Chapter 249 245. Sudden shock

Kawei's surgery is over.

According to modern surgical practice, the gallbladder will be sliced ​​for pathological examination. The stones will be cleaned and the number and size will be counted. If the surgeon has a collecting habit, these items may become his exhibition room after careful selection.

a member of.

Kawei doesn't have this quirk and now prefers to promote surgery.

This is the world's first cholecystectomy, and it is a cholecystectomy that does not take more than an hour. If the publicity is in place, it can become a routine surgery in the future, second only to cesarean section and appendectomy.

For this purpose, the gallbladder cut open by scissors and the gallbladder stones scattered around became his postoperative trophies.

With trophies comes bragging rights. Kawei’s way of showing off was very crude, that is, walking into the operating room with a metal tray for everyone to watch. This is gangrenous cholecystitis. Even if the general surgeon comes on stage, he has to take deep breaths repeatedly to stabilize his mind.

of severe acute abdomen.

He could completely rely on Rogaro as a patient to give everyone present a vivid lecture on hepatobiliary surgery.

However, as soon as Kawei walked in, he felt something strange in the operating room.

The originally noisy operating room has become much quieter. The operating table where Ignatz is sitting has been replaced by a new surgeon. He looks unfamiliar, but Kawei remembers that he should be Ignatz’s assistant during the operation just now. Lying on the operating table

The injured person also changed, from being shot in the abdominal cavity to having debridement of trauma to the right upper limb.

As for Ignatz himself, he went to another operation.

If you were just watching, there would be nothing wrong with it. Kawei originally liked wandering around in the operating room, and it was always right to watch and learn more. But now the chief surgeon left his wounded and went to someone else's operating table, holding his hands

The atmosphere was extremely tense as I held the gauze and tissue forceps.

"Teacher Ignatz, this is the gallbladder of the patient just now." Kawei walked up to him with a metal tray and said, "You have never seen an unprecedented gallbladder."

"Um"

Ignatz was very interested in gallbladder removal, but he only looked back and looked away. And Kawei's attention was also attracted by the surgical incision in front of him: "Huh? Spinal surgery?"

"The bullet hit the spine from the lower back. I originally wanted to open it to see if I could remove the bullet and do a simple debridement." Ignatz looked at the original surgeon in front of him. "Later, I might have to remove the bone fragments.

I accidentally injured a blood vessel when I was doing it, causing a lot of bleeding."

Bleeding a lot

There is already a lot of bleeding in the spine, and the anatomical position is covered with various large blood vessels. Whether it was careless during the operation, or whether the bullet damaged the blood vessels in the first place, it is difficult to say without imaging.

What needs to be more concerned about now is the condition of the wounded, and the situation is definitely not much better.

"Find a place to bury it." Kawei directly put the metal plate into a nurse's hand, and then continued to order, "When you go out, turn left and there is a temporary operating table. Ask those people to come over and help as soon as possible."

The nurse didn't know Kavi, but it was easy to tell from the tone of his voice that his status was not lower than that of Ignatz, and he must act according to the instructions: "Oh, okay."

Kawei waved to another nurse aside and asked for a new leather skirt and gloves. Then he looked at the nurses and assistants who were probably anesthetists beside the operating table as usual: "Here, who can report the blood pressure and heart rate?"

.”

"."

"What's wrong?"

"They are not in the habit of measuring heart rate." Ignatz seemed to have become accustomed to the front-line operating table, "nor are they equipped with blood pressure monitors."

"Heart rate is a strictly required vital sign. How can we not do it? And I remember that the division-level rescue center has blood pressure monitors, and there are three of them." Kawei was very surprised, "This shouldn't be the two infantry divisions of the Seventh Army.

A vanguard force formed by this? Such an operating room should be equipped with a blood pressure monitor."

"There was one before, but now I can't find it." A nurse said, "And the doctor who originally knew how to use the sphygmomanometer also lost his life in the previous battle, so"

"Okay, so who is going to report the heart rate?" Kawei had already put on gloves and said to the two nurses who were still in a daze, "He is bleeding seriously, and I want to know the condition of his bleeding now."

After talking to this point, they carefully pinched the wounded man's wrist.

In fact, it's not that the two nurses couldn't do the job of measuring the heart rate, it's just that they were suffocated by the tense atmosphere and their reaction was a little slow. What they wanted was practical experience, not abuse, but the current situation was special, and Kawei could only

Choose to let them go.

Herman and Damirgon took Kawi's surgical team into the operating room.

This includes Amor and two experienced nurses who have been with Kawei. One specializes in delivering equipment, and the other is mainly responsible for helping Amor and Bergt handle other chores.

"How is Rogaro doing now?"

"It's good. You should wake up soon."

"Substitute people." Kawei waved his hand and asked his team to come on stage. "Leave a few nurses and others to treat other injured people. Don't waste time here. Teacher Ignatz and I will take over."

Already."

Immediately, the doctors and nurses surrounding the operating table began to disperse. Amor habitually found a chair and sat at the head of the wounded man. He placed a hand on his carotid artery pulse point and said, "The pulse is weak and the amount of bleeding is not small."

