Hospital rounds have been around since ancient times.
To put it simply, when a doctor wants to understand the patient's current condition and changes after taking medication, he needs to repeatedly check the patient's physical condition, which is called ward rounds.
But this was limited to internal medicine. In the 19th century when disinfection measures were just emerging, surgical ward rounds mostly allowed doctors to see clearly the results of their operations, that is, the patient's life or death.
Of course, internal medicine is not much better. The only difference is that internal medicine will rack its brains to come up with new treatment methods, while surgery can only watch quietly as the ulceration of the incision after surgery slowly affects the patient's body until he eventually dies.
The end result is the same, the patient dies, but in the eyes of the patient, the physician repeatedly changes the treatment method, obviously trying his best, but the surgery can't do anything, it should be just something wrong with the operation.
Patient responses and outcomes also feed back to doctors, changing their treatment style. Eventually it will turn into a very embarrassing pattern. Surgery no longer performed operations or rarely performed operations, while internal medicine raised the banner of bloodletting. Although this situation has eased in the mid-19th century, it is still the mainstream in military hospitals.
To this day, Prussian military doctors still maintain relatively traditional practices. If it can be bandaged, bandage it; if it cannot be bandaged, then choose surgery. The mode of surgery is still to cut out wounds that cannot heal, that is, amputation.
As for the ward rounds that Kawei has always emphasized, they are doing them twice a day, at 9 a.m. and 11 p.m.
This was a rule set by the British during the Napoleonic Wars, which also included that one head nurse and six nurses must be provided for every 100 hospital beds. It was still illegal to employ women at the time, but many soldiers' wives were still included in the military medical care team.
Prussia perfectly inherited this rule and also learned some lessons from the Crimean War.
Unfortunately, lessons learned have not fundamentally changed the rules of the game for military doctors. Postoperative care requires not only knowledge and experience, but also the most fundamental infrastructure construction.
"550 people have died since the 26th." A head of the Prussian military medical department was reporting the military medical logistics work in the past few days to Lieutenant General Gustav stationed in Granseny. "The shipment arrived on the first day. More than 300 wounded soldiers died here, and through the subsequent work of our military doctors, the daily death toll was controlled to less than 100."
"Fries, you did a good job. Not only did you complete your work well, but you also showed excellent commanding skills." Gustav looked at the report delivered to him and did not show surprise. "Actually, There is no need to make such a fuss if there are no immortals in a war."
"But the mortality rate is over 45%."
"Well, by the way, have all the bodies been buried? I don't want a plague to appear in Glenseni."
"It's all buried."
"You did a really good job, you tried your best."
In Gustav's eyes, as long as he can treat the wounded soldiers, give them comfort, and bury the bodies well, 90% of the work of a military doctor has been completed. The remaining work is not of much help to the war, and he doesn't understand it, so there is no need to report it to him.
However, the head of the military medical department named Fries is not here to take credit: "I hope to improve the environment of the hospital wards, and at least expand some rooms. It has been raining lightly these days. If the war continues If we go down, many wounded soldiers will have no place to stay.”
"Those residential buildings can be requisitioned," Gustav said. "Hospitals in the suburbs can also be used temporarily. This is not difficult."
Fleiss nodded and quickly got the military order from the lieutenant general: "There is one more thing."
"Speaking."
"The hospital can be expanded, but the number of doctors is fixed. It would be inappropriate to send all injured soldiers to the rear."
Fleiss also had a registration book in his hand, which contained a bunch of information related to wounded soldiers: "Some soldiers' injuries do not need to be sent here at all, they can be taken care of on their own on the front line. And some of them are not necessary even if they are sent here." It’s meaningless. I just got a simple bandage when I came here, but died within two days. It’s not as good as that.”
"Why not?" Gustave smiled, stood up and picked up a cigar from the table, "Why not put it on the front line and wait to die?"
Fleiss gritted his teeth and admitted: "In order for this hospital to operate normally, this is unavoidable. As you just said, there will definitely be casualties. We military doctors can only do our best to ensure that all soldiers are treated as quickly as possible. Get treatment instead of coming here and lining up to die.”
[Innocent]
Gustave muttered something in a low voice, without saying anything clearly, but asked: "How are the working conditions of the military doctors now?"
"Work 10 hours a day." This is also a question that Fleiss wanted to raise. He wanted to report it last, but he never thought that the other party would bring it up first. "Take me as an example. I get up at 7 o'clock in the morning and may have to work until You can’t rest until 9pm. All the doctors and nurses here have a workload beyond normal and everyone is very tired.”
"Since there are so many wounded soldiers, you might as well work for two more hours."
Fleiss didn't understand what he meant: "What did you say?"
