Ectopic pregnancy leading to fallopian tube rupture and bleeding is just like foreign bodies in the male bladder. It is not common in clinical practice, but one or two cases will occur from time to time, reminding doctors on duty not to forget it. Because once you forget, there will be serious consequences.
The girl in bed 97 had vague symptoms at first, with abdominal pain but only abdominal pain. There was no pregnancy test, and menstruation was unclear.
Because in the early stages of ectopic pregnancy, there will be signs of miscarriage, that is, a small amount of bleeding. In the 19th century, only a few doctors who were at the forefront of obstetrics and gynecology really understood the menstrual cycle. Some of them were not even involved in clinical work. Ordinary people had no idea about menstruation at all, and it was in vain to ask.
Now as the ectopic pregnancy continues to develop, the symptoms become more and more obvious, the most typical one is internal bleeding.
When Kawei and Peang rushed to the maternity ward together, the girl's face was bloodless, her heart rate was over 100, fast and weak, her limbs were clammy, her hair was wet, and blue-purple ecchymosis could be seen around her navel. 【1】
Even if the cause of the disease cannot be concluded, the conclusion of "massive intra-abdominal bleeding plus shock" can be made.
She had abdominal pain, hemorrhagic shock, and no history of trauma. Taking into account her gender, age, time of onset, and conditions, Kawei could only think of ectopic pregnancy and aortic dissection.
The chance of acute hemorrhagic pancreatitis and tumor rupture is minimal and can be ignored.
Although the types of diseases are different, the treatment methods are the same, open abdomen.
The girl's condition changed drastically in a short period of time, and Hujir finally realized the seriousness of the problem.
Fortunately, he had enough surgical background and had served in the army when he was young. He knew what it would be like to lose a lot of blood. Therefore, he did not choose bloodletting, which is still regarded as one of the methods in internal medicine. He only used some fumigation and massage items. After struggling for a long time and finding no solution, he agreed to Kawei's request.
Of course, Hugier had to be the one performing the surgery.
The patient has been classified as an obstetric patient, but the surgeon is a young Austrian who has only been in Paris for two days. He can't live up to his reputation. Kawei has no such worries. He is not afraid of taking the lead when he is the chief surgeon, and he has no problem being the first assistant.
In the eyes of the medical students watching, it was indeed Hugier who performed the surgery, but in fact Hugier was just a "decoration".
It cannot be said that he was useless. The old man had very solid basic surgical skills and knew the rules of surgery, but he did not know the detailed steps of abdominal surgery. Or in other words, Hugill's treatment of some details is almost non-existent.
This may seem fatal to the surgeon, but as long as he takes over this part of the job, he is still a qualified surgeon.
This kind of disguise can only deceive beginners, but it is impossible to deceive experts. The three doctors with rich surgical experience immediately saw the relationship between Kawei and Hujir.
"The old guy's skills are really unfamiliar."
"Laparotomy is not easy. He hasn't had any surgery for so many years. He only relies on the technique of dissecting and stabilizing cadavers. It's already very good to be able to do this." Even though he had just quarreled with the other party, Cediyo still remained objective, "You Don’t ask for too much.”
"That's true." Kaushik put out his pipe and began to concentrate, "But it's too shameful to let a 20-year-old young man lead him by the nose, or even help him step by step. Alright."
Cediyo sighed: "Can you blame him? Even if you go up, you will be held back."
Kaushik has never partnered with Kavi, nor has he undergone abdominal surgery, so he is not familiar with the process. But it is not difficult to compare the hand speed of the two. Kawei's hand speed was originally faster than Hugill. This is not only the difference in age and reaction, but also the familiarity with surgery.
"Indeed." Kaushik didn't care about his own praise. He stared at the surgery area and couldn't stop nodding. "This guy cooks the stove, prepares the ingredients, cooks by himself, and puts the food on the table by himself. I think I just need to pick up the spoon and put the food into the mouth for the old guy."
"You're exaggerating. There's no way it's that exaggerated."
"It's a bit exaggerated, but not too exaggerated," Kaushik said. "Not only does he do