General acute upper gastrointestinal bleeding will cause continuous loss of blood. If not treated, the patient will soon develop anemia or even hypovolemic shock. Clinically, hemostatic drugs and gastroscopy are mostly used to stop bleeding. If there is no condition for gastroscopy, only a three-lumen two-bag tube and iced saline can be used to stop bleeding. 【1】
Kawei had nothing in his hands, so he had always emphasized that this was the reason why Fernand would not survive.
However, not being able to survive does not mean that you will die immediately. As long as you find a way to delay time, there is still a chance, but the method is a little more brainless.
Since the gastrointestinal tract continues to bleed and the amount remains at a high level, and existing methods cannot stop the bleeding, the only way to make up for it is through blood transfusion. Autologous blood transfusion is definitely not realistic. After the contamination of the digestive tract, the spitted blood cannot be reinfused again, and allogeneic blood transfusion can only be used.
Allogeneic blood transfusion was not a particularly new concept in the 19th century. Many people had already tried it in order to save the lives of the wounded after severe trauma and to play a back-up role in some complex operations.
"When I was having a cesarean section, I discovered that Dr. James Brandel in the UK had tried blood transfusions for everyone as early as 50 years ago, but the success rate was relatively low," Carvey said, "But I Recently I have discovered some ways to improve the success rate.”
Without Fatolad and Ingenac, Kawi became the only doctor in the police station who could guide the treatment work.
It is obviously inappropriate and unnecessary to go to see a doctor outside at this time, because I am afraid that Kawei is the only one in Vienna who knows how to save him. Even the forensic doctor Musil is willing to believe Kawei's method: "Do we need to give him a blood transfusion?"
"That's all you can do if you want to save his life."
Most of the police officers were resistant: "Is there no other way?"
For reporters or other people, the reaction is stronger: "Yes, it is the doctor's responsibility to save people, why should we use our blood?"
"I don't agree with blood transfusion!"
In front of Kawei are all living beings, a bunch of unrelated and complex emotions, because of the strange phenomenon of unanimously opposing an extremely dissatisfying event. After all, when the proposal was made just now, like Fernan, they all agreed immediately.
Especially those reporters, the change in attitude before and after is really huge.
"I don't have time to waste time with you."
Kawei looked at the blood-collecting cup placed in front of Fernan again: "Since you are so hesitant, then let's forget it. I'm quite tired too. It's time to go back to bed after a busy day."
After saying that, he was ready to get up and walk out.
"Mr. Kawei's attitude is always so tough at times like this." Musil had stumbled on Kawei and knew that he would definitely not come back after leaving, so he stood up and came over, stopped him and said, "I still hope you can wait, at least wait for the results of those two people."
"His Majesty the King will definitely agree, but Fernan's gastrointestinal tract has been bleeding. Whether the rescue is slow or incomplete, his life may not last three days." Kawei sighed, "So I just said, if it doesn’t work, just give up, don’t force yourself.”
"Don't give up. This is actually a pretty good idea." Fernand was now locked in a single cell, lying on a small bed. "It's just a blood transfusion for me. I won't have to die in the end." …
Kawei knew that this suggestion was against common sense. Although the result was death, everyone else present had to choose a process that was more disgusting to them.
He has his own reasons for bringing it up.
The first is to solve all the troubles at once. At least this method of surgical presentation is recognized by everyone. Perhaps under his own influence, Yingnaz felt more and more that surgery should not be too performative, but when faced with this situation, he could not come up with a more appropriate solution.
In addition, demonstrating the surgery was a rare opportunity for Carvey.
After all, having so many surgeries can only prove his talent and work ability, and it will only rarely improve his status.
Many surgeries have received enthusiastic responses in the community. When Morasso and Franz heard about them, they were actually just a small surgical innovation, and their value would not be much greater than a telegraph machine.
If he could stay in Vienna forever, Kawei wouldn't care too much about status, but the next step was a battlefield with dangers everywhere, and he had to mention his identity again to ensure his basic safety.
Now that the Military Medical Department has Inspector Morasso, it seems to be much more secure, but in fact there is a hidden danger.
He doesn't understand logistics, let alone medical care, and much of the real power is still in Edinson's hands. Edinson has always regarded himself as a thorn in the side, and his evaluation is relatively objective. But when it comes time to allocate medical resources, he might make some tricks.
In fact, it's not a good thing for Morazo to enter the military medical office, because with his slightly arbitrary character, he never knows when he will rush to the front line. It's okay for him to go to the front line. I'm just afraid that he will take him with him as his personal doctor. This matter will be serious.
Kawei has skills in his hands, but he is still a general surgeon. Although he is not sent to the front line as a stretcher bearer, it is disgusting enough to be sent to be an accompanying doctor at the regimental and battalion level.
The situation on the battlefield changes rapidly, and these entourages are not only tired, but also dangerous.
There are definitely not enough key medical supplies. The frontline troops only have the most rudimentary surgical stress tools. Maybe they have to bring their own scalpels and pliers.
That's why he took care of the old marshal's lumbar disc herniation and Justina's breast cancer removal, in order to stay in a large hospital behind the battlefield. It didn't matter to him whether he was a high-level person, but at least he had to be like Hills and not be someone else's outcast.
According to the original plan, the successful completion of Justina's breast cancer removal has actually pushed Kawei to a very high position, basically squeezed into the first echelon of Vienna's surgical department where Yingenatz is located.
But now it seems that some levels cannot be obtained by surgery alone. This surgery alone is not enough. There is a considerable gap between the chief surgeon and the first assistant.
Although he provided the surgical technique, in the eyes of outsiders, it was Waterman who was doing the surgery after all, and in the end most of the credit was given to Waterman. Of course, Kawei also received praise, but the money had no other meaning to him except to increase funds for some research experiments.
