246. Whether to stabilize or seek greater victory

[Just stepped down, the department fell five, and I was on duty again. Fortunately, there was nothing to do next ... wait for me to change it, delete this sentence after changing, forgive me]

In this case, severe bleeding, not only medical knowledge or so -called surgical technology, but more deeper experience in treating surgery. If there is no experience, only theory and technology, even if this surgery is taken, it will be able to take this operation.

End with failure.

The experience here itself covers these two things.

Internal medicine may also need a lot of logical inferences and theoretical knowledge. That surgeon is an ordinary person who has never received medical education. After ten hundreds of surgery such as surgery, it can also become a surgeon.

Of course, the types of trauma that this "surgeon" can deal with is very limited, and the cost -effectiveness of pouring strength is also very low.

But Ignatz is different.

He is the holder of the "genius" of the former Austrian surgery. He has the inheritance of the two generations of sons and sons. At the same time, he is also the chief physician of the surgery of the Municipal General Hospital. Any title is enough to let the patients on the operating table eat peace of mind pills.

It is definitely much larger to instill experience to such a surgery elite.

This is also the main purpose of Kavi to let Ignakus help to do clamping blood vessels, just as he wears it here, it will be almost the same as young people.

However, it is necessary to give other people's motors to drive. It is impossible to give up. At least to ensure that when the error is wrong, you can still control the scene. If you want to control the scene that you can't determine

Simple evaluation.

The conditional factors are limited, and Kavi is just an ordinary person is not a machine. It is impossible to clearly see the bleeding port. If you want to do evaluation, you need to do some special small actions.

During the period of stabilizing blood pressure, he did not simply press the bleeding point as gauze, but he was constantly adjusting the blocking position and strength of his fingers to make the evaluation creation.

The first thing to do is repeatedly rinse the abdominal cavity that had just been immersed by the blood, rinse unnecessary blood, so that the field of view is clearer. Only when the field of vision is clear enough can the bleeding situation after the fingers change the first time.

The second is to regulate the pressure of the finger.

In fact, the pressing force given by Kavi is not small at all. It can be clearly felt that it is not simply compressing the bleeding to stop the bleeding, but to close the whole root arterial blood vessels.

Come.

Finally, the roughly scope of the lipstick through the movement of the movement has the most basic cognition of the degree of rupture.

Now Carve almost seal the bleeding with the whole finger. Any movement will bring blood exudation, indicating that the range of the break is very large, and the diameter may have exceeded 1cm.

As for whether the blood vessels are simply rupture or a worse situation, Kavi cannot make a judgment.

"Teacher Ignatz, no anatomy is separated around the aorta and branches, so the blood vessel body can not be seen at all, and what I can see is simply bleeding points. My current oppression causes no way to make a pliers, so

Later, you need to judge the blood vessel rupture position through the bleeding point, and then clamp the rupture of the rupture with an antibody resistance. "

"Well, I understand what you mean." Ignatz looked at the surgery vision surrounded by several hooks. The hematopoietic tongs had already been hung in the air.

"How about blood pressure now?" Kavi asked Ammore again.

This is already the 17th blood pressure measurement: "Stability is about 110/60, and the heart rate is relatively large, it should be the result of the drug effect."

"No time, just now, you need to pay close attention to his blood pressure."

"Well, rest assured."

Kavi looked at Ignatz: "Listen to me, 3,2,1!"

He quickly moved away his fingers, and the oppression position quickly rebounded. The bleeding point was exposed to the eyes of the two. At the same time, a swarm of Yin Hong poured out in an instant, quickly covering the bleeding point just now.

Ignatz is not a surgeon who has experienced many life and death surgery. The more nervous the scene, the more concentrated his attention, the more often the play is.

Unfortunately, although the pliers are clamped with the tissue around the bleeding, the bleeding has not stopped, or it stops completely.

"Still bleeding!"

Kavi went to touch the position of the Ignatz clamp with his left hand, and quickly picked up a hemostatic forceps into the pool of blood, trying to help closing the bleeding port together.

: "The blood pressure is dropped, now 85/44, the heart rate exceeds 120!"

"Administrative, increase infusion."

Kavi still said that, because there is no better way except to do so. At the same time, his right -hand hematopoietic pliers are clamped above the pliers of Ignzz.

There is no way around the blood pool when the liquid flows out, and the bleeding seems to be stopped, but when the attractor is smoked, you can still see a lot of leakage around.

The area of ​​the finger compression is much larger than the pliers, but the two hematopoietic tongs have not been able to stop bleeding. Kavi realizes that this is not a small break.

Then, then

Of course, this may also be caused by the inadequate pliers.

Because there are many sheaths and other tissues around the blood vessels, the blind -looking wild pliers in a short period of time may make mistakes, and there may be sliding teeth. In contrast, finger compression is more directly effective.

