Nineteenth Century Medical Guide

Chapter 86 83. Doing nothing: not sewing is also a kind of sewing

Dongnilinle Street is located in a remote location, full of fish and dragons, and there is no police booth in the alley, so you have to go to Hoynz Street to find the police.The patrolling police there are used to seeing gangsters fighting, and they often seem very numb. The surrounding environment is such that lying flat is their mainstream.

Without suitable means of transportation, it is impossible for them to arrive at the scene in the first time, and it is already considered dedicated to show up within half an hour.

The situation in the dark alley was complicated, and the two patrolmen insisted on acting together for fear of accidents. They planned to come to No. 155 to find out the bottom line first, and then make plans.

Many people surrounded the gate of No. 155 under the darkness of night. The former neighbors saw the lonely Nora sitting next to the corpse, and they could only discuss in a low voice, not daring to go forward.

The blood overflowing from Fleurney's stomach was like mud, and it had already pooled under his body to form a pool of blood, and then flowed out several semi-frozen streams in various forms.Even the old fritters who have been patrolling Hoinz Street for many years, seeing such a bloody scene, it is still hard to imagine the tragedy at that time.

After finding someone to understand the situation, they carefully took Nora's knife away, and then they started to separate.

One patrolled the police booth to report to the police station, while the other first controlled the murderer, and then surveyed the scene. Every step was as required by the superior, step by step.

But what they didn't expect was that besides the murderer and the victim, there was a fourth person at the scene.What they didn't expect was that Li Ben, one of the victims, was still alive.

"Alive?"

"I'm alive, but the situation is not optimistic." Carvey briefly explained the reason why he appeared here, and then asked, "Is the carriage coming?"

"Carriage? What carriage?" The patrolman didn't know what he was talking about.

"Didn't the person who called the police tell you?"

Only then did the patrolmen remember that they had indeed heard this request half an hour ago, but they only took it as a joke.After all, when something happens in this area, it is often either to wait for death or to bandage it casually. It is impossible to spend unreasonable money to take a carriage to the hospital.

The patrolman thought that it would take half an hour for his partner to make a round trip, and he lost his direction for a while: "What should we do now?"

"Wait."

"By the way, aren't you a surgeon? How about you deal with it first, just like those two wounds."

"It's the neck, full of blood vessels, what if it's damaged?" Kavi spread his hands, "I'm just an unknown surgical assistant."

"It was so"

The carriage didn't come, and Li Ben's time to be sent to the doctor had to be postponed.

Carvey doesn't care, he has fulfilled the responsibility of a young surgical assistant in the 19th century.

Under such difficult conditions, the failure to suture the neck vessels was a perfectly normal thing, and no one would blame him.On the contrary, when Li Ben was sent to the dissection table, all the surgeons involved in the dissection, including Ignatz, had to praise him with these two suture techniques.

Therefore, it was Li Ben who collapsed.

Li Ben sat by the wall, feeling very tired, his left eyelid slowly drooped involuntarily, and he couldn't open his eyes more and more.Seeing that the carriage was nowhere in sight, and Kavey was about to leave again, he really thought he was dying, so he had to agree to Kavey's request: "As long as I admit it, it's fine."

"Yes, Mr. Police just happened to be here too. You can tell him what happened at that time."

Li Ben looked at the bloodstains all over the floor, threw away the stick, nodded and said, "Okay, I will."

The patrolman didn't know the relationship between the two, but was worried about Li Ben's body. He had never seen a man who was covered in blood and could speak, and it was a miracle that he could be rescued: "I think it's better to wait until we go to the hospital. Let's find you to find out what happened."

"Look, can I go now?" Li Ben couldn't control so much, "Let me finish talking soon."

There is no need to go into too much detail about what happened, just point out that he and Fleury were the first to do it. Nothing can explain the problem better than the victim himself voluntarily admitting it.

However, for the patrol police, the record of the details of the case is very important, and mistakes before and after are not allowed.If there is a problem, those sheriffs and chiefs will not take the blame for them, so be careful and be careful:

"Did you threaten her with sticks first? She didn't want to do it, or did you do it as soon as she came up?"

"As soon as you come up, do it."

"No, you didn't hit her when you first came up?" The patrolman was very surprised, "That girl is quite short."

Li Ben was dizzy from being surrounded by him, so he could only correct it according to his intention: "Yes, yes, he came up to threaten him, after a while, and then he made a move."

"Huh? Why did you change it again?"

"Anyway, let's hit her first."

The patrolman looked around: "There is only this one stick at the scene, is it you using it, or is Flenny outside the door using it?"

