Medical puncture technology has appeared very early, and the instruments used are similar. However, the puncture in the 19th century and the puncture in modern medicine have completely different purposes and effects.
The former is a helpless move that cannot be handled by surgery, and blind punctures that cannot be seen directly are used, often without success, and may even cause iatrogenic secondary injuries due to needle tip penetration.
The latter is different. With perfect imaging positioning, puncture has become the best way for invasive diagnosis because of its small damage, simple operation and short time.
And for those who drain the accumulated fluid in the body, puncture can also play its role well. Even without the aid of imaging, modern medical blind puncture becomes much safer due to the operator's solid anatomical knowledge.
Lucius's puncture was indeed a helpless move at the time, because the injured person's injury was in such a critical position that there was no room for treatment.
Seeing that his respiratory rate dropped and the blood transfusion was not effective, his first reaction was that there was active bleeding in his lungs.
The chest cavity where the lungs are located is a closed cavity because the pressure provided by the closed cavity is needed to regulate the contraction and expansion of the lungs.
The pressure during thoracic blood vessel bleeding can easily exceed the pressure of the lungs to expand. When the blood begins to squeeze the expansion space of the lungs, breathing naturally becomes difficult.
Lucius's judgment lies in this. Since the blood is squeezing the lungs and surgery cannot open the heart, using a puncture needle to remove the blood must be a good way.
【1】
"I chose the bottom of the lung, which is between the seventh and eighth ribs, for puncture." Lucius said as he passed by.
"The result of the puncture was pretty good. A lot of blood flowed out, and the wounded man's breathing recovered quickly. But..."
"It's just that he was injured too badly and died soon after." Kawei suddenly asked,
"Do you know the cause of death?" Lucius shook his head: "This needs to be confirmed after an autopsy, but we don't have time to do this now. In order to free up space in the ward, the dead wounded soldiers will be moved out as soon as possible. Buried."
"I remember that many of you entered military medicine just to dissect corpses. Why don't you do dissections now?" Kawei felt a little regretful.
"Such good material..."
"We surgeons are so busy that sometimes we don't even have to eat."
"What do you mean sometimes? I haven't had a regular meal order in the past few days, and the food that was delivered to me when I recovered was all cold."
"Me too, I don't even have time to sit down from morning to night."
"Doctor Kawei, you just arrived yesterday and don't know the situation here. That is to say, there are few carriages in the early morning. In another two or three hours, when it is close to noon, the evacuation carriages will bring batches of wounded soldiers. Basically all of us have to go into the operating room and wait." Now that Kawei started talking, the audience started to complain about their workload.
The sudden excess workload made them very uncomfortable. After all, in the original hospital, it might only take two or three days for an operation to be performed, so there was no need to work so hard.
"Be patient, the doctor reserve in the fortress hospital is much better than the battlefield central hospital in Italy on the southern front." Kavi explained,
"As for the autopsy, I personally hope you can do it. This will also increase your experience. Of course, I will not force you. If you don't have time, you can ask the assistant to do it for you." Let the assistant do it for you?
Isn’t this called forcing? There seems to be nothing wrong with this light remark. It is normal for assistants to fill the vacancies for the chores that the surgeon does not do. They have always done this.
But if you think about the situation carefully, something is wrong, because although dissection is tiring, it is not a chore. It is the main way for them to improve their surgical skills.
In these three days alone, nearly 1,000 wounded soldiers died in the fortress general hospital. If we exclude the fatal injuries on their bodies and the missing parts of their limbs, the quality of the corpses is actually not bad at all.
Those were all strong young soldiers, and they would be the source of corpses that major hospitals would rob in peacetime.
If these anatomy tasks were handed over to assistants, wouldn't their skills also be improved? The improvement of assistant skills is naturally a good thing, as it can bring a lot of convenience to surgeries, but these are extraordinary times, and the competition brought about by the points system cannot withstand such technological improvements...
"Dr. Carvey, we really don't have time."
