Chapter 301 297. Commander Tower

Ectopic pregnancy causes rupture and bleeding of fallopian tubes, just like foreign bladder in men. It is not common in clinical practice, but one or two cases will come from time to time, reminding doctors on duty not to forget it. Because once you forget it, serious consequences will inevitably occur.

The girl in bed 97 had blurry symptoms at the beginning, with abdominal pain but only abdominal pain. There was no pregnancy test and her period was not clear.

Because ectopic pregnancy will have signs of miscarriage in the early stages, that is, a small amount of bleeding. In the 19th century, the only one who truly understood the menstrual cycle was the forefront of obstetrics and gynecology was the doctors who were at the forefront of obstetrics and gynecology. Some of them did not even participate in clinical work. Ordinary people had no idea about menstruation, so it was useless to ask.

Now, with the continuous development of ectopic pregnancy, the symptoms are becoming more and more obvious, and the most typical example is internal bleeding.

When Kawei and Peron rushed to the obstetrics ward together, the girl's face was not bloody, her heart rate exceeded 100, she was fast and weak, her limbs were wet, her hair was also wet, and blue-purple ecchymosis could be seen around her navel. [1]

Even if we cannot draw a conclusion on the cause, the conclusion of "massive bleeding in the abdomen and shock" can be cured.

Having abdominal pain, bleeding shock, and no history of trauma, Kawei considered her gender, age, onset time and conditions, and all she could think of was ectopic pregnancy and aortic dissection tearing.

The chances of acute hemorrhagic pancreatitis and tumor rupture are almost negligible.

Although the types of diseases are different, the treatment methods are the same, opening the abdomen.

The girl's condition changed drastically in a short period of time, and Hujil finally realized the seriousness of the problem.

Fortunately, he had enough surgical foundation and served in the army when he was young, and knew what it would look like when he lost a lot of blood. So he did not choose bloodletting, which is still considered one of the methods of internal medicine. He just used some fumigation and massage items. After struggling for a long time, he agreed to Kawei's request.

Of course, Hujil must be the principal surgery on the operation.

The patient has been classified as an obstetric patient, but the surgeon has become an Austrian young man who has just arrived in Paris for two days. He can't stand it any face. Kavi has no such concerns. He is not afraid of emerging as a surgeon, and there is no problem with being a helper.

In the eyes of the medical students watching, Hu Jill was indeed the surgery, but in fact Hu Jill was just a "decoration".

It cannot be said that he is useless. The old man has solid basic surgical skills and knows the rules of the surgery, but he does not know the detailed steps of the abdominal surgery. In other words, Hujier has almost no treatment for some details.

This seems to be fatal to the principal, but as long as he takes on this part of the job, he will still be a qualified principal.

This kind of disguise can only deceive beginners, and it is impossible to deceive experts. The three doctors with rich surgical experience immediately saw the relationship between Kawei and Hujil.

"The old guy's technique is really unfamiliar."

"On-open surgery is not easy. He hasn't had surgery for so many years, and it's already great to be able to do this by just dissecting the body and stabilizing the body." Even though he had just quarreled with the other party, Seidio remained objective, "Don't ask too much."

"That's right." Kaushke wiped out his pipe and began to concentrate. "But it would be too shameful to let a young man in his 20s lead his nose and even help him lay the groundwork step by step."

Sedijo sighed: "Can you blame him? You are also led by you."

Kaushke has never had a partner with Kawei, nor has he undergone abdominal surgery, and is not familiar with the process. But it is still not difficult to compare the hand speed of the two. Kawei's hand speed is faster than Hujill. This is not only the difference in age and reaction, but also the familiarity with the operation.

".Indeed." Kaushke didn't care about his praise, stared at the surgical area with his eyes tightly, and nodded uncontrollably, "This kid cooks his own stove, lays his own ingredients, cooks himself, and moves the meal to the table by himself. I think it's almost like picking up a spoon and putting things into his mouth for the old thing."

"You're saying this too much, why is it so exaggerated?"

"It's a bit too much, but it's not too exaggerated," said Kausk. "Not only does his help, he also needs to help with some troubles, and also coordinate the work of Albaran and Peron. It's so amazing, this kid is still so young."

