Veins are completely different from arteries. Veins have thick lumens, thin walls, low elasticity, and much slower blood flow. Bleeding from venous rupture cannot be like an arterial jet, which means that in trauma, venous blood is more likely to remain around the rupture to form a blood clot. 【1】
Blood coagulation itself is a self-protection mechanism of the body. When injured and bleeding, blood coagulation can block the blood vessel breach and prevent bleeding.
But the presence of a blood clot certainly doesn't fit the word "healed." So before crossing, when Kawei encountered this situation, for the sake of safety, he would clamp the blood vessels, remove the clot, and then perform repair sutures.
He has also encountered situations where the trauma lasted for a long time, and the blood vessels had been completely blocked by blood clots and self-repair, and the repair was abandoned in order to prevent secondary damage. But this is just a passive catering, another option after having a blood clot.
The conditions for this choice are harsh and need to be checked repeatedly before execution. In most other cases, he can sew.
The situation is different now. Kavi has gradually adapted to the crude medical conditions of the 19th century, and cannot let go of anything that can be used.
Once the concept is changed, the original passivity becomes active, taking the initiative to create blood clots. Because Li Ben suffered a simple cut injury and there was no defect in the blood vessel, the blood clot could completely block the blood vessel after solidification and attachment, and then further help the lumen to heal.
All Kawi has to do is do nothing and wait.
Wait for the blood to coagulate and seal the rupture. 【2】
Things were going in the direction Kawei hoped for. It didn't take long for the bleeding from the original bleeding spots around the wound to gradually slow down. Five minutes later, the newly formed blood clot completely sealed the breach, and the bleeding completely disappeared.
Originally, after blood vessel repair, it was necessary to flush with normal saline to check for leaks. Now there is no clean water, so it is not necessary to prevent the blood clot from falling off.
After dealing with the blood vessels, the remaining finishing work was much simpler. Kawei quickly connected Li Ben's disconnected muscles and skin, ending the neck incision injury exploration technique that was completed under candlelight.
The entire operation process, from examination, negotiation, leg suturing, arm suturing, to the final neck exploration, only takes about 40 minutes. Especially the final neck exploration ended very neatly, and most of the time was spent on the "waiting".
So much so that when Werther arrived in the police station carriage, Li Ben could still limp onto the carriage with the help of others and relying on his other good leg.
To this day, Werther still remembers the way Nora's dull eyes suddenly became energetic when she looked at Li Ben and Kawei. Anyone would find it incredible that a guy who was cut into bloody pieces by himself miraculously recovered in less than an hour.
"If I had known that Dr. Kawei was so powerful, I would have chopped him more times..."
Thinking of Li Ben’s appearance when he got in the car, Nora was filled with anger. Seeing her like this, Witt couldn't help but explain: "This guy has told everything, and with the testimony of you and Mr. Carvey, I think the sentence can be reduced significantly."
"That's why I regret that this dwarf is still alive!" Nora was a little excited. "I don't hate Dr. Kawei for saving him. It's natural for doctors to save people, but I feel sick when I think about this guy's face!"
At this time, Musil suddenly said: "It's just that we are still alive now. It is normal for wounds to ulcerate after surgery. Don't ask me how I know this. I was a surgeon before and I know very well how painful wounds are. Think about him There are so many wounds all over the body, it’s not an exaggeration to say that life is worse than death.”
After saying this, Noila’s anger calmed down a little.
Musil gave the autopsy report in his hand to Witte, stood up and walked out: "You can hand the things to the director's office together. I have to go to the hospital to have a look."
"Why did you go to the hospital?"
"Based on your description alone, I can't imagine how a person with such severe trauma could stand up." Musil was completely interested. "It just so happened that I had to go to assess his injury. This is also One of the jobs of a forensic scientist.”
Werther looked at the report and asked, "Aren't you going to go home and sleep?"
"How can we rest in this situation?" Musil pointed to the "serious injury" in Werther's report and asked, "He was stabbed four times and his neck was cut. It was a serious injury like being cut into blood, but in the end he died on his own. He opened the door, jumped into the carriage, and was still talking and laughing. Is this a serious injury? Are you kidding me?"
"Um..." Werther looked at what he had written and couldn't make a conclusion.
