Nineteenth Century Medical Guide

Chapter 71. 68. Metamorphosis—Variation

Varela, surgery columnist for the Vienna daily, got his first taste of being kicked out of the theater an der Wien today.

The direct reason is that he taunted a few words after Hills failed to expand the incision, and was kicked out by Kavi on the grounds of affecting the operation.Facing the sticks in the hands of two theater guards, his usual slickness was completely useless, so he could only obediently leave the stage.

Varela looked back at the signboard, took out the cigarette case and matches in his arms, and lit a cigarette for himself.

He knew it was a bit too much today, and he would never have done it before.He has tracked and reported surgical performances for more than ten years, and he must know that keeping as quiet as possible during the operation is the most basic respect for doctors and patients.

But Varela couldn't hold back.

He didn't know why Ignatz wasn't there today. The operation was so difficult that he was still unknown. Now that there is no chief surgeon, the result is self-evident.

Maybe it was because Ignatz didn't play that made him feel a little absent-minded, or maybe it was Sears who fell short when he was about to succeed, which made him impetuous. Anyway, for Varela, today was terrible.

The basin of cold water that Kavey poured over his head calmed him down a lot, but one size fits all, and the failure of the operation is inevitable.

"The time is approaching the 20-minute mark, and the baby hasn't come out yet, and there's so much blood. Sears is like a fool, and he doesn't know how Ignatz taught people." Varela went to the sky Breathing out the smoke ring, he complained about the operation and the people, "20 minutes is a hurdle, it's over, it must be over, the operation failed again."

He has been to many countries and has seen other people's surgeries.

Britain and France are big countries in medicine, and both surgery and internal medicine are ahead of Austria.And Germany in the west and Tsarist Russia in the east also faintly showed signs of overtaking. The cigarette case in his hand was a gift he received when he visited Tsarist Russian medical and health officials. 【1】

Healthcare reform is underway across Europe.

The United Kingdom has already opened the University of London, which accepts the admission of civilians, and several well-known medical journals in Europe; France and Germany have successively increased medical industry standards, and Russian surgery is also actively seeking exchanges with other countries.

Among the big countries, only Austria is still planning major events in Hungary, and medical care is not on the agenda at all.

Although belittling Ignatz is a new attempt by the newspaper to increase sales, Varela does not deny that he also has his own hatred of iron and steel in it.Remarks such as "not actively innovating" and "relying on old theories" are all labels put on Austria by the health systems of other countries, and they are used by him to borrow flowers to offer Buddha.

Unlike Ignatz, he guards his own one-acre and three-point Vienna, and the enclosure is self-indulgent.

As a columnist who travels all over Europe, I have to exchange some surgical techniques with other countries every time I travel.Let alone Britain, France, Germany and Russia, even surgeons from the Netherlands, Sweden, and Belgium shook their heads at the Austrian surgery, which means that a guy like Ignaz can still put on the table and say a few words.

He desperately needs a victory to prove his country's surgical skills.

"never mind."

Varela pinched out the cigarette butt, a little disheartened, pulled up the lapel of his coat, and stopped a carriage: "Go to the Vienna Daily newspaper office."

"Isn't this Mr. Varela, why did you go to work so late?"

"I have to write a manuscript in a hurry, tomorrow's front page headline"

The placenta is a highway for the fetus to obtain nutrients from the mother and send away waste products. The large amount of blood passing through it is the vehicle for these nutrients and waste products.

In the 20th century, it gradually entered the formal modern obstetrics department. It is necessary to complete the b-ultrasound examination before cesarean section to clarify the position of the placenta.In addition, the selected lower uterine segment incision can naturally avoid non-placenta previa. Unless the patient has never had an examination and the operation is urgent, the operation will hardly damage the placenta.

Of course, there are no absolutes in the world. It is perfectly normal for poor people not to have antenatal checkups. In clinical practice, placental damage will still occur during surgery.Once the placenta is injured, it is equivalent to cutting off the entire highway, the amount of bleeding is very exaggerated, and it is not easy to stop the bleeding.

There must have been no B-ultrasound in the 19th century, only luck. Obviously, luck is not on their side today.

No one knew that Nora's placenta would be in this position, not even Kavi.Therefore, when performing a cesarean section, you should not rush to cut the uterus to take the fetus, but you need to observe the position of the placenta first. 【2】

It's not that Hills has never seen blood, on the contrary, he has become numb to seeing blood every day.The blood splattered everywhere was not a good sign. His rich amputation experience told him that he had screwed up the operation, and Nora would definitely die.