.”

"Well, after measuring the heart rate, you can watch the administration."

"good."

Five months ago, Amor was a very ordinary surgical assistant, having just graduated from medical school with no experience. But now, he has learned the technique of adjusting the dosage of drugs to stabilize the patient's vital signs.

Kawei only taught the techniques of ether anesthesia, but not much in this area, because the components of the two extracts were too complex, and even he himself could not master the relationship between weight dosage and changes in vital signs.

The relationship between him and him was able to achieve this step entirely through his own careful experimentation and exploration.

There will inevitably be some surprises at the beginning, but as long as you get through it, you can turn them all into experience.

Kawei glanced at the wounded man lying on the operating table. The spinal incision was still there, and gauze was pressed on it. The bleeding seemed to have stopped. But this hemostasis was only superficial, and the real condition of the wounded man was far worse than what he saw with the naked eye.

Much more.

"His face is pale and his abdomen is swollen." Kawei touched the bulging abdomen from both sides, lifted the surgical drape, exposed his legs, and "cut his pants!"

After the nurse quickly cut the trouser leg, she could clearly see several ecchymoses on the right lower limb.

"Have you had these bruises before?"

"Not sure."

"If not, it should be ischemic ecchymosis, and the shock is a bit severe." Kawei found the key to the problem, and naturally touched the dorsalis pedis artery on his right foot with his hand, "The pulse disappeared, we are in big trouble!"

He quickly screened the blood vessels in his waist and found that the only thing that could cause such a degree of shock was the aorta in front of the vertebral body: "There should be a problem with the abdominal aorta. We need to turn the person over first and make an emergency laparotomy."

The wound on the back was simply sutured, and the injured person's body changed from prone to supine with the combined efforts of three people.

"The belly is quite big." Kawei looked at the nurse who was already measuring blood pressure, "How is your blood pressure now?"

The nurse shook her head slightly, with a solemn look on her face: "Press up 79, press down again"

"knew."

As soon as she finished speaking, the nurse took off her stethoscope and said, "I'm going to find someone for a blood transfusion."

This situation is also extremely difficult on the modern surgical operating table. It generally requires a large number of imaging examinations to determine the location before a judgment can be made. Sometimes it is also necessary to perform vascular intervention to find the bleeding site, and then perform emergency closure.

However, abdominal aortic bleeding is severe, and the tertiary operating room is pretty good, and everything can be done. If the conditions are more ordinary, you need to transfer from the ordinary operating room to the interventional operating room. The transfer time is enough to change many situations, maybe just after the operation

Not so with Taiwanese.

"Severe shock caused by massive blood loss, the bleeding volume must have exceeded 1000ml, maybe 1500ml." Kawei could not judge the amount of blood loss, and could only give a simple inference, "The bleeding site should be at the right branch of the abdominal aorta.

Lateral iliac vessels, which caused severe ischemia in the right lower limb."

The nurse has already handed the scalpel to Kawei: "Open the anterior abdominal wall and the bleeding is in the retroperitoneum. Damirgang, go and prepare two suction devices. I will use them right away."

"good."

The situation was so urgent that Kawei didn't even bother with the disinfectant drapes he always emphasized, and just cut open his stomach with a knife.

He and Ignatz are old partners, each other's assistant surgeon, so they are very skilled in the operation. Putting aside some insignificant bleeding points, it entered the abdominal cavity in less than 3 minutes. In these short 2 minutes, Kawei basically explained

Knowing what might happen next, I hope Ignatz can cooperate with me as soon as possible.

Any small mistake will prolong the operation time and cause the injured to die on the operating table.

"First of all, its bleeding site is in the right common iliac artery, and the blood accumulates in the retroperitoneum. When I reveal the bleeding site, a large amount of blood will pour out." Kawei looked at Ignatz, "At this time, it is necessary to

The teacher quickly found the bleeding point and clamped it accurately."

Ignatz thought that Kawei would do it by himself, but he didn't expect that this burden would fall on his shoulders: "Me? I don't have this kind of experience."

"I will first block the blood vessel break with my fingers, and then guide you to do the clamping."

“So that’s how it is”

"I estimate that the continuity of the entire artery has been interrupted. Sewing the breach and restoring the blood flow to the right lower limb as soon as possible will be the key to saving the right lower limb." Kawei said, "I can't determine how difficult it is to repair the damaged vascular area.

Evaluation, but I know that if the ischemia lasts for too long, the entire right lower limb will have to be amputated."

Ignatz nodded: "This may be a good result."

"Well, the worst result is that the heart stops beating during the operation and the casualty dies." Kawei looked at the original surgeon who was still standing aside. "Deaths on the operating table require a written report to the medical committee. In the end, is the operation

The mistake was that the injury was already serious and we still need to wait for a follow-up autopsy."

"I, I understand."

"Don't be too nervous. Maybe there will be so many things happening next that we won't have time to do an autopsy."
To be continued...