It took Kawei less than a minute to quickly complete the report in a messy journal style. He looked at the whole process, but seemed to say nothing.
This approach deeply stimulated the nerves of those surgeons.
Even the bad-tempered anatomy professor in medical school didn't speak like this when dealing with troublesome students. What's more, the person standing in front of Kawei was still a director-level doctor who had been involved in surgical theaters for so many years, and he was reporting on table-pressure surgery. How could he be so deceptive?
You should explain the details clearly!
"Finished?"
"It's over." Kawei spread his hands, "It's not a good operation in the first place. It's actually Dean Waterman who put me in this position. If you have any questions, just ask. If you don't have any questions, just leave. I see that everyone is quite tired after a busy day."
Saying this made the doctors in the audience very depressed.
In the past, how could they, who were so superior, endure such humiliation? If there were young people in the stadium acting like this, they would definitely attract huge criticism. It ranges from being sprayed off the podium to being directly kicked out of the college venue.
In fact, that was their plan from the beginning.
An ordinary woodcutter, by chance, got a job at the Municipal General Hospital, and by chance, he performed one or two surgeries due to Ignatz's advice.
After reading the report, ordinary citizens will call him a once-in-a-century surgical genius. Young surgeons may envy his surgical talent, but director-level doctors who have already achieved some achievements feel differently.
Although they are the front wave, they will also envy the back wave, but the back wave is so strong that it almost becomes a huge wave, and it may be able to swallow them up before they reach the beach.
So envy quickly turned to jealousy.
Some were jealous of Kavi’s complicated surgery, while others, more theologically, were jealous that he was under God’s care.
Of course, these two surgeries exist objectively, and the process is almost perfect. As senior surgeons, there is no way they could miss it. But their purpose is not pure. In addition to learning some details, they must also have some questioning eyes.
It's a pity that the noble certificate that Kawei just produced quietly planted the seeds, subtly suppressing their thoughts in their hearts...
The regular meetings of the College of Surgery are not about drinking and eating, chatting and joking among colleagues, but about communication and learning. The new trends in the morning were only fresh, but what really attracted them was the surgery report in the afternoon.
There wasn't much in the first half of the report, and many doctors selectively ignored it, because they usually performed those surgeries, and it was just about the success rate and postoperative recovery, which were out of their control. The second half was different. They were major surgeries that they rarely performed, and the technical difficulty went up several levels.
For example, rhinoplasty + mandibular resection is not something everyone can do, and even if it is done, there are not so many successful cases. According to Kawei, cesarean section relies on oxytocin, and the appendix relies on a little bit of luck when looking for it.
The technical threshold for these operations is very high, and the success rate is very low, but at least they know the operation process, and some have even done it, but the success rate and courage are not enough.
In contrast, the last on-site rapid hemostasis suturing was really a blind spot for them. Let alone doing it, they had never even seen it.
Those who had been to the front line as military doctors stayed in rear field hospitals to perform surgeries during the war. The front line and the rear were too far apart, and it would definitely be too late to send them back by field carriage. In case of serious limb injuries, they had to amputate them on the spot, and the neck injuries were gone halfway.
The city is even more troublesome. There is no emergency system, the streets and alleys are complicated, both large and small roads have rush hours in the morning and evening, and traffic jams are also the norm. 【1】
The external conditions are such that people with severe trauma can only wait for death at the scene, and doctors have no chance to practice their skills.
Many people have never even seen a patient with a jugular vein rupture, and they don't know how to control the incision and quickly suture it before the blood bleeds out. For them, cricothyroid membrane puncture after hematoma appears in the neck is even more unthinkable.
"Green Gourd Sword Fairy"
The questions were all based on checking for omissions and filling in the gaps in the complete report. Now Kawei made it clear that he did not want to give a good lecture and left out answers. He did not even let the students think about their ideas.
They had no way of asking, so after much deliberation they had to reconstruct the entire scene from scratch. Since first aid is being done on the spot, you need to have a sense of being there: "Can you describe the basic situation of Mr. Li Ben at that time?"
"Well... there is blood all over the ground, and there is also blood on people's bodies. Forgive me for not having enough words to describe it." Kawei thought for a while and said, "If you insist on making a comparison, just compare it with the body." He looked pale as he sucked blood from dozens of leeches."
