Nineteenth Century Medical Guide

Chapter 445 441. It won’t be too late to intercept after I finish the test

Kavi knew exactly what he was doing.

Although the explosion was very close to Franz and Elizabeth, neither of them was injured. He had briefly asked them before, so he was right. Otherwise, he should have stayed with Franz instead of staying here.

As for Morasso, Cavi knew him very well. The probability of him sending someone to assassinate Franz was probably lower than that of Napoleon III announcing his abdication and slipping back to Corsica to retire.

He also believed that with Morasso's current status, unless Casper had some decisive evidence, he would not take action against him. But if it really came to this, what would be the point of him being there?

Both sides were protected and he was not injured. If he stayed there, he would just be watching. It was a sheer waste of time. What really needed him were the hospital, the operating room, the three injured guys, and the operation that needed him to complete.

As soon as he got off Casper's carriage, Kavi walked straight towards the operating theater without looking back.

He was busy the whole afternoon, dealing with several princes and nobles, and then participated in first aid and transporting the wounded, which consumed a lot of energy. Now, when he thought about the evening's social activities being ruined, and completely getting rid of political constraints, and then using the pile of instruments in his hands, Kavi was so excited that he trembled, and he couldn't wait to see the results of the operation.

The first people to see Kavi enter the theater were not the doctors and nurses who were busy running around, but Bertie and Viscount Lytton who were in the audience. Bertie stood up and waved at him, but his voice sounded a little hoarse because of the mask he was wearing: "Hi! Kavi, you're finally here!!!"

"Your Highness." Kavi still used the honorific title, "Why are you here?"

Bertie was excited when he thought of the operation that Kavey had performed before. It was not because he knew much about surgery or liked it, but because he thought it was new. Anything new could stimulate his nerves, whether it was art, women, or surgery:
"Didn't you promise to let me watch the surgery? But if you don't come up with something new and interesting, I'm leaving now."

"I don't know if it's fun, but it's definitely new enough."

"How new?"

"The new ones I can see here are the only ones in the world."

"You always surprise me. I really like you more and more. If my father were still alive, he would be the same as me." Bertie took off his cloak and put it aside. "I think today's operation should be as exciting as the anoplasty I did before."

Kavi didn't know how to define the beauty in the prince's eyes, but the things in his hands should leave a very deep impression on him.

He put the two suitcases on the ground and took off his coat. "It's so hot here! Why don't you open all the windows? Too high a temperature is not conducive to wound healing and will aggravate the infection."

"You, you still have the nerve to say such sarcastic things?"

In sharp contrast to Kavi's excitement at this time was Landreth who was still in the operating theater.

He stayed here for more than an hour, dealing with three seriously injured soldiers at the same time. He had to control vital signs, disinfect wounds, and deal with some uncontrollable emergencies. Except for participating in a few combat operations in the army, he had never done such tiring work in his life.

Landreth sat slumped on the side, his coat and vest thrown carelessly on the hanger, his shirt unbuttoned and mostly soaked. Blood and water stains could be seen everywhere on the corners, cuffs, and chest of his shirt, which stuck to his body in a mess, not looking like an aristocrat at all.

"You agreed to take over, why are you here only now? What time is it???"

"I'm going to the hotel to get something. Otherwise, it's hard to treat an open fracture." Kavey walked down the stands and saw Holmes. "Hey, aren't you the American student who watched the surgery that day? Why are you here too?"

"Dr. Kavi, I didn't expect to see you here! I have agreed with Dr. Landreth that I will temporarily work in the surgical ward of the Main Palace Hospital." Holmes was originally standing at the side, taking care of the coachman. When he heard Kavi calling his name, he stood up happily and took several steps forward. "If you feel..."

Kavi knew what he meant and quickly stopped him: "Since you are here to work, then help me quickly and take out everything in the box for disinfection."

"Ok!"

"After seeing my surgery, you should know how to disinfect, right?"

"I remember, rinse it with clean water first, then soak it in carbolic acid solution for about 10 minutes, and use sterilized instruments to remove it." Before Holmes finished speaking, he saw Kavi open the instrument box and dump all the things into the cleaning sink. He was speechless for a moment, "What is this?"

