338. The Sorrow of Bizet

Author: Hao Xifeng

As long as the amount of simple incision and drainage is large enough, the quantitative change will become a qualitative change. Moreover, to form such a large abscess cavity in a short period of time indicates that the patient itself should have some underlying diseases, which also creates conditions for qualitative change.

There were many incisions and a large amount of fluid. A large amount of inflammatory substances irritated the incisions, and the irritation of invasive items such as saline and gauze made Amor's already stretched anesthesia management even worse.

Blood pressure, heart rate and respiration are the only three indicators that can be used to judge physical condition.

Any mess will make Kawei uneasy, fearing that an accidental patient will die on the operating table.

But other surgeons in the audience did not have this mood. They have always regarded anesthesia as a gamble with a high probability of winning. As long as there is no accident, there will be no accident. If there is an accident, the patient will have to admit that he is unlucky.

Their understanding is the same as that in Vienna half a year ago. Doctors are just bystanders of anesthesia. It can be said that those who do not know are fearless.

For this aspect, Kawei tried his best to talk as little as possible or not at all. The main reason is that internal medicine has too many horizontal implications, involving many undiscovered physiology, pathology, biochemistry, cell biology, and histological level. It is almost impossible to explain clearly.

He also doesn't have the ability to demonstrate and explain things clearly.

What Kawei has to do is confess the facts, become a discoverer, and then let those big guys who are willing to delve into the theory slowly study it.

"The heart rate is fast and the blood pressure is low. The patient is probably in shock." Kawei stopped the scalpel in his hand and waited for Amor's retest. "I brought a medicine from Vienna that can stabilize the blood pressure.

, and can also be used to stop local bleeding.”

"Blood pressure. I have never understood the meaning of blood pressure. Can Dr. Kavey tell me?"

"The heart needs to pump blood to the periphery, which requires a pressure, which is blood pressure." Kawei explained simply, "Once the pressure is too low, blood cannot smoothly enter other tissues of the body, and it cannot."

Next, the blood carries oxygen, and the body tissues consume oxygen and metabolize to produce energy, and then take away carbon dioxide and complete blood circulation and breathing.

This phenomenon was discovered very early, but just like the situation encountered in Vienna, these Parisian surgeons were still unable to understand the true role of blood, and they did not even know that humans needed oxygen.

"The blood pressure is up, 123/77."

"Test in five minutes."

"good."

Kawei picked up the scalpel again and made incisions downward along the skin lines, about 5cm apart: "Without blood circulation, a person is as good as dead. Facts have also proved that excessive blood loss and cardiac arrest

All lead to death attractors.”

It's still the same steps, incision, drainage, lavage, trimming of necrotic tissue, and finally hemostasis. It's just that the abscess cavity in the leg is not big, so suction alone is a bit more troublesome. More importantly, it is better to use gauze to absorb and wipe it.

Generally speaking, under reasonable anesthesia management, the operation is almost not difficult. Especially for emergency surgeons like Kawei, as long as the vital signs are ensured, draining the pus is as simple as turning on the faucet and draining the water.

The real key lies in the recovery after pus removal.

The so-called ability to retract and expand freely, to be able to cut and recover is what modern surgery is.

"I wonder if you have ever seen hydrogen peroxide, which is hydrogen peroxide solution." Kawei asked Herman to take a glass bottle from the preparation table. "I went to the Paris Institute of Chemistry this morning to get this. The concentration is 3

About %. Wounds cleaned with it can greatly reduce the chance of ulceration."

Kawei brought another brand new "medicine", and everyone came forward to take a closer look at the magical power of this bottle of potion.

Herman opened the cap of the glass bottle and poured the pungent-smelling hydrogen peroxide onto the patient's wound. Instantly, large and small bubbles or even foam appeared on the skin surface, as if the metal had been corroded.

"Is it really okay to use this thing?"

"What an exaggerated reaction."

"Don't be nervous, it's just a normal chemical reaction." Kawei did not explain the explanation clearly, but only explained, "Hydrogen peroxide is unstable and can inhibit the growth of bacteria, thereby reducing the formation of ulcers."

Because Professor Pasteur lived in Paris, and his theory was based on the growth of bacteria, these doctors in front of them had a fairly good reception to the topic of "the relationship between bacteria and wound ulcers."

At least it's much easier than in Vienna.

Herman followed Carvey's instructions and poured a whole bottle of hydrogen peroxide into the patient's incision and abscess cavity. Then he used diluted methylene blue for a second rinse. After repeating it twice, he finally chose normal saline.

The entire surgical area felt like a heavy rain had just fallen, and the surgery was in its final stages.

“I don’t know if you know about negative pressure drainage.” While the assistant was cleaning the patient, Kawei showed everyone his homemade VSD. “Choose a natural sponge to cover the clean incision, and cut out a number of small ones from one.

The rubber tube in the incision is connected, and the exudate in the incision is introduced into a glass bottle that is pumped to negative pressure."

"Is this to keep you dry?"

"Yes! It is also the best way to isolate the incision from the air."

Sedieu covered the incision with the sponge handed over by Kawi, adjusted the position of the rubber tube, and then Kawi covered it with several layers of gauze: "There need to be at least three layers of gauze, the bottom layer is clean gauze, and the middle layer is coated with gauze.

