Everyone makes mistakes, and this is especially true for surgeons who have to make choices in every action. Even Kawei is no exception.
In order to strive for excellence, the emergency surgery department where Kawei worked previously held regular meetings every week, mainly discussing the gains and losses of emergency surgeries.
Each operation will be analyzed starting from the surgical records and discussed to the patient's postoperative complications and physical recovery. There is praise and criticism, but mostly I hope that I and my team can learn from it.
In Vienna before, he was only a surgeon who could perform surgeries at most, and did not have that much authority.
But his super surgical ability, coupled with the outbreak of the war, allowed him to regain this special "power" now.
At 7 o'clock in the morning on September 29, except for the chief surgeon who was still in the operating room, almost all the surgeons in the fortress hospital were sent into the conference room by him. It sounds like a large scale, but there are only more than 20 people who can really be targeted by him.
There is only one purpose, to review the work of the past few days by discussing cases and prepare for the upcoming war.
The meeting will focus on case discussion, mainly analyzing several wounded soldiers who are in serious condition, and will be interspersed with some educational reviews.
"At that time, I will ask some surgeons to come on stage and describe the operation process in detail." Kawei looked down at the medical records and list in his hand, with no expression on his face, and said coldly, "You don't have to worry about the subsequent wounded soldiers. treatment, because the only doctors I allow to go to the operating room are those who don’t need to go on stage.”
The first thing to discuss is Ronagne’s cranial firearm injury.
The main reason is naturally that his injury is the most troublesome in the past few days, but even if there is no Ronagne, Kawei will choose some other cranial firearm injuries as teaching examples. But doing so will lack some sense of reality, and the teaching significance and effect will be worse.
Because except for Ronane, those soldiers who could serve as examples are all dead.
Cranial firearm injuries are not uncommon on the battlefield. Bullets and shrapnel are not long-lasting. Once they hit the head, the outcome is often not good. Ronagne's ability to survive to this day is not only due to luck and his own physical fitness, but also thanks to the first debridement at the frontline rescue center and the second debridement by Kawi last night.
Since the first Ronani can survive, Kawi hopes that there will be a second and third one...
"Cranial firearm injuries are divided into three categories: scalp soft tissue contusion, extracranial penetrating injury and cranial penetrating injury." Kawei gave a brief introduction, "The first two cases are not serious and are generally minor injuries. Just simple debridement and bandaging is enough.
What I want to focus on is penetrating cranial injury, which is divided into tangential injury, blind leg injury, rebound injury and penetrating injury. Ronagne is a typical penetrating injury. "
A white cloth was pulled out from the front of the conference room, and a rough image of the injury and surgery was drawn on it, including the entrance and exit of the bullet and the broken bones.
"The bullet entered from the left forehead and exited from the top of the left temporal region, causing massive fragmentation of the lateral skull along its path."
Kawei described the general situation: "The injury was serious, and there was brain tissue spillage at the time. When encountering this kind of wounded, the army doctors, rescue center surgeons and our central hospital surgeons have to do different things. We What needs to be completed is a closed loop of treatment, and no mistakes can be made, otherwise the wounded will die at any time.
The case of Ronagne illustrates this point well.
I need to focus on praising the army doctor on the front line. This doctor played his role very well and knew what to do at this time. Seeing that there was no atmosphere in the audience, Kawei began to ask, "Do you know what he did?" "
"...Injected him with anti-hemostatic drugs?"
"It must be bandaged to stop the bleeding. When I came here, I saw several layers of bandages."
"It should be vasopressor drugs. Such patients can easily lose blood pressure and die in a short period of time. I have encountered several cases where the blood pressure could no longer be measured when they were delivered."
After listening to these answers, Kawei said: "It is true that a bandage was applied to stop the bleeding, because with such a severe craniocerebral injury, there is a lot of bleeding. Seeing the blood on the injured person's head, everyone would bandage it, but... ..”
Although the "but" is late, Kawei wants to emphasize not just bandaging to stop bleeding, but how to bandage to stop bleeding.