"Since there are more wounded soldiers, doctors will naturally have to work more." Gustav used the simplest example, "Just like the current frontline battlefield, if Austria increases its troops, then we will have to continue to increase our troops. OK."
"If that's the case, then it should be the doctors who should be added."
"It can't be done." Gustav suddenly paused for a moment. "Maybe you can go to the surrounding countryside to find some amputee surgeons."
"No, those crappy surgeons can't do the surgery at all!"
"So I'm right, you can handle it by increasing your working hours."
Fleiss collapsed: "If we increase the working hours any more, we will all be exhausted."
"You see, you also know that this is not appropriate." Gustave smiled, leaned back on the chair, and said, "The firearms on the modern battlefield have long been beyond the capabilities of military doctors. This is what you must do after the development of the times. Face the facts. How can this be done while preserving all soldiers without increasing the workload?"
"But."
"I know that there are indeed some problems with the transportation, but it is not a big problem." Gustav affirmed his work. "The Military Medical Department has done a good job overall. I will write down your deeds of fulfilling your duties in the letter and send it to you. Go to the staff office." [1]
"Your Excellency Lieutenant General, we should make changes. This is the current shortcoming of the Military Medical Department."
Gustav shook his head and said with a smile: "Our battle on the front line is becoming more intense, but the overall situation is in our favor, and any change will change this situation. The instructions from the staff office are very clear, contain the Austrians on the northern front , the First Army will invade Austria from the west, making it difficult for them to take care of themselves."
"But we cannot just watch our soldiers die in vain."
Gustav's face turned cold, he took off the cigar from his mouth and exhaled a pile of smoke: "You are going too far, they are defending Prussia's iron-blooded spirit!
You have to remember that the Austrian casualties were higher, and those wounded who survived the first round of fire were more seriously injured than our soldiers. Don't worry, based on my understanding of the Austrians, in a day or two they will not be able to bear the casualties and choose to retreat. "
This military doctor's opinion did hit the mark in today's Prussian military medical care, but he did not know that it was not easy to complete a transport like Kavi's.
In order to complete the batch transfer system, frontline military doctors must be raised to a very professional level, otherwise everything will be empty talk. This alone requires a lot of training of military doctors before the war begins, which Prussia today simply cannot do.
The improvement of professional level cannot be achieved by just talking. It also requires the most critical "Military Medical Manual", the gold standard of modern trauma surgery.
As for the number of medical tents, equipment and drugs required to accompany the army on the front line, it will also greatly increase the logistical burden. The matching horses and engineers to build temporary medical offices need to be calculated and further allocated.
It took Kawei four full months to barely reach this point. Prussia's changes now may really cause some unpredictable situations.
Of course, today's Austrian army is not peaceful either, and Gustav's high casualty rate is not wrong. The advanced breech-loading guns overwhelmed the Austrian army. No matter how hard the rear hospitals worked, they could not withstand the doubled number of injured.
Although the mortality rate at Olmitz Fortress Hospital was not high, the number of deaths was no less than that in Prussia because the base was too large.
After three days, the number of dead soldiers exceeded 500, allowing Kawei to witness a high turnover rate that he had never seen before: "If we put it in modern times, this turnover rate would be incredible."
"Dean, what did you just say?"
"Oh, it's nothing." Kawei took two sips of coffee, stuffed half a piece of bread into his mouth, and asked, "Are the medical records ready?"
"Everything is ready."
"Then let's go and continue with the rounds."
Generally speaking, surgical ward rounds are more concise than those of internal medicine. The focus is generally on the incision, the amount of drainage in the surgical area, the patient's basic condition, and whether there are surgical complications.
Generally speaking, if there is no problem with the first three, the operation can be regarded as basically successful. Complications are often difficult to predict, because no matter how beautiful the operation is, there is still a chance of complications.
After all, it is a manual operation, and there will always be errors that are difficult to detect with the naked eye. Coupled with the individual differences between human bodies, no one knows what will happen after the operation is completed.
Even if all the previous 100 operations were successful, as long as one operation fails, a review is needed to find out the problem. Then statistical calculations are made on the postoperative results, and finally an approximate probability of occurrence is obtained.
Perhaps the key points for preventing such complications will be discovered in a few years, but doctors cannot eliminate the chance of a certain surgical complication to zero.
Due to the risks of the surgery itself and the existence of complications, postoperative ward rounds and medical history recording have become the last resort to ensure that the surgery is safe. This is the product of hundreds of years of doctors' experience. If I really had to choose a typical example, it would be Ronagne who was still lying in the ward without opening her eyes.
If it were a modern surgery, Ronagne's situation would be that of an extremely critical patient who should be placed in the ICU for close observation after surgery.
