Chapter 358 354. May God bless this lovely French chef, Amen

Author: Xifeng

This meeting, which started more like a farce, was finally on the right track in the face of super high mortality rates.

"It's a long time to deal with the burns, and it's far from just covering it with gauze."

Cavelo listed several requirements that need to be achieved: "The first point is to fight shock. As soon as the injured are admitted to the hospital, a reliable intravenous pathway should be established as soon as possible and rehydration should be started as soon as possible. The method has been mentioned before,

Fill liquid into the body through the infusion bottle and rubber tube. The valve can be used without using it, and choose the knot to control the flow.

But burns themselves require rapid and large amounts of fluid replenishment, and often do not require knotting. I have also written the calculation formula here. Please remember that children and adults are different, so you must pay attention when calculating!"

Kavey took out several black and white photos taken by reporters, which contained large-scale burn patients who had successfully treated them, and everyone had normal saline.

Under the pressure of Hort and Kavey, everyone gradually accepted the common sense of burn fluid replenishment, began to record these common sense and prepared to return to the hospital and put them into practice.

"Are you noticing all these?"

"Tell me down"

After hearing this, Kawei wiped off all the text, forms and mathematical formulas with the eraser, and then said: "Remember them firmly and you will use them next time you encounter them. Remember to give priority to rehydration, and every hospital has prepared them.

A little needle and rubber tube, anyway, surgery is also required.”

"Well, I will use it next time I encounter it. Next time? Hum???"

"Wait, what does it mean to use it next time you encounter it? This time? Can't it be used this time?"

"It's really not available, the infusion period has passed," Kavey explained. "The last injured person should have been sent to the hospital yesterday morning, and it's already 24 hours away. Infusion now will increase the burden on the body and accelerate death.

”

It is beyond their understanding to use large doses of fluid to support the burns. Now there is another opposite concept of "it is more harmful to exceed the prescribed time". Almost everyone's minds are stuck.

Kawei is talking about the reperfusion damage caused by delayed liquid resuscitation, which is indeed a difficult point. [1]

The theory is boring and difficult to understand, and it is difficult to explain clearly with the existing medical knowledge system, so I can only explain it with examples: "When I was working in Italy with my father, I would say that my throat was sore and thirsty, and I would drink water very much

It is difficult to relieve it. We later learned that the body needs a lot of water, which is similar to the blood, that is, water with salt added.

Remember, it is 0.9% NaCl, and the water needs to be boiled and then covered and cooled."

Kawei emphasized the importance of normal saline concentration and high temperature disinfection, and then began to tell them the "case": "Infusion is very effective. The earlier the infusion, the more the infusion is, the more the infusion is, the more it can increase their survival rate.

Once, a patient died shortly after the infusion.”

"How did you die?"

"We did an autopsy and used a lot of staining and microscopy," Kawei said. "Because my father and I had not solid foundation in physiology and pathology, we only found that the organs of the body had swelling and damage. The rest

We don’t know what the reason is.”

There was no sound in the audience, only Hot and Sediyo, who were sitting in the back row, applauded softly: "This special phenomenon needs to be studied."

"In fact, those patients who urgently need to correct their shock have died almost within these 24 hours."

Kawei told the truth without hesitation: "We count the remaining ones at the second highest survival rate of 35%. Some of these surviving wounded people are in extremely dangerous situations, and rehydration is useless at this time.

Others who are lucky often have little burn area, and it doesn’t matter whether they are replenished or not after the early stages.”

There are many strict indicators of reperfusion injury caused by delayed resuscitation, and the corresponding drug protection mechanism is also a product of modern times and is not suitable for the 19th century.

What Kawei can do is not criticize their early solutions by criticizing them, but letting them learn from their failures.

"Delayed infusion is a taboo, and we will have a good talk about the second leading cause of death next."

Kawei circled the second "breath" of the previous five words: "If you have time, you can try an autopsy for the dead and injured. You will see that many people's throats are very swelling. Their

The airway is edema caused by high temperature burns, which causes severe obstruction, and is suffocated to death."

Airway obstruction is easier to identify than shock. These directors in the audience have a little less theoretical knowledge, but they have rich experience.

At this point, they felt deeply: "Indeed, several wounded people were fine just now, but for some reason they suddenly couldn't breathe, and they couldn't do it in a few minutes."

"I have it here, and this is a very tricky situation."

"We tried to use airway dilators, but some people have damage and adhesion in their mouths, and the insertion effect is not good. Maybe the front end has not entered the throat, and the person fainted."

"You haven't considered tracheotomy?" At this time, Hort suddenly asked, "Just like treating diphtheria, you choose surgical methods to cut the airway and use artificial ducts to connect the lungs to the outside world."