Kavi brought things they had never seen before, including several steel racks, a large bundle of steel needles, and a whole bag of steel screws.

He doesn't look like a surgeon at all, but more like a machine repairman.

"What are you doing? What are these things?"

If the man had not been named Kavi Hines, Landreth would have thrown him and the two boxes of things he brought out of his operating theater. But once this name tag was attached, the seemingly useless things became key items in the operation.

"This is an external fixator specially used to treat severe open fractures. Holmes, why are you just standing there? Come and help." Kavi spread the things flat on the bottom of the pool and put a tube connected to a large bucket of carbolic acid in it. Then he asked, "How is the debridement going?"

"It's all done. Take a look for yourself." Landreth sighed. "If you're not satisfied, do it yourself. I don't have the energy anyway."

Now there are three patients in front of him, and Kavi has to choose one.

Judging from the degree of debridement and the changes in vital signs during this period, Devinke lost the most blood, the fracture ends were partially exposed, and the wound surface was the most complicated. On the contrary, the driver who should have had a craniocerebral injury survived the ordeal and is still conscious.

Out of rigor, Kavi did not skip the driver and asked, "Brother driver, how are you now?"

"I'm fine!"

The driver, Fisher, was lying in the corner with an IV in his hand. As long as you ignored the large piece of wood on his eye, he looked no different from a normal person.

"Are you feeling unwell?"

Fisher pointed to his head and said, "I have a headache and dizziness, but they are not serious. My eyes hurt a lot. But it doesn't matter. I can bear it. I got out of bed and went to the bathroom earlier. I'll show it to those two first."

“The situation is relatively stable.”

Kawi walked up and carefully observed his eyes, and then looked at the vital signs recorded during this time, and suddenly found that some transparent liquid was flowing out of Fisher's nose. He dipped his finger into the liquid and rubbed it back and forth: "You didn't catch a cold before?"

Fisher: "No, I don't know where the snot came from, it's strange." "It was caused by trauma, but it doesn't look like a big problem now, let's observe it for a while." Kawi said briefly, and then let him lie back on the bed quietly, "If there is no other problem, prepare to remove the eyeball."

Fisher wiped his nose and felt a little sad. He thought Kavey could save this eyeball like he did with the fractures of the other two. It seems that he was dreaming. But: "Is it really impossible to save it?"

"He's too badly injured to be saved."

Kavi explained, then looked at the doctors: "I need to take care of two open fractures first. Who of you can remove the eyeballs?"

"I won't do it. I'm so tired!"

Landreth was the first to refuse and threw the surgeon to Peon: "Let Peon do it. I've been here for so many years and this isn't the first time I've had an eyeball removed."

Of course, Peon was unwilling to do so. Who would give up the opportunity to watch Kawi's surgery up close? But the operating area here was small and could not support two operations at the same time. He could not disobey Landreth's order, so he had to pack up his things and take Fisher and another nurse to another operating theater.

The only consolation is that the eyeball removal process is not slow, and I will definitely be able to eat some leftovers when I come back after it is finished.

Without the coachman, the only choice is between the general's wife and Devinke.

Regardless of the wound or the overall condition of the body, Devonke should be dealt with first.

"Mr. Devinke was in shock, his vital signs showed violent pulsation, and the fractured end of his tibia was slightly exposed, which was more serious than the general's wife's arm." Kavi glanced at Devinke's leg and continued, "The debridement was not thorough, so we have to do it again."

"Isn't this thorough?"

Landreth stood up after hearing this, his movements were smooth and he didn't look tired at all. "I followed your disinfection principles and washed him inside and out several times. I almost washed his stomach. How could it not be thorough?"

"This is an open fracture. Washing alone won't work. You have to remove all the useless parts."

The debridement that Kawi required was far more stringent than anyone present had imagined, so strict that it required trimming away necrotic skin and tissue that had lost its blood supply, as well as severely contaminated tissue and inactive fat tissue beneath the skin.

"How can we determine whether there is blood supply?" Holmes suddenly asked.

"Good question." Kavi put on a black leather skirt that blocked water, "Since we are looking at the blood supply, we only need to trim it until we can see the bleeding point."

"This"

"Get the scissors and clean water ready." Kavi asked the two nurses to go directly to the boiler room. "You two ask the boiler room to continue to boil water. When you have water, bring it over and put it in the sink. We're going to use a lot of clean water today."

