Nineteenth Century Medical Guide

Chapter 70 67. Metamorphosis: Interlude - First League LoveMIkeG Han Zong Jiachang (15)

Modern surgical techniques pay attention to meticulousness and gentleness, whether it is treating nerves, blood vessels, or skin, fascia, and muscles.

This is due to a stable anesthesia environment, such as deep sleep-induced analgesia, and muscle relaxation that is so quiet that there is no resistance.It is also derived from advanced surgical instruments, such as the rapid coagulation of electric knife, the exquisite toughness of suture needles, various convenient staplers, etc., as well as the advanced anatomical knowledge and understanding of surgery of surgeons.

Every step of the operation is under the control of the chief surgeon, new bleeding points will be blocked immediately, and hidden blood vessels in the tissue will be easily avoided.

With such multiple blessings, an ordinary elective surgery, including a surgery that goes deep into the abdominal cavity like a cesarean section, will have very little blood loss as long as there are no accidents.Of course, doctors will still choose to prepare blood before surgery, but there are very few operations that really need to use these blood preparations.

Patients in the 19th century were not so lucky.

Under the interference of the two words "lower uterine segment" and "pararectus abdominis incision" in Kavey's mouth, Hills' thoughts led the scalpel to draw a strange arc around Nora's navel.Although this incision is also considered as an incision next to the rectus abdominus, it always gives Carvey a visual sense of acetabular fracture surgery. 【1】

It looked alike, because he had seen it before.

But Carvey didn't have time to think about it further, because the blade quickly penetrated the soft tissue and fascia under the skin.

Hills did get the true biography of Ignatz. The movements of his hands are fast and smooth, which is very ornamental in the eyes of outsiders, but in the eyes of Carvey, it looks very rough.

When Ignatz was young, he had been pursuing the speed of surgery because he did not have anesthesia, but the rise of anesthesia made him realize that speed is not everything. At this age, he has begun to switch to fine operations that are closer to modern surgery.

Of course, the characteristics of being fast and fast still exist, and roughness is inevitable.It's just that this kind of roughness is a product of Ignatz's deliberate control, and it doesn't have much impact on the operation itself.

But Sears, who is eager for quickness, is different.

For subcutaneous bleeding points, he usually uses cloth to stop bleeding, or simply stop bleeding.It's just that Kawei reluctantly used the pliers as he stuffed something into his hand while talking about the crow's beak pliers.

"The pliers are used here, what about the next uterus? There are only seven crow-beak forceps."

"Don't worry, you'll be able to loosen the clamps after you've ligated the two big bleeding spots."

Hills reluctantly clamped the bleeding point according to Carvey's request, and then took the needle and thread from the nurse: "You just need to tell them the process I did, when to use pliers, when to use I have the final say on gauze."

"."

"There is no need to suture this kind of bleeding point at all, and the bleeding can be stopped when the incision is stretched."

The words are true, but Carvey is also for the sake of safety.In the current surgical environment, there is no such thing as blood preparation at all. The total amount of blood is fixed, and it is possible to save a little bit.
Forget it.

Seeing that his complexion was not good when he was suturing, and his tone was extremely firm, Carvey could only sigh, and continued to raise his voice: "Mr. Hills' technique is exactly the same as that of Mr. Ignatz, fast and sharp. The incision has been completely broken. Cutting through Nora's skin, we can even see the rectus sheath inside.

Now comes the first critical point, and then the teacher will separate the anterior abdominal wall and the rectus abdominis in order to feed.”

Carvey's previous commentary can still walk ahead of Sears, avoiding pits for him from time to time.

But when it came time for the actual operation, Sears' movements were like a wild horse running wild, completely out of tune with his gentle and refined appearance.Before Carvey finished speaking, the tip of the scalpel had entered the abdominal cavity.

This knife directly penetrated the anterior abdominal wall, the rectus abdominis, the rectus sheath, and the transverse fascia. It can be said that the concept of "sharp knife" has been brought to the extreme, just like Fernan swiping a knife to cut a leg of pork.

But Dr. Hills, who can inherit the title of "Quick Knife" from Ignatz, is not so happy now.Because the knife was inserted too quickly just now, the necessary blunt dissection was not done, and the blood vessel was not detected. The blade directly cut off the blood vessel under the abdominal wall. 【2】

Immediately blood flowed.