Looking at the past two months before the war, the only one who could truly be called a celebrity among Kavi's surgeries was Marshal Ludwig. …
At first, he had the gimmick of performing surgery on the marshal to enhance his status, but now it seems that this may not have much effect. Because this will not bring benefits to Franz, and even because of the marshal's illness and his own surgery, the supreme commander of the Austrian army is likely to be replaced.
It's already good enough that Franz doesn't resent himself.
So rather than saying this is a show, Kawei prefers to call it a stage set for the French ambassador. Who makes Franz value the French more.
Of course, in addition to this, Kawei also hopes to use this absurd open-air surgery to experiment with the effects of new drugs and the feasibility of upper gastrointestinal bleeding surgery. In an era where alcoholic cirrhosis, liver cancer, gastric ulcer, gastric cancer and esophageal cancer are all highly prevalent, acute hemorrhage does require a treatment plan that is in line with the current era.
It has to be said that in an era when information transmission is extremely expensive, although this method of presentation violates the principle of surgical sterility and infringes on personal privacy, it does have its merits.
"Who told Fernand to die?" Kawei warned. "You nodded to my suggestion just now and said yes there. Why is there no sound now? If time goes on, by then the advertisements for open-air surgery will spread. , people are gone, but it’s not good for anyone.”
"Just to draw some blood." Musil took off his shirt and rolled up his shirt sleeves, "How much do you want to draw?"
"Don't worry, just a few drops of blood are enough for the first step." Kawei took the blood cup, which contained two mouthfuls of blood that Fernand had just vomited out. "Here are the droppers and test tubes. What?"
"Here they are. As you requested, there are 11 pipes here."
"Okay." Kawei glanced at the policemen in front of him, "Come on, there is a knife next to it. I have sterilized it. Just put two drops into it from a tube for each person."
Everyone is resistant to blood transfusions, but they can still do it with just a few drops of blood. A few minutes later, the tubes dripping with blood were labeled with their names one by one, and then placed in a row in front of Kawei.
"What's next?"
"Let's see if your blood and this prisoner's can coexist."
The blood in the blood-collecting cup has begun to coagulate, and the cellular components inside have begun to sink, while a layer of clear yellow liquid has precipitated on the surface. Modern people all know that it is serum, but in the 19th century there was insufficient understanding of blood components. Even if they knew that such a thing existed, it was difficult to think of its role.
Kawei used a dropper to absorb this layer of serum and conducted a blood type matching experiment on the blood samples of the 21 people in front of him.
"There are different types of blood, and different bloods are mutually exclusive." Kawei said as he dripped serum into these test tubes. "Whether blood can be transfused is entirely God's will."
Once you put a religious cloak on something, you can always get twice the result with half the effort.
In fact, after Kawei introduced this theory, no one stood up to question the credibility of the experiment. They all watched the changes in the test tube, hoping to see some revelation from God.
The experiment is not very rigorous because no anticoagulant was used, so the results will be different.
Fortunately, the blood coagulation reaction was sensitive enough, and the 11 test tubes showed changes quickly after Fernand's serum was dripped into them. …
The blood in 7 of them only became a little pale, and there was no agglutination reaction after the shock, while cotton-like precipitates quickly appeared in the remaining 14: "What a coincidence, the two detectives and Teacher Musil are both Same blood type."
Blood type was a new word to them, but now was not the time to think about that.
“Why us???”
"It's unbelievable! My blood actually coexists perfectly with the prisoner's blood?"
"How much blood do I need?"
"Let's try transfusing 200ml first, but there are still a lot of things missing." Kawei is actually not particularly sure about blood transfusions. After all, he has encountered some dangerous blood transfusion reactions in clinical practice. Without modern medical measures, it is likely to be overturned. " Wait until my people arrive before losing."
He had to wait for Damirgaon, who lived in the Municipal General Hospital, and Savarin, who lived in the laboratory of the medical school.
In order to ensure that the blood transfusion can be completed smoothly, in addition to needles and infusion hoses, a certain amount of anticoagulants and emergency drugs are also required.
The former can help him bring these infusion tools, and the latter can provide him with the finished adrenal gland extract. Because the adrenal gland is very small and is not divided into cortex and medulla during extraction, it contains not only norepinephrine and epinephrine from the medulla, but also glucose and mineralocorticoids from the cortex.
Of course, in addition to these, there are dozens of other substances.
If something goes wrong with the transfusion, Kawi will have to rely on them.
Early the next morning.
Various newspapers published reports about the mysterious disappearance of many people in Vienna, describing Fernand's figure, appearance and experience in large sections. In addition, a part of the crime story was also written, but most of the latter was compiled by reporters. 【2】
Kawei's blood type matching experiments were also mentioned by them, but the theoretical basis of these experiments was not what he said was God's revelation, but the antigen-antibody reaction between blood types.
What really made the headlines was the introduction to Fernand's execution.
It was not an ordinary hanging, beheading or other punishment, but an extremely dangerous operation.
As soon as this news came out, whether it was ordinary citizens, fellow surgeons, or people who had interacted with victims and prisoners, they were all deeply attracted by it. The once closed surgical theater was transformed into a surgical square, and the excitement increased more than ten times.
And the most important thing is that people who could not afford to pay can come and watch it live.
Those who have put a lot of effort into this surgery have come up with a price that almost everyone can accept, and have found a good place to spend the money:
"Each spectator only needs to pay 1 crown to occupy a good seat in the decorated surgical square. The money will be used for Vienna's municipal management and military construction. It doesn't matter if you don't have money, St. Michael's Main Square It can accommodate nearly a thousand people, and everyone can watch this grand event from the outside.”