"it is good."

Kaxiu repaired a lot of skin and fat tissue, and then pulled up a small piece of severed muscle with tissue forceps. "The color looks good, but it's a pity that it has no contraction and toughness. Let's try to cut it open to see if there is any bleeding."

Landreth kept complaining about Kavi being late, but whenever Kavi spoke he would quietly listen carefully, fearing that he would miss any details.

Since Kawi promoted the preoperative disinfection technique, Landreth and Sediyo have become more and more concerned about preoperative preparation. In Kawi's disinfection concept, cleaning is a necessary preoperative operation to avoid tissue infection, which is definitely important. However, on this very important step, Landreth found that he and Kawi still had differences in principle.

Kavey's handling principle is more like a high-speed capital machine, much more ruthless than his previous methods. Any unusable organization must be abandoned, just like entrepreneurs abandon workers who have lost their labor power without hesitation.

"The nerves are fine, and the broken blood vessels have been ligated."

After seeing that the surface was basically clean, Kavi did the opposite and further enlarged the wound with a scalpel: "Mr. Devinke suffered a high-speed injury. The tibia is relatively clean, and there is not much broken bone and contamination. Otherwise, part of the bone must be amputated to completely avoid infection. Bring the saline solution and methylene blue!"

After several rinses, the equipment is almost disinfected.

Kawi first took out a tibial fixation clamp, loosened it and put it aside, and Holmes and Albaran were responsible for resetting the tibia: "I need to stabilize the fracture ends first, and then fix them with instruments."

"I think I've heard about it." Landreth had changed into his new clothes and put on his three-piece surgical suit and came to the operating table. "The wooden screws they used at the time didn't work very well."

"Wood is easy to twist and break, but human muscles are quite strong." Kawi said, "Let's do the reset first."

Reducing fractures is a very physically demanding task. Modern surgery uses a calcaneal traction device for traction reduction, but in the 19th century, there was definitely no such condition, so it had to be done by manpower. Holmes stood at the distal end of Devinke's affected limb, and Albaran jumped onto the operating table and hugged his thighs. The two of them worked together, one in front and one behind, to align the dislocated fracture ends. Kawi and Landreth were responsible for the middle fixation, biting the bone shaft and tightening the screws.

[Please change your perspective, Devin is the right leg]
"It's a very good design. It can be used to stabilize the broken ends of the fracture after reduction to prevent it from shifting again." Landreth couldn't help but admire it. "Is this thing also in your surgical atlas?"

"Atlas? What atlas?" All Kavi could think of were the ones in his home in Vienna. "Oh, no. My atlas only shows the surgeries I've performed. I've never had the chance to try open fractures."

Landreth felt more balanced: "Looking at your posture, are you going to inject steel needles into the entire tibia next?"

"Yes."

After fixing the fracture ends, Kawi gave up the original wound and looked for a safe area for needle insertion. He first drew the needle insertion point on the proximal part of the tibia with a pen, and chose the position to insert the first needle in the anterior medial side: "In this plane, the common peroneal nerve goes around the back of the fibular head to the front. When we use the fixed needle, we can choose the front of the tibia and both sides of the patellar ligament to avoid the blood vessels and nerves."

[The blue arrow area is the safe zone]
For the second injection, Kawi chose the proximal 1/3 of the tibia, below the tibial tubercle: "We chose this place not because there are many options for needle insertion, but because there is less soft tissue coverage, which can reduce infection and exudation caused by the insertion of the needle, and also reduce the pain caused by traction when the muscle contracts."

"Next is the backbone area"

"Wait." Landreth was a little scared by Kawi's bold and exaggerated behavior. "How many nails are you going to put into this broken bone?"

"It is estimated that four rods will be inserted. If the fixation is not satisfactory, several more may be needed." Kavi threw his confidence in the success rate of the operation into the animal experiment that had never been done before. "I have done several experiments before, and they were all successful."

Landreth was a little confused: "What if it doesn't work?"

"It's not easy if it doesn't work?" Kavi found the bones on both sides of the fixture and said, "Amputation. You wanted to amputate it anyway. It won't be too late after I try this thing."