The method Kawei used was not the first. Doctors had used intravenous infusion to correct the fluid imbalance in cholera patients more than 30 years ago. 【1】
At that time, ordinary salt water was used. Although simple NaCl solution would produce "hyperchloremia due to excessive chloride ions" and "still cannot correct hypokalemia caused by severe diarrhea", it could be directly injected into the vein to provide sufficient Aqueous solutions can at least prevent death by dehydration. 【2】
In the days before antibiotics, cholera mortality was very high, and infusions gave people hope.
It is a pity that this infusion method has not become popular, because in addition to dealing with severe dehydration, blood has always been an annoying thing in daily medical work. Replenishing fluids is the opposite of bleeding and is a tedious process that is quickly forgotten.
Kawei used the infusion method used during cholera in ancient times, and the liquid he produced was a super low-preparation version similar to modern balanced fluid. 【3】
Hemorrhagic shock trifecta: hypothermia, coagulopathy, and acidosis.
There is no way to solve coagulation, because it is a constantly changing thing that needs to be monitored. At the same time, there are no corresponding drugs, so you can only rely on luck. But low temperature and acidosis are not difficult to solve. It can be solved by boiling water to increase the temperature, and then adding a small amount of sodium bicarbonate to increase the alkalinity.
What really made him feel awkward was the injection method of rehydration.
Modern infusion bags + leather straps are used to inject liquids into blood vessels by atmospheric pressure and gravity. Kawei didn't have such a thing, and the only thing he could use was a syringe, so he could only rely on the syringe to slowly inject it into Orji's body.
Although the speed is not slower than the infusion pimp, it is really labor-intensive. Moreover, the four of them are not skilled in the use of syringes, and it is easy to make mistakes when changing syringes.
Nurses don't look like nurses, doctors don't look like doctors, and their hands are clumsier than those of undergraduate interns.
It's so messy...
Kawei stood aside, with the left outer lobe of the liver in his hand reaching the final stage of dissociation. He had been distracted by Orgi's heart rate and blood loss. Now looking at the busy rehydration scene, he could only think of new ways to replenish fluids: "You only have this kind of syringe here?"
"Yes, it's only 1ml."
As an emergency surgical doctor, Kawei has a strong ability to respond on the spot.
What he has to do now is to pump all the water into his blood vessels. Changing the syringe back and forth can indeed accomplish the goal, but the reality is much worse than he imagined. Moreover, problems such as "blood reflux" and "air entering the syringe" may occur when switching back and forth [4]. Kawei must find another way: "If there is no syringe, there must be an enema machine."
Nurse A: "Enema device? Yes!!!"
Nurse D: “There are a lot of them in the ward, I’m going to get them now.”
At this time, Lockard put down the syringe, walked to the desk, and opened a drawer in the corner: "Here is the enema device used by Teacher Orji himself."
"Find all the enema machines you can find and rinse them clean." Kawei no longer cared about whether they were clean or not, and said directly, "First compare whether they can be inserted into the syringe, and then find the most suitable one to fill it up. water, then wrap it tightly with a bandage to seal the interface as much as possible, and finally push the water into the blood vessel..."
Once the matter has been explained to this point, if you can't understand it anymore, it's just a matter of IQ.
What Kawei wants is a stable channel for injecting liquid. Even if this channel is leaky, it is not clean, but now this is the only way to save Orji's life. At the same time, this nesting-doll injection method can also free up one or two hands for him. The subsequent left outer lobe incision is difficult to complete with only his own two hands.
"Where is Nurse B?" Kawei separated the root of the left hepatic vein and tied it with two sutures. The entire left outer lobe of the liver was completely freed. "Where is the iron rod I want???"
"Coming, coming~"
Hills walked to the door and looked out, and saw Nurse B, who had just run out to look for sticks, holding several iron rods in his hand, breathing heavily: "Things are coming, thick ones, thin ones, long ones." , I found all the short ones.”
"so many......"
"What to do next?"
"Pick the thinnest and shortest one." Kawei raised his head and glanced briefly, then bent over and found the scalpel in the box where the instruments were placed. "Clean one end of it, and then bake it on the stove. , tell me when it burns red."
"good."
"Dr. Kavey, Dr. Orji's heart rate has risen again, now 135..."
