A good surgeon is a combination of a physician and an surgeon. Without good basic skills in internal medicine, something will happen sooner or later.
Of course, the development of modern internal medicine is based on the common development of theoretically profound basic medicine and complex pharmacology and toxicology and other disciplines. In the 19th century, it was difficult to lay these foundations in a short time, so Kawei’s requirement was to be a good surgeon first. As for the internal medicine stuff, it can only be instilled in them subtly.
Because these things are difficult to understand at once, Kawei needs to use some mandatory requirements when instilling them.
For example, when using alcoholic carbolic acid, Kawei will not explain their disinfection mechanism. He can only say that the experiment is very effective. The current hydrogen peroxide and suturing methods used for debridement in the ward are the same. The standards should be established first, and the principles can only be filled in slowly.
Regarding the concept of perioperative period, Kawei will not emphasize the concept, but will only teach them a series of standards and ask them to strictly implement them. There is quite a feeling of helplessness that cannot be explained clearly when teaching children to read.
The peak period of death is the 24 hours after surgery in the perioperative period, and the first to third days after surgery are the key to determining the success of the operation.
It is impossible for Kawei to see every operation performed, and he can only complete the assessment work through the operation records they wrote and the patient's current condition.
The hospital has 1,400 beds, and with the addition of a number of temporarily added tents and other rooms outside the main building, the number of beds has reached nearly 2,000. Compared with the chaos of the Prussian Grand Seni Central Hospital, it is much more orderly here, and of course the situation of wounded soldiers is also much more serious.
Prussia's frontline battlefields were almost ungraded, and anyone could be moved to the rear.
But Austria was different. The professional evacuation system made the fortress hospital full of 2,000 seriously injured patients. This means that there are more wounded soldiers in the temporary rescue shelters on the front line, and it also verifies from the side how powerful the Prussian breech-loading percussion guns and new Krupp artillery are.
Although military commanders have been shouting to charge, since firearms began to be used instead of cold weapons on European battlefields, cuts caused by swords have basically disappeared from the sight of military doctors, and various complex firearm injuries have become mainstream.
Kawei is not a military doctor. He has only seen some firearm injuries occasionally in the past. Now the scene of the ward rounds can only be described as "spectacular."
"Bed 1, Second Lieutenant Lars of the Klavov Infantry Battalion, shotgun wound, 11 pellets in the left arm, comminuted fracture of the humerus. 2 pellets in the left abdomen, ruptured spleen."
The person who talked about the patient's condition was a 33-year-old surgeon. Although he had been working as a surgeon in his hometown in Graz, he failed Kawei's assessment. According to the assessment requirements, he could not stay in the central hospital and should become a doctor with the army. Although it was dangerous, it was at least self-defeating, but he chose to lower his status and stay here as an assistant.
"What kind of surgery was done?" Kawei looked at the wound and asked.
"The trauma to the left arm was very serious. The rescue center only performed simple debridement and bandaging. When it was delivered..." Golam was not familiar with the new word "blood supply" and it was difficult to speak. "The blood supply to the forearm was cut off when it was delivered, so Dr. Hills chose to amputate it."
"Where's the abdominal cavity?"
"Splenectomy."
Kawei looked at the rubber tube coming out of the wounded soldier's belly: "How's the input and output?"...
"How much...in and out?"
Golam didn't understand what he meant for a while, and Kawei had to explain: "The records should contain how much fluid was transfused, how much blood was produced, how much urine was excreted, and what was in the drainage tube. How much blood was produced. Aren’t military doctors trained before they join the job? Have you forgotten?”
Golam did forget, but it is not easy for a doctor in his 30s who has already formed a fixed medical philosophy to change his old habits in a short period of time.
"I'm sorry!" He quickly reported the data. "During the operation, he had an infusion of 1,000, and the bleeding exceeded 1,000. There was almost no urine on the first day. After the operation, Dr. Hills gave him another 1,000, and the next day the urine count was around 1,100. , the discharge volume of the drainage tube is 50. Today..."
"Okay, I get it."
Kawei looked at the wounded soldiers
With the surgical incision and drainage tube in hand, he smiled happily and said to Ingenac beside him: "Teacher, Hills can also perform splenectomy now."