All it takes is an instant of discouragement, and death can take away a doctor's will and courage.

"Ms. Sears! Teacher Sears!!!"

"The amount of bleeding is too much." Hills looked at Herman who was still trying to pump blood. Although he tried his best to press the bleeding port with the gauze in his hand, he had no fighting spirit in his heart. "How is she doing now?"

The nurse quickly answered his question: "The heart rate is 110 beats per minute."

“A bit fast”

Hills was pressing on the bloody incision, and although he was still trying to stop the bleeding, there was no fighting spirit in his eyes.

Carvey was well aware that Sears was out of use, but he couldn't kick people away just yet.

I just kicked off the annoying Varela, and it would be very arrogant if I kicked him out again.And the more important point is that the next mess is not easy to deal with, and it is difficult to complete it by himself and Herman alone.

However, before deciding whether to stay or stay with Sears, the audience must be calmed down, at least let them understand the progress of the operation.

"We cut the placenta, and the amount of bleeding is a bit heavy, but there is still a chance, and we have to get the baby out first."

After clarifying the direction of the next operation, Carvey turned to look at the midwife beside him: "Come and help me, the tall one will help Herman pump blood, and the short one will come over and get the baby out first. Herman will get it Two umbilical cord clamps and the bottle of medicine I brought, hurry up!!!"

Under the command of Carvey, this temporary surgical "team" has a little bit of first aid.

The tall midwife worked hard to pump blood, while the short midwife easily reached into the enlarged uterine cavity with small hands, and immediately pulled out the blood-covered child.Herman followed up and clamped the two ends of the umbilical cord, and quickly cut off the umbilical cord, allowing Kawei to focus all his attention on the operating table.

"The fetus has been delivered, and the next thing to do is to remove the damaged placenta as soon as possible."

As soon as the words were spoken, Carvey's hand had already penetrated into the uterine cavity, and at the same time said to Sears beside him: "Mr. Sears, there are still two bleeding holes here, use gauze to hold them down."

"."

"Teacher, I need gauze strips to stop the bleeding!!!"

"Ok?"

Hills was just like Bergett who panicked at the beginning, pinching the uterine incision in his hand, thinking about how to face all this after the operation, he had already lost his mind: "Stop the bleeding?"

Kavi no longer cared about his status, snatched the gauze and crow beak pliers from him, leaned forward and said in a low voice: "If you still want her to live, just do as I said. Do it. If you can't, get the hell out of me! Nora doesn't need a piece of wood to operate on her!!!"

Hills was a little confused by the scolding.

Those "colleagues" around the operating table also heard a little bit, and were also very confused.

Even some of the spectators in the stands smelled something, and saw some shadows of team infighting.

Carvey is just an assistant, born as a civilian, and has not received systematic medical training. It is a taboo to commit the following crimes during the operation.But Sears' failure and numbness were obvious to all, and Carvey's reaction at least saved Nora's life and allowed the operation to continue.

Moreover, the right to speak has been in the hands of Kavey from the very beginning, and outsiders can't see that the command has been handed over.

Hills seemed to be woken up by the scolding, and looked at the slightly pale Nora again, and nodded: "I will."

"There are not enough hands and crow's beak forceps, just cover the incision with gauze, don't worry about it." Carvey made a judgment, and then said amazingly, "All you have to do is stand on the operating table and put your hands into her abdominal cavity , pinch the uterus tightly with the palm of your hand.”【3】

Hills had never heard of this method of stopping bleeding: "Pinch the uterus?"

"Do it!"

Carvey stopped talking to him. After the task was assigned, he needed to completely remove the placenta as soon as possible.As long as the placenta remains in the uterus, the uterus cannot contract well, and the uterine contraction is poor, and the blood vessels inside will continuously bleed out like a faucet that is unscrewed.

The placenta is deeply embedded in the uterus, and you need to find its edge, then use your fingers to separate it, and then tear it off in one piece.

"No implants. Don't have implants. Don't implants."【4】

One minute later, Carvey dragged out a large lump of black-red fleshy tissue from the womb, and left Nora's body with the umbilical cord and cord forceps just taken out: "Everyone, our luck is not bad, Nora The placenta was not adhered or implanted, and it was peeled off very smoothly, and then it only needs to wait for the uterus to contract further to stop the bleeding."

He breathed a sigh of relief, delivering the placenta was the first step to stop the bleeding.