This is a very important blood vessel responsible for the nutrition of the anterior wall muscles and the outer skin, as well as blood circulation around the lower abdomen and perineum.Undertaking this responsibility, the blood vessels will naturally become thinner.

The transverse incision in modern cesarean section will also cut off these blood vessels, but in the case of preparation, they are ligated and cut off.Carvey knew that Hills and Herman didn't know enough about the anatomy of the abdominal cavity, and had already chosen a longitudinal incision that was not easy to cut off the sub-abdominal blood vessels, but things were still rushing in a direction he couldn't change.

"Two crow's beak pliers!" It's no longer the time to play pretend play with Hills, "Gauze, hurry up!"

Hills didn't understand what happened, so he immediately shut up and followed to stop the bleeding.

Kawi is fast.

Taking advantage of the moment when Hills and Herman sucked up the blood, the two crow-beak forceps stuck directly at the place where the incision was bleeding, as if they had eyes, and stopped the bleeding in an instant: "Dr. A small blood vessel, I had to help with ligation, but fortunately, it was not a big problem."

In just a few tens of seconds, Hills was still immersed in his mistakes, and Kavey's operation had been completed, and he didn't even have time to be surprised.

Seeing that the broken end of the blood vessel was locked between the teeth of the forceps, the next thing he had to do was to take the needle and thread and sew off the blood vessel as soon as possible.

"So it's not in the womb yet." Heman took a breath and whispered, "I was scared to death."

"Where can it go in so quickly." Sears was a little unwilling to do the most common suture work, and warned, "The suture is very thick. Be careful when you loosen the forceps. When the blood vessel breaks open again."

"I know."

After dealing with one trouble, Carvey continued to talk about the commentary:

"Mr. Hills made a large incision at one time. Fortunately, the amount of bleeding was not much. Except for the blood vessels under the abdominal wall just now, there are no other bleeding points worth suturing. Now the two teachers will slowly pull apart the surrounding skin and musculature, maximizing the view at the incision, and then exposing Ms. Nora's distended uterus.

If you are sitting in the front row, you should be able to see the regular contraction of the uterus, which is the contraction of the mother during labor.”

The blood vessels under the abdominal wall just now touched Hills a lot, and he seemed to have been taken aback. After the blood vessels were stitched up, his movements were much slower.It's like the feeling of stepping on the brakes when driving at high speed, and the rhythm is suddenly interrupted, so that Kawei doesn't know what to say.

"The teacher should further judge the exact position of the fetal head to ensure that the next incision will not damage the skin and head of the fetus. As long as you find the position, use two crow's beak forceps to lift the uterine serosa layer, then can cut the uterus layer by layer”

Kawei was in a hurry, and he talked about this himself, and told the whole process, everyone should know how to do it, why didn't he do it?
The stage looked at the operation area eagerly, and there was no sound in the arena.

Carvey had no choice but to continue: "Uterine contraction will affect the position of the uterine incision, and will further affect the follow-up operation of exploring the uterus. Mr. Hills needs to wait for the contraction to end before making a suitable uterine incision."

Circus's words were very natural, and his tone was very gentle, but he felt a fire in his heart: You really cut it!

Hills wanted desperately to cut open the uterus and to get the baby out of it as quickly as possible.But the next operation was his blind spot. He needed to cut the uterus, stop the bleeding, suture, take the fetus, and then suture. Every step was blank and he had to complete it by himself.

He needs to be as precise as possible while taking into account the speed, and every wrong step will cause Nora to die directly.

Hills looked at Nora who was asleep, his hands trembling slightly.

Fear, this is a process that a new surgeon must go through when facing an unfamiliar operation.

"Hills" Carvey walked to him, and the long-prepared reprimand in his throat instantly turned into comfort, "What's wrong with you? Is there something uncomfortable? If you feel uncomfortable, take a rest by the side."

Hills shook his head: "Nothing."

The operation started for more than ten minutes, and finally reached the most critical moment, the audience on stage did not want to be so appetizing.But out of basic politeness, at most they would exchange a few words in a low voice and would not say much.

But Varela on the side was not so easy to talk: "What are you all waiting for? Are you waiting for the child to pop out by itself?"

