Both of Delvaux's two beds of wounded patients developed typical compartment syndrome after surgery. Once it develops to this stage, it means that the limb injury and surgery have caused muscle swelling, compressing the bones, interosseous membranes, and muscles. The septal and deep fascia jointly form the osteofascial compartment.
[1] There are blood vessels and nerves running in the osteofascial compartment. After being compressed by the swollen surrounding tissue, the blood supply will naturally be cut off. At the same time, various symptoms will occur when the nerves are compressed. The first is pain, then sensory impairment, and gradually loss of consciousness. perception.
This situation has always been the enemy of limb salvage surgery, and it is also something Kawei has emphasized in training before.
Delvo must have heard it and memorized it. He must have received a passing score in the final training test, otherwise he would not be standing here.
Some people regard the Fortress General Hospital as a starting point and a platform for learning. They stay here to better learn technology.
And some people regard it as the end point, a harbor to avoid frontline work, and stay here just to ensure their own safety.
"Even your assistant thinks there is something wrong with their calf and knows how to write something in the record book. You must not have read the medical record to say that this is common sense." Kawei asked,
"Where did you get your common sense? University of Innsbruck Medical School?"
"No!" Delvo felt uncomfortable hearing that his alma mater was being ridiculed, and quickly retorted. It's a pity that his rebuttal was very broken because his memory of theoretical knowledge was not strong: "What you mentioned... I have paid attention to this concept, but the result is not always bad."
"Aren't you talking nonsense? Soldiers don't always die of illness on the front line, so there is no need to hire military doctors and let them fend for themselves." Delvaux knew that he had made a mistake, but he still I hope to find a reason to excuse myself: "According to what I said before, when encountering such a situation, you need to make a small incision on the calf in time to reduce the pressure inside. But there were many wounds on their calf at that time. If such a small incision is made again, what will happen? No..." [To be honest, I have recently updated it, switched sources, and have many reading sounds. .yeguoyuedu is available for Android and Apple.
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"There was no need for stitches."
"Who could have foreseen this kind of thing? They behaved very normally at the end of the operation!" Kawei nodded, but did not agree with him: "Of course it is not foreseeable, but after you find that they are abnormal, It is completely possible to open the newly made incision again. I personally think that cutting a few sutures should not be difficult for a good surgeon, unless he doesn't want to cut at all, or is too lazy to cut at all." Delvaux's eyes were solemn. He stared at the medical records in front of him, not knowing how to answer.
This was his first mistake, and both soldiers lost their only remaining calf at almost the same time.
But before this loss could be realized, the two of them passed away together. Kawei then said: "It doesn't matter. We are all surgeons. No surgeon will make mistakes. As long as you know your mistakes and can correct them. However, knowing your mistakes does not change the fact that points will be deducted. 4 points will be deducted from your points."
"4 points? Shouldn't one mistake for one bed be 2 points?" Delvaux thought that he attributed the death of the wounded in the two beds to his mistake, and quickly explained: "I was in the operating room when they died unexpectedly. , did not participate in the rescue, and did not receive any notification."
"Let's not talk about this for now." Kawei still aimed at his calf.
"You failed to save their legs, so you will be deducted points. The assistant wrote these descriptive paragraphs and specifically told you that you ignored them, and you will be deducted points. So each of the two people made 2 mistakes, and 4 points will be deducted first." Delvao I am a little concerned about points. After all, low scores will bring a series of unpredictable consequences.
But if it only deducts four points, it is still within the acceptable range. Moreover, he also knew that he had no way to refute, so he could only respond: "Okay, I admit it, so it's over." After saying that, he threw down the stack of notebooks and prepared to leave.
"Don't worry, we've already come, why don't we stay a little longer." How could Kawei let him leave? He quickly asked,
"Have you forgotten how the two wounded soldiers in beds 37 and 122 died?"
"As I said just now, I was not present when the two of them fell ill and had an accident."
"You have to at least talk about the final diagnosis, right?" Delvaux looked at the short diagnosis written in red pen at the end of the medical record and said it word for word: "Brain contusion and laceration caused by craniocerebral trauma. ..."
"Do you know what it means?"
"It was probably a violent impact on the brain, which caused damage to the brain."
"Now that you know, why didn't you save me?" Delvo looked at Kawei in surprise: "I just made it so clear, I was not around when the disease started. Do you understand 'not around'???"
"But that's your patient."
"This is too overwhelming. I can't possibly leave the patients on the operating table and go back to the ward to give them the next step of treatment. Besides, how effective are these treatments?"
"You didn't understand what I meant." Kawei shook his head, very dissatisfied with this explanation.
"They are your patients. As the chief surgeon, you should be able to basically understand their physical condition. At least you know what risks there will be after the operation." Delvaux put his hands on the edge of the podium, with an inexplicable bitter smile on his face, and his face was incredulous. .
He has also participated in military doctor training and must be aware of the perioperative concept proposed by Kawei. But at that time, he didn't pay much attention to it, thinking it was just a random stunt thrown by a utopian, and no one would take it seriously.
Who would have thought that this concept has followed Kawei for more than 30 years and was written into the military medical manual by him.
Delvo didn't buy it, and wanted to use his more than ten years of work experience to try to refute Kawei: "You don't really think that the treatment after the operation can change the outcome of the operation, do you?"
"You still haven't learned to understand the concept of 'perioperative period' and the meaning of naming it." Kawei said this not only to Delvaux, but also to other doctors in the audience.
"The medical treatment performed during this period is not to patch the operation, but an important part of allowing the patient to safely pass the dangerous period after the operation." Delvao did not understand: "I don't understand, an operation is an operation. The operating table is the internist's business, what does it have to do with me?"