"Yeah, I'm really exhausted at the end of the day!" Kawei just said casually. He really didn't expect this level. After listening to their incoherent complaints, he was a little confused: "Didn't I say, the assistant can do it?" Come on, I just want to know their causes of death. This is not only for the development of military medicine, but also to increase your clinical experience. Why not do it?" Some people's answers were very implicit: "Those assistants won't be there until then. Everyone went to do the autopsy, and no one cared about the surgery."
"You are absolutely right. In the final analysis, the work of the hospital is more important. We must prevent this kind of putting the cart before the horse." Some people put it very bluntly: "We are busy operating, and they are busy dissecting cadavers and adding technology?"
"Mad! I don't want to be robbed of my position as the surgeon!" When their core interests are violated, they will burst out with a more positive side.
However, at this time, after considering their workload and rest time, Kawei still pressed the pause button for them: "I didn't consider this, and the assistant was indeed a little sloppy in conducting the autopsy. The autopsy must be done. Regarding the diagnosis of the cause of death, I will discuss it with you later as to who will do it." It was rare that Kawei was willing to understand their hard work, and everyone breathed a sigh of relief.
"Okay, let's continue talking about other patients..." Just as he finished speaking, there was a knock on the door. After opening the door, a 30-year-old doctor walked in: "I'm afraid there's another patient on the front line. The fighting started, and two carloads of wounded soldiers arrived, 12 people in total."
"Lucius, Fausto, Fred, you three bring your surgical assistants to deal with it." Kawei named him, then called Lucius,
"Find Delvo to help you, keep an eye on him, and report his work attitude to me truthfully." Lucius didn't like this kind of surveillance job, but he couldn't refuse Kawei's order, so he could only nod. He responded: "Okay..." Being demoted from chief surgeon to assistant is a very frustrating thing. With Delvo's character and way of dealing with things, it is very likely that he will choose to lie down and die.
If everyone did the same thing as him, this hospital would not be able to continue to operate. Therefore, monitoring and a one-to-one assessment system are very necessary.
"I reiterate again, demotion is not only a punishment for making mistakes, but also allows the wrongdoer to re-examine the ward and wounded under his jurisdiction in a different environment. But this is based on normal work." Kawei sighed,
"If you no longer have the enthusiasm to continue working, then there is no point in staying here." The content does not seem that serious, but the environment at this time is not the hospital where they are located, but a military doctor.
If they are judged to be inactive in the Fortress General Hospital, what awaits them will not be as simple as being kicked out of the army, but a more severe punishment.
After Kawei warned everyone, he glanced at Sarson who was sitting in the front row and said: "You are also the chief surgeon now, so go ahead and find your favorite surgical assistant to go on stage with you. But now you have experience If it’s not enough, we can only do a simple amputation.”
"good!"
"Pay attention to the indications for amputation. As long as the distal limb is intact and the blood vessels are pulsating well, it is necessary to save the limb." Kawei emphasized,
"Also, pay attention to debridement!"
"I know!" The four people left the conference room. Kawei clapped his hands and drew the attention of others: "It's just a small episode. Let's continue to discuss the case."...The seminar started After half an hour, the biggest winner now is Sarsen. It is not easy to complete the class jump in three days.
For him, the job of surgeon is full of challenges, but even more exciting. Just being able to preside over an amputation operation already makes Sarson tremble with excitement. This is basically impossible at the Municipal General Hospital.
Although the main focus of surgery is amputations, the number of amputations in peacetime is not large. In addition, Yingenaz's strict order on the probation period of fresh graduates means that Sarson and the others have no chance to practice surgery. Even dissections have to be done by others. A person's face can do it.
However, the field general hospital is full of wounded soldiers like this. Of course, Kawei's attitude towards amputation is much stricter than other military doctors.