"What, what's the matter? We are the ones who hit first!" Li Ben exhausted his last bit of strength, "I beat people, I'm dirty, I'm a beast, I deserve it, I'm not human!"

Seeing that his neck started to ooze blood again, the patrolman hurriedly persuaded him, "Okay, okay, you beat him, you beat him, don't get excited."

It seems that the swelling of Li Ben's neck is not serious, but unconsciously, his speaking pattern has changed.The original complete sentence was broken into small paragraphs, and the pause in the middle seemed very funny.

In fact, it was because there was pressure from the palm outside, and the slowly growing hematoma in the neck squeezed inward, which further affected the airway.Carvey knew very well that this progressive hematoma must be accompanied by a ruptured artery.

"...I'm done, Doctor."

Seeing that Li Ben pressed his fingerprints on the contents recorded by the patrolman, Carvey said: "Mr. Patrolman, he is bleeding too much, and it will take some time for the carriage to arrive. I think I should help you first." Stop the bleeding."

"You paid back just now." The patrolman didn't bother to care about this, put away his notebook and walked out the door, "Forget it, I'd better go see how the girl is doing."

Li Ben finally breathed a sigh of relief, but his breathing became more and more urgent, as if his throat was blocked by something: "Doctor, I can't breathe, I'm out of breath. My eyelids also fell off, here they come."

"I know, stop talking."

By candlelight, Carvey also noticed that his eyelids were drooping, but not on both sides, but on a single injured side.Combined with neck hematoma, it is not difficult to judge the cause of drooping eyelids, which is the Horner syndrome caused by compression of the sympathetic trunk in the neck. 【1】

The sympathetic nerve runs deeper than the blood vessels. If it was a cut, the common carotid artery must have been severed, and Li Ben would definitely not be alive now.After a simple exclusion method, it should be possible to determine that it is caused by long-term compression of the neck.

Carvey re-tested his heart rate first, and it was stable in the early 100s. His skin was far from the clammy feeling of hemorrhagic shock. The key consciousness was still there, so he was breathing a little faster.

The guy's body can handle it, but the hematoma is a problem.

The focus returned to the neck. This time he did not choose to suture at the corner of the wall, but moved Li Ben to a slightly spacious ground and lay down.Carvey also needs to help Liben re-establish the airway before he can fix the ruptured blood vessel.

If it is a modern hospital, when encountering a huge hematoma caused by neck trauma, opening the airway is more important than stopping the bleeding.Generally, trauma centers use direct (percutaneous) tracheotomy, which is similar to that done by Laszlo.

But Carvey doesn't have the corresponding equipment in his hand now, and what is put in this box is just a simple incision and suture box, which was used when Ignatz used to drain pus from the body surface of the nobles.

"no solution anymore."

Carvey dug out a needle from the box, which should be a drainage tool for the deep abscess cavity: "It will be rough next time, bear with it."

Li Ben:? ? ?
Before he could react, Carvey felt the needle insertion position in the depression between the thyroid cartilage and cricoid cartilage.Considering the thickness of the subcutaneous tissue and the hematoma, he used his fingers to control the needle insertion distance to be about 0.5cm-0.8cm, raised his hand and inserted the needle. 【2】

There was no hesitation, nor any sloppiness.There was only a slight snort, and Carvey felt a sense of emptiness in his hand, and the needle entered the trachea smoothly.

The stimulation of the needle made Li Ben cough twice, the trembling of his body brought severe pain, and blood splashed everywhere, but the fresh air that followed immediately made him feel comfortable again.

"How is it now?"

"It hurts. But it feels better."

The location of neck surgery is special, so it is obviously unrealistic for Li Ben to be in charge of lighting.Not to mention that he couldn't hold it steady, even if he held it firmly, it would be difficult to maintain the correct angle of light incidence, so Kavey could only do it by himself.He put a layer of gauze on the candle, bit it with his teeth, then removed the oppressive hand, and began to do neck exploration.

The basic situation is similar to what Carvey thought. When the wound is opened on the surface, the broken anterior neck muscles can be seen, and the broken anterior jugular vein can also be seen on the upper and lower sides. 【3】

There are many collateral circulation pathways in veins, and the anterior jugular vein is not that important. There are also some other small blood vessels, which can be ligated directly.The premenstrual muscles need to be sutured, but it is now necessary to continue to explore forward, because it is unlikely that a single anterior jugular vein will cause such a large hematoma.

"Don't move around!" Kawei stopped the bleeding and vacated his field of vision, and then quickly ligated, "After this blood vessel is ligated, I have to turn it down. Please bear with me. This place is not like a thigh. There are blood vessels everywhere around it. I don't care."

Li Ben could only endure the pain and nodded slightly.