"You want a physician to handle your post-operative patients?" Kawei couldn't understand this time.
"Isn't it because you have done so many surgeries these days that your reaction has become sluggish?" Delvaux said confidently: "I don't accept such criticism, because this is how the professors have taught me since medical school. You If you want to blame, just blame those professors, it has nothing to do with me." Kawei sighed and did not answer immediately when faced with the candy. Instead, he quickly found a medical record at the bottom, and suddenly he was at a loss. He said: "What you said is inconsistent."
"Contradiction? Where is the contradiction?"
"You said that the patient should not be under your control after the operation is over?"
"Of course, I have to work 10 hours a day and perform as many surgeries as anyone else, so I don't have time to take care of post-surgery matters." Delvaux seemed to want to mobilize the masses and said to the audience,
"Do you think it is necessary for the patient to undergo further treatment in the ward after undergoing his own surgery?"
"Then let's take some time to take a look at this injured person." Kawei shook the medical record in his hand, and then went back and forth in it to find the numbers that each injury number should have.
"This wounded man doesn't seem to have a bed number. How strange..." Delvaux immediately realized who he was talking about: "You don't need to do this."
"No need?" Kawei gave up looking for the bed number and looked at him again.
"I think it's necessary to let everyone see how you skillfully use the concept of 'perioperative period' and then give them some clinical reference."
"He has the rank of major general!" Delvaux did not hide his desire to curry favor with the other party at all.
"The son of Count Crumb Glass."
"So only the earl's son is qualified to let you perform medical work according to the military medical manual?" Kawei didn't bother to wait for him to speak, and said first: "On the afternoon of the 26th, Major General Ma Qieyin, the earl's son, He suffered a bullet in his left leg. According to the description of the triage surgical assistant, the stretcher team that escorted him was so dedicated that if it had been any later, the blood from the wound would have dried up." Delvaux stood awkwardly in front of the podium. I can only let Kawei do his best, not knowing what to say.
“After hearing that Major General Ma Qieyin arrived at the hospital, Dr. Delvaux, an extremely outstanding representative of our surgical team, left a wounded patient who had been shot in the abdomen on the operating table, handed him over to his assistant, and then left quickly He went to the operating room." Kawei didn't know how to characterize this behavior, so he could only complain: "After all, you also have the rank of lieutenant colonel. If you really want to express yourself, you should find a lieutenant general to be high-level." Originally Kawei was unwilling to put this more private personal choice on the table of the seminar. After all, ordinary soldiers in the 19th century did not have much status at all, so it was reasonable to choose officers for treatment.
But you should at least not delay the treatment of soldiers, let alone engage in double standards.
"Just one hour after Major General Macheyin entered Olmitz, this unique and difficult debridement surgery was performed in a courtyard outside the general hospital." Kawei described,
"It was a large hospital for wealthy people, and the 'surgery' was completed very smoothly. Dr. Delvao patiently explained the matters that need to be paid attention to after the operation, and returned to the hospital again that night..."
"Okay, stop talking!"
"Since the operation was completed on the afternoon of the 26th, you have visited Major General Ma Qieyin's temporary residence six times, and each time you left a large piece of medical record text [2]." Kawei looked at the medical record and sighed,
"You are willing to spend so much time for a major general who has a slight injury to his calf, but you are not willing to spare any time for the wounded soldiers."
"I was just following orders."
"No, you are ignoring the lives of the wounded soldiers. You have to be responsible for the deaths of those two wounded soldiers."
"Don't be ridiculous, they were not in good condition when they came to the hospital. Death was already doomed."
"Oh?" Kawei pulled out another medical record,
"Then let's take a look at a lieutenant of the Dragoon Regiment in bed 321. He was also shelled and his lower limbs were injured. He also suffered a craniocerebral injury caused by a fall. The condition when it was delivered the day before yesterday was the same as that of 37 and 122, but now But he was lying peacefully on his hospital bed."
"321..." Delvaux seemed to have some impression of this patient.
"I remember his name was..."
"The name is not important." Kawei emphasized,
"Everyone only needs to know that his operation was completed by his assistant. Just because he said at the operating table, 'It's the same patient again, you should do it. I'll go find Major General Ma Qieyin.'"
"You are slandering!"
"But I have records here." Kawei smiled, flipping through the notebook in his hand, and said,
"I have to say that your assistant is very good. He has recorded almost everything that can be written in the medical record." Delvo swallowed, seeming to realize the storm he was about to face.
"Four points were deducted before. Two points will be deducted for each soldier's death. Two points will be deducted for leaving the operating table twice and giving up the operation. You have deducted a total of 8 points. Now you only have 12 points." Kawei announced that he had arrived at the fortress. The first penalty order after General Hospital,
"I am now announcing that Dr. Delvaux will be removed from the ranks of chief surgeon and demoted to surgical assistant."
"Hey, hey, hey, we don't have enough surgeons anymore, why are you downgrading me?" Delvaux gently patted the table and asked,
"You said it yourself before, the chief surgeon's downgrade must be exchanged with an assistant. Now I have 12 points, which assistant can exchange with me?"
"Let's not talk about the downgrade exchange. This is what I decided alone. I can change it however I want." Kawei looked at a young man sitting in the corner of the audience and said: "As for the exchange you mentioned I have also found an assistant for you, your former first assistant, Sarson Frayo Som. He has won praise and now has 13 points, which is more than you." I'm so busy that I don't even have time to finish this chapter, so I can only wait for the time being.
After I finish finishing the things at hand, I will start accelerating this book]