"So, how do you bandage and stop bleeding? Is it the same as bandaging limbs? Press the bleeding point tightly to stop bleeding?"
This is a very serious issue, because no matter how strong the surgical capabilities at the rear are, the first hurdle the wounded encounter is the frontline military doctors. If the military doctor handles this kind of wound improperly, there will be no need for follow-up treatment.
The problem stumped them.
"Generally, bleeding from craniocerebral trauma requires packing with gauze for pressure treatment." Kawei gave several examples. "In bed 65, the scalp laceration caused by shrapnel looked like only a long wound, but the amount of bleeding exceeded 500ml. .The front-line military doctor's packing was loose, so there was considerable bleeding.
But let’s look at bed 112 again. The same scalp laceration has the same length and depth as bed 65. But because the packing pressure was sufficient, the wound was basically stopped when we arrived at the hospital. The surgeon only needs to do simple suturing at this time, or even take care of other wounds first and leave them alone for the time being. "
After the audience listened, someone asked: "So Ronagne's head is bandaged very tightly?"
"But I heard that he was still bleeding when he came here. If he hadn't given more fluids, he might have died."
"That's the problem," Kawei said. "If the bandage is too loose, it will cause bleeding, but what if the bandage is too tight?"
The audience did not have basic knowledge of neurosurgery, so they completely lost their voice when they heard this: "..."
"First of all, we need to make two points clear. First, two things will inevitably happen to the brain tissue after being severely traumatized. One is swelling, and the other is bleeding." Kawei explained, "Second, the brain tissue is very tender, and any damage may Destroy its function.”
These are the two premonition conditions given. As for why these two situations occur, why the function of the brain tissue is destroyed by a slight touch, and what function is destroyed, Kawei did not give a clear reason.
What he wants to do is to let these doctors make the logical thinking response they should under the existing conditions.
"You are army doctors now, and there are wounded people like this around you. After knowing this, what should we do? How to bandage them?"
"The bandage can't be too tight...and it can't be too loose?!"
The first person to respond was Hills' assistant Golam. He gave a good answer, but he just lacked confidence in himself. Kawei nodded and affirmed his answer: "I would rather not stop the bleeding, but also ensure that the bandage is not too tight. Because bleeding can be maintained by infusion, but bandaging too tightly will further compress the swollen brain and cause brain damage." hernia!"
This was a concept that was briefly mentioned in training, and Carvey brought it up again.
"I said at the beginning that if a head injury is accompanied by severe headache and severe vomiting, it is necessary to open the skull to decompress the brain. This is also the best and most direct way to maintain stable blood pressure and breathing, no one else."
Kawei took two relevant cases from hand and continued: "During the previous training, I didn't have any examples in my hand, so you may not understand. But now, there are 122 beds that were just declared dead this morning, and yesterday morning's Bed 37, I have read the medical records, it was caused by not performing decompression surgery in time."
From the seriously injured to the fatal cases, and the cases had clear bed numbers, the atmosphere in the conference room took a turn for the worse, and even the surrounding temperature seemed to have dropped by a degree or two.
They are all more or less familiar with Kavi's current temper. After all, he is the youngest, most capable, and most powerful surgeon in Austria, so his temper is naturally not much better. But compared to the same status of Chief Surgeon Yingenatz and Director of the Military Medical Department Edinson, Carvey's approach was more ruthless.
"Dr. Delvaux."
The clear voice was like a road sign, drawing everyone's attention to the rear right side of the venue. Sitting there was a doctor who was less than 40 years old, wearing a military uniform and wearing a pair of black-rimmed glasses. He didn't seem to have much reaction to the title.
"I am."
"You are the surgeon in charge of the wounded in beds 37 and 122, right?"
"Yes." Delvaux stood up and answered very concisely.
"Please come on stage." Kawei's request was also very concise, so concise that the other party had no reaction. "Did I not explain clearly? Or do you not understand German?"