Nurse C finally knew the nature of her work and reported Kawei’s heart rate immediately, but the number reported was really disappointing. Kawei turned sideways and glanced at Orgi, then touched his arm with the back of his hand. His skin was clammy and his face was pale, typical of hemorrhagic shock.
However, because an abdominal opening was performed on the spot to stop the bleeding, the rescue was timely enough and the severity was not serious. At least the lips are not severely cyanotic, and there is no real lack of oxygen yet, so there is still hope.
There are rescues, but the next surgery is also full of variables. The method of removing the liver must be meticulous enough to minimize the amount of bleeding, because any bleeding will push Orgi to death.
"Here comes the enema, here comes the enema..."
Lockard yelled twice. He and two nurses brought more than ten enema tubes into the office: "Quickly try the size and find the most suitable one."
"good!"
Seeing that the rehydration solution was about to be put in place, Kawei asked Nurse B, who was baking the iron rod next to him: "How is the burning of the iron rod?"
"Not red yet."
"Bring it to me to try first."
The electric knife relies on high-frequency alternating current to produce a thermal effect to cut and electrocoagulate tissue. In fact, it uses high technology to drastically improve the medieval soldering iron hemostasis method, making its usage precise and controllable. 【5】
There are a large number of small blood vessels throughout the liver. You must face them when cutting off the liver. It is unrealistic to just rely on catgut to suture them one by one.
Every minute his abdominal cavity was open brought more danger to Orgi. The blood lost and the bacteria in the air could kill him. Kawei doesn't have much time to do sutures, not to mention the quality of the current catgut is so poor and the needles are thick. Whether it can really stop the bleeding depends on luck.
Therefore, the most direct way is to simulate the effect of electrosurgical surgery to speed up the surgery.
He carefully took the iron rod handed over by Nurse B, and under everyone's horrified eyes, gently touched the left outer lobe of the liver that was about to be cut off.
Hey~
"Kavi, what are you doing???"
Compared to a room full of doctors and nurses who are closer to those who stop bleeding with irons in the Middle Ages, Kawei, a modern person, is more familiar with this scene: "It's okay, I just make a judgment in advance. The temperature to stop bleeding must be controlled, otherwise the cross section of the liver will be easily burned, which is not conducive to healing. ."【6】
The operation before them was far beyond their imagination. The nurses were originally from the bottom of society and had not received systematic medical education. They were surprised and had nothing to say, so they could only continue to work hard.
Unlike Hills and Lockard, Carvey's approach actually embraced the medieval branding iron, completely overturning hundreds of years of medical progress.
"Are you using the soldering iron method to stop the bleeding?"
"You actually drove history in reverse? Just hit the iron... This is too scary..."
"It's a good idea to stop the bleeding. Why are you so anxious?"
The iron rod that was not completely red still left a faint scorch mark on the surface of the liver capsule. Kawei handed the stick back to the nurse: "Move the stove to my feet and insert the stick inside to burn. "
"good."
Kawei found another scalpel from the pile of instruments on the side and began to cut the left outer lobe of the liver: "Hiles held his liver in place." [7]
Hills hesitated, but looked at Orji's open belly and stood over. The medical theory he had studied for more than ten years collided fiercely with the reality that appeared before him. He did not want to believe that Kawei's approach was correct, but now no one could take over the position of chief surgeon.
And he also really wanted to see how dense liver tissue should be removed.
Kawei's next procedure was much rougher than modern left lateral lobe resection. In order to speed up the procedure, he had to treat the liver tissue on the left and right sides differently.
The scalpel starts about 2cm away from the edge of the injury, and cuts from the lower edge of the liver from bottom to top.
He needed to be as careful as possible with the right section that remained in the body. First, lightly and carefully cauterize the disconnected blood vessels and hepatic ducts to achieve temporary coagulation, and then use sutures for final ligation.
As for the discarded left outer lobe on the left side, he used a hot iron rod to perform carpet-scalding. 【8】
Scalpels, sutures, and fire sticks, along with the billowing smoke and the smell of charcoal-roasted liver, made the operation scene very exciting: "Dr. Lockard, why are you still standing there? Get the suction device. Take the cigarette away! There is smoke in front of me, what should I do?"
Although soldering iron and oil are the traditional advantages of European surgery, Lockard and Hills were both born late and did not catch up with the good times, so they have never seen such a big scene.
“This counts as surgery???”
