Chapter 122 119. "Middle Doll-style Consistent Injection Method" and "Dream Back to the Medieval Retro Hemorrhage-Stop"

The method used by Kawei is not the first. As early as more than 30 years ago, doctors used intravenous infusion to correct fluid imbalance in cholera patients. [1]

At that time, ordinary saline was used. Although simple NaCl solution would produce "hyperchloremia with excessive chloride ions" and "hypokalemia caused by severe diarrhea cannot be corrected", sufficient aqueous solution that can be directly injected into the vein can at least prevent dehydration and death. [2]

On days without antibiotics, cholera mortality rates are very high, and infusions give people hope.

Unfortunately, this infusion method is not popular, because in addition to dealing with severe dehydration, blood has always been annoying in daily medical work. Replenishing fluids is the opposite of bloodletting, and the process is complicated and is quickly forgotten.

Kawei used the infusion method of ancient cholera, and the liquid mixed with it is a super low-end version similar to modern balance liquid. [3]

Three-piece set of hemorrhagic shock: low temperature, abnormal coagulation and acidosis.

The coagulation cannot be solved because it is a constantly changing thing that requires monitoring, and there is no corresponding medicine, so you can only be lucky. However, it is not difficult to have low temperatures and acidosis. Boil water to increase the temperature and then add a small amount of sodium bicarbonate to increase the alkalinity.

What really makes him feel awkward is the injection method of rehydration.

Modern use is an infusion bag + pliable input, which relies on atmospheric pressure and gravity to press the liquid into the blood vessels. Kawei does not have such things, and the only thing that can be used at hand is the syringe, so he can only use the syringe to slowly inject it into Olgi's body.

Although the speed is not slower than the infusion pierced pier, it is really laborious. Moreover, the four of them are not proficient in using syringes, and they are prone to make mistakes when changing syringes.

Nurse is not like nurses, nor is it like doctors, and their hands are more stupid than those undergraduate interns.

It's really messy.

Kavi stood aside, the left outer leaf of the liver in his hand had reached its final stage. He had been distracted by Orgi's heart rate and blood loss. Now looking at the busy rehydration screen, he could only think of new ways to rehydration: "You only have this kind of syringe here?"

"Yes, it's only 1ml."

As an emergency surgeon, Kawei has strong on-site response ability.

What he has to do now is to pour all the water into his blood vessels. Changing the syringe back and forth can indeed achieve the goal, but the reality is much worse than he thought. Moreover, when switching back and forth, problems such as "blood return" and "air enters the syringe" will also occur [4]. Kawei must find another way: "There is no syringe, there is always an enema device."

Nurse A: "Enema? There is!!!"

Nurse D: "There are many in the ward, so I'll get it now."

At this time, Locard put down the syringe and walked to the desk, and opened a drawer in the corner: "There is an enema device that Teacher Orgi himself uses."

"Come all the enemas you can find and rinse them." Kawei had no time to worry about whether he could do it clean. He said directly, "First compare whether he could fit into the syringe, find the most suitable one to fill it with water, then wrap it tightly with a bandage to try to seal the interface, and finally push the water into the blood vessels."

The matter has been explained to this point, and if you don’t understand it, it’s a simple IQ problem.

What Kawei wants is a stable channel for injecting liquid. Even if the channel is a little leaky, it is not clean. But now only cooking this way can save Orgi's life. At the same time, this nesting doll-style injection method can free him up one or two hands. The next cutting of the left outer leaf is difficult to complete with only two hands.

"Where is Nurse B?" Kawei isolated the root of the left liver vein and made a sewing with two sutures. The entire left outer lobe of the liver was completely freed. "Where is the iron rod I want???"

"Here's here~"

Hills walked to the door and looked out, and saw the nurse B who had just run out to find a stick, holding several iron sticks in his hand, gasping for breath: "I've found things, thick, thin, long, and short."

“So many”

"What should I do next?"

"Pick the thinnest and shortest one." Kawei looked up and looked at it for a moment, then bent down and found the scalpel in the box where the instruments were placed. "Cleaning one end of it, then baking it on the stove, and letting me know when it is red."

"good."

