Since the last cesarean section that Kawei successfully completed, the Lakeside Theater has been preparing for the next cesarean section.
The main target of the work was Kawei, and the price and success rate of the operation became important bargaining chips in the conversation between the two parties. After several contacts, the Riverside Theater recognized Kawei's ability and promised to give him a 5% share as long as Kawei's cesarean section operation was successful.
5% is neither high nor low. After all, Kawei is too young to give too high a proportion at once.
But for Kawei, this is not a matter of more money and less money. The value of your surgery is life-related and should not be measured by money. If we really want to use money to give a definite value, then 5% is really too low. After all, this is not a modern place where even abdominal strokes are about to become an assembly line operation.
He did not get entangled with the other party. Anyway, he never signed any written agreement with the theater from beginning to end. After the cesarean section was over, Kawei would once again suggest that the hospital open its own surgical theater.
As for whether the hospital management supports Kawei or stands with the theater and maintains the status quo, it depends on the results of this operation.
The lower the success rate of a surgery, the economic value it brings once it is successful cannot be calculated by simple mathematical formulas. The ticket price already explains part of the problem. If Kawhi's surgery is ultimately successful, his value should not be a pitiful 5%.
The Lakeside Theater is no fool and has changed its mind after seeing huge revenue of tens of thousands of crowns in just a few days.
The venue of the theater cannot be changed, but the internal facilities can be updated. All the original candle lights on the wall have been replaced by wall-mounted oil lamps, and the candlesticks used to illuminate the surgeon have also been replaced by more advanced portable lamps.
The types of food sold have also changed, slowly expanding from simple snacks to staple foods such as fried bacon, roasted pork knuckle, and veal steak. The food is cut into small pieces in advance and small forks are provided, which is more user-friendly. There will naturally be no shortage of corresponding desserts, fruits, and fine wines.
This time, the theater also considered the experience of the audience in the back row, and specially set up a temporary sales point for high-power telescopes dedicated to surgical theaters at the entrance.
It's not expensive, priced at 150 kronor. If the operation is successful, you can use a telescope to ask the surgeon for his signature. 【1】
These are all changes to the audience experience. For the surgical center area, the theater has not forgotten Carvey's habits. They specially made changes to the rest area and created a space for disinfection preparation next to the tap water. Salt, baking soda, kettles and stoves are all available.
In addition, the operating table was also redone according to Kawei's wishes.
The table legs and table top are not embedded in a fixed relationship, but can be adjusted in height, making the operating table no longer a simple horizontal surface. The upper end has a movable cushion that is close to the acromion and clavicle, and the lower end can be bent downward to place the patient's legs. 【2】
These changes captured the audience's attention from the very beginning, creating the most glorious moment since the Lakeside Surgery Theater was built.
At 11 o'clock at noon, the host slowly walked into the venue in a gorgeous dress and calmed down the noise in the venue with his unique smile and posture: "Ladies and gentlemen, welcome to the most famous surgical theater in Europe. one......
...Today we have the honor to invite the youngest surgeon in Vienna, a young man who is famous in Vienna for having successfully performed several abdominal operations.
His reputation may not be comparable to that of Ignatz, or famous surgeons such as Waterman, Orgi, and Massimov, but his cesarean section is destined to bring everyone a completely different and exciting experience. "
As soon as he finished speaking, the door opened, and Kawei walked into the theater wearing his black coat.
"Good afternoon everyone, thank you all for taking the time to come and support me."
Kawei asked the assistant on the side to change into a surgical leather skirt, then stepped forward and patted the host on the shoulder, saying: "It's getting late, and everyone is an old audience, so there is no need to be polite. The assistant is still the same old person as before. Faces Hermann, Bergert, Mellen and Sarsson, let’s introduce today’s patients as quickly as possible.”
Just when Kawei got the right to speak and attracted all the attention, four assistants filed in and began to prepare the pre-operative work that had been discussed before.
The water has been boiled and disinfected in the morning, and now you only need to mention the temperature before it can be used. The ratio is still according to Kawei, 1L water + 9g salt. Sodium bicarbonate was not used this time, because the mother is usually in good health, and now she is not in shock due to blood loss, and there is no risk of acidosis.
