Chapter 226 223. The operation is "successful"

The caliber of guns in the early 19th century was very exaggerated, the main reason was that the internal airtightness of the barrel was not good enough, and the black gunpowder energy was limited, and only by increasing the caliber could it be maintained. However, the exaggerated recoil and the barrel without rifling were difficult to ensure the initial speed and accuracy of the bullet, so the power was impossible to talk about.

But in the mid-19th century, the Minerboro was born. [1]

This conical bullet is paired with a few simple rifles, and its rotation not only improves accuracy but also increases its power. Infantry no longer needs to be close to 100 meters to shoot, but can conduct accurate snipers two or three hundred meters away.

Speaking of the Prussian-Austrian War, we have to mention the French-Austrian War seven years ago.

In the battle with France, Austria was defeated quite completely, destroying their confidence in unifying Central and Europe.

According to some later research conclusions, the Miner bomb equipped by France and the loopholes in the Austrian military's own training and command have become the main factors that determine the success or failure of the battle. However, the authorities are obsessed with the fact that both France, Austria and other European countries believe that the infantry's bayonet charge won the final battle victory.

Even the Three Emperors and their own military experts regard the morale generated by their own fighting spirit and courage as the iron rule for victory on the battlefield.

This misunderstanding and determination to implement it made France pay an extremely painful price in the Franco-Prussian War and World War I.

In fact, from the perspective of a military doctor, even if you can't see the chaos in Austrian command in the last war, you can still see the power of the opponent's weapons from various wounds, and at least you can tell whether France's key to winning is a saber or a bullet.

At this point, Watman, who became the chief surgeon at the time, had begun to study the management of the military surgical team. He did not care about this detail and did not mention it. However, Ignaz, who had stepped to the front desk step by step from the grassroots level, had his own insights. [2]

However, because of his low status at the beginning, his books were always eaten in the library and were never valued by senior military officials.

Seven years later, Austria began to imitate France and equipped its own Lorentz front-mounted rifled rifled with Austrian-made Mineral (there was a mistake before, Austria had long used rifled rifled) [3]. At the same time, the infantry commanders also began to use the charging tactics that the French were proud of.

It's very strange.

Minie has a long range and high accuracy. The lead-based warhead used to make the bullet roll when it comes into contact with the internal structure of the human body. If it is in contact with bones, the bullet will not only break the bones, but also a soft warhead may also cause a burst in the body, greatly increasing the lethality.

However, the Prussian Dresse fired gun was one step further.

Its power is slightly less than that of the Minie bullet, but the integrated post-loading design of bullet gunpowder greatly increases its loading speed. Lead-made acorn-shaped bullets can also produce similar rolling and bursting effects, and their lethality is not small.

In front of Kawei is a soldier who was shot by a Prussian rear-loaded gun.

Judging from the injury report, he should have encountered the other party's cold gun during a field investigation, and the doctors with the team sent him to the temporary ambulance. The doctors working in the ambulance judged the situation and sent him all the way back to the fortress hospital.

The injury position is like Bill Rotter said, on his left head.

The common people know that the skull and brain firearm injury is often a single straight-line penetration injury. However, in real skull and brain firearm injuries, the bullet penetration injury often shows a worse and more complex scene.

"The 11th Rampage Soldier of the Third Army, Ronalgie." Bilrot pointed at his head and made a brief introduction to the injury. "The bullet should have been taken from his left forehead, passed through part of his brain tissue, and then shot out from the left temporal part. The entire skull that passed by was broken, like a cracked biscuit."

Kawei looked at the overflowing brain tissue and asked about several indicators.

The result is quite decent: "When I came, my blood pressure was only 80/40. After using a lot of adrenal extract, my blood pressure is now maintained at around 100/60, and my heart rate fluctuates between 120-140. I controlled my breathing at 20 times per minute, with my left pupil 3mm and my right pupil 3.5mm."

"Where is the infusion?"

"I lost 500ml of normal saline on the front line. This is the second bag of 500ml, and half of it has been entered."

Kawei looked at the simple respirator in the nurse's hand [4] and sighed: "The fortune has been saved for the time being, but he is still in a deep coma, which is a little troublesome."

