Donnyringle Street is located in a remote location and is full of people. There is no police booth in the street and alleys. To find the police, you have to go to the Hoints Street entrance. The patrol police there are used to seeing gangsters fighting, and they often appear to be very insensitive. With the surrounding environment being like this, lying down is the mainstream for them.
Without suitable transportation, it is impossible for them to arrive at the scene as soon as possible. Being able to show up stably within half an hour is considered dedicated.
The situation in the dark alley was complicated, and the two patrol officers insisted on acting together for fear of an accident. They planned to go to No. 155 to get a feel for it before making any plans.
Under the cover of night, many people gathered around the gate of No. 155. The former neighbors looked at the lonely Nora sitting next to the body. They could only discuss in a low voice and did not dare to come forward.
Fuleni's belly was like mud, and the overflowing blood had accumulated under her body and formed a pool of blood, and then flowed out in various shapes into several semi-solidified rivers. Even a veteran who has been patrolling Hoints Street for many years can still hardly imagine the tragedy when he saw such a bloody scene.
After finding someone to understand the situation, they carefully took away Nora's knife, and then started to act separately.
One person went back to the patrol booth to report to the police station, while the other person first controlled the murderer and then surveyed the scene. Every step was done step by step as required by his superiors.
"I Have a Picture Book of Ghosts and Gods"
But what they didn't expect was that in addition to the murderer and the victim, there was a fourth person at the scene. What they didn't expect was that one of the victims, Li Ben, was still alive.
"Still alive?"
"We are alive, but the situation is not optimistic." Kawei briefly explained the reason for his appearance here, and then asked, "Is the carriage coming?"
"Carriage? What carriage?" The patrolman didn't know what he was talking about.
"Didn't the person who called the police tell you?"
The patrolman then remembered that he had indeed heard this request half an hour ago, but they only regarded it as a joke. After all, if something happened in this area, people would often either wait to die or just bandage it themselves, so there was no way they would waste money on taking a carriage to the hospital.
The patrol officer thought that it would take half an hour for his partner to fight back and forth, and he lost his direction for a moment: "What should we do now?"
"wait."
"By the way, aren't you a surgeon? Why don't you treat it first, just like you treated those two wounds."
"That's the neck, and it's full of blood vessels. What if the treatment is broken?" Kawei spread his hands, "I'm just an unknown surgical assistant."
"So that's it..."
The carriage didn't come, and Li Ben's time to go to the hospital had to be postponed.
Carvey didn't care, he had fulfilled his duties as a young surgical assistant in the 19th century.
Under such difficult conditions, it was normal for him to fail to suture the blood vessels in his neck, and no one would blame him. On the contrary, when Li Ben was sent to the dissection table, all the surgeons involved in the dissection, including Ingenac, had to use these two suturing techniques to praise him.
Therefore, it was Li Ben who collapsed.
Li Ben sat by the wall, feeling very tired. His left eyelid slowly drooped uncontrollably, and he became increasingly unable to open his eyes. Seeing that the carriage was far away and Kawei was about to leave again, he really thought that he was about to die, so he had to agree to Kawei's request: "As long as I admit it, that's all."
"Yes, the policeman happened to be here too. You can tell him what happened at that time."
Li Ben looked at the blood on the ground, threw away the stick, nodded and said: "Okay, I admit..."
The patrol officer didn't know what the relationship was between the two, but he was just worried about Li Ben's health. He had never seen Li Ben covered in blood and still talking. It was a miracle that he could be rescued: "I think we should wait until we go to the hospital. Let me ask you about the situation of eucalyptus."
"Look, can I go now?" Li Ben couldn't care so much, "Let me finish my words soon."
There is no need to go into too much detail about what happened, just point out that he and Frenny were the first to do it. Nothing can explain the problem better than the victim himself voluntarily admitting it.
However, for patrol officers, recording the details of each case is very important, and mistakes are not allowed. If there is a problem, those police chiefs will not take the blame for them, so you have to be careful:
"Did you use sticks to intimidate her first? Did you do it only when she refused, or did you do it right away?"
"As soon as we came up, we started taking action."
"That's not right. You didn't even hit her when you started?" The patrolman was surprised. "That girl is quite short."
Li Ben was so dizzy that he could only follow the meaning and correct it: "Yes, yes, he came up to threaten me, and then he took action."
"Huh? Why did you change it again?"
"Anyway, let's hit her first."
The patrolman looked around: "There is only this stick at the scene. Is it you who is using it, or is it Fernie outside the door?"
"W-what does this have to do with anything? We were the ones who hit first!" Li Ben used up his last bit of strength, "I hit people, I'm dirty, I'm an animal, I deserve it, I'm not a human being!"
