Tracheotomy [1] is indeed not a difficult surgery. It is simple to operate, has few steps, and does not require high medical equipment. The reason why it is positioned at level 2 in modern surgical classification is entirely because of the anatomical structure of the neck.

complexity, and the danger of failure.

Tracheotomy was first performed using a bare short metal tube, but it soon became what it is today because it could not be fixed.

In fact, the silver horn-shaped artificial airway used by Ignatz already has a modern prototype. You only need to make a hole and insert the tube into it, and then pull the ropes on both sides to fix it around the neck. [2]

In modern times, the upgrading of tubes is actually just to facilitate the operator and reduce the risk. The really important surgical step is to open the hole before intubation.

The neck is one of the most important parts of a person's body. In the eyes of people who have never done it before or who have only a little knowledge of anatomy, this area is too special and has a low error tolerance. It is inevitable that there will be a sense of fear when going under the knife because you really don't know what to do with it.

Ignatz is certainly not this type of person.

In terms of the number of dissections he has performed on cadavers, he is definitely the best, and he already knows the structure of the neck. Even if he has not actually practiced it, his years of surgical experience will not lie, and his rich experience will help him.

Make correct judgments.

In this case, he may be a little nervous and a little anxious, but he will be more focused than usual, just like before when dealing with inguinal hernia.

That's how Kawei judged it.

He stood aside with a pillow stained with blood in his hand. He seemed to be concentrating on it, but when he saw the fleeting opportunity slipping away from his fingers, he couldn't help but feel upset. Because as long as there were no accidents, Ignatz could do it.

Successfully saved Laszlo's life.

However, accidents have always been a matter of probability.

When low-probability events come together, as long as you are a little bit unlucky, something that should never happen will happen immediately.

Under the dual effects of long-term fatigue and drunkenness, Ignatz's hand had become somewhat unstable. Coupled with Laszlo's continued lack of oxygen, the time left for him was passing by minute by minute.

The earliest tracheostomy generally used a longitudinal incision [3], which was a rough and very direct operation. It was just a matter of directly piercing the skin and the front wall of the trachea to make room for the artificial airway tube.

But haste makes waste. His first knife was too hasty and the position he chose was a bit off. After penetrating the skin under the Adam's apple, it did not hit the trachea directly. When he tried to find the trachea again, his field of vision had already been blurred.

Covered with blood, nothing could be seen.

Kawei quickly wiped away the blood with a pillow and tried his best to expose the muscles and deep cervical fascia that needed to be completely separated.

The incision made by Ignatz was indeed crooked, violating the requirement that the tracheotomy must be kept in the center, but there was still a chance to remedy it. Kawei used a pillow to cover some unnecessary areas, and secretly helped to straighten the position of the field of view.

"teacher......"

"Well, I know, the position is crooked."

The sudden stabbing made Laszlo tremble all over in pain and scream. Naya's crying behind him continued, and the surroundings were filled with the cold eyes of his colleagues.

Ignatz resisted the pressure and tightened his grip on the scalpel again, using the pads of his fingers to press the skin on both sides to try to stop the bleeding. He needed to make a new incision.

The second knife...

The position was correct this time, and the tip of the knife completely penetrated the midline of the muscle fascia. Judging from Ignatz's reaction to the feel, it seemed that he had cut into the trachea.

However, the scalpel used by Ignatz was very small, with a blade width of less than 1cm. Such an incision was obviously not enough. In order to allow a catheter with a diameter of more than 1cm to pass smoothly into the trachea, the incision needed to be enlarged, at least to 2cm.

Success is imminent, and there is only one last step left for the incision.

But at this time, the large amount of alcohol accumulated in his body, fatigue and a slightly relaxed mentality after successfully passing the first step, made Ignatz make a small mistake that only appeared in the 19th century.

He did not change the direction of the blade to open the trachea upwards, but chose to continue cutting the trachea directly downwards.

The blood vessels around the trachea are richer the further down the trachea is, and the knife will definitely bleed. Kawei originally wanted to persuade him, but his reaction could not keep up with the speed of his hand. Before he could say anything, the knife had already cut it.

But after thinking about it carefully, he felt it was nothing.

After all, this was the 19th century, tracheostomy was a new surgery, and there were naturally no standardized operations [4].

Ignatz did not suture the surrounding small blood vessels, nor did he separate the muscle fascia from the thyroid isthmus at the entry point. After this series of operations, damage will be caused wherever it passes, and cutting down will only damage some small blood vessels.

As long as it does not exceed the fifth ring of the trachea, it will be fine.

But what neither of them expected was that Laszlo's neck blood vessels were different from ordinary people and had special mutations [5].

Ignatz's fingers were very sensitive, and he stopped his hand as soon as he noticed something was wrong. His lack of clinical experience in tracheotomy made him very confused. He didn't know what he had cut, and he didn't know whether it was considered a success or a failure.

Suddenly, an extremely strong stimulation forced Laszlo to break away from Berget's arm, bend his body and choked violently.