"Doctor Kavey, Dr. Olgi's heart rate has risen again, now 135"

Nurse C finally knew the nature of his work and reported his heart rate to Kawei as soon as possible, but the number reported was really unhappy. Kawei turned to look at Olgi, touched his arm with the back of his hand. His skin was wet and cold, his face was pale, and he was typical of hemorrhagic shock.

However, because I had an open abdominal distension and stopped bleeding on the spot, I saved it in time and the degree was not serious. At least my lips were not seriously cyanotic, and it was not time to really have an oxygen deficiency, so there was still some help.

There is a rescue, but the next surgery is full of variables. The liver removal method must be meticulous enough, and the amount of bleeding needs to be minimized, because any bleeding will push Olgi to the gates of hell.

"The enema is here, the enema is here"

Locard called twice, and he and the two nurses brought more than ten enema devices into the office: "Try the size quickly and find the most suitable one."

"good!"

Seeing that the fluid was about to be in place, Kawei asked the nurse B who was roasting an iron rod next to him: "How is the stick burning?"

“Not red yet.”

"Try it with me first."

The electric knife uses high-frequency alternating current to produce thermal effects to cut and electrocoagulate tissues. In fact, it is a drastic improvement of the medieval soldering iron hemostatic method using high-tech to make its usage accurate and controllable. [5]

There are a large number of small blood vessels everywhere in the liver. When cutting off the liver, they must be faced. It is unrealistic to just rely on the sheep intestinal thread to suture them one by one.

Every extra minute of the abdominal cavity is open, it brings some danger to Olgi. The lost blood and bacteria in the air can kill him. Kawei doesn’t have so much time to do sewing, and the quality of the intestinal thread now is too poor and the needles are thick. Whether he can really stop bleeding depends on luck.

Therefore, the most direct way is to simulate the effect of the electric knife and speed up the surgery.

He carefully took the iron rod handed over by nurse B, and under everyone's horror, he gently touched the left outer leaf of the liver that was about to be cut off.

Oh ~

"Kavi, what are you doing???"

Compared to the medical staff who are closer to the medieval iron to stop bleeding, Kavi, a modern person, is more familiar with this scene: "It's okay, I just make a judgment in advance. The hemostatic temperature must be controlled well, otherwise the liver section will be easily burned, which is not conducive to healing." [6]

The surgery in front of them was far beyond their imagination. The nurses were originally at the bottom of society and had never received systematic medical education. While surprised, there was nothing to say, so they could only continue to work hard.

Hills and Lockard are different. Kavey's approach actually embraces the soldering iron of the medieval era and completely overturns these hundreds of years of medical progress.

"Are you using a soldering iron to stop bleeding?"

"You actually reversal of history? It's terrifying to just go to the soldering iron."

"It's a good idea to stop bleeding. What are you anxious about?"

The iron rod that was not completely burned red still burned a faint burn mark on the surface of the liver capsule. Kawei handed the stick back to the nurse: "Move the stove to my feet, and the stick is inserted into it and burned."

"good."

Kawei found another scalpel from the pile of instruments on the side and began to cut the left outer lobe of the liver: "Hills helped his liver." [7]

Hills was a little hesitant, but looked at Olgi's open stomach and stood there. The medical theory that had been learned for more than ten years and the reality that appeared in front of him had a fierce collision. He was unwilling to believe that Kawei's approach was correct, but no one can take over the position of the surgery now.

And he also really wanted to see how dense liver tissue should be removed.

Kawei's next approach is much more crude than modern left outer lobe removal. In order to speed up, he must treat the liver tissue on both sides differently.

The scalpel starts about 2 cm away from the edge of the injury and cuts from the bottom of the liver from the bottom.

He needs to be careful as much as possible for the right section remaining in the body. He first performs a slight and fine burning of the broken blood vessels and liver ducts to achieve temporary coagulation, and then use sutures for final ligation.

For the left outer leaf discarded on the left, he used a hot iron rod to burn it on a carpet-style basis. [8]

The scalpel, suture, and fire stick accompanied by the rolling smoke and the burnt aroma of the charcoal-grilled liver made the operation scene very exciting: "Doctor Locard, why are you still standing there? Use the suction device to suck the smoke away! There is smoke in front of me, how can I continue to do it?"

Although iron rolling oil is a traditional advantage project in European surgery, both Locard and Hills were born late and had not caught up with the good times, so they had never seen such a big scene.

"This is also considered surgery?"