But what he did next made many people confused.
"The person who went on stage today to undergo a cesarean section was the brave Ms. Brenda, a baker's wife. She had vaginal bleeding three weeks ago and was diagnosed by the obstetrician at Graz Hospital as having placenta previa.
The surgery was dangerous and the surgeon at Graz Hospital refused to do it.
This is normal and not something to regret, because there are not many doctors who actively choose to perform surgery knowing that it will fail.
As we all know, cesarean section surgery is a problem all over the world, and placenta previa is a big problem for cesarean section surgery. Today I will use some new equipment and new drugs to try to solve this problem. I hope that in addition to bringing you a visual experience, it can also pave the way for future cesarean sections. "
Brenda sat quietly in a wheelchair and was pushed into the venue, but everyone's focus was not on her, but on an iron frame next to the wheelchair, or to be more precise, a full iron frame on the iron frame. Glass bottle for liquid.
The bottle passed through a long brown tube and a connector into her arm. 【3】
Kawei is no longer a surgical assistant who has only been on the job for two days. Several successful surgeries and successful speeches at regular surgical meetings have gained him a lot of popularity and prestige.
The young medical students immediately took out pens and paper, hoping to learn some new knowledge from this operation. The doctors were prepared for possible difficulties, shortcomings and causes of death during the operation, hoping to get answers during the operation.
The glass bottle and rubber tube on the wheelchair were the first answer given by Kawei.
"What is this?"
"I don't know...maybe it's another newly invented gadget from abroad."
"I see that the rubber tube was inserted into the arm. Is it to pour the medicine in the bottle into it?"
"Pour water into the blood? Is this possible?"
"Actually, it has been around for a long time. Someone did this when the cholera broke out more than 30 years ago."
Kawei cleared his throat and briefly explained the principle of the infusion set. The principle is very simple. What is really important is the purpose of the infusion, because directly injecting saline into a normal person's body would seem strange no matter what age it is.
"Caesarean section with placenta previa can lead to massive bleeding and death. I have been thinking about this question since I performed surgery for Dr. Orji for massive abdominal bleeding."
Kawei helped Brenda onto the operating table and explained: "When facing major bleeding, since we cannot change the amount of bleeding, can we rely on injecting some fluids in advance to increase the total blood volume to increase the remaining blood volume after bleeding in disguise? the goal of."
This is a long and convoluted sentence, but anyone who understands it will feel like they have opened the door to a new world and write down all their ideas in a notebook.
"I have infused 500ml of saline into Brenda's body. The concentration is 0.9%. Please remember this concentration." Kawei tapped the glass bottle on the infusion rubber tube with his finger. "I have used various The safest concentration of saline solution is infused into the blood vessels of voles and rabbits, no more or less will do."
Concentration is actually related to plasma osmotic pressure. These knowledge points will eventually be integrated into the paper and published by him, so I will skip it for now.
"0.9%, must this concentration be?"
"Please make sure to maintain this concentration." Kawei said, "This is supported by actual experimental data."
After explaining the preoperative infusion, Brenda was already lying on the brand new operating table. The clothes were lifted halfway up, revealing her round belly.
"This is my improved operating table. It no longer uses the conventional horizontal plane operation method, but uses a height-adjustable table leg combination to achieve the purpose of changing the patient's position during the operation."
Kawei said: "There are pedals at the end, and the knees can be folded to place the legs. The front end is also designed with several grooves and removable soft cushions to support the patient's shoulders according to their height and prevent them from sliding down."
If you are a rich person with no medical background, you will only think something novel when you see the improved operating table, and you may forget it after just one glance. But the surgeons who often go on stage are different. The brand-new operating table immediately caught their attention, and many sketches have already appeared in many notebooks.
After the infusion bottle, the operating table was his second answer.
While giving answers, he also continued to express his opinions. Of course, Kawei concealed many physiological and pathological concepts and put a filter of the times on these shock-related views.
