Nineteenth Century Medical Guide

Chapter 406 402. Kawei’s routine

The entire perioperative management of pediatric surgery is different from that of adults, and the requirements are much higher. The doctors had to jump through several hurdles before entering Bertha's abdominal cavity.

The first trouble I encountered was anesthesia.

儿童不是成人的缩小版，而是一个不断生长发育的有机体。身长、体表面积、体重之间的比例和成年人完全不同。一个正常新生儿的身长是成人的1/3.5，体表面积是成人的1/9，而体重则是成人的1/12。

There is not much difference in the use of modern anesthetic drugs between children and adults, except for the difference in dosage. Both the dosage and the maintenance dose need to be further refined, and the level of anesthesia must be judged more accurately.

But in the 19th century, only ether and chloroform were available, which not only had serious side effects, but also had a small window for safe dosage.

Chloroform is not likely to cause respiratory depression, but it is highly toxic and can cause liver and kidney damage, especially cardiac arrest. Kawei is more accustomed to using ether. The advantage is that it is less toxic, but the disadvantage is that it easily causes respiratory depression and is prone to explosion and combustion during storage.

Children are very sensitive to both drugs and need to be careful about breathing problems if ether is used. A slight overdose will cause the partial pressure of ether in the brain to be too high, and the level of anesthesia will disappear after deep breathing, which will be very troublesome.

If it is a minor surgery, you only need to follow the medication method given by Kawei to solve it in one go. However, if it is a major operation, such as the current laparotomy, the operation will take a long time, and it will need to be continued several times to maintain the partial pressure of ether in the brain. The amount of refill required is very particular, and Amor has to be very careful, not to mention the anesthesia technology here.

In addition to this factor that most affects the operation, we must also consider the panic, communication difficulties, resistance to the smell of ether, overreaction, etc. when children face the operation alone. Even if Kawei had a way to deal with it, the thought of so much trouble gave him a headache.

Landreth put on the mask, gloves and leather skirt designed by Carvey, and reluctantly handed the anesthesia that was originally left to the intern into his hands.

"Of course." Kawei immediately directed the intern, "Go get the ether bag and connect the breathing mask. Pay attention to her eyelid reflexes and pupil changes."

Landreth looked up at Kawei, hesitated for a while, then leaned over and started washing his hands. Then he asked the nurse to bring the disinfectant alcohol and carbolic acid to the operating area, and then looked at the little girl lying on the operating table, shaking slightly. Keep going: "What do you mean, just say it."

Kawei didn't have time to teach on the spot, so he only said the worst possibility: "You are a surgeon. You must have encountered a situation where the patient died on the operating table not long after the operation started."

"What does this have to do with the medal?" Kawei explained, "Children's anesthesia is very troublesome. Believe me, if there is a problem, you can't solve it."

Those who don’t know are fearless. Naturally, Landreth will not have any concerns in this regard and will not let Kawei interfere in his operation.

"I have read Peon's notes after learning your anesthesia rules. It said that you divided anesthesia into several levels, and each level corresponds to changes in the body. Doctors can use these changes to judge the level of anesthesia to avoid possible harm. ." Landreth didn't lie. What he just repeated was Carvey's exact words, "You think you can avoid anesthesia accidents?"

After taking care of the anesthesia, Landreth and two assistants began to disinfect, and Kawei also began to look for the next "target."

Landreth asked with a smile: "You do anesthesia and you need an assistant?"

"But the chances are very high in children."

"I'm not an assistant, I'm only responsible for anesthesia." Seeing his unhappy look, Kawei continued to emphasize, "It's just anesthesia. Just sitting closer will not affect your surgery."

"The probability of such an accident occurring is not high, and it is a normal phenomenon."

Kawei still hopes that the dispute can be resolved peacefully, at least there will be no accidents during the operation: "I think we need to have a good chat before the operation."

While teaching people, he also did not forget to comfort Bertha: "You will feel a little uncomfortable, just be patient and it will pass."

"Yes." Kawei emphasized. "Controlling the amount of ether can make it very safe. Of course, the ether inhalation device must be airtight enough, and the flame must be as far away as possible."

Kawei did not let the intern leave: "Stay, I also need an assistant."