To others, it was just a surprising thing, but when it came to Musil, it became a huge conceptual impact, which made him feel uncomfortable.
Fortunately, he is not alone, because the surgeons at the Municipal General Hospital are also in trouble.
...
10:18 pm
As a nurse came in and said a patient was here, Yingenatz dropped the microscope and pathology report and hurriedly left the autopsy room: "Where is he?"
"Sent to Ward 3."
"No. 3? No. 3 is the post-operative rest ward. Why are we sent there?" Ingnatz looked at the general ward at hand, "Isn't there an empty bed here?"
"That's what Dr. Carvey said."
That's true, but the person standing in front of her was the director of surgery after all. The nurse looked back at Ward 3 in the distance and asked, "How about I change the person back again?"
Ingenac hesitated for a moment and shook his head: "Forget it, I'll go take a look. You can bring the equipment box from the general ward."
"oh."
In his impression, Kawei was not a random person, and there must be a reason for him to be sent to No. 3. Ingenac still had some premonitions. But the gap between premonition and reality was still too big after all. The state that Li Ben should have suffered from a serious stab wound and his current state were completely separated.
Ingnatz had been on the battlefield before, and sword cuts were not easy to treat.
Especially with the small incision on Li Ben's neck, his field of vision is very limited. If you want to find the ruptured blood vessels, you must first make a large incision. Since the neck is rich in blood vessels, making a large incision will cause more intense bleeding, and then enter an endless cycle.
The most terrible thing is that this cycle dies very quickly.
Ingnatz carefully examined Li Ben's neck. The incision was about 8.5cm, diagonally from the upper left to the midline. There is nothing to say about suturing the skin. The key is how to stop the bleeding: "Is the bleeding serious?"
"It's not bad. The amount of bleeding throughout the body is estimated to be about 800ml, and the neck should account for 80% of the total."
800ml may not sound like a lot, but that’s not what Li Ben’s clothes say. Just looking at the black and red shirt, you can tell how badly it was injured. The front part was completely soaked.
"Only 800?" Seeing that Li Ben was fine, Yingenatz couldn't help but believe it, so he could only continue to ask, "Where are the injuries?"
"The neck is the most serious. The anterior cervical muscles are all severed. The left anterior jugular vein and superior thyroid artery are also severed. Several small branches are also severed. The internal jugular vein is ruptured."
"The internal jugular vein was also ruptured?"
"Well, I did a simple sealing of the about 4mm breach, and it should be fine now." Kawei said lightly, "Some small arteries were severed in the legs and arms, so it won't be a problem. The main thing now is Bites on his nose and corners of his mouth."
Simple blocking?
Not in the way?
It was difficult for Yingenatz to understand how a young doctor who had never been on a battlefield could immediately find the order of treatment when faced with compound trauma.
He had no nurse, no other doctor's assistant, and no one to help hold the lamp. The conditions were much more difficult than on the battlefield. This is like trying to solve a maze in a very short time. Once you choose the wrong path, there is no possibility of going back and choosing again.
The most critical thing is not which path to choose, but how to stabilize your mentality in the face of such heavy pressure.
It took Yingnaz three years of his military career to just learn to stay calm in everything, but this was still a long way from being able to truly remain calm in times of crisis. After five years of stumbling, he barely managed to do this.
He has been using it for so long, how many years has Kawei been using it?
"Teacher, are there new patients?"
"Um."
Just when Yingenatz was still confused, Herman walked into the ward: "Do you need help?"
help?
How can I help in this situation?
Yingnaz shook his head, his helplessness and endless curiosity hidden in his slowly shaking head: "Kavi had finished sewing at the scene. Unexpectedly, the new patient had just entered the hospital and was already walking out of the hospital before he could sleep peacefully. On the way."
Herman was a little surprised, but thinking about the previous appendix and cesarean section, the degree of surprise was much lighter. He just hummed and stepped forward and asked, "Is it compound trauma?"
Seeing that Herman had no reaction, Yingenatz was even more surprised: "A neck incision of about 9cm, a leg incision of 10cm, and two arm incisions, 5cm and 3cm respectively. Four incisions, a total of more than ten breaks blood vessels, including the anterior jugular vein, superior thyroid artery, and internal jugular vein.”