"Important organs that maintain the operation of the human body are all in the abdominal cavity. After a massive hemorrhage, the organs will lose serious blood, and the human body will die. I know you must have many questions, but the reason is very simple, because people who have amputated hands and feet can still live. No more People with internal organs will definitely not survive.”
Many people didn't understand the true meaning of his words. In the end, Ignatz and Waterman in the stands realized the key.
"No wonder you want to use such an operating table to change the place where blood flow gathers by changing your body position!"
"Nowadays, the head-down position is used. Due to gravity, the blood is hidden in the blood vessels of the lower limbs. When the bleeding is serious, it is changed to the head-down position, so that the blood stored in the lower limbs will flow into the trunk to protect the body. ...It’s wonderful!”【4】
Just when everyone wants to block blood vessels to reduce intraoperative blood loss, no one has ever thought of relying on changes in body position to reduce the changes in physical signs caused by massive blood loss.
Two answers in a row inspired many people and gave them a lot of confidence in the surgery: "This may really be able to deal with bleeding from placenta previa."
But there are still many people who maintain their due objectivity and do not think that these small tricks can change the results of the surgery: "I still hold a conservative attitude. Placenta previa often causes thousands of milliliters of blood loss, which cannot be corrected by a simple 500ml rehydration." .”
"Don't forget the oxytocin you used last time. The contractions are very effective in stopping bleeding."
"That's only for ordinary cesarean section. If you really encounter an 'exaggerated' placenta previa, things are not that simple."
...
Very few women survived cesarean section in the 19th century, and placenta previa was simply placenta previa and would not develop into the dangerous placenta previa that is only seen in modern times [5]. Brenda is a multiparous woman, but she has had normal births before, so there is no possibility of dangerous placenta previa, so this operation should be less difficult in terms of difficulty.
However, due to the limitations of the times, Kawei lacked many supportive drugs for mothers, and general anesthesia such as ether was also a risk factor for children, so he did not dare to take it lightly.
The preparation work is still done according to the set rules. After the abdominal disinfection is completed, the inhalation anesthesia takes effect and the operation officially begins.
"Sarson first prepared the oxytocin injection, and Meren prepared 30°C warm salt water, a suction device, and a clean water basin." Kawei pointed to an area with his toes, "Put the water basin and suction device at my feet. Come on, cut open the uterus and come here to draw blood.”
"okay, I get it."
Hermann had previous experience as an assistant in cesarean section, and this time he stood as the first assistant, while Bergt served as the second assistant, mainly responsible for retracting the hook and maintaining lighting and vision.
"The baby will be taken out within 2 minutes and the bleeding will be controlled within 5 minutes. I hope it will be successful."
"The circuit breaker is ready."
"let's start."
After saying this, the scalpel has cut through the skin and fat according to the incision position of classical cesarean section. After further separating the muscle fascia and opening the peritoneum, it only took Kawi a minute to enter Brenda's abdominal cavity.
No need to look for it, the enlarged uterus is just below the incision.
The people on the stage could not help but secretly applaud the speed of the operation, because in addition to the speed, Kawei also minimized the bleeding at the incision, and the entire surgical area could be described as clean.
But just when everyone thought the operation was about to get down to business, Kawei stopped holding the knife in his hand. In front of him was a patch of purple-red swollen blood vessels like earthworms, twisting and crawling on the uterus. This was no ordinary placenta previa.
Kawei sighed and reported the operation process to the audience on the stage: "I have entered Ms. Brenda's abdominal cavity. You can see that this is her uterus, and the placenta should be in the front. But the placenta's condition is not the same. No, these wantonly growing blood vessels are digging deeply into the myometrium...it’s a bit troublesome.”
What he is facing now is not just the problem of placenta previa. The real trouble is these blood vessels. Modern medicine has a term for it: placenta accreta.
It seemed that the third answer had to be moved: "Sarson, bring me my medicine box."
"The one who puts the oxytocin in?"
"Yes, there is a small bottle in the corner." Kawei looked at the implanted placenta, frowning, "Mellen, prepare gauze, fold every eight pieces together, prepare a few more, I will use it later. "