The patrolman saw that blood was starting to ooze out of his neck again, and he quickly advised: "Okay, okay, you're the one who beat me, you're the one who beat me, don't get excited..."
It seemed that the swelling in Li Ben's neck was not serious, but unknowingly, his speaking pattern had changed. The original complete sentence was broken into short paragraphs, and the pauses in the middle looked funny.
In fact, it is because there is pressure from the outside with the palm of the hand, and the slowly growing hematoma in the neck is squeezed inward, further affecting the airway. Kawei knew very well that this progressive hematoma must be accompanied by the rupture of arterial blood vessels.
"...I'm done, doctor."
Seeing Li Ben pressing his fingerprints on what the patrolman had written down, Kawei said: "Mr. Patrolman, he is bleeding too much. It will take some time for the carriage to arrive. I think you should let me help you first." Stop the bleeding."
"You just..." The patrolman didn't bother to care about this. He put away his notebook and walked out the door, "Forget it, I'd better go see how the girl is doing."
Li Ben finally breathed a sigh of relief, but his breathing became more and more rapid, and he felt as if his throat was blocked by something: "Doctor, I can't breathe, I'm out of breath. My eyelids also fell down, here they come."
"I know, stop talking."
By the candlelight, Kawei also noticed that his eyelids were drooping, but it was not both sides, but the injured side alone. Combined with the hematoma in the neck, it is not difficult to determine the cause of eyelid drooping, which is Horner syndrome caused by compression of the sympathetic trunk in the neck. 【1】
Sympathetic nerves run deeper than blood vessels. If it was a cut injury, the common carotid artery must have been severed. Li Ben would never survive now. After a simple elimination method, it should be confirmed that it is caused by long-term compression of the neck.
Kawei first re-measured his heart rate, which was stable at just over 100. His skin was far from the clammy coldness associated with hemorrhagic shock. His key consciousness was still there, and he was breathing a little faster.
The guy's body can still handle it, but the hematoma is a troublesome problem.
The focus returned to the neck. This time he did not choose to sew in the corner, but moved Li Ben to a slightly spacious ground to lie down on his back. Before fixing the ruptured blood vessel, Kawei also needed to help Liben re-establish his airway.
In a modern hospital, when encountering a huge hematoma caused by neck trauma, opening the airway is more important than stopping the bleeding. Most trauma centers use a direct (percutaneous) tracheotomy, similar to what Laszlo did.
But Kawei doesn't have the corresponding equipment in hand now. What's in this box is just a simple incision and suturing box, which Yingnaz used in the past when he went to drain pus from the body surface of noble gentlemen.
"no solution anymore."
Kawei took out a needle from the box, which should be a drainage tool for deep abscess cavities: "What follows is a bit rough, please bear with it."
Li Ben:? ? ?
Before he could react, Kawei accurately positioned the needle in the depression between the thyroid cartilage and cricoid cartilage. Taking into account the thickness of the subcutaneous tissue and hematoma, he used his fingers to control the needle insertion distance to about 0.5, then raised his hand and inserted the needle. 【2】
There was no hesitation or sloppiness. There was only a slight pop, and Kawei felt a sense of loss in his hand, and the needle successfully entered the trachea.
The stimulation of the needle made Li Ben couldn't help but cough twice. The shaking of his body caused severe pain and blood splashed everywhere, but the fresh air that followed made him feel relieved.
"How is it now?"
"It hurts...but it feels better."
The location of the neck surgery was special, so it was obviously unrealistic to let Li Ben be responsible for lighting. Not to mention that he couldn't hold it firmly. Even if he could hold it firmly, it would be difficult to maintain the correct angle of light incidence. Kawei could only do it by himself. He put a layer of gauze on the candle, held it with his teeth, then removed his pressing hand and began to explore the neck.
The basic situation is similar to what Kawei thought. If you open the surface of the wound, you can see the broken anterior cervical muscles, and the broken anterior jugular vein can also be seen on the upper and lower sides. 【3】
Veins have many collateral circulation pathways, and the anterior jugular vein is not that important. There are also some other small blood vessels, which can be directly ligated. The premenstrual muscle group needs to be sutured, but now it is necessary to continue to explore forward, because it is unlikely that a unilateral anterior jugular vein will cause such a large hematoma.
"Don't move!" Kawei stopped the bleeding to free up his field of vision, and then quickly tied it. "After tying this blood vessel, I still have to turn it down. Please bear with me. This is not like the thigh. There are blood vessels everywhere around it and they will be damaged. I don’t care.”
Li Ben could only endure the pain and nodded slightly.