Expert consultation may have been done before the operation, and the focus should be on the scope of debridement and how to deal with bleeding. After surgery, you have to face stubborn cerebral edema, as well as a scalp that cannot completely cover the brain tissue and a cracked skull. Perhaps only through in-house consultation can you find the best postoperative recovery plan.
But in the 19th century, it was already a miracle that Ronane could make it off the operating table alive.
"Two nurses, thank you for your hard work. You keep holding the air bag." Kawei did not have a simple ventilator in his hand. Faced with a patient whose brain stem was squeezed, his breathing was very unstable and he could only rely on his hands to hold the air bag to supply oxygen. "Has the shift changed? ?”
"It's almost there, there are still two hours." The nurse was really tired after pinching the air bag all night.
Kawei sighed and asked: "How is his drainage now?"
"Still a lot, bloody."
"Where's the body temperature?"
"38.4℃."
"Continue to use the medicine, and measure the cerebrospinal fluid pressure again at night. You continue to observe, especially the changes in blood pressure." Kawei looked at the gauze covering Ronagne's head. "After the cerebral edema subsides, do a simple scalp scalp surgery." Stitches, and hopefully the infection will be better by then.”
After the cranial debridement, he had been in a coma. If there had been no postoperative follow-up, he would have died of severe cerebral edema caused by the surgical debridement last night.
"Let's look at the next one." Carvey turned back to look at Rogerini, who was sleeping on the other side of the bed, and asked, "Are you awake?"
"Yes, I'm awake." Rogelini was very weak and could only speak a few words.
"how do you feel?"
“It hurts a little but it’s okay”
Kawei nodded and asked Goram who was standing aside: "How much drainage is there under the sword process?"
Goram Hui reported: "Now 10ml."
"Not bad." Kawei wanted to step forward and take a look at the incision, but he never thought that there was a patient also wearing a hospital gown standing next to the bed. "Come on, let me go, I want to check the surgical incision."
Unexpectedly, the patient just walked a few steps in and leaned against the wall, but did not choose to leave. Kawei still retains a lot of modern concepts of doctor-patient relationship. In addition, the operation was very successful and there were no other troubles after the operation, so he was in a good mood and did not drive him away.
He briefly looked at the gauze on the incision and saw that there was not much leakage, and then asked about the vital signs, which seemed to be completely normal. Only then did Kawei remember to ask the surgeons following behind him: "Do you remember how to diagnose cardiac tamponade?"
"The heart beat is weakened, the jugular veins are dilated, and"
"There are five symptoms in total. In addition to these two, there is also a decrease in pulse pressure difference, and"
Kawei sighed: "Don't you remember?"
"I remember, but I spoke too fast and didn't remember everything."
Kawei reiterated the possible symptoms of cardiac tamponade: "The most important thing is shock. The bleeding from the heart rupture is so serious, you can't forget shock. The next step is to look at the jugular vein. Because the heart is restrained, we return The heart blood volume is reduced and the jugular veins will be distended. Secondly, during auscultation, the heart sounds will be very distant.
In addition, there is also a very fast heart rate. Rogelini's previous heart rate exceeded 140 beats/min. Finally, he was emotionally irritable and restless, which needs to be distinguished from the reaction after drinking. "
At this time, in addition to the sound of people around me writing notes quickly, someone suddenly asked: "Excuse me, do the five syndromes of Carnage have to be present at the same time to diagnose cardiac tamponade?"
Kawei was stunned. He never thought that the original Beck's triad would be changed to his name. It was just like the previous cesarean section: "Actually, there is no need to write my name on it. Just say pericardial tamponade five." Zheng is easier to remember."
"That's too long, I can't remember it."
"It would be cool to add a name, Kaspersky cesarean section, Kaspersky brain debridement, Kaspersky heart repair."
Whether it's a big cold or not, that's obviously too much. At most, it's called a big flu. I'm keeping this in mind, and I don't agree with it. I don’t know if you have ever had the flu. The illness will most likely last three days and the fever will be around 39 degrees. More than 90% of the time it will be fine. The past three days were very uncomfortable. I was cold all over, my muscles ached, I had no strength, and I couldn't eat anything except drinking water. But I got through it after a while. 10% of those who have trouble will develop pneumonia. As for the mortality rate, you can find it online. The symptoms of COVID-19 are definitely stronger than those of influenza. The reason why the physical difference is not big is because of the weakened virulence + three-shot vaccine. The trouble now is contagiousness. Any chance will turn into a huge number in front of a huge sample. I've only had the flu once so far, and it's incomparably more contagious. So, please take it seriously. Finally, here is a medication chart [Follow doctor’s advice]
(End of chapter)
