Krafft's Anomaly Notes

Chapter 302 Emergency and Disaster Medicine

Many people who aspire to pursue a career in medicine will encounter a question at some stage in their studies, a question of priorities and last resorts, often posed by their teachers.

Suppose that one day, you and your colleagues are unfortunately in a situation where time and manpower are limited, but multiple patients come in at the same time. The specific situation is as follows:

Option 1: Accompanied by a male friend, complaining of dizziness and headache, blurred vision, chest tightness and chest pain, difficulty breathing, abdominal pain and nausea, weakness in limbs, congenital heart disease, immune disorders, wind-heat affecting the lungs, disharmony between the spleen and stomach, and kidney yin deficiency The weak young female patient cries to you about her discomfort.

Option 2: A work-injured patient who was sent to the hospital by a co-worker and found a random spot in the corridor to sit and smoke a cigarette, silently holding a wad of paper towels and thinking about something, but the paper towels contained two pieces of fresh fingers.

Option 3: The elder brother who may have just fought bravely in an unregulated drinking place, had several cuts on his head from a broken wine bottle, his skin and flesh are turned out, blood is all over his head and face, and he is crying and howling louder than the radio.

Option 4: Being picked up by the elderly at home, neither crying nor fussing, "Everything was fine before, I never had any serious illness, I just had a cough for a few days and no fever, let's take a look." Now my breathing is fast and my lips are a bit dark. Young children.

Option 5: The children were driven here, and the middle-aged man was lying on the bench next to him without saying a word, with no obvious injuries on his body, ignoring the noisy environment around him, and enjoying a baby-like sleep.

Option 6: Everything is fine, but the dean is his father.

Okay, the question stem and options are as above. It is forbidden to call for consultation or ask for instructions from superiors. Please independently select the objects that should be reviewed and dealt with as soon as possible within ten seconds. Multiple selections can be made and sorted.

When the time is up, all the trained doctors must have chosen what they think is the best answer.

I’m sure most people would have a hard time not laughing out loud when asked, but their instructors usually don’t interrupt the laughter.

Because they have no idea that they might be in it one day. Such as the scene Kraft finds himself in now.

The core logic of this outrageous question is to deal with problems with vital signs and state of consciousness first.

"Quick, quick, quick!" Kraft dragged the injured who was too close to the wall away from the building where God knows if a brick and a half would fall. "I'm a doctor, come and help!"

"Wait... No, don't touch the patient yet."

The unlucky guy who was rubbed by the gargoyle fragments probably only suffered a broken bone, and his wailing sound was full of anger. Because they were at the center of the incident, the crowd dispersed here, thus avoiding being stepped on.

After a brief inspection of the affected area and the conclusion that it was a closed fracture of the humerus of his left arm, Kraft left him where he was and quickly rushed to the injured patients who were enjoying a "baby-like sleep."

It was right not to let lay people move the patient immediately. The second patient I met was lying in a strange way, his neck was stiff and blocked, and he made a gurgling sound when someone came over.

Still conscious, but unable to speak due to limited neck movement and pain.

The force and direction of the trauma he received were quite tricky, and it seemed that he had been forced out of the cervical spine to dislocate. If he had moved it at will and allowed the cervical spine to swing at will, he might have suffered a high-level spinal cord injury.

"Leave this here, I'll bring the flatbed to move it later!"

Quickly inspecting the injured patients who were holding their injured limbs and still howling, Kraft prioritized his time on those key objects of attention that had gone silent, and quickly singled out those that needed special treatment.

"Those with broken ribs should be moved back a little. Wait, why is there one with several broken ribs, a flail chest? Wait for me to fix it." It can be dealt with, but it needs to be controlled as soon as possible.

"There are so many bleeding points, traumatic asphyxia. The heartbeat is still there, go slow it down, and remember not to hold your breath next time when you are squeezed." This is a special type of injury caused by a sudden increase in intrathoracic pressure due to squeezing. Fortunately, the heartbeat did not stop.

"Unconscious, but the heart rate and breathing are still stable. No injuries are seen. Stay tuned!" It may be mild or serious, but there are no signs of death for the time being.

"It seems to be a pneumothorax, closed. Apart from pain, there is no dyspnea or anything. Let's wait until the needle comes from the clinic." After the evaluation, decide whether to handle it.