"The internal jugular vein was also ruptured?"
Herman finally showed the proper expression, and Yingenatz finally felt a little more comfortable.
"Director, your equipment box is here."
At this time, the nurse hurried in without looking at the people on the bed. She went directly to the ward's diagnosis and treatment table and opened the lid, preparing to deliver instruments to them: "Force, crow's beak forceps, gauze..."
"No, just put it back."
"Um?"
Before the nurse could react, Yingenatz scolded her out of the ward: "I didn't even look at the patient when I took over the door. Why do I need an instrument box when all the wounds have been sutured?"
Seeing that he was in a bad mood, Kawei quickly changed the subject and described the scene during the suturing: "The main reason is that the aorta was not injured. If the common carotid artery was really injured, I might not even be able to find the target blood vessel. "
Ingnatz carefully inspected the neck wound, and then asked Xiang Kawei: "Have the anterior jugular vein and superior thyroid artery been ligated?"
"Well, the anterior jugular vein is actually fine, and the amount of bleeding is not much. The main reason is that the superior thyroid artery is relatively strong, and it is more serious than the one that was injured when Mr. Laszlo performed the tracheotomy." Kawei gave Yin Gnatz made an intuitive comparison and continued, "I was lucky and found the location of the blood vessel immediately."
Why is it good luck again?
The tracheotomy was to look for ruptured blood vessels and he said he was lucky. Morazo also said he was lucky when his wound healed. He said he was lucky to have a cesarean section. Tonight's appendix diagnosis was also said to be good luck...
One is lucky, two are lucky... Five of them are lucky!
Yingnaz was no longer too lazy to complain, nor was he too lazy to think about why Kawei was so powerful. Thinking of the cleft lip repair surgery that I have yet to fully understand, my eyes are full of desire for surgical knowledge and technology:
"Just tell me how the internal jugular vein was sutured? What kind of suture needles and what kind of sutures were used?"
"Oh, I didn't sew."
This answer made Ingnatz, who wanted to know the answer, not sure how to understand the meaning of this: "No... no sutures???"
"The needle and thread were too thick, so I didn't dare to sew." Kawei told the truth, but it always sounded a little weird. "Later, I saw that the blood flowing out was getting less and less, and the blood clot seemed to have blocked the blood vessel and ruptured it. Mouth, no sutures were done.”
"Just leave it like this?"
"Yes, I checked for another two minutes. I didn't see any bleeding, so I sewed the muscle and left it alone."
A large vein with a diameter of 1cm seemed to be no match for those capillaries in his mouth, and he refused to sew it.
But facts speak louder than words. Apart from the dried blood stains, there was nothing unusual about Li Ben's neck: "Is it true that the internal jugular vein can be repaired without suturing..."
"With such a thick suture needle, it is already the limit for sewing intestinal tubes." Kawei said, "The lumen of blood vessels cannot withstand such an operation. Once the endothelium is damaged again, the rupture will only be more serious than the previous one."
“Are blood clots safe?”
"It's okay, it's better than dying on the spot."
"All right."
Yingnaz didn't expect this kind of handling method, which was really eye-opening. After taking some simple notes and excerpts about Li Ben's whole body, he then turned his attention to Herman: "When I was taking pathological slices of the appendix just now, where were you?"
"Oh, I went out to find someone."
Ingenac straightened up and looked back at him: "Is it Hills?"
"......Um."
"Where is he going?"
"have not decided yet."
"I guess it's Graz. After all, it has the highest bids and offers many opportunities for major surgeries." Yingenatz showed off his sharp tongue. "The surgical mortality rate in Austria is expected to increase again this year."
Heman remained silent, not daring to say anything.
"Okay, Mr. Li Ben, you can rest in peace and recuperate." Yingenaci sighed and said to Kawei, "I'll leave it to you. Finish the disinfection work and come back as soon as possible. There are some pathological findings. "
"Oh, no, I'll go with you now."
"No more alcohol?"
"Yes." Kawei smiled and raised his voice slightly: "Sir Ben Li's body is very strong. I don't think there is any need for disinfection."
The master and apprentice mentioned Li Ben's name twice, which made a patient who was also hospitalized in Ward 3 particularly concerned: "Li Ben? Is it the coward Li Ben?"
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