In the case of limited medicines and equipment, there will definitely be a sequence in the treatment of wounded soldiers. Usually, we try to stabilize the situation that is slightly better, and then try our best to rescue the situation that is in bad condition.
The vital signs of the wounded soldier who had just been sent to the operating room were unstable, with low blood pressure and high heart rate, and he was already in hemorrhagic shock. If you don’t perform surgery to stop the bleeding, suture the blood vessels, or directly choose amputation, you will definitely die in the church in the end.
In comparison, the lieutenant deputy company commander named Opper seemed to be much more relaxed.
It can be seen from Mendelstein's dictation that he was accidentally hit in the face by a stone. According to this logical line of reasoning, the injury is a one-time event, with at most a single fracture and skin and muscle cuts, which are generally not serious.
But when Opal was carried into the church, Kawei realized that he had been deceived.
Whether in the 21st century or the 19th century, the rhetoric of "family members" is certainly important, but you still need to maintain a certain degree of vigilance when obtaining this information.
"It was hit too hard!" Kawei blurted out, but immediately realized that this was not a good topic, and quickly returned to the wounded person himself, "It looks like he was hit seven or eight times, including his nose, left ear, and left eye. , the lips are all lacerated, and the mandible is broken..."
The content of his soliloquy was simple, but being able to say it out loud already represented its seriousness.
The bridge of Opal's nose collapsed again, and blood is still oozing from her left nostril. The area around the left eye orbit was bruised and swollen. With breathing, the cracked skin under the orbit continued to flutter. The dents made by stones could also be seen in the outer canthus (outer corner) of the left eye. The skin lacerations were deep enough to reach the internal blood vessels. Active bleeding was seen.
In addition, the upper part of the left auricle was broken again, the skin of the upper and lower lips was lacerated in several places, and the upper and lower jaw bones were obviously broken.
With such serious maxillofacial trauma, the first thing that needs attention is not the amount of bleeding, but the consciousness of the injured person and some more unexpected things.
Consciousness represents the possible damage to the brain. In the absence of imaging examinations, a rough judgment can be made by simply asking, looking at the pupil and doing some pathological reflex physical examinations. The judgment may not be 100% accurate, but Duoduo can see some problems.
"May I have your name?"
Seeing that it was a doctor, Opal quickly moved his lips, but unfortunately the pain and some invisible factors prevented him from speaking properly.
"Does your head hurt?" Kawei just finished asking and then added, "It's not the pain from the wound, it's from the inside of the head."
Opal shook her head slightly.
"Are you dizzy? Vomiting?"
Opal still shook his head.
Kawei asked while looking at Tong Kong, then at his broken upper and lower jaw bones, and immediately realized a very bad situation: "Do you feel out of breath?"
Opal's breathing could not be called rapid, but the frequency was faster than usual, from about 20 times to 25 times per minute. Even he himself did not realize that he was feeling any discomfort.
After all, lying down for a long time in the resting state does not require much oxygen.
Opal shook her head at first, but after taking a few conscious breaths, she changed her head to a nod: "Yes... a little."
Kavi knew that his injury was beginning to worsen, so he turned around and found Damirgan, who was still doing "examination and treatment" for the original patients: "Damir, come here with my equipment box."
"good."
Mendelstein had never seen this kind of consultation method that could predict symptoms. He always felt that the young man in front of him was very different from the surgeons he was familiar with: "Dr. Carvey, what is Opal's condition now? Why is he wheezing?" Not angry? I think he's pretty good."
"The airway is blocked." Kawei directly explained the reason. "The damage will not only cause bleeding on the surface, but also bleeding inside the mouth. Look at the upper and lower jaw bones. If the bones are broken, the tongue will not be supported without support. Falling backward into the airway, coupled with the internal flow of blood, causing blood clots to accumulate..."
Mendelstein seemed to be listening to a book from heaven, and Kawei stopped talking and said, "I have to cut open his trachea."
"Cut the trachea?" This sounded very painful. Mendelstein looked at his comrades and continued to ask, "Where to cut?"
"Here." Kawei pointed to his neck, "a small incision, and then insert a tube, the breathing will be improved."
Kawei's preventive tracheostomy is definitely the product of a large amount of experience in emergency surgery, and it belongs to a branch of otolaryngology.