Seeing Kavi stitching the precision cutting into a barbecue stall, Hills's brain couldn't help but tremble. But in fact, the cutting of the left outer lobe of the liver was indeed very smooth, with no bleeding on both sides, and the cross-section was very clean.

Crow beak clamps, scalpels, fire sticks, and suture needles and threads line up in sequence, taking turns to enter Kawei's hands and flying on the liver section.

Locard was busy smoking smoke and maybe not carefully looking at the specific operation, but Hills stood opposite him and did see clearly. This was his first time to truly observe Kavey's surgery, and he also realized Ignaz's mood for the first time.

He finally knew why his teacher protected this guy so much, and why he was indifferent to his departure. Such superb skills, let alone Hills, even two more Ignazs would not be able to compare with.

Is this the gap between ordinary people and geniuses?

From being curious to surprise at the beginning to questioning, Hills now had a deep sense of powerlessness. He was confused, and he didn't know how much effort it would take to catch up with this gap.

ten years?

Twenty years?

It is recognized that Ignaz, the most powerful in Austria, should not have such skills. Hills thought repeatedly in his mind and could not find a way to catch up with Kavi. However, after half an hour of confusion, the left outer lobe of the liver was finally completely removed and moved out of Olgi's abdomen.

The bullet shot into the middle of the upper abdomen, smashing the vest outside, and then punching the rags of the shirt into Olgi's body. After piercing through the abdominal muscles, the lead bullet penetrated into the left outer lobe of the liver.

Fortunately, it was a pistol, and the bullet did not penetrate the liver, because further back was the largest arteriovenous blood vessel in the abdominal cavity.

Kawei tried to slowly release the blocking belt of the first liver portal. The suture was very tight and clean, and there was no sign of bleeding. At this point, the left external lobe resection of the liver was basically successful.

"Give me the suture." Kawei moved the liver away and began to suture the residual liver on the right. "How is the heart rate?"

“132.”

"Okay, very good." Although the changes in the numbers were not obvious, Kawei could feel that the fluid was starting to work, at least the shock did not worsen, and he was in a good mood immediately. "The next section cannot be opened just like this, which will affect the healing of the liver section."

After saying that, he clamped the front and posterior edges of the liver section, then sewed them with needle and thread to hide the section in it. [9]

If it was normal, he would choose to let the young people around him come forward to practice. But the situation is different now. Olgi does not have the support of many modern maintenance drugs and will deteriorate at any time. He looked at Hills and chose to finish the next stitching of the liver by himself.

After the suture is over, the next step is to finish the liver cutting.

For example, use the ligament just separated to cover the suture wound, and then use the large omentum to carry out secondary wrapping to protect the wound.

"Next we continue to have laceration hematoma on the spleen."

The operation has entered the final stage, the most serious liver damage has been removed, and the spleen bleeding is not serious. Although Olgi's vital signs are still a little unstable, overall, it is developing in a positive direction, and Kawei has relaxed a lot: "The liver is cut very successfully, don't be stern."

"And there is a spleen."

"The spleen is in good condition." Kavey took away the gauze that lined the spleen hematoma, and the blood was not obvious. "You see, this kind of wound does not need to be cut at all, it only needs to be sutured. Don't always think about cutting wherever it breaks, and see if it can be remedy. If it can't be remedy, it's time to cut it."

Although the office was busy, the atmosphere was still like a stagnant pool.

Seeing that the two of them just nodded, Kawei suddenly asked, "I'm very curious, why did that person rush in and murder Dr. Olgi? Was the operation failed?"

"The operation is not a failure, it can only be said that complications have occurred." Hills changed his remarks to the failure, "But that guy refused to give up. He first asked the teacher to waive his medical and surgical expenses, and later blamed the teacher for ruining his love. You also heard it at the gate just now. He was a guy with a brain problem."

"Does love ruin?" Kawei suddenly went gossip, "Can you tell me the details?"

Hills was a little uncomfortable, but Locard, who was beside him, said directly: "The teacher told his fiancée two days ago that he would never have any children in his life, so he ruined his wedding."

There are a lot of things to talk about in the operation, and it is too slow to write it. In reality, the rescue of liver and spleen rupture is far less simple. The operation is accompanied by risks everywhere. I need to make some details. Here, I can only downplay the plot. Keep going to the stage.
Chapter completed!