"I don't know what the point of being on stage is?" Delvaux pointed to the door, "I have nearly a hundred beds in hand, and I didn't even do the ward rounds this morning..."
"You don't usually do ward rounds, and besides, someone is already doing it now." Kawei asked an assistant to bring a small chair from the audience, took the information in his hand, and sat on it, "Don't worry, He’s not just any surgeon, he’s Mr. Ingenac, the chief surgeon.”
The chief surgeon's job is to coordinate all surgeons, rate their performance, and preside over some very difficult surgeries.
According to convention, he should appear in the rear area, such as the military medical office in Vienna, drinking tea and reading telegrams with Edinson. Or appear at the army headquarters, that is, stay with Brecht, the commander-in-chief of the Northern Front, to coordinate and direct all surgical and medical dispatching work.
But now that I am here, in addition to wanting to see how the General Hospital established by Kawei operates, I also want to give her a platform. After all, a surgeon as good as Carvey also has a weakness, which is that he is "too young."
"The chief surgeon is doing rounds... just to let me, a little surgeon, come on stage." Delvaux seemed to have heard something and took the lead in attacking, "I can't compare with this kind of human relationship. I can't compare."
"This is not something you should care about." Kawei pointed to the podium, "Please! You! Get on! The stage!"
Delvo seemed to have his own confidence and objected on the spot: "What if I say no?"
"Then you will have 20 points deducted from all your basic points, and you will immediately get on the army transport carriage and go to the front line to work as an emergency doctor." Kawei immersed himself in talking about the points system he created, "In this case, your salary will be from The price was reduced from 1 crown per day to 30 hellers per day, and you had to be with those bullets and bombs at all times.”
Points are a system similar to "reward and punishment" that Kawei came up with in order to improve their skills and postoperative management capabilities.
The chief surgeon has a basic score of 20 points, and the assistant has a basic score of 10 points. One point is deducted for each mistake made, and 3 points are awarded for each praise received. If the assistant is more advanced than the surgeon, their jobs are interchangeable.
Of course, this exchange is not mandatory and depends on the assistant’s qualifications and surgical experience.
Military doctors and frontline first aid officers do not receive this kind of treatment, but relatively, they have easier access to frontline commanders. Commanders can recommend qualified doctors to Kavi through letters of recommendation, but it all depends on luck as to how many commanders are willing to transfer outstanding doctors they think are qualified.
"Okay, okay, I'm on stage." Delvaux finally walked up to the podium, opened the familiar medical records in front of him, and said, "Both wounded soldiers fell down after being shot or blasted. He was hit hard on the head."
"Have you done the inspections in the order written in the manual?"
"Do..." Delvaux shook his head again, "Several neurological examinations need to be completed through the legs, but they have all been amputated." [I have written about this in the previous book, so I won't go into details]
"Only one leg was amputated, but the other one was saved, wasn't it?"
"After the operation, they all felt very painful in their legs and could not do any tests."
"You probably don't know that their painful leg didn't hurt at all in the end."
"It doesn't hurt anymore?"
Delvaux still followed his original work experience in Innsbruck and only presided over the operation. He did not participate in the postoperative ward rounds, so he was not clear about this matter. But since it doesn’t hurt anymore, that’s a good thing. There’s no need to keep asking: “I don’t know exactly, the assistant didn’t tell me.”
Kawei nodded, not wanting to hold him accountable for his negligence, but he didn't miss any of the questions he needed to ask: "Do you know why it doesn't hurt?"
"Why?" Delvaux smiled and looked at the surgeon, who was much younger than him. He really didn't understand why he was targeting her. "Isn't it the most basic common sense that pain after surgery should be pain-free?"
"common sense?"
Kawei read a description from the medical record, which should have been written by an assistant: "'The patient's surgery was completed, and his right leg was very painful. I could see that the whole leg became extremely pale. I was worried, and again I checked the dorsalis pedis artery pulse according to the requirements in the military medical manual, and I found that the pulse seemed to have disappeared...', you call this change in condition common sense?"