Let alone these surgeons today, even in modern times, surgeons who are not usually exposed to ear, nose and throat injuries will not make the judgment of tracheotomy at this stage if they do not have several years of experience in emergency surgery.
Mendelstein has nothing to rely on now and is willing to trust the doctor's judgment, but his preconceived ideas still build an invisible wall in front of "belief".
Opal's face was smashed by the soldiers of the sniper team. No matter whether these people were Italians or Austrians, he could not completely trust the other party. He would also silently doubt in his heart whether the other party was deliberately retaliating: "I think he My breathing is fine, why do I need this kind of surgical operation?”
"He himself admitted that he had trouble breathing."
Kawei got the equipment box and followed his usual work habits, ignoring Mendelstein's advice: "The congestion is starting to block his throat. He needs a tracheotomy immediately."
"Aren't you going to do intubation?" Damir was also sincere and directly asked a question that shouldn't be asked at this time.
Kawei turned and glared at him, and quickly explained: "Intubation requires raising the head and opening the mouth. His upper and lower jaw bones are broken, his tongue has fallen back, and there is blood in his mouth. There is no way to intubate."
Damirgan immediately realized that he had said the wrong thing and nodded repeatedly: "So that's it, I learned it."
After finishing this, Kawei looked at Mendelstein again, and started to use some slightly "threatening" words according to the method of dealing with family members: "Maxillofacial injuries are not uncommon. I have personally seen that someone suddenly died three hours after being hit." A patient who had difficulty breathing. He died in less than an hour because the doctor who didn't see him didn't perform a tracheotomy in time."
Mendelstein frowned, obviously frightened.
Opal is his old comrade, and they have slowly climbed from soldiers to their current position together. Being injured already made him uncomfortable. If he lost his life, he would never accept it.
In just a moment, the Prussian captain's eyes changed in a way that is difficult for ordinary people to detect, but Kawei could still detect this change from the other party's tone and attitude: "Okay, I am willing to believe you, I will make the decision for Opal. , agreed to do the tracheotomy you just mentioned."
"Damir, give me the scalpel..."
"Don't worry yet." Mendelstein interrupted, "Before the operation, I need to make one thing clear to you."
Kavi:? ? ?
"I have no other request, I just hope you can take care of Lieutenant Opal's trauma." Mendelstein gently patted his old comrade's leg and said to Kavi as if to comfort him, "He is mine. Old comrade, I don’t want anything to happen to him.”
Kawei had to lament that in the early days of the development of modern medicine, the doctor-patient relationship was quite good.
Although the other party was a hostile officer, had a gun in his hand, and made death threats in person, compared to the various sneak attacks with knives, direct beatings, numerous court summonses, and even threats to his family that Mendelstein had encountered in the past, Mendelstein Because at least it's straightforward enough.
Kawei is like an old monk who has gone through all kinds of hardships, showing no fear of this threat: "I will try my best."
"please."
"But I can't do anesthesia." Kawei said, "The wounded soldier's condition is more serious and he can't save ether."
"It doesn't matter, just tell him it's for Opal, he can bear it..."
Seeing his comrade speaking like this, Opal raised his arm with difficulty and pulled his sleeve, then shook his head repeatedly. The shaking of his head at this time was obviously much larger than before, for fear that Mendelstein wouldn't be able to tell: "It's nothing...nothing..."
Perhaps due to the exertion of muscles and difficulty in speaking, after gaining the initiative in anesthesia, Opal's breathing rate became faster than before. Simply breathing after lying down can no longer satisfy your lungs, and you need to breathe hard.
Without him having to say anything, Kawei could also see the rise and fall of his chest and abdomen: "It must be very painful to be incised, but you still have to endure it."
Opal nodded: "Come..."
He was worthy of being a soldier fighting on the front line. The same tracheotomy showed completely opposite reactions in Laszlo and Opal. Although individuals have different feelings of pain, when the pain reaches a certain level, the difference is actually not that big.
Laszlo almost fainted from the pain, but Opal managed to withstand the cutting of the scalpel blade by relying on her tight muscles without making a sound.
"Fortunately, the neck is not injured, and the midline can still be touched." With the help of Damirgang, Kawei quickly separated the muscles and exposed the tracheal ring. He cut it off without caring about other things, "Gauze, hemostatic forceps."
