According to the modern concept of trauma, emergency treatment of trauma patients should follow the ABC principle [1].

There is nothing missing in the 19th century, and there is definitely not much attention. Kawei can examine the current situation and adapt to changes, without strictly following the order. But the principle is principle, the order can be changed, and ABC cannot be missed, and the things that should be checked must be

Need to check.

The bullet does not have eyes, and the position of the body is also very ambiguous, in the middle of the upper abdomen. Kawei does not know the angle of the bullet and there is no radiographic examination in his hand. He needs to eliminate the bullet ballistic trajectory and rise into the chest cavity as soon as possible.

possibilities.

Shooting is very troublesome, especially in the 19th century, the bullets were insufficient kinetic energy and were also lead bullets. After the bullets entered the human body, they would rotate and turn, forming an irregular blind cavity.

If it is really penetrated into the lungs, it will cause bloody chest, and then Orgi will be really hard for God to save him.

After Kawei quickly found the damage in the liver and spleen, he began to explore the diaphragm upwards. Fortunately, the bullet's injection angle was not tricky, and he only made a hole in front of the left outer lobe of the liver, and did not even penetrate the liver.

Now Olgi's breathing is fine. A and B in ABC are normal, and there is only one C in trouble.

The liver and spleen are all substantial organs in the abdominal cavity, with a large amount of blood in it. Once trauma occurs, contusions and lacerations are often accompanied by a large amount of blood loss. No matter who it is, after seeing the non-coagulation in this stomach, you know Or

It won't last long. [2]

Although Kawei has never seen a bullet pierce the liver, liver contusion and laceration are very common in his eyes. He stops bleeding as the top priority, but at the same time, considering that the operation cannot be completed in a short period of time, he still needs to give Orr.

Ji Expanded.【3】

"Whoever has time to get some water, clean water!"

Kawei first used gauze to put it under the spleen with a broken mouth, and used the organs to squeeze it to help with the pressure. At the same time, he did not forget to ask someone to prepare other things: "Where is the tap water here?"

“It’s in the theater.”

"Pick two kettles to get the water." Kawei used another piece of gauze to pinch out a corner, stuffing the bullet holes that kept bleeding in the liver to stop bleeding, "After taking the water, take some salt and baking soda,

Just use the kitchen.”

Locard didn't know why Carvey did, but Hills seemed to understand something.

In his eyes, Kawei's surgery was done carefully and cleanly, and water was indispensable both before, during and after surgery. Especially for abdominal surgery, water can be used to wash your stomach, just like the one that Hills missed before

Like the appendix.

Water is easy to understand, what about salt? Where is soda?

"Water can rinse the abdominal cavity, what is the salt used for? Isn't soda used to make bread?"

"The surgery hasn't been done yet, why are you dying?" Kavey was too lazy to explain, so he casually found a nurse and said, "If you're fine, go get something."

The nurse was a little confused. The previous order could still show the purpose, but now she didn't know what Kawei wanted to do. She glanced at the two surgeons in our hospital, meaning she wanted to ask clearly whether she should be.

It should be done as Kavi said.

But the problem is that Locard and Hills are also confused. The surgery needs Kavey, but the requirements are indeed weird. They don’t understand why he always likes surgery that can be solved by scalpels, forceps and some surgical instruments.

With something else.

It used to be alcohol, bleaching powder, but now it requires salt, soda and water.

They were not afraid of the failure of the operation. Even if Orgi died directly in the office, it would not be unacceptable, because they were indeed too seriously injured. But if they could have survived and were finally killed by Kawei's operation, it would be too

Depressed and tired.

In this way, the three of them stood there and didn't know how to answer for a while.

"If you want to save someone, you have to be obedient. If the thing comes too late, don't blame me if you die when you die." Kawei used gauze to press the bleeding from the broken liver, and touched the first liver port with his fingers [4],"

Come, Loccard holds the gauze and Hills gives me the crow beak tongs.”

If the liver is injured, Kavi can still be sutured, but now with a broken or defect, things will become very complicated.

Bullets not only produce ballistics in the liver, but also may necrotize the tissues around the ballistic. Kawei cannot judge the subsequent evolution trend of the tissues around the ballistic in the early stage with the naked eye. In order to achieve the problem for all, he can only directly remove the left outer lobe of the affected liver.

Cut them all off.

The abdominal cavity is the forbidden area for surgery, and the liver is the forbidden area in the forbidden area. There are rich blood vessels here, including liver ducts, bile ducts, various ligaments, gallbladders, duodenum, etc. They don’t even understand the liver lobe division, let alone talk about it.

Go for liver surgery.

The real liver surgery enlightenment was in 1888. At that time, the left and right lobes of the liver were distinguished by the shunt of the portal vein. In the same year, a doctor underwent tumor resection of the left external lobe of the liver.

If Kawei's surgery is successful, it will be able to advance 22 years.

He and Locard exchanged positions, and took the crow beak clamp and scalpel given by Hills and slowly began to separate the connective tissue near the liver vent: "The liver rupture is too much bleeding, so Olgi can't lose blood again

, I now need to block the portal vein of the hepatic vein."