After leaving the conference room, the four of them saw the wounded being carried off the carriage one after another at the entrance of the hospital. Lucius directly became the on-site commander. He looked at the casualty list that was sent and started to assign the wounded: "Abdominal injury, unstable blood pressure, send to operating room No. 1, Fred. Come here. Chest and neck For head injuries, I'll come to the operating room No. 2. If your left arm + left shoulder has good blood pressure, send it to the operating room No. 2. Sarson, you can do the amputation first and leave the rest to me. For craniocerebral injuries and neck injuries, send him to the operating room No. 2. No., Fausto, please handle it first..." Sarson immediately got the opportunity to operate, and asked Goram, who is still working as an assistant, to be his first assistant: "Teacher Goram, please trouble you. ”
"It's okay, let's learn from each other." Golam looked calm on the surface, but he had already begun to complain in his heart.
But when he actually stepped onto the operating table and began to deal with the stump, he realized that Kawei's decision was not unreasonable.
Surgical amputation was not born to treat injuries, but to remove useless limb tissue. It is also to prevent damaged tissue from ulceration and infection. It allows the remaining healthy limbs to recover as quickly as possible by amputating irreparable parts.
Therefore, it is very important to grasp the resection site. If you cut too much, it will affect the function. If you cut too little, it will not be effective.
This was the concept originally proposed by Kawei, which made senior surgeons who were accustomed to doing one thing all very uncomfortable.
But young doctors don’t have this problem, and they are exposed to new knowledge much faster. Sarson had been exposed to it at the Municipal General Hospital a few months ago and has long lost the childishness of a fresh graduate.
His operation was completely free of the clumsiness of other new surgeons, and his experience and skills could be felt in his techniques, just like an experienced veteran who had already mastered amputation.
"Your technique is quite good." Although Goram felt uncomfortable, he was better because he had a good attitude and did not hesitate to praise him: "In Grants, young people like you don't have such delicate knife skills. , Amputations are always done in a rough way.”
"It's Dr. Kawe who taught you well." Sarson said this kind of praise without much emotion, and he didn't show much happiness on his face, but Goram knew in his heart that no surgical technique could be achieved overnight. .
"It seems that you have made enough preparations for today."
"Because the new chief surgeon must start with amputation, so after I failed the Vienna military medical examination, I kept the relevant surgical indications and operational requirements for amputation in my mind, and reviewed them when I had time." Sarson said,
"He has followed dozens of amputations in the past three days. He has seen various lengths and various removal positions."
"Dr. Kawei is diligent enough and can see people quite accurately." With a solid theoretical foundation, the surgical experience is like running into a high-speed suction tube, quickly entering Sarson's brain from the operating table.
Now he is holding a scalpel and hemostatic forceps in his hands, and he relies on feeling the muscles and blood vessels to truly transform this knowledge and experience into his own.
"33 minutes, the operation was clean and neat." Sarson didn't pay much attention to the time, but carefully looked at the suturing technique he had done.
The skin at the two incisions is neatly aligned, and the skin is wrapped very tightly. There is no exposed muscle or fat tissue. It should be able to meet Kawei's usual amputation suture requirements.
"Sure enough, it would be a good idea to learn suturing from Mr. Damirgaon..."
"Huh? What did you say?"
"Oh, it's nothing." Sarson inspected the wound, performed a simple disinfection, and prepared to find Lucius to deal with other damaged parts.
The wounded man not only had severe shrapnel cuts on his left forearm, but also suffered two bullets in his shoulder. Although gauze and bandages were used to stop the bleeding, it was up to the other surgeons to decide how to deal with it next.
"Teacher Lucius, I'm done here." Sarson turned around and looked through the messy operating room to another operating table not far away.
The wounded man with a chest injury was still lying on the operating table, and Lucius, the chief surgeon, had long disappeared.
Sarson was very surprised: "Didn't it mean that the chest wound only needs simple suturing and then conservative treatment?"
"Dr. Lucius just left," said Delvaux, who was on the same stage.
"Where did he go?"
"Going to find Kawei." Delvo was full of hostility towards Sarson, but now he was still more confused.
"This injured person has some unexpected circumstances. I'm afraid we won't be able to handle it."