"Excessive bleeding?"
In this era, doctors are worrying about the amount of blood. If there is too much blood, bloodletting will naturally be used, but if there is too little, bloodletting will not work. It is obviously not possible to eat dozens of leeches together. One can imagine how exaggerated Li Ben's blood loss was at that time.
Many people have tried to stop bleeding in history. From the earliest physical pressure on the body surface to large-area soldering irons and boiling oil, and now back to physical pressure, sutures can be made more precise and detailed.
In fact, in the not-too-distant future, when electrical equipment enters the medical field, hemostatic methods like soldering irons will return to the hands of surgeons. It's just that compared to the Middle Ages, modern electric knives can be more precise and detailed, and can even replace part of the functions of scalpels.
But the Four Liquids Theory has always had a blind spot. It has always been about bloodletting, but not blood transfusion.
If the doctor really determines that the patient has insufficient blood, he can only rely on prepared herbs to slowly replenish the blood. More direct blood transfusion has always been a problem. 【2】
Kawei can't do blood transfusion now. What he can do is to stop the bleeding in a short time and reduce the risk of death. This is what the doctors in the audience want to hear most: "Dr. Kawei, when facing such a wounded patient When there were wounds and bleeding everywhere, how did you make a judgment?"
"Because the neck incision is very long and bleeds the most. Considering the carotid artery, I will definitely check the neck wound first. Of course, before checking, I have to check whether the thigh wound has injured the femoral artery. These two places are definitely more important than the femoral artery. The arm is important and needs to be prioritized.”
Kawei's two simple sentences sounded like a heavenly book to them: "How...how can I check this?"
"Of course I opened it and checked."
"The bleeding in the neck is very serious. Once it is opened, can it be stopped?"
Doctors who have experienced cesarean section all know how violent this kind of bleeding is. The uterus is leaking out in a large area, and the veins themselves are gurgling and leaking out like a broken water pipe. Their concept of hemostasis is still based on passive observation and large-scale compression, and they are not familiar with refined suturing and ligation.
"How do you know whether the broken artery or vein is broken without opening it? How do you know where the injury is specifically without opening it? How do you stop the bleeding without opening it?" Kawei asked three times in a row, leaving the audience speechless. "What's inside?" It’s just a matter of speed. Once you see severe bleeding, you need to find the bleeding point immediately.”
"Then what?"
"Use crow's beak forceps to clamp the blood vessels above and below to cut off the blood flow."
"...Can you be more specific?"
Kawei was a little helpless: "It's already very specific."
"Dr. Kawei, you may have misunderstood. What we can't understand is how you found the bleeding point in a neck wound that was overflowing with blood by relying only on a candle lamp. You must know that although the wound is ten centimeters, it is It wasn’t too long, you were alone at the time.”
"It's incredible."
"Although it's not polite, I still have to doubt the authenticity of the case."
After hearing these words, Kawei finally "kept up" with their thinking: "Oh, this is what you are asking about. I asked Mr. Li Ben to pull the hook himself."
After saying that, he imitated Li Ben's movements at that time and made a bow-drawing look: "The hook he helped pull exposed enough vision. I can provide light with a candle in my mouth. Next, I only need to use my fingers." Block the gap in the blood vessel, suck up the blood, and then use the crow's beak forceps to stop the bleeding."
"I see."
"This is probably the on-the-spot reaction of young people."
"It's so amazing. It reminds me of a time when there was no ether more than ten years ago..."
"The patient was lying in the hospital, and the situation at that time has been recorded in the police station. If you don't believe it, you can go check it out." Kawei was also tired and too lazy to talk to them about anything other than surgery. "It's the same thing. Believe it or not, it’s up to you, I don’t care anymore.”
"We just find it incredible because we've never seen anything like this done before."
In Kawei's eyes, hemostasis of large blood vessels is only the basic skill of emergency surgery, because this is often the case in car accidents. If hemostasis of large blood vessels cannot be done well, at least half of the injured in emergencies will die in the debridement room.
But by the 19th century, this basic skill was a brand-new technology that overturned everyone's thinking.