Next was something the two had never seen before. Locard and Hills couldn't help but put their heads in the money and opened their eyes wide to see what was going on.

"So who will get the water?" Kawei used pliers to fiddle with the surrounding tissues, and took the time to take a pulse: "The heart rate is 120, and the blood loss is estimated to be above 1,000ml" [5]

As for this, Hills and Lockard didn't have to say anything more. A nurse immediately stood up and said, "I'll go."

Kawei buried his head in separation and said, "Get as much as you can, go and go quickly."

"I see."

The nurse thought of a large kettle in the ward. Just as she was about to go out, she suddenly shouted by him: "By the way, are the salt and soda powder in your kitchen clean? Last time I asked the vendor last time that the salt bought was not pure salt, soda

The fans also mixed up some other messy things."

"Ours are formal channels, but." Hills was not sure, and looked at Locard beside him, "It should be no problem."

"Forget it, I can't care about that much. I have to get the things over first."

"good."

Kawei looked at the remaining three nurses and began to assign jobs in turn:

"(Nurse A) She is gone, don't stand stupidly, you (Nurse B), go find a kerosene stove, I want to boil water [6]; you (Nurse C), listen to his heart rate,

Be optimistic about breathing; and you (Nurse D), helping hand over the equipment, we won’t be able to free up later.”

Soon the nurses performed their own duties, and the office finally had a bit of the smell of an operating room.

Oergi was seriously injured. Although the knife wound in his left abdomen was not deep, it also damaged the intestine and spleen. Maybe there were injuries elsewhere. The bullet in the middle of the abdomen tilted a little to the left, hitting the liver, and knocking out

A gap of about 2cm in diameter was found.

Considering that there is too much blood loss, Kawei has not had time to do other places to investigate. Fortunately, the spleen is temporarily safe, so he can stabilize the bleeding of the liver first.

"The bullet destroyed the left outer lobe of the liver, and it was unrealistic to repair it. I decided to remove the left outer lobe of the liver."

Kawei finally separated the anatomical structure of the first liver portal [7], found the portal vein, used a gauze strip as a liver portal blocking belt, and then asked Locard to hang a crow beak clamp on the strip. Locard was like

An intern who had never been to the operating table, stood there blankly, not knowing what to do next, holding gauze in one hand and holding pliers in the other.

Kawei gently patted the pliers in his hand with the back of his scalpel: "This is to put it outside to prevent the gauze strip from being missed. Why do you keep pinching it with your hands?"

Locard let go of his hand: "."

Kawei changed the back of the knife and slapped it on his other hand: "The liver door is blocked, why are your gauze still stuffed inside? Does it look good?"

"Forehead"

Locard has been practicing medicine for eight or nine years, and has done a lot of surgery at all. He never felt so stupid. It was the same as when he first entered medical school and had no idea about anatomy: "Dr. Kavey, you said just now.

Where is this liver?”

"The left outer lobe of the liver."

Kawei added another force to the hook, tried to open the field of vision, and then used a scalpel to divide the liver surface in turn: "The liver can be divided into five leaves and eight sections, the upper and lower sections of the left outer leaf, the inner leaf, and the right anterior leaf.

The upper and lower part, the upper and lower part of the right posterior leaf, the caudal leaf.”【8】

Locard had never heard of this anatomical term, and the familiar liver in front of him suddenly became unfamiliar: "This"

"I can be sure that there is no such method of leaf division in the anatomy book, and can the liver really be leaf division?" Hills asked directly, "Where did you learn it?"

“Self-study.”

Kawei said casually and continued to prepare for the removal of the liver lobe.

If you want to cut off a certain organ, you should not just pinch the blood vessels and cut them out with one piece of cake. Because the organs are surrounded by supporting ligaments and many connective tissues, you must first free the cut parts before cutting.

He first cut off the round liver ligament, then clamped the round liver ligament with crow beak clamp and gently pulled down, freeing the sickle-shaped ligament, left coronary ligament, part of the right coronary ligament, left triangular ligament and hepatogastric ligament, fully freeing the left liver

Outer leaves.【Supplement】

“Self-study?”

Looking at Kavi's skillful operation techniques, Hills certainly didn't believe it, but he really couldn't find anyone with this ability: "Stop kidding, I've never seen anyone who can learn to be self-taught."

"I can't teach myself, is anatomy avatar God invented?" Carvey didn't want to waste time on this matter, "Nurse C, report your heart rate."

The nurse was stunned and realized that C was referring to him: "Uh, it's been around 120."

"It's still stable." Kawei looked up at the door and continued to bury his head to separate. "My father often has the body left behind in his hand. I found that the liver was quite interesting, so I tried to do it."

"But the liver is just a whole piece, why do you need to divide leaves?"

"It looks like a whole piece of the naked eye, but if it is based on the distribution of blood vessel supply, it can be divided into leaves and segments." Now rescue is important, Kawei can't explain in detail, "Do as I said first, wait until the operation is over.

Let's discuss it again, is it OK?"

Freeing the liver duct and the left outer lobe of the liver are both very troublesome and time-consuming.
To be continued...