The soldiers were seriously injured. Even if they were placed in the modern battlefield, they needed modern medical equipment and active and rapid rescue and transportation to obtain effective treatment. Now, this soldier named Ronalne can reach the fortress general hospital alive. In addition to luck, it also benefits from the front being close enough to the rear and the battlefield handling principles brought by Kavi.

"You just said it was the third army, and the person in charge of the doctor in the army should be Lockard, right?"

"Yes, it's Dr. Lockard."

"The treatment was quite well done, with boosting, infusion, and opening the airway. If it weren't for this tube and respirator, I'm afraid that people would have died on the road." Kavey looked at the air-cutting horn tube on the soldier's neck, and turned around and said to Ignaz, "Locard has also grown a lot."

"The stitching is a bit messy." Ignaz's requirements seemed to be higher.

"I guess I'm not familiar with the needle holder enough. I have to let him and Damirgaon learn well when I go back." Kawei made a brief comment, and then continued to look at the injured person's head. "The left forehead is a bullet hole of 1*1cm, the left temporal parietal occipital is a scalp defect of 3*2.5cm, a 5*4cm skull defect, and a comminuted fracture of the surrounding skull, with an area of ​​about 11*8cm."

The assistant next to the operating table made a quick record. Although these numbers are of no use for treatment, they can simply judge the damaged parts and brain tissue defects when the bullet passes.

Bill Rotter is quite confident in abdominal surgery, but he really has no way to start with such complex cranial and brain firearm injuries. What he lacks is not the surgical technique that is full of scattered, but the principle of treating cranial and brain injury.

The treatment principle is based on the basic principles of surgery. It is slowly introduced through the analysis of the causes of death and postoperative recovery of the injured, and it is impossible to appear for no reason. Without a large amount of surgical treatment, lack of sample and experience accumulation, and without modern surgical theoretical knowledge, Bill Rotter will naturally find it difficult.

But where did Kawei learn the principles?

Bill Rotter asked him several times, and the answer was nothing more than his father, his father's old friend, a flash in the pan, a dream, and other answers without factual basis.

Kawei took off his clothes, washed his hands quickly, changed into a clean leather skirt, and asked, "What is the cause of death from the brain injury?"

"Brain tissue damage?"

“Breathing is damaged?”

Kawei shook his head and walked onto the operating table: "No, the most fatal cause of death, the highest proportion is bleeding! Now some small arteries can still be seen in his wounds, which means that the hemostatic effect of the posterior pituitary lobe extract is not good, and the bleeding is still very serious. What we need to do first is to stop bleeding."

Bill Rotter responded immediately: "Get the brazier, wire, hemostatic forceps, scalpel."

"good!"

"What is the cause of the next death?" Goram, who was standing beside him, suddenly asked, "Is it because you said that Dr. Lockard's tracheostomy was beautiful."

Kavey looked back at him and replied: "The central nervous system in the brain controls breathing, but judging from the location of the injury, the injury does not involve that part."

"But he still had respiratory damage." Goram was puzzled.

"Yes." Kawei affirmed his judgment and also threw the questions back to him, "So the question is, what caused respiratory damage? I mentioned briefly when doing military medical training before, this is a whole chain reaction."

This knowledge point is very important, Kogolam forgot.

It’s not that he is not easy to learn, nor is he that has a poor memory. After all, he is also a doctor who graduated from a serious medical school and cannot have poor learning ability. The main problem is that there were too many training contents in that month.

All they have to do is memorize all the rules and regulations in the entire military doctor manual and keep them in mind.

Most people need to rely on understanding, and the basis of understanding is the result of interspersed basic theories and a series of logical relationships. However, the contents before and after this military medical manual have no logical relationship, and there is no theoretical basis, and there is only a series of practical operations.

This may not be that difficult for Ignaz, Herman, Salson and others, because they all watched Kavi's surgery all the way. Bill Rotter hadn't seen it before, but he watched it many times in the following four months, and he also had his own understanding of debridement and disinfection.

But for doctors like Golam, they didn't work in Vienna and had basically never had contact with Kawei. They just heard such a name from some of their colleagues.