He pressed the arteries again with his left hand, and felt a slight beat: "Pump the blood here first, clean it twice. Tell me as soon as possible after the blood pressure stabilizes."

"good."

The two attractors work hard again, and the color of the blood flowing into the glass can also seems to be slightly lighter than the one just now. But now no one cares about this problem. As long as the wounded soldiers are still alive, it is necessary to continue to rescue.

Kavi and Ignatz on the side discussed the processing method of rupture.

"The pliers may not work."

"What should I do?"

"Do it directly."

"Is it feasible?" Iigner frowned, "Also! Originally, you said you wanted to protect your limbs, but now you need to sew the right iliac artery? What is the difference between amputation and amputation?"

"It's just a short upstream sewing, find the rupture below, and then match it." Kavi said, "Now the hemostasis is definitely the first priority, first stop the blood to do it."

Ignatz has no experience in such great bleeding: "I'm the first assistant now, you are the main knife, you can grasp it yourself."

"Then do that, giving me a wire thread!"

Kavi's hand reached into the equipment nurse on the side, and soon a needle holder with a stitched needle line was sent to his hand.

After the blood vessels are behind the peritoneal, there are a large amount of abdominal content in front, that is, the intestinal tube, the surgical field created after the hook is very small. Now there are two hematopoietic tongs around the crust.

Entering space.

So this time the role of the two people was swapped, and it became the countdown of Ignatz. Cavi was prepared aside: "Old looks, 3,2,1!"

The two hemostatic claws were released almost at the same time and quickly moved away in the hands of Ignutz. Cavi's left hand also quickly penetrated into the abdominal cavity, pressed the blood vessels by pressing the position and feel of the memory.

This step of exchange was given to him the next step, Kavi was also relieved, knocking on the hooks on both sides with a needer: "The hooks on both sides are stabilized, and the lights come over.

that's all!"

Ignatz's two hands completely withdrew from the surgery area. The next sewing work was basically nothing to do with him. What he could do now is to put the hemostatic pliers at hand and prepare to give Kavi at the bottom of the critical moment.

"The attractor tube came over." Cavi gently tapped the tissue above the index finger of the left hand with the needle line.

"Understand."

Damirgang took a half step forward, occupying the position of Ignatz just now, which is convenient to attract. The opposite Kavi gently moved the index finger. It may be less than 3-4mm distance. The blood poured out again.

Ignatz is very nervous, and the hematopoietic tongs have been waiting at the incision: "Do you want to help closure?"

"No." Kavi quickly put the needle next to the bleeding position, bypassed the blood vessels by experience, and put the needle tip out of the needle from the other end.

Kavi's left hand should be blocked by blood vessels, and only one hand cannot be ligated. I can only let Ignatz help to do it. He himself quickly takes over the second stitching needle line and wait for the ligation.

Slowly move your fingers, then find the bleeding position

Go down, pass through, sew.

Go down again, pass through, sew again

With all the six stitches, the break is like a dam that was quickly closed by super powers.

At this point, there is no more active bleeding in the entire abdominal cavity. The blood pressure is lifted from low pressure and self -infusion to almost normal levels. The entire surgical table is overflowing with a satisfactory smile.

It has exceeded their expectations.

But in Kavi's eyes, all this is only the second step of the entire surgery. The blocking of the rupture only rescued his life.

If you want to have a long way to go like a modern surgeon, there is still a long way to go. What is really troublesome is the third step: how to keep this ischemic right leg.

In the modern battlefield, because the power of firearms is getting greater and greater, the conditions for limb surgery are becoming more and more harsh. In fact, it is really not common to be able to do limb surgery.

Guarantee blood supply.

Without blood supply, nutrients cannot be sent in, metabolic products cannot be sent away, and the limbs that have been guaranteed are just cumbersome. They will soon be necrotic and infected, and then further back to their owner.

Ghanz considers amputation.

According to the "Military Medicine Manual" and the medical level here, there are indeed no conditions for further limbs, and barely probability is a waste of time: "Now bleeding stops, the foot artery is not recovered, the right lower limb is the same as what you just said.

Severe ischemia, I suggest ""

"I understand the meaning of the teacher, but I still want to try it."

Ignatz heard the "Military Medicine Manual" that Kavi was opposed to his writing: "Try? How to try?"

"Since the bleeding has stopped, then open the blood vessel sheath and see what it looks like inside." Kavi said, "If possible."

"Do you want to do vascular repair?"

"I think there is still a chance, you can try it."

"It's too difficult, the location of the blood vessels is too deep, and this kind of consistency is likely to occur again." Ignatz was very worried. "If bleeding again, this will make everything just done.
To be continued...