"The operation is difficult, Mr. Hills needs to be quiet." Carvey explained, "It's the same as when you are sitting in the office holding a manuscript."

Everyone didn't know for a while whether he was helping Hills or hurting him, but what was certain was that Kavi had reached the point where he couldn't bear Varela.

"It's a pity that I don't want to write a manuscript today. The cesarean section without Ignatz is doomed to fail." Varela took two sips of ale and continued to add, "Of course, even if he comes, it will be successful." The odds are poor."

"host"

Seeing that Carvey was about to get serious, Varela admitted his cowardice: "Okay, okay, I'll shut up."

"Please stop talking until the operation is completed." Carvey warned him, and changed his face: "Everyone, the reason why a cesarean section is called a cesarean section is that the uterus needs to be exposed."

"Okay, Kavi."

After waiting for a long time, Hills spoke again: "Herman, hand over all the pliers in your hand to the nurse, and get the suction pump."

"kindness."

"Kavi helped with gauze packing to stop the bleeding. Next, I will cut the uterus. The blood will stain every part of this bed red. It must be stopped."

"do not worry."

Carvey looked at the uterus still shrunk in the abdominal cavity, picked up two pieces of gauze and folded them into small squares, and handed them to Hills: "I remember Teacher Ignatz said before that to completely expose the uterus, you need Do some stuffing stuff."

"Did he say that?"

"Of course I did."

Hills nodded, according to what he said, the uterus was padded, and the incision was pulled outward, so that the uterus had been fully exposed.Then Hills and Herman located the fetal head, each selected a position, and performed a serosa layer lift. The scalpel quickly made an incision in the middle.

There wasn't much amniotic fluid, just blood from the uterine incision.

Kavi was very fast, with both hands together, and quickly protected the edge of the incision with gauze.And the suction work that Heman trained for more than a month also helped a lot, the blood flowing out quickly left Nora's body under the rapid rotation of the handle.

In front of Hills was an empty and clean uterus, as well as black fetal hair in the uterine cavity.

The bleeding wasn't too much, the fetus was still moving, and the nurse who kept counting Nora's heart rate didn't warn her of excessive blood loss.It seemed that everything in this cesarean section happened to be in the best position. The only flaw was the sub-abdominal blood vessel just now, but it was harmless.
Hills never dreamed that everything would go so smoothly, as long as the fetus was removed and the uterus was sutured, the operation would be complete.

This must be the whole of Vienna, no, it should be the most successful cesarean section in Austria, and the mother and child are safe!Even his teacher, Ignatz couldn't do the super difficult operation, but he did it in his hands!
Victory was just around the corner, and Hills repeatedly warned himself that the operation was not over, so don't be dazzled by the victory.

He took four deep breaths in a row, and finally stretched out his hand into the uterine cavity.

He felt the fetal head, the child's shoulders, and his tiny torso.The position is good, the size of the incision is suitable, and the fetal head should be able to come out.Hills tried to stretch out the other hand and entered the uterine cavity together, hoping to use both hands to pull the baby out together.

"No, the incision is not enough, my hands take up too much space."

Herman raised his head suddenly: "I have small hands, why don't I come?"

Hills shook his head: "No, I'm afraid yours won't work either, and besides, you have to take care of the blood pump."

"Try to squeeze it first. The uterine wall is very elastic and can squeeze the baby's head out."

Carvey talked about the modern practice of cesarean section and quickly helped to push the uterus.However, the uncertainty of surgery taught them another lesson. The incision was not as flexible as Carvey said, and the fetal head was still stuck in the incision and could not come out.

Carvey's first reaction was that the anesthesia was not complete and the uterus was contracting, but his reaction still failed to keep up with Hills' decision.

"Expand the incision!"

This was the only correct way Hills could think of. From making a decision to picking up the scalpel, the thinking time in the middle did not exceed five seconds.Just as Kawei was about to do an intrauterine examination to determine the location of the placenta, the scalpel had already cut it.

Every surgical operation is accompanied by risks, and the chief surgeon can only see the area in front of him.Cesarean section has never been a direct vision operation. Except for the uterine incision, the fundus and the other half of the uterus cannot be seen.

And death just stays in the shadows.

(End of this chapter)