The ointment blocks the air, and the top layer is impregnated with vegetable oil for further protection.”

After covering it with three layers of gauze, wrap it with oil paper, and use a large amount of grease to create an isolation cavity: "Pump out the air."

Bergert shook the hand rocker, and the gauze that was still bulging just now began to shrink inward. After the rubber tube began to deflate, the tube was connected to a simple negative pressure bottle made by Damirgang with a fixed syringe.

"If you find air leakage around the gauze, you can add a few more layers of gauze, or seal it with tape."

Kawei said: "Don't think that this is a waste of materials. The most expensive part of the entire device is the sponge, not the gauze. Now that we have done it, we must do it to the best of our ability. The subsequent success or failure has nothing to do with us."

The operation process was not long, and it only took more than an hour from incision to final treatment.

Kawei used up all the wide-mouth bottles. The dozen rubber tubes mentioned before were simply not enough. Even if all the inventory was put in, it would still be the result of Kawei using sparingly. The only thing left was a sponge, after all, the lower limbs

The length of the incision is limited and the number of openings is not too many.

But the cost of the entire operation is staggering.

"What? 2,580 francs?"

When the director of the Palace Hospital saw the list of items sent by Cediyo, his whole face turned green: "Is there really no labor cost included?"

"Definitely not. He has never charged such a fee. It is as if his skills were learned innately and are not valuable at all." Cediyo shook his head, not knowing whether to appreciate or dislike Kawi, "To be honest, he is so

It is his freedom to do it, but it also belittles the huge cost of medical education."

"This is his private matter and we have no right to interfere."

The director's hands were trembling, and he still couldn't believe his eyes: "When did surgery become so expensive? Isn't this a very common anal fistulotomy?"

"He chose new materials and new care methods. The natural sponge inside is relatively expensive." Sedieu pointed at the natural sponge with his finger. "This alone cost 2,000 francs."

"It's too exaggerated. These are ordinary people. Why do we need such good materials for surgery? Do you really think that the hospital's money comes randomly?"

The dean took out his handkerchief and gently wiped away the sweat on his forehead: "Just for a pg, he paid an ordinary doctor a month's salary!"

Cediyo nodded and agreed that treatment should not be too extravagant and wasteful. But now that the money has been spent, it is impossible for him to pay for it himself: "Dean, you also know that the materials are not cheap. I paid for them all in advance."

"I know"

With a long sigh of relief, the dean finally calmed down and said, "He has been going back and forth in the Main Palace Hospital for more than a week, right?"

"Well, it's been 8 days."

"Such a powerful talent and such a wonderful operation should be showcased in other hospitals." The dean stuffed the list into the drawer, looked up at Cediyo, and then sat back firmly on the office chair.

"What do you think of this arrangement?"

How about it?

Of course it’s not that great!

Cediyo definitely didn't want Kawi to leave. Although he didn't like this person very much, his surgical skills were blameless. After an ideological struggle, he just put down his position as director and suddenly asked Kawi to leave, which was not good for his own studies.

But it is impossible for him to say that he wants to continue to see more of Kawei's surgery, and he can't stand this old face.

Moreover, the direction the director is considering must be different from his. All the expenses incurred for the surgical demonstration must be borne by the hospital, and people who watch the surgery are completely open to other hospitals for free. No one is willing to be taken advantage of.

The surgery in one week alone has cost the hospital more than 4,000 francs, and this is just counting VSD. If this kind of care is effective, then the Palace Hospital will probably face an astronomical figure.

"But several patients have already been admitted to our hospital."

"Why are there new patients?" The dean's brain, which was down for a while, immediately responded, "Oh, yes, he just held a free clinic yesterday. Why are you so bored? Why did he hold a free clinic when he had nothing to do?

How much money?"

"It must be a lot of money. I went to the auction two days ago and I heard the money was very generous."

"Then let him pay for it himself."

Cediyo looked at the dean, blinked, and then said reluctantly: "But the problem is that we asked him to perform surgery demonstrations, and the results were good. If you are not willing to pay even this small amount of surgery fees, once word spreads,

go out"

"Who asked him to come? Oh!!! Yes, it's the one from the Ministry of Foreign Affairs."

"Call Edward."

"Yes! That's right!!" The dean slapped the table, furious, "Just let that Edward pay!!!"

Of course, Kawei didn't know about this conversation, and he didn't know anything about the attitude of the main hospital.

He only knew how many patients he had admitted, how many operations he would perform next, and the physical condition of Bizet who followed him to the ward. As for how much the operation would cost, how to allocate materials, and whether he could meet the income and expenses.

He didn't want to think too much about balance, whether he could achieve the balance between supply and demand. In fact, he thought too much and saw too much in his previous life. There were restrictions and walls everywhere.

He didn't want to do that, but considering the general environment, it was awkward to have to do that anyway.

"This is the simplest laryngoscope." Kawei found a rather primitive long-tube endoscope from the cabinet and began to assemble a few small parts. "Because there is almost no curvature, it will definitely be uncomfortable during the inspection.

, just bear with it."
To be continued...