But the operating theater, which was quiet just now, suddenly became noisy, and it was only then that Carvey realized that he had said something wrong.

The commentary just now is placed in the 21st century, and even medical students can understand it, because it is written in the textbook.But in the 19th century when cesarean sections were blank, it would seem unconstrained and confusing.

In addition to those high-ranking nobles, there were many medical students and working surgeons in the auditorium.It is difficult for their brains to accept so much irrelevant knowledge at one time, and after asking each other to no avail, they can only ask questions on the spot.

"Mr. Carvey, what do you mean by placenta accreta?"

"Implantation should mean that it is difficult to peel off."

"But what does stripping have to do with hemostasis? As long as the umbilical cord is clamped, it can prevent the placenta from bleeding profusely. Isn't it more appropriate to control the tear just now?"

"Yeah, why didn't you stop the bleeding just now, but take out the baby first? Can't you stop the bleeding first and then take out the baby?"

"The child can understand it. After all, staying in the uterine cavity will cause damage and affect the hemostasis operation. But it is difficult to understand the placenta first. I have studied a large number of obstetrical medical books and records of cesarean section operations, but there is no mention of it." The placenta needs to be removed first."

"Mr. Carvey said just now that placental separation helps the uterus contract."

"Of course I know! I have been admiring this operation carefully, and I must have written down this sentence, but I just want to ask why? Why must the placenta be removed first? Judging from the operation process, this step seems very important."

Once someone speaks first, questions flood in like a flood.

Carvey has been introducing the operation process, and he is also directing the team to do the hemostasis work. This time, he was careless and used the theater as a teaching operating room, and did not make a distinction between the times in advance.

Facing the questions from those people, he used gauze strips to press the uterine wound after the placenta was removed, and could only feign a shot: "The operation is not over yet, if you have any doubts, you can discuss it with me after the operation is over. "

These words are procrastinating for time, but seven points of them are true.

The first delivery of Nora's baby and placenta was successful, but her uterus wasn't contracting well.With the joint efforts of the seven crow's beak forceps, the uterus is still bleeding slowly and cannot be stopped at all.

Carvey had to prepare for the worst: "Nurse, how is she doing?"

"Heart rate is a bit rapid."

"I know the rush, I want specific numbers!"

"Probably around 125-130."

"Is the heartbeat weak?"

The nurse was a little nervous, looked at Carvey's face, and nodded in fright: "It is indeed lighter than before."

The faster and lighter heartbeat is a manifestation of insufficient blood volume, and the bleeding must be stopped immediately, if the bleeding does not stop, Nora will undoubtedly die. 【5】

Carvey had no choice but to call Herman: "Get the needle ready, it's in the drawer of Mr. Ignatz's box. Hills, continue to squeeze the uterus tightly to help it contract."

"it is good."

"understood."

After speaking, he picked up the test tube rack that Herman had kept on the ground just now. There were two tubes of transparent solution on the rack, which were the oxytocin that Kavit had left for Nora's life-saving.

It’s just that these oxytocins are mixed with vasopressin, which was difficult to separate in the 19th century, and it is considered a semi-finished product.Moreover, his experiment has just started, and he only knows that the reagent must be effective, but he does not know the concentration and safe dosage.Now that the situation is critical, we can only take a gamble and break into her womb together.

"Here comes the needle."

Carvey unscrewed the stopper of the test tube, took the needle, pumped up the oxytocin, and injected it directly into Nora's uterus.But this was not over yet, in the next 2 minutes, Carvey gave her four injections one after another. 【6】

Five full needles almost emptied Carvey's reagent tube, but the result was good, and Nora's uterus began to contract.

"Kavi, I can feel my uterus moving!"

The contraction drove the entire uterus, and the incision opened just now also began to contract and compress the blood vessels in it. This natural hemostasis method is much more useful than the crow's beak forceps.

Until now, Kavi was completely relieved: "Herman, give me a needle and thread!"

　Thanks to the following book friends for their rewards (ranked in no particular order): Xingyun Ruoyu Forgot Account (Rabbit Jing Ermeng), Baibu Huanyang (Hearted Big Brother Sanmeng), Apple is not loved by apples and not by stacked quilts (Apple boss four cute), an unknown cupid at the beginning of 13 (a handsome guy), Shu Moliang, shopkeeper Mo, spoon, and counter spells.Thank you for your support after it was put on the shelves, and thank you to all the readers who subscribed and read in the first place, and now it is 1/20 more.

　　
　
(End of this chapter)