"It's really not easy." Ingnatz also looked at the incision, "He spent a lot of time studying corpses simulating bullets."
Splenectomy can only be considered a moderate difficulty among the current Austrian surgical team, and any surgeon who can perform the surgery in the central hospital will do it. This is a basic requirement during surgical training. But the real trouble is not the splenectomy itself, but the blind cavity after the bullet is injected.
Hills strictly complied with Carvey's request, and the incision followed the bullet. While suturing, he tried to ensure the tension of the incision and at the same time, he paid attention to removing some burned and necrotic tissue.
The surgery was indeed beautifully done.
Kawei nodded: "Only 5% of the drainage tube came out today. If there is no problem tomorrow morning, the tube can be extubated."
"Okay." Goram wrote in the record book, "Two beds are also shot wounds, also from the Klavow Infantry Battalion, Second Lieutenant Feto. A total of dozens of pellets were inserted into the left and right legs, and the right leg was Three fractures, one in the left leg."
"Operation?"
"The right thigh was amputated, and the left calf was amputated." Goram glanced at the second lieutenant who was leading the charge with a gun a few days ago, and said cold numbers, "The right leg was seriously fractured, and the left calf had a chance, but ...But the blood supply was not good. A total of 24 iron pellets were removed during the operation, and some remained in the body."
Compared to Bed 1, Fito's situation was much more serious. Whether the shotguns were deflected or ricocheted, almost all of them were directed at his lower body. Most of the wounds were concentrated on his right thigh and left calf, but some went to his vagina.
"How to deal with it here?" Kawei lifted Feituo's quilt and asked.
"After cutting it open, we took out some of the projectiles." Golam answered simply, "Some of them were shot too deep, so we didn't dare to move them."
"You guys? Are you on stage too?"
"I'm Dr. Hills' first assistant."
"How's Gao Maru doing?"
"After entering the vaginal sac, we saw that the right one had been shattered, the left one was hit by two pellets, it was very swollen, and the vas deferens was broken..." Golam looked at Fei again. Tuo said helplessly, "We can only perform excision."
Kavi nodded, this was the right choice.
The shot pill has basically lost its function. There is no benefit in leaving it in, and it will only aggravate the subsequent infection. This kind of infection will not subside due to the stimulation of the projectile by the low-efficiency antibacterial drug methylene blue. In the end, repeated infections are likely to affect the whole body. ….
This is not a major third-tier city in modern first-tier cities. By then, it will be too late to think about surgical repair.
"Good job." Kawei replied, then looked at the patient, "How do you feel?"
Fito is 25 years old. He has been in the army for three years and has been in the Klavow Infantry Battalion for three years. He can be considered a veteran of the army. This battle didn't come suddenly, and it might even bring him a lot of honors, but it's a pity that this shotgun came so suddenly.
My legs are disabled, I have no pills, and now there are many wounds on my lower body that are being drained with gauze strips. I look like a disabled person.
Feituo was very depressed. Now he heard Kawei's cold question, and his mood became even worse: "I feel very bad. Without my legs and pills, what is the difference between me and a useless person? It's better to just let me die on the battlefield." Come on, this way you can also leave a good reputation on your tombstone!"
"Don't worry about your leg. I will help you get a set of prosthetic legs after you return to China." Kawei checked the wound at the amputation site. "You will definitely not be able to run by then, but with the help of crutches, you can still walk. That's right. Walk slower."
"Can prosthetics allow me to walk?"
"The Municipal General Hospital has the best prosthetic rehabilitation technology in Austria." Kawei said eloquently, "However, in the end, it still depends on your own rehabilitation situation."
This news made Feito feel a little more energetic: "What about Gaowan?"
"I really can't do anything about that thing." Kawei shook his head.
, began to walk to the next bed.
"I heard that if you use cow gao pellets to put it in, the effect might be even stronger?"
"Who did you listen to?"
"The newspapers, the famous surgeons, and that ogre Fernand."
"Sorry, I don't have the ability..."
Kawei didn't have time to talk about these topics with him now. After saying a few words, he came to the bedside of the third bed: "What's his condition?"