"this"

“Wouldn’t it be crazy to do this?”

"Besides, tracheostomy takes time, we don't have that fast speed."

Kawei roughly understood their ideas, and took out several simple puncture introduction pictures from a stack of documents in front of him and distributed them one by one: "You can choose to do cricothyroid membrane puncture directly as shown in the picture.

, positioned between thyroid cartilage and cyclic cartilage."

This technology is no longer a secret in the Vienna surgical community.

At least five or six chief surgeons, including Ignaz, have mastered the skills of tracheostomy and puncture.

However, there are only a few patients who need to do incision and puncture directly, and there is almost no first aid system, so under the halo of large-scale surgical procedures, this practical first aid method is not famous.

"You can actually enter from this location"

"This is probably the medical advancement brought about by anatomy."

France has a history of tracheostomy for decades and is also the country with the most tracheostomy in Europe. Of course, the mortality rate has always been very high. Most of the causes of failure were summarized by Kawei in this report with less than 3 pages.

, and a correct correction plan was given.

"Although this is a mature surgical procedure for the Vienna surgical community." Kawei's tone is sincere and rigorous, "but you just come into contact with it and still need a lot of practice. Do not use it directly if you are not proficient enough

Clinical, if it is really a last resort, please boldly complete it. Even if it fails, don’t blame yourself too much.”

They all understand the truth,

“Vienna surgical community?”

"Does surgeons in Vienna have studied tracheostomy?"

"I dare not take it for research, but the success rate of tracheostomy in the past six months is more than 70%. "Kavi paused for a moment and calculated the probability, "It is indeed more than 70%. If I included the tracheostomy that I first had incision.

If it is opened."

"This is impossible!"

"As far as we know, Austrian surgery has not performed tracheotomy, how could it be that high success rate?"

Children who own toy cars will not be jealous of adults who own real cars. What really makes them feel jealous is those peers who own higher-level toy cars. The sense of superiority accumulated over the years is deprived of by people.

Feeling very painful.

These chief doctors were in this stage. The first surgical crown that had been working hard for decades was ruthlessly slapped on the ground by Kawei, and he almost stepped on it.

“The success rate of cesarean section in Vienna is higher than that of tracheostomy.”

"That's different!!!"

"This is the birthplace of modern tracheostomy. The success rate of the origin of the surgery is actually less than 50% every year, and it is easily surpassed by other countries."

"Stop talking, it's a failure!"

Unlike Vienna's step-by-step development, Kawi compressed the results of more than half a year in Paris to one month, and the density and strike force far exceeded the former, which would naturally cause such a strange reaction.

"There is nothing to say about this section. It is the second most common tube in the emergency response to burns, the artificial trachea." Kawei quickly skipped the trachea and opened it, "The next thing we want to talk about is the urethra catheter."

"Cassification?"

"Why do you need to urinate if your body is not hydrated?"

"It is not for catheterization, but for monitoring the amount of urine. The amount of fluid entering needs to be comparable to the amount of urine. When the amount of urine decreases, it can be judged that the human body is very dehydrated."

Kawei mentioned a simple sentence and focused on surgical operations: "Cassic is an important examination project for Chief Dr. Mosie, Main Palace Hospital. It has been carried out for many years. There is nothing much to say about the specific operation process. I don't understand the guidance.

I didn't urinate much, so we skip this by time.

Because Dr. Mosier is living in Vienna now, if you need it, you can go to the main palace hospital to ask Dr. Juyong, the current acting director of urology."

Speaking of catheterization, the faces of these directors finally looked a little better: "What is Vienna's catheterization technology?"

"It's really not as good as France, we don't even have a specific urology." Kavey said like coaxing a child, "at this point Vienna needs to learn from Paris."

"Surgery technology is like this. Everyone learns from each other and learns from each other. Today you are one step ahead, and tomorrow I will surpass a little, so that will make progress."

It seemed that the atmosphere in the venue had eased a lot, but there were still two people with bad looks. Because the words just now looked more like a kind of pity from the strong to the weak, and it was more difficult to accept than being simple backward.

.

"It's really funny to think that surgical technologies in France and Austria are on the same level as they are just ahead of one catheter technology."

Hort held the quill stick tightly, feeling resentful: "Everyone is content with the status quo, and he doesn't think about why Mosier stayed in Vienna! Can they do bladder cancer removal? Can Mr. Edham rebuild a new bladder

Is it???”

"Okay, okay, you'll be gentle, and say less, so it's not good for them to hear it."

Seidio has been lost in the motivation to struggle by Carvey these days, and it is clear that this paralysis is not all bad. "The most important thing now is to deal with the wounded, at least to let those who have survived the shock survive.

.”
To be continued...