The technique cannot be learned overnight. If you want to master it proficiently, you need to memorize the detailed neck anatomy first, and then slowly practice it with a large number of neck trauma patients. As your fingers become familiar with the feel of your skin and muscles, the feeling of blood flowing will become more and more obvious.
This is really out of line for them.
In order to calm down the discussion, and to cool down the heat for himself and keep a low profile, Kawei had to cross himself on his chest, and then gave half of the credit for stopping the bleeding to God.
"Perhaps God blessed me and gave me a pair of skillful hands that can save people at that time. Anyway, the whole process of stopping bleeding is like this. After I found the breach and found that the blood clot had blocked the breach, I did not do it again. Vascular suturing,,,,,,”
Speaking of this, Kawei suddenly remembered the cricothyroid membrane puncture: "Oh, by the way, due to neck compression to stop bleeding, severe hematoma occurred around Mr. Li Ben's neck. The swelling compressed the trachea inward, causing breathing problems. It was difficult. In order to facilitate first aid, I first performed a small operation similar to a tracheotomy to reopen the airway."
Everyone only knew that it was a complicated hemostasis suture machine for knife wounds, coupled with Laszlo's tracheotomy, but they never thought that there was a tracheotomy at the murder scene at that time.
"You said tracheotomy is a minor surgery?"
"The tracheotomy itself is not easy." Kawei made adjustments taking into account the factors of the times and explained, "Because the time to stop the bleeding was limited, I just used a needle to make a hole in Mr. Li Ben's neck."
"Can we still open a hole for tracheostomy?"
"Is it useful to open a hole?"
"Where is it?"
"The cricothyroid membrane above the trachea." Kawei touched his neck, "Here."
"Can Qi Qie be done here too?"
"It can, but there is a certain risk, and it must be used under unavoidable circumstances." Kawei simply put Laszlo's tracheostomy operation together and said, "For example, Mr. Laszlo's laryngeal edema at the time was... You can do cricothyroid membrane puncture. Because the incision is fast enough and the recovery is fast, the disadvantage is that it doesn’t last long.”
The weird hemostasis was followed by the unheard-of cricothyroid membrane puncture. All of this seemed so simple under Kawei's understatement, so much so that the surgeons who thought highly of themselves had the illusion that they had entered a magical world.
...
The regular meeting did not officially end until six o'clock in the evening.
Kawei benefited almost nothing from participating in the conference for the first time, but he formed conflicts with several doctors. For this reason, he had to go to the dean's office immediately and ask Waterman for the admission letter: "Dean, I have said everything that needs to be said, the letter...has the letter been sent?"
"You are so studious that you keep thinking about this matter." Waterman rolled his eyes at him and said, "You have already given it to the postman."
"That's good."
A big stone fell in Kawei's heart. With Waterman's letter of introduction and his current achievements, it would be easy to get admitted: "Dean Waterman, are you particularly familiar with Dr. Lister from England?"
Waterman raised his head and looked at him: "It's not particularly familiar. What's wrong?"
"Can you give me his address?"
"Why do you want his address?"
"I wanted to write him a letter, something to do with carbolic acid."
"The address...I don't have a specific address. How about you send the letter directly to his hospital." Waterman wrote a specific address by hand, "...it's a hospital in London. By the way, do you know English?"
"Yes, I am very interested in two medical journals in the UK. One is the BMJ British Medical Journal, and the other is La Lancet, so I have roughly studied them."
Waterman frowned: "British Medical Journal? You can publish the surgical records in an Austrian medical journal."
Kawei shook his head: "Let's take a look at today's regular meeting. I'm afraid it will attract a lot of criticism."
"Alas, they are a bunch of old stubborns." Waterman had no choice but to say with a wry smile, "Are you interested in his carbolic acid? It's much cheaper than your alcohol."
"Carbolic acid is indeed much cheaper." Kaweixian affirmed Lister's disinfection method, but immediately changed the topic and said, "But I think carbolic acid still has many hidden dangers. There are many reports claiming that it is toxic. If Long-term clinical use requires switching to safer disinfectants.”
"It's hard to find replacements."
"Oh, I already have an idea, which is one of the reasons why I wrote this letter."