The excitement period of ether does not last long in children, and it passed in a while. Bertha endured the irritation in her throat and fell into a drowsy sleep.

After spending many days together, the little girl still trusted him, and she had not shed many tears until she entered the hospital. It’s just that his uninjured left hand will unconsciously grasp the blanket next to the bed. The fear of surgery seems to be stronger than the pain: "I, I know."

"What could go wrong?"

Things inevitably developed in the direction Kawei expected.

It's a pity that the other party is still very stubborn and has already thought of Carvey's intention: "I know that you are a person who takes extra measures. Once you enter the theater, you will have more demands. A qualified gentleman should not be like this, an officer of the Legion of Honor." Recipients of medals should be more strict with themselves.”

In addition to anesthesia, another key factor in surgery is fluid replacement. In particular, rehydration of children with massive visceral bleeding is more demanding. This is not something that a 19th-century surgeon could deal with.

If anesthesia in Landreth's eyes is still an analgesic method that allows surgeons to demonstrate their skills, then rehydration is just a micro-evolution or strange variant of the four-liquid theory.

Fluid replenishment is on-demand, and the amount needs to be judged based on body weight and intake loss, so as to determine how much fluid needs to be replenished at how fast to maintain her body at normal levels, rather than copying Kawei like Landreth did. Previous rehydration strategies.

On weekdays, Kawei doesn't care about anything, seems to have no desires, and is very polite to others. Although he is not elegant, he can still be considered a gentleman. But in the surgical theater, he will become a sophisticated surgical machine. When he sees others mishandling the situation, he will expose all the problems one by one without giving any face.

Especially if the other party is a tough talker, don't blame Kawei for being rude. As soon as he got the anesthesia, the next order and questions came one after another: "Who gave me the rehydration?"

"This" nurse didn't dare to speak.

"It's me," Landreth admitted. "What's wrong?"

"How much rehydration should be given to a child whose weight is only 3-4 or even 5- of an adult?"

".500ml is placed first."

Kawei measured Bertha's blood pressure and heart rate again, and explained: "Bertha is only 6 years old, 110cm tall, and weighs around 14-16kg. She is very thin. Her physique is related to heredity, and it is also related to her limited nutrition and caloric intake all year round. related."

Landreth didn't understand why he said this: "Dr. Carvey, this is an operation, not a judgment on whether her physique meets the standards of her peers in Paris."

"The Paris World Expo is just around the corner, and Britain's latest locomotive is now lying in the World Expo exhibition hall."

However, Kawei went further and further: "If you want to pull the train, you need workers to add coal to the boiler. Every time you leave the train station, you need to calculate whether there is enough coal left. If it is not enough, you have to make up. But if you give too much, even halfway People keep pouring coal into the carriages, which will increase the burden on the train. "What, do you mean to give too much?"

"She is only 15kg, and her blood volume (75-80ml/kg) does not exceed 1L. If she directly takes 500ml, her body will not be able to handle it."

Kawei asked the intern to change the glass bottle to a smaller one and measured his blood pressure again: "73/40, the blood pressure is still at a low level, indicating that the bleeding is ongoing, but it is not particularly serious. Give me disinfectant cotton, and then Give me the needle."

Since he said he would be given the anesthesia position, Landreth was prepared to be "difficult". As long as you stop worrying about these things and focus on the surgery: "So much time is wasted, let's speed up the progress, come on, give me the scalpel."

However, Kawei had no intention of stopping: "This hanging bottle and strap were designed by me last time here. Every 5 drops is about 1ml. Do you know how many drops per minute?"

The intern was only responsible for anesthesia and knew nothing else. The target of the question this time was Albaran: "Huh? I, I don't know."

Landreth never thought that just replenishing body fluids would require so much attention. You have to calculate the total amount and pay attention to the drip rate.

But he knew that as long as he ignored Kawi, this matter would have nothing to do with him. So he endured so many questions and still used a scalpel to cut open Betha's abdominal skin, trying to ignore it and get through it.

Kawei saw that he was shameless, so he simply became shameless: "Albaran, assess the child's blood loss. I taught you before."

"what?"