"Cough cough cough~~~cough cough~~"

The cough pulled the surrounding wounds, and while squeezing the scalpel open, two injections of blood spurted out. Both the height and the color told Kawei that Ignatz's blade must have cut an artery.

Instantly the room was in chaos.

The physicians in the outermost circle retreated one after another, fearing that the donated blood would stain their clean and bright gowns.

Berget, who was standing at the head of the bed, was shaken away by the powerful force, but his previous experience told him that he must control the patient immediately, so he quickly stepped forward and pressed Laszlo's shoulders and head: "Bear it a little longer.

, it will be ready soon!”

Ignatz was closest to the wound and must have borne the brunt. His eyes and nose were covered in blood, so he could only retreat temporarily: "I can't see, please give me a piece of cloth."

Behind her, Naya didn't know what had happened, so she handed over her handkerchief out of reflex. But when she saw her father between the people, tears fell again. If it hadn't been for Fatto

Ladd was holding her by his side, and she might immediately pounce on her and cry.

In the whole room, the only one who remained calm and thought of a remedy was Kavi.

He kept looking at the wound, avoiding blood injection, and immediately thought of the location of the bleeding [6]. While others were still panicking, he had already pressed the entire wound with a pillow: "Teacher, it must have touched the wound."

The artery has been reached and needs to be ligated as soon as possible!"

Ignatz wiped his face and reached for his surgical instrument box: "Needle and thread...needle and thread...found it!"

"Teacher, give me another pair of crow's beak pliers."

"Pliers...here!" Ignatz wiped away the blood and threw away the handkerchief, "Did you see the bleeding location just now?"

"Well, it should be at the bottom of the incision, probably the artery that supplies the thyroid gland."

Kawi took the pliers, ignored Laszlo's shouts, carefully wiped the wound, and tried to accurately locate the bleeding area based on the newly emerged blood.

The needles and silk threads of the 19th century were not thin enough, and there was definitely no way to properly treat this artery. Kawei could only use crow's-beak forceps to grab the hair from his eyebrows, wrap the wound with the remaining fascia, and perform a one-time ligation.

"Luckily, the breach was blocked."

The clamping strength of the crow's beak forceps was very low, and Kawei could only slowly lift it at an angle to free up some space for Ignatz to perform the ligation: "Teacher, as long as this piece of tissue is sutured, the bleeding should be completely stopped."

The words slowly fell, but there was no response from Ignatz in the noisy space.

"teacher?"

Kawei withdrew his attention and looked up at the edge of the bed. Ignatz, who should have been standing there and listening to his instructions, was holding his forehead and shaking: "Teacher, what's wrong with you?"

"It's okay, I'm just a little dizzy..."

"faint?"

Ignatz was not just dizzy, there were countless small cold sweats on his cheeks, and the shirt in his dress was already soaked through.

These all point to a common condition: hypoglycemia.

"Teacher, you didn't eat much at the dinner?"

"Um, I've been chatting with Mr. Laszlo."

"I've been tired all day, and it seems I can't keep up with my physical strength." Kawei used a more down-to-earth term instead of "hypoglycemia after drinking" [7], and then suggested, "Teacher, why don't you take a rest first?"

, let me finish it next."

"No, I'm fine."

Ignatz was still reluctant, wiping the sweat on his forehead with his sleeves, and holding the needle and thread to do the sutures.

Kawei had no choice. He was just an apprentice, and there was no way he could embarrass him in front of so many people. If he wanted to seize power without his approval, Ignatz himself would not have to step forward. Those internal medicine doctors who attach great importance to the relationship between superiors and subordinates

Instead, doctors would be the first to stand up and denounce this rebellious young man.

However, there are no absolutes in the world, and risks and benefits coexist. If Laszlo's condition worsens, Kawi will still consider taking risks.

He took the opportunity to glance briefly at Laszlo.

This rich man is different from ordinary civilians. He usually eats nutritious food and is willing to exercise. He is indeed in good health. Three minutes have passed since the onset of laryngeal edema, and he can still maintain some consciousness.

Fortunately, there is still time.

Kawei held the crow's beak pliers, ready to give his "mentor" another chance.

At this time, Ignatz seemed to be more awake. He stood still, picked up the thread and prepared to thread it into the eye of the needle. However, he failed several times: "Kavi, I hold the pliers, but you should thread the thread."

Kawei was a little hesitant, fearing that he would mess up the hemostasis he had just made: "Teacher, please be careful, there is an artery underneath."

"I know."

Kawei gave the pliers over, took the needle and thread on the bed and quickly threaded it, not daring to take his eyes off the crow's beak pliers for a moment. Just when he was about to hand over again and send the threaded needle and thread back, Ignatz suddenly said

: "It's better you do the stitching, the light here is better."

a little better?

The window of the house faced south, and Kawei was just an assistant. Naturally, he turned his back to the window and gave all the light to Ignaz. How could the light here be good?

This sounds like a lame excuse.

Perhaps realizing that his words were a bit outrageous, Ignatz quickly added: "I can't see clearly in the reflection here, and it's too late to change positions now. It's better for you to perform the sterilization. This isn't the first time you've done it."
To be continued...