As soon as he finished speaking, some bloody secretions in his trachea spurted out along with the airflow.
"Captain, don't be nervous, it's okay!" Kawei immediately stabilized Mendelstein who was standing aside and was extremely worried. He quickly used gauze to absorb the secretion in his hand, and then carefully separated it with a hemostatic forceps amid the blood red color. Incision, "Scaffold."
"Here." Damirgang watched Kawei's operation under his blind field of vision, protecting the incision with one hand and holding the tracheal cannula with the other.
Compared with the ramrod tube Yingnaz used on Laszlo's neck before, the tube in Kawi's hand has an extra silver sleeve. If Ingnatz's tube becomes clogged with secretions, it will need to be replaced with a new one because it cannot be cleaned.
But with the inner tube, cleaning will be very convenient and the pain of replacing the tube will be reduced.
Opal's situation was different from Laszlo's. It was far from the level of suffocation, but the severe pain without anesthesia still needs to be considered. Kawei's hand speed is already very fast. The incision that originally took about 15-20 minutes was completed in less than 10 minutes under his operation.
"It's okay, your breathing should be smooth now, right?"
Opal could feel that there was a foreign object stuck in his throat, and the surrounding tissue was stretched and painful. But if you put aside these, the labored breathing was indeed much better: "Well..."
"Okay, now that your breathing has stabilized, the next step is to deal with these wounds."
No X-rays were needed. Just a simple inspection of the wound revealed that Opal's nasal bones, upper and lower jaw bones were fractured, and the fractures were comminuted. What he could do to deal with these fractures was very limited. The conditions were so bad that it would be irresponsible to perform incision and reduction.
"Debridement first?"
"Well, we can only do debridement first." Kavi pointed to the two lacerations on the scalp, the laceration on the left ear and the damage around the eye socket, and said to Damirgang, "You can do debridement first and suture the loose parts. Sexually bleeding wounds.”
"good."
"Be careful to stop the bleeding and make sure it's clean."
"Ok, I know."
"The nose cannot be treated in the first place. Use a simple cold compress to reduce the swelling." Kawei said. "As for the upper and lower jaws, you should suture them first to prevent infection of the open wounds."
"What to do with these broken bones?"
Just as Kavi was about to continue speaking, he heard a familiar voice in the distance: "Kavi, Yin... Teacher Qino asked you to come over."
Kawei knew as soon as he heard that the matter was not simple. In the operating room over there, Yingnaz probably couldn't stand still: "Am I dealing with patients? What's wrong with the teacher?"
"The wounded man just now was injured a bit seriously. I want you to come and help." The man may have seen Mendelstein and immediately added, "I can't keep up with the teacher's speed as a first aid, so you have to come."
"Okay, I'll be there right away." Kawei still followed the procedure and had to inform the captain of Opal's current situation first. "Lieutenant Opal's injury is not serious, but his airway has been opened now. The superficial trauma It’s not a big problem, it’s mainly about stopping bleeding, suturing and reducing swelling.”
His answer was as conservative as ever, which made Mendelstein always feel strange: "The surface trauma is not a big problem? Then... what about the deep ones?"
"As you can see, there is a shortage of doctors and medicines here. If there is a problem deep inside, I can't deal with it." Kawei glanced at Damirgang's skillful operation, "I don't have X-ray eyes, so I can't guarantee that his internal wounds will occur. What kind of changes, also included in his brain and some other soft tissues."
Mendelstein couldn't hear those proper nouns, and he only felt that there was uncertainty between the lines in Kawei's words: "So, his life is still in danger?"
"I can only say that it is not possible now, but in the future, this possibility cannot be said to be impossible." Seeing that he was a little anxious, Kawei quickly gave an approximate time, "Let him rest in the church for two days. If something happens in the middle If there is a problem, I can respond immediately."
"Two days..."
"Yes, if everything is fine after two days, it will basically be fine." Kawei pointed at Damirgang and said, "This is my junior fellow student, named Damir. He is very skilled in debridement and suturing. He is very good at facial treatment. You can rest assured that the wound will be sutured."
Seeing that he didn't say anything else, Kawei left Opal behind and prepared to run to the operating room.
"Are you going to the operating room?"
"Yes, the soldiers sent in just now seemed to be a bit seriously injured."
Opal looked at Kavi: "I'll go with you."