This once modest and studious urology intern finally realized the dangers of society. What Peon left was not the operating table, but the violent storm in the sky. What he left to himself was not Isuke's seat, but the center of the storm.

This is obviously not a problem that can be solved with just a few words. Albaran held the hemostatic forceps and didn't know what to do: "Um, this"

"Just say whatever you have to say." Landreth didn't object.

"First check the dehydration, such as eye sockets, tears, dry mouth, urine, skin condition, respiration and heart rate." Albaran has a good memory and said it almost. "Then check whether there is shock, and replenish fluids in a timely and sufficient amount." "

It was very good to be able to remember it to this extent, and Kawei was very pleased. According to his original plan, if Albaran was unreliable, he might really have to die personally. Now that there is a mouth substitute, it is equivalent to the small confederate country among the three big countries of France, Prussia and Austria, which plays a buffering role.

"Dr. Landreth achieved a sufficient amount, but it was too much. The lumen of this kind of pimp strip is too large. It has to be controlled at 12-15 drops per minute, and it is not easy to adjust the speed."

Seeing that he was looking at his immediate boss and not daring to speak, Kawei had no choice but to continue fanning the flames: "I remember that I asked for a small-lumen pimp, right?"

"Have"

"Professor Sedieu specially asked someone to do it. Do you know where the thing is?"

"I know, I know."

"Then why are you standing there, why don't you go get it?"

This shout awakened the memory that had been sleeping in Albaran's mind for several months, causing him to subconsciously put down the hemostat, take off his gloves and skirt, turn around and run out the door. No matter what Landreth said, he didn't want to stay here anymore. It was really uncomfortable to be caught in the middle.

"Be careful, walk slowly, don't fall."

Landreth's scalpel had just cut into the peritoneum, and the separation of the soft tissue and muscles had not been completed enough, and it was no longer possible to proceed. He put the instrument aside helplessly and used gauze to briefly stop the bleeding, but his face had long lost the look it had just now: "What do you mean?"

Kawei continued the examination he needed to do: "I'll check my blood pressure."

"You took two people away, how can you ask me to perform surgery?"

"I really just wanted to get closer at first, and I didn't want to be like this. But the problem is that the pre-operative preparations were really not done well, so I had to let them do it." Kawei looked at the midline incision on his stomach. Bertha asked again, "She is a child and her body is no better than that of an adult. You really need an experienced assistant."

Landreth was so disturbed by him that he lost his temper and finally handed over the position of assistant.

The operation was proceeding in an orderly manner. Although there were many hiccups, the atmosphere in the venue was also very tense. But Kawei held Bertha's vital signs data in his hand and found no signs of shock after close contact. At least the situation is still controllable now.

In comparison, Mayer, who has always been separated from the door, has not been so smooth.

Kawei is an old face at the Main Palace Hospital, and the news spread as soon as he entered the hospital. Half an hour has passed since the operation was confirmed and Kawei entered the surgical theater. It may be more than an hour, maybe only half an hour, and other reporters will arrive at the hospital one after another.

When that time comes, his advantage will no longer be an advantage.

what to do? Where is the first-hand information?

Mayer immediately made the decision to give up interviewing Carvey and focused on three middle-aged women not far away. His intuition told him that Kawei's disappearance and kidnapping were likely to have something to do with them.

Martha, Fran, and Bertha's mother had little friendship. After Carvey entered the theater, they just went out to comfort Veronica for a few words and then left.

As for the ransom, regardless of whether Kawi will abide by the agreement or not, staying in the hospital is quite dangerous. After all, they were also involved in the kidnapping, at least as accessories. Before leaving, Lex kept emphasizing that he should leave as soon as he dropped off the person and never linger.

"You two, do you want a carriage?" The coachman who came to the hospital from them just now did not leave. He has been waiting for business at the door. "Regular customers, I will give you a discount."

"I won't sit down, thank you." Martha waved her hand and pulled Fran to leave.

"Only 2 francs!"

"We only have seven sous on us."

The coachman shook the whip in his hand, cursed a poor man in his mouth, and wanted to leave. Unexpectedly, a man suddenly came behind him, put a 5-franc silver coin into the coachman's hand, and then opened the carriage door: "I will pay you to take you back, can you two ladies do it for me?"

(End of this chapter)