option of taking risks. If Laszlo's situation deteriorates further, he may choose to seize power.

Carvey took the opportunity to glance at Laszlo briefly.

This rich man is different from ordinary civilians. He usually eats nutritious food and is also willing to exercise. His body is indeed very good.It has been 3 minutes since the laryngeal edema appeared, and the hypoxia has not yet reached the point where it is hard to return, and he still maintains a part of consciousness.

Fortunately, there is still time.

Carvey held the crow's beak pliers, ready to give the "mentor" another chance.

At this time, Ignatz seemed to be more awake. He stood still and picked up the end of the thread to thread it through the eye of the needle, but failed several times: "Kavi, I will hold the pliers, and you will thread the thread."

Carvey hesitated, for fear that he would mess up the hemostasis he had just made: "Teacher, please be careful, there is an artery clamped underneath."

"I know."

Kavey gave the pliers away, took the needle and thread on the bed and quickly threaded it, not daring to take his eyes off the crow's beak pliers for a moment.Just as he was about to do the handover again and sent back the threaded needle and thread, Ignatz suddenly said, "You should do the stitching. The light here is better."

better?
The windows of the room faced south, and Kavi was just an assistant. Naturally, he turned his back to the window and gave all the light to Ignatz. How could the light here be good.

Saying that sounds like a lame excuse.

Maybe because he realized that his words were a bit outrageous, Ignatz quickly added: "I can't see clearly with the reflection here, and it's too late to change positions now. It's better for you to do the vasectomy, and it's not the first time you have done it."

"Oh."

Now that the opportunity was given, Kawi naturally wouldn't let go, and made a beautiful ligation at the lower end of the crow's beak forceps in a short while.In order to speak for his teacher, he said while doing it: "I never thought that the ligation technique that Earl Moraso learned from the teacher during the operation before would have the opportunity to practice so soon."

"Well, the knot is pretty good."

Ignatz was so dizzy that he didn't even look at Carvey's operation, but just followed what he said and continued to ask: "Is the knot stable?"

"Well, it's stable."

"Okay, I let go."

The crow's beak pliers slowly left the wound, the knot quietly stayed at the wound, the surrounding area was very clean, and there was no bleeding at all.

Carvey's response to this wave was perfect, and it took less than a minute to get rid of this troublesome artery.Even in modern times, such a straightforward operation should be greeted with applause.

But in Laszlo's room there was nothing.

Physicians don't bother with surgery and don't understand it at all.And Ignatz, who can understand everything, is suffering from dizziness and dizziness, and doesn't even look at it.The only person on the scene who saw all the operations clearly was Bergett, who had been diligently pressing Laszlo's body.

This was the first time he observed Carvey's operation so closely, and there was only one question in his mind: Why is this person so proficient?

Carvey was at best a surgical assistant, semi-literate with no medical education, even with some previous work experience.But why can it be done in one go from clamping blood vessels to suturing tissues, why is it so proficient?So proficient as not to be an assistant at all.

However, there is no answer in reality.

After ligating the ruptured artery, the wound was fully exposed under Kavey's retractor, and Ignatz picked up the horn catheter and inserted it directly into the wound.

A severe pain tearing his neck quickly swept across Laszlo's whole body, but the continuous flow of air into his lungs through the artificial airway made him feel much more relaxed in an instant.The pain took away the irritability, and the trance consciousness was slowly recovering. In these 3 minutes, Laszlo fully realized what death is.

"Father!"

Laszlo couldn't speak, and could only respond to his daughter with a smile on the corner of his mouth.

There were some sporadic applause at last, and even as proud as Fatolad, he did not hesitate to praise: "Congratulations, Dr. Ignatz, you once again created the history of Austrian surgery."

"Thank you doctor!"

Naya wanted to go forward and say sorry, her own waywardness almost killed her father just now, if Ignatz hadn't forced the operation, Laszlo would have become a corpse now.It's a pity that Ignatz can't hear anymore. After accepting the thanks and praise, fatigue and hypoglycemia quickly made him pass out.

"teacher!"

"Quickly, help him to a spacious place, and bring him some water!"

Kavey dropped the things in his hands and was about to go around the edge of the bed to help, but Laszlo's situation repeated again.

He's running out of oxygen again
(End of this chapter)