"Unconscious, there is trauma on the head, breathing is fast and slow. Bad, tidal breathing, intracranial problem." The problem is huge, but it cannot be solved for the time being.

Vadin saw a confident professional temperament in this guy, instructing the people in the square who could still stand to do what he was asked to do, without showing any signs of indifference. His behavior was so natural that no one raised objections or questioned his identity. Some people who were a little hesitant also accepted the situation with doubts because others did not object, allowing a person from the medical school to sneak in.

There is no need to introduce where he came from. In the chaotic situation, Kraft took over the command of the scene and sent Vadin to the clinic to get tools and shake people.

There were no labels or pens at the scene, so we relied on the patient's trouser legs to mark and classify. This method sometimes doesn't work so well. Some people wearing robes may not have pants to fold, so they have to fold sleeves instead.

Fortunately, there are not many patients who are serious enough to require immediate treatment. Most of them have flesh injuries.

Kraft went around the field in a short period of time, sorting out the fractures that needed to be reduced or fixed, those that were suspected of having problems and needed to be kept for observation, and a few cases that might really be life-threatening.

By the time Brother Vardin arrived with Coop and the toolbox, Kraft had already used borrowed cloths to treat the first patient in the temporary indoor shelter, a flail-chest patient with multiple broken ribs. The pressure bandage was fixed, and although he was still grinning in pain, at least he had the strength to grin.

"We're here just in time. There's a patient with a pneumothorax over there, and his lungs are a bit compressed." Kraft took the tool box and assigned tasks to Kupp, who had just arrived. "You've also done a lot of thoracentesis recently. , go and relieve him."

"I?"

"Yes, you do it, I have to deal with that side first." The professor didn't waste a second, opened the box directly, let him click on the tools independently, and walked towards the particularly quiet area.

I just had time to make a rough judgment, and now I am entering the step of detailed inspection.

When there are too many patients, it is not so suitable to rely on spiritual senses instead of imaging departments for diagnosis.

Fortunately, in an era when imaging technology was not so developed, doctors still had to see patients, and a systematic physical examination method was formed that could indirectly reflect the degree and type of damage to the nervous system.

Their names are long and confusing, such as Knig's sign, Brudzinski's sign, Babinski's sign, Oppenheim's sign, Hoffman's sign, Chaddock's sign, etc., but all they do is raise their heads. , lift your feet or scratch the insteps and soles with sharp objects, and then observe the body's reflexes.

For those who are skilled in operation, it basically only takes a few minutes to complete a set.

It was previously judged that the person who was in a more serious condition was indeed not in good condition. In addition to confusion, he had already shown quite obvious pathological signs. His voice, speech, and pain response were all low, and he was in a deep coma.

Even if you rely on your mental senses to position yourself and find a way to resolve the hematoma's oppression, you probably won't have a chance to save someone from the hands of death.

The helping church staff brought a light source, and he opened the patient's eyelids, preparing to check the pupils one last time.

Under the illumination of the lantern, the patient's eyeballs were repeating a small movement - turning upward slightly and jumping back to their original position.

The amplitude of the movement was indeed not that obvious, and it only lasted for a few breaths. In addition, the firelight swayed, so if you didn't look carefully, you would have missed it.

"Nystagmus?" It seems to be a manifestation of intracranial injury. Combined with the abnormal breathing pattern, it should reflect that the damage involves the cerebellum and brainstem in the posterior position.

But is this what nystagmus occurs with intracranial injury? To be honest, he is not a neurologist, so he still has some doubts about this, but time is limited, so he can only go to other patients first, and while the fire is brightest, he will quickly check the pupillary light reflex of each person.

"Huh?" Kraft said in slight surprise when he opened the eyelids of another comatose patient who had no obvious reaction to pain.

The patient's eyeballs also moved upward slightly and repeatedly, then jumped back to their original position.

【so coincidental? 】

Another nystagmus, and the tremors were all downward and vertical. It makes people a little self-doubt. Is it some obscure clinical knowledge point that is not covered in books, or is it a coincidence?
It could be a coincidence, but the knowledge he had learned told him that the probability of standard vertical nystagmus appearing in two deeply comatose patients at the same time was extremely small.

Kraft, who did not believe in evil, opened the eyelids of another comatose patient and began to observe and wait.

When he was almost laughing at his inexplicable thoughts, the eyeballs that were staring at the ceiling inconspicuously jumped downwards a few times.