As he spoke, he looked at Seidio meaningfully, his eyes full of unspeakable meaning.

"What's wrong?"

"You're the surgery for rectal cancer in the afternoon?"

"yes."

"Kavi Ichisuke?"

".right."

Kausk looked at the surgical area: "Will you want to be like him by then?"

Seidio finally understood what he meant and nodded, "Renal cancer surgery is much more complicated. He alone cannot solve the surgery of that size. Besides, my ability is stronger than that of Hujier, so what's there to be afraid of!"

"I hope this is true." Kausk suddenly asked, "By the way, is this theater?"

"After all, major surgery must be chosen here."

"Okay, I'll come and have a look."

Kawei did burst out with the scheduling ability that he had never shown in his daily life.

The little girl was in shock and lost a lot of blood. She had no hands that she used to using. He had to seize the time from the source. While he was catching up on the time, he also felt as if he had returned to the Municipal General Hospital half a year ago.

The nurse lacks consciousness, the assistant cannot keep up with his ideas, and the surgical steps of the main surgery are in chaos.

If this is an elective operation, the patient is still healthy, and the doctor can take it slowly. The situation is critical now, and he can only slightly expose his domineering temper to minimize the chance of the operation failure.

"Don't stand there. I promised to report my heart rate every 3 minutes. My scalpel is almost cut to the peritoneum. Can you be more diligent?"

The nurse had never experienced this atmosphere. She was stunned for a while before she remembered to take a pulse: "Now. It seems a little quick now."

"What I want is data! The heart rate per minute is reported every three minutes!" The abdominal skin and muscles in front of me had been completely opened. Kavey quickly said to Albaran on the side, "Go and get a bottle of medicine in my box, the label is sodium citrate, hurry!"

"good."

"You can see that the patient's peritoneum is also blue-purple, just like her umbilical. If you are lucky enough to see the inner mesangial membrane, you might be able to see this color."

Cullen's sign was so obvious, and Kawei basically guessed that the blood loss was not optimistic, but he still hoped to save the person by self-blood reflux: "Teacher Pei'an went to prepare two wide-mouth bottles, needles and matching rubber tubes."

Peon had long been trapped in Kavi's speed vortex.

He didn't have time to think, so he automatically "hmm" after hearing the request. After putting down the hook in his hand, his mind realized: "Rubber tube? I remember there seemed to be no rubber tube in the surgical preparation room."

"So big Paris, do you think there is no hose?"

The rubber tube needs to connect the bottle and the needle, and if there is no, you have to use other solutions. For patients with a large number of blood loss, whether it is to choose a thankless injection or switch to a fixed metal pipe, it is not ideal or even realistic.

"Wait, how do I remember there?" Kawei turned around and found Ju Yong on the stage. "Teacher, do you have rubber tubes in urology? Teacher Mosie told me that he had used it before."

"Rubber tube" Ju Yong was also mobilized by him and quickly got up and got out of the audience, "Yes! I'll get it now!"

"Is this bottle?" Albaran in the distance ran over quickly, "it said"

"Sodium citrate, I used Latin!" When Kawei saw that he was carrying a ball of methylene blue written in German, he shook the pituitary extract on the edge of the operating table, "Just like this, take it all!"

"oh oh."

"113 times." The nurse finally found a chance to speak and suddenly said, "She has a heart rate of 113 times a minute."

"Okay, I will report automatically every three minutes next. If you have to tell me more than 120."

"knew."

"Teacher Hugir, we are now in the abdominal cavity." Kawei pulled the skin with one hook in one hand and the suction in the other, "Albaran, are you okay?"

"Here's here."

"Put the medicine next to it and you come over to rock the pole." Kawei said more and more anxiously, and he missed all the titles that could be ignored. "Nurse, take a washbasin to pick up the blood."

"Blood?" The nurse was confused, but her body and mind had long been separated. Her mind was still thinking about why she had to catch blood, but her hand handed a basin of water to herself, "Give it."

Hugil gently cut the peritoneum that Kawiti pulled, then separated a small mouth with his finger and entered the abdominal cavity. He felt a bloody smell coming to his face: "Attractor."