Carvey clamped the muscle with tweezers, then pulled it away with a hook, and handed it to Li Ben himself: "Hold it firmly and press it, even if it hurts."

"Um"

Just when he wanted to continue to investigate, a stream of blood suddenly spurted out.It was about 10 centimeters high, and it filled Li Ben's neck wound in an instant.

The bleeding came suddenly, and Carvey didn't see where the bleeding was, so he could only touch the place where the blood gushed out with his fingers and press it down.After sucking away the surrounding blood, he discovered that this location should be the bleeding caused by the rupture of a branch of the carotid artery.

Inside is a common carotid, and what separates upwards is the outer and inner carotids, all of which are large arteries.This one is definitely not that big. Judging from the shape, it should be the first branch descending from the outside of the neck, the superior thyroid artery. 【4】

Carvey determined the location of the bleeding. The fingers of his left hand and the crow's beak pliers of his right were half-covered and half-clamped to quickly control the breach and ligate it quickly.

Just like the blood vessels in his legs, the only thing he could do with the gut in his hand was ligate, and suturing was obviously impossible.As for the blood supply of the thyroid gland in the future, it can only depend on Li Ben's luck.

With luck, the side branch builds up, and it's fine.

Bad luck, the establishment of collaterals is slow, and the thyroid function will definitely be affected.

But now Li Ben will definitely choose to ligate, as long as he can survive, he can do it, and the internal jugular vein seen by Kawei is the same.

Carvey's exploration did not find a breach in the internal jugular vein, but found that there were more blood clots in the deep part.This is actually very common, and he encountered many problems along the way, but experience told him that the problem was not simple.

After further exploration, Carvey discovered a rupture of about 0.4 cm on the main trunk of Li Ben's left internal jugular vein.The opening was mostly blocked by a blood clot, and blood was slowly oozing out.

This is a blessing in misfortune, because the common carotid artery in the inner position is fine, and the pulse is strong.

The trajectory of the blade can basically be restored from the wound. It can only be said that Li Ben's reaction is really fast enough, maybe he took half a step back at the moment of cutting.The blade drew a strange arc on his neck, which strangely avoided the external jugular vein, trachea, esophagus and common carotid artery, allowing him to live until now.

"It's over, you kid is really lucky, and you have avoided all the troublesome places."

Carvey looked at the opening of the internal jugular vein, making a decision in his mind.

The internal jugular vein is very thick, even if it is a vein, the blood flow is not small, and it mainly controls the return of blood from the brain to the heart.Blind ligation is definitely not acceptable. This is equivalent to cutting off the blood return of half of the brain. Before the right circulation appears, direct ligation may cause blood stasis in the brain, resulting in cerebral edema.

The tear is actually not that big, and it would have been sutured long ago in a modern Kavi. Vein suturing is not a difficult task, and if it doesn’t work, a patch can be applied.But look at the tools eliminated by Ignatz in his hand. It is passable to sew skin and muscles, and the fascia can also be used, but if you sew blood vessels...
Just because of the exaggerated suture needle and thread, a small half of the blood vessel has to be blocked after suturing, and it is also a secondary injury to the blood vessel itself. Whether it can heal is another matter.In addition, thick sutures can also irritate blood vessels and cause scarring, which can cause blood to swirl, which can form plaque and blood clots over time.

Once the embolus falls off and the blood flows back into the heart and then into the lungs, it is a pulmonary embolism, a fatal situation.

Now that the shot has been taken, Carvey will not let Li Ben die in his own operation. These obvious postoperative complications need to be avoided.But now I can't do sutures, and I can't easily do ligation, and the blood vessels are still oozing out slowly, what should I do?
Carvey suddenly thought of Moraso's groin. He was quite shocked by Ignatz's simple and rough handling at that time, and he also realized how pitiful contemporary surgery is.

But shock is nothing but shock, is there nothing worth learning from his approach?
Suddenly, Carvey let go of the hook in his hand, put the needle and thread aside, and continued to open Li Ben's wound, so that the bleeding blood covered the blood vessels as much as possible, and then pressed it gently with his fingers.Surgery sometimes needs some divergent thinking and inspiration. If suture and ligation are not feasible, then simply do not stitch or tie.

The so-called governance by doing nothing, sometimes not sewing is also a kind of sewing.

It sounds strange, but there is a need to try.If it really doesn't work, Li Ben is out of danger anyway, and it's not too late to do the stitches.

Li Ben felt strange seeing him squatting beside him blankly, not doing anything: "What are you doing?"

"I'm waiting, 10 minutes first."

"Ok?"

"If you're lucky, your blood vessel should be plugged in 10 minutes."

　night out, sleep~
　　
　
(End of this chapter)