"It was also shotgun. A total of 13 pellets were taken out from the left shoulder and the left side of the abdomen." Gorham said, "The options were left arm amputation, splenectomy and descending colon anastomosis."
"Oh? The intestines are also broken?" Kawei finally heard about a patient worthy of analysis, but the scene of the incision he saw next made his mood hit the bottom. "Who performed this surgery? Hills?"
"It's not Dr. Hills, it's Dr. Delvaux."
Kawei didn't have much impression of this name before, but after the scene in the office just now, he had already remembered the surgeon from Innsbruck Hospital: "Is it him? Give me the surgical records."
Kawei changed his questioning attitude and took the record and read it: "Why is there no drainage tube in the abdominal cavity for such a major surgery?"
"This..." Golam was frightened by the sudden question, "Maybe it was because there were not enough tubes during the operation."
"He came to the hospital at noon on the 26th. He was only 50 minutes late for bed 1. So it's all used up?" Kawei glanced at the patients behind him. "Aren't there other patients using abdominal drainage tubes later?"
Gorram lost his voice for a moment.
Because the earl's son was given priority to treat a minor calf injury, Kawei remembered the name, so the requirements became particularly strict: "The operation record did not include the amount of blood loss, nor did it include the exploration process... ..Look at this incision!”….
After speaking, he put the cold back of his hand on the forehead of the wounded soldier: "Where is the temperature record?"
"I measured it this morning and it was around 38 degrees."
"Why is there no temperature record sheet in the medical record?"
"In the morning...a large number of wounded soldiers came in this morning. We are too busy."
Kawei sighed, lowered his head and removed the gauze from the wound, and then gently pressed the surrounding skin with his fingers, causing the soldier a moment of pain: "What he did was a colon anastomosis. I should have said that during the original training, Abdominal intestinal anastomosis must be cleaned, and it must be cleaned repeatedly before and after the anastomosis! Now the incision has begun to become infected, and there must be a problem with the intraoperative cleaning!"
Goram stood behind him, not daring to say anything.
"Did you do this surgery?"
"not me."
"Get me someone!"
"Doctor Delvaux should still be sleeping in the lounge..."
Three consecutive days of high-intensity surgery left almost all the surgeons either sleeping or resting or working hard on the operating table. Although Kawei was angry, he was still young after all, so he would not be so disrespectful to the other party: "When he wakes up, pass my message and ask him to come to the dean's office."
"OK, Got it......"
"Forget it, no need. I have a meeting tomorrow morning, so let him come to the conference room."
"oh."
Kawei looked at the incision, then looked back at Yingenatz: "Teacher, the doctors here are busy, how about you take care of it?"
Ingenac nodded: "Anyway, I, the chief surgeon, am here to help. The operation is not difficult. Just re-open and rinse thoroughly."
"We still have to see how well his anastomosis is done," Kawei said. "A doctor who is so careless may have problems with the suturing. If there is a break or necrosis in the intestinal segment, then... ...."
"Cut it off and make an anastomosis."
"Yes, also pay attention to whether there are other abscess cavities around it."
"I understand this."
Just when Ingnatz was about to appoint this assistant next to him as his first aid
At that time, suddenly a familiar voice came from the door: "I heard that Kawei is coming? Where is he???"
"Mr. Billroth?"
Kawei put down the record book in his hand and walked to the door. What he saw was Bill Rotter who had just come off the operating table. At this time, he was still wearing the leather skirt from the operating room, and the gloves on his hands had been taken off, but mottled blood stains could still be seen from the cuffs: "What are you..."
"It'll be good if you come back. Come with me quickly to see that wounded soldier, he's dying!"
"Another multiple bullet wound?"
There are indeed many differences of opinion between Kawei and Billrot, but he still chooses to call each other "teacher". This is directly related to Bill Roth's reputation as the father of general surgery. Facts have also proved that after training at the Military Medical Department, it was Bill Roth who had a strong foundation in abdominal anatomy that reassured Carvey the most.
Since it is difficult for even him to deal with it, it shows that the situation of wounded soldiers is very complicated.
"It's not a shotgun, it's a bullet, just one."
"One?"
Billroth pointed to his head: "It was really bad luck that I hit him on the head."
West wind