Watching Kawei turn the precision cutting and stitching into a barbecue stall, Hills' brain couldn't help but tremble. But in fact, the cutting of the left outer lobe of the liver went very smoothly, there was not much bleeding on the left and right sides, and the section was very clean.
The crow's beak forceps, scalpel, fire stick, and suture needles lined up one after another, and took turns entering Kawei's hands, flying on the cross section of the liver.
Lockard was busy inhaling the smoke and may not have seen the specific operation carefully, but Hills stood opposite and did see it clearly. This was the first time he had truly observed Kavi's surgery up close, and the first time he had experienced Ignatz's mood.
He finally understood why his teacher was so protective of this guy and why he was indifferent to his departure. With such superb skills, not to mention Hills, not even two Ignatz could compare.
Is this the difference between ordinary people and geniuses?
Hills went from being curious to surprised to questioning, and now all she has in her heart is a deep sense of powerlessness. He was at a loss, and he didn't know how much effort it would take to catch up with this gap.
ten years?
Twenty years?
But Ignatz, who is recognized as the most powerful in Austria, probably does not have such skills. Hills thought over and over again in his mind and could not find a way to catch up with Kawei. However, after half an hour in which he was confused, the left outer lobe of the liver was finally completely removed and moved out of Orgi's abdominal cavity.
The bullet entered from the center of the upper abdomen, shattering the outer vest, and then entered Orji's body with the rags of his shirt. After penetrating the abdominal muscle, the lead bullet pierced the left outer lobe of the liver.
Fortunately, it was a pistol, and the bullet did not penetrate the liver, because behind it were the largest arteries and veins in the abdominal cavity.
Kawei tried to slowly release the blocking band on the first porta hepatis. The suture was very tight and clean, and there was no sign of bleeding. At this point, the left lateral lobectomy of the liver was basically declared successful.
"Give me sutures." Kawei removed the liver and began to suture the remaining liver on the right side. "How is your heart rate?"
"132."
"Okay, very good." Although the change in the numbers was not obvious, Kawei could feel that the rehydration was beginning to take effect. At least the shock did not worsen, and his mood immediately improved. "The next section cannot be left open like this. It will affect the healing of the liver section."
After saying that, he brought the front and back edges of the liver section together, then sewed it with a needle and thread, hiding the section inside. 【9】
If it were normal times, he would choose to let the young people around him come forward to practice at this time. But the situation is different now. Orgi does not have the support of many modern maintenance drugs and can deteriorate at any time. He glanced at Hills and chose to finish the next part of the liver suturing himself.
After the suturing is over, the next step is the finishing work after cutting the liver.
For example, use the ligament that was just separated to cover the sutured wound surface, and then use the greater omentum to wrap it twice for protection.
"Next, let's continue to do the laceration hematoma on the spleen..."
The operation has entered the final stage. The most serious liver damage has been removed, and the bleeding in the spleen is not serious. Although Orji's vital signs are still a little unstable, overall they are developing in a good direction. Kawei feels a lot more relaxed: "The liver was successfully cut, so don't keep a straight face."
"There's also a spleen."
"The spleen is in good condition." Kawei took away the gauze lining the spleen hematoma. The blood stain was not obvious. "Look, this kind of wound does not need to be cut at all, it just needs sutures. Don't always think about what's broken. Cut somewhere and see if it can be repaired. If it can’t be repaired, it’s too late to cut.”
Although the office was busy and busy, the atmosphere was still like a stagnant water.
Seeing that the two men just nodded, Kawei suddenly asked: "I'm curious, why did that person rush in and murder Dr. Orji? Did the operation fail?"
"The operation is not considered a failure, it can only be said that complications occurred." Hills explained the failure in a different way, "But the guy refused to give up. First he asked the teacher to waive his medical and surgical fees, and later he blamed the teacher for ruining the operation. He fell in love with him. You heard it at the gate just now. He is a guy with a brain problem. "
"Ruined love?" Kawei suddenly started gossiping, "Can you tell me the details?"
Hills was a little embarrassed to speak, but Lockard on the side had no worries and said directly: "The teacher told his fiancée two days ago that he will not be able to have children in his life, so his wedding was ruined."
－－－－－－Digression－－－－－
There are a lot of things to talk about in the surgery, and I was slow to write. Also, the rescue of liver and spleen rupture in reality is far from simple. Surgery is always accompanied by risks. I need to make some trade-offs in details. I can only downplay it here for the sake of plot. Go on stage...