After contacting them, they realized that a month was too short and there was very little time left for themselves.

"No hurry, think about it slowly, let's have the surgery first."

Kavi was not sure about the operation when it reached this level.

Because in craniocerebral injury, what the surgeon can do is not treatment, but provide a good environment for healthy brain tissue. This includes extremely thorough debridement and control of bleeding and intracranial pressure.

Simply put, the surgical process is to turn an open brain wound with bleeding, contamination, brain fragments and various foreign bodies into a wound that stops bleeding thoroughly, cleans the inside, and completely closes the surface to achieve the purpose of decompression and prevents infection.

The real difficulty lies in how to protect the surviving brain tissue as much as possible, which is extremely important for the injured to restore daily life functions in the future.

He can only do it according to the principle of brain injury: "Although brain tissue is important, what everyone sees is the brain that has been hit by high-speed projectiles and roasted with high temperatures. What we need to do is to expand the scope of the surgery on the basis of hemostasis and remove things that will affect brain recovery. Come on, give me hemostasis forceps first."

Kawei temporarily ignored the brain tissue that was smashed by the bullet. With the help of the suction device, he stabilized the two bleeding arteries with hemostasis forceps and did a sewing to stop bleeding. After the sewing is completed, the brazier wire is in place, and he began to use point burning to assist himself in the next step of debridement.

There is no need to do ct. You can guess from the range of the injured skull that there is not much brain tissue on the left half of the injured soldier. It is estimated that some of the cerebellum in the rear are also affected:

"We then removed foreign objects, which included brain tissue broken into paste, scattered hair, cloth pieces on the hat, bone fragments and metal bullet fragments. Give me a scalpel and I want to expand the surgical area." [5]

Kavi's movements were more brutal than what Bill Roth had just dealt with. He cut off some useless scalp and tried to keep the larger bone blocks connected to the dry mater as much as possible, and prepare for closing the wound later: "Prepare hydrogen peroxide and methylene blue rinse solution, pay attention to the proportion, I will use it later."

Stop bleeding, remove hair, rinse, stop bleeding, remove bone fragments, rinse and stop bleeding, remove two warhead fragments.

Kawei repeated these procedures at the operating table, and he needed to be more careful and gentler than those diners who wanted to keep the dishes intact and pick out the annoying onion garlic.

The long operation lasted for more than two hours, and Kawei, who saw the wound after all foreign objects were removed, breathed a sigh of relief: "The remaining brain tissue still had slight blood seepage and swelling, but it was not damaged by the impact force of the bullet. The filling level of the cerebral blood vessels is also good, so it can close the wound. I gave me the debridement and rinsing solution I asked you to prepare just now."

"What to do if you stitch it?" Bill Rotter was thinking about a more realistic question, "The scalp is not enough."

Kawei made a simple measurement and found that the remaining scalp and skull could not completely cover the wound. If it was forcibly covered, it would only compress the remaining brain tissue, which was a taboo for neurosurgery.

"Sew the cap-shaped aponeurosis on the forehead and the skin will not be stitched for now."

“Open?”

"First do a simple covering, and I will think of a solution after the operation is over." Kavey handed the suture to Bill Rotter, asked about his vital signs, took off his leather skirt and got off the operating table.

During the entire operation, Ronalne's blood pressure fluctuated twice, and his heart rate remained above 120, and he could die on the operating table at any time.

Adrenaline, posterior pituitary, methylene blue, normal saline, and blood provided by some medical staff and guards after matching, Kavi used all the means he could use on him, and finally awakened Ronalne's tenacious will to life.

He survived the operation.

But the operation is not only about the operation on the operating table, but also about the troublesome postoperative recovery, which accounts for a higher proportion of brain trauma than any other surgery.

Especially for such large-scale craniocerebral injury, violent debridement and large-scale surgery will cause severe stimulation of the brain. After the operation, brain edema and intracranial high pressure will definitely occur, and thin anti-infection measures will definitely lead to infection and high fever.

So Kawei never said "the operation was successful" from beginning to end, but just left the operating room alone after getting off the operating table.

Whether for him or Ronalne on the operating table, the real danger of brain trauma has just begun.
Chapter completed!