The nurse only now knows what the so-called blood sucking means.

A large amount of blood does not coagulate like a unscrewed faucet. With the efforts of Albaran's hands, he kept pouring into the wide-mouth bottle. In a short while, the first 500ml was filled: "Where is the wide-mouth bottle?" [2]

"Here's here!"

"Change the bottle and put the sodium citrate in." Kawei controlled the suction head to swim between the organs and sucked out the remaining blood as soon as possible, while saying for Hujil, "After the blood is clean, we need to expand the peritoneum and find the bleeding point."

Hugil quickly cut open the peritoneum as he asked, and then Kawei's hand reached into the abdomen.

First touch the uterus, then use the uterus as the starting point to move towards the possible position of the lesion: "Please pull the hook with Dr. Perang, stretch the abdominal cavity a little further, and then prepare hemostatic forceps."

Ectopic pregnancy is different from ordinary abdominal elective surgery. Everything is focused on seizing time. Kawei cannot separate slowly, nor can he leave this matter to Hujier. He must use his bare hands to separate the attachments and surrounding tissues, especially the adhesions in the rectal depression.

The girl's condition is indeed the same as Kavi imagined. The right fallopian tube is enlarged and a 5*6cm mass can be felt: "Sure enough, it's an ectopic pregnancy! The fertilized egg that should have entered the uterus is stuck in the fallopian tube. Heart rate?"

"I just tested it, 117 times per minute."

“Where is the rubber tube?”

Kawei looked out the door and didn't see Ju Yong, so he could only open the path first: "How is the sodium citrate adjusted?"

“It looks almost done.”

"Who can do intravenous injection?" Kavi made a rare request, but no one dared to respond. "No one can do intravenous injection?"

The nurses at the Main Palace Hospital are still in the primary stage of simple bed care and delivery of items. In fact, their professionalism is better than the Municipal General Hospital when Kawei first arrived in Vienna, but now it has no longer been comparable.

In the end, Pei An, who was a Nishuo, helped: "I'll do it."

"There are veins on the left and right arms, and the veins in the head or the middle of the elbow." [3]

Kawei talked about the puncture position. Pei'an's technique was a bit clumsy, but relying on the experience accumulated from experimental work, he tried it a few more times and still stabbed it in. This is not easy for an ordinary surgeon. After all, the patient is still in shock and his veins are all deflated.

"Doctor Kavey, his heart rate has risen again, 124 times per minute."

“What should I do now?”

"Where is the salt and water I asked for before?"

"It's ready, but heating will take time."

Kawei found the rupture on the fallopian tube mass, blocked the blood vessels with his fingers, and then pulled them out together, and then used hemostasis forceps to make clamps: "Don't worry, let's inject it first. Professor Hujier, let's just" [4]

Hugir turned a blind eye to shock and just did the surgery himself: "Doctor Kavi should handle the assistant's job, I'll do the mass removal (I understand)."

While speaking, he also used hemostasis forceps to cut the mass around it. After seeing Kawei nodding, he took the surgery part over, and Kawei could also free up his hands to deal with the problems in intravenous infusion.

Just when others were wondering whether they should listen to Kawei's words and take the injection directly or consider whether it was safe to inject clean water into the human body, the gate of the surgical theater was finally pushed open by Ju Yong: "The pipe is here, the pipe is here!!!"

Now is not a time to worry about whether these two rubber tubes have been cleaned. Even if they have just been pulled from someone else's body, they still have to use them.

Two 500ml wide-mouthed bottles sent blood into the girl's body again, and then supplemented her with 500ml of normal saline.

In fact, as long as you survive the main battlefield of shock, as the surgery to directly attack the cause of the disease, it is not difficult and the surgical process is not complicated.

Before the mass appeared, Hugir had no idea about surgery, so he could only take one step at a time. But when the mass and the rupture appeared, the purpose of the surgery was very clear, that is, to cut off the fallopian tube where the mass was located, ligate the blood vessels, and stop bleeding.

The second half of the operation was very smooth in Hujier's oral statement, and in the end, it only takes the residual blood accumulation in the abdominal cavity.
Chapter completed!