Kawei clamped the muscle with tweezers, then pulled it open with a hook, and handed it to Li Ben's hand: "Hold it firmly and press it, even if it hurts, press it."
"Um......"
Just when he wanted to continue exploring, a stream of blood suddenly spurted out. It was about 10 centimeters high and filled Li Ben's neck wound instantly.
The bleeding happened suddenly. Kawei didn't see the bleeding location, so he could only use his fingers to touch the spot where the blood was gushing out and press it. After sucking away the surrounding blood, he discovered that this location should be the bleeding caused by the rupture of a branch of the carotid artery.
Inside is a common carotid artery, which separates the external and internal carotid arteries, both of which are large arteries. This one is definitely not that big. Judging from its shape, it should be the first branch descending from the outside of the neck, the superior thyroid artery. 【4】
Kawei identified the bleeding location, half-covered and half-clamped with the fingers of his left hand and the crow's beak forceps on his right hand, and quickly controlled the breach and quickly tied it off.
Just like the blood vessels in the legs, the catgut in his hand could only be ligated, and suturing was obviously impossible. As for the blood supply to the thyroid gland in the future, it all depends on Li Ben's luck.
If you're lucky and the side branches are established, you'll be fine.
If you are unlucky and the collaterals are slowly established, your thyroid function will definitely be affected.
But now Li Ben will definitely choose ligation. As long as he can survive, he can do it, including connecting the internal jugular vein that Kawei saw.
Kawei's exploration did not find a break in the internal jugular vein, but found a relatively large number of blood clots deep in the vein. This is actually very common, and he encountered many of them along the way, but experience told him that the problem was not simple.
After further exploration, Kawei discovered that there was a rupture of about 0.4cm on the main trunk of Li Ben's left internal jugular vein. The tear was mostly blocked by a blood clot, and blood was slowly leaking out.
This was a blessing among misfortunes, because the common carotid artery in the inner position was fine and had strong pulses.
The movement trajectory of the blade can basically be restored from the wound. It can only be said that Li Ben's reaction was indeed fast enough. He may have taken half a step back at the moment of the cut. The blade drew a strange arc on his neck, strangely avoiding the external jugular vein, trachea, esophagus and common carotid artery, allowing him to survive until now.
"The investigation is over. You are really lucky. You have avoided all the troublesome places."
Kawei looked at the tear in the internal jugular vein and made a decision in his mind.
The internal jugular vein is very large. Even if it is a vein, the blood flow is not small. It mainly controls the return of blood from the brain to the heart. Blind ligation is definitely not possible, as this is equivalent to cutting off the blood return to half of the brain. Before the right circulation appears, direct ligation may cause blood to accumulate in the skull, causing cerebral edema.
The tear is actually not big, and it would have been sutured in modern Kawei. It is not difficult to suture the veins, and if it doesn't work, you can still put a patch on it. But look at the tools that Ingenac has eliminated in his hand. It's okay to sew the skin and muscles, and the fascia can also be made do, but if it's to sew blood vessels...
Just because of the exaggerated suture needles and threads, less than half of the blood vessel has to be blocked after suturing, and it is also a secondary damage to the blood vessel itself. Whether it can heal is questionable. In addition, thick sutures can also irritate blood vessels and produce scars. Scars can cause vortexes in the blood, which can lead to the formation of plaques and thrombi over time.
Once the embolus breaks off and blood flows back into the heart and then into the lungs, it is a pulmonary embolism, a fatal situation.
Now that he has taken action, Kawei will not let Li Ben die during his surgery. These obvious postoperative complications need to be avoided. But now we can't suture, and we can't easily ligate it. The blood vessels are still slowly bleeding out. What should I do?
Kawei suddenly thought of Morasso's groin. At that time, Yingenatz's simple and crude way of handling it shocked him, and he also realized how pitiful contemporary surgery was.
But it was a shock. Is there nothing worth learning from his approach?
Suddenly, Kawei let go of the hook in his hand, put the needle and thread aside, continued to open Li Ben's wound, let the blood flowing out cover the blood vessels as much as possible, and then gently pressed it with his fingers. Surgery sometimes requires some divergent thinking and inspiration. If suturing or ligation doesn't work, then just don't suture or tie.
The so-called cure by doing nothing, sometimes not sewing is also a kind of sewing.
It sounds strange, but it’s worth trying. If it really doesn't work, Li Ben is already out of danger anyway, so it won't be too late to stitch it up.
Li Ben saw him squatting beside him blankly, not doing anything and felt strange: "What are you doing?"
"I'm waiting. Please wait for 10 minutes."
"Um?"
"If you're lucky, your blood vessel should be blocked in five minutes."
－－－－－－Digression－－－－－
Go out at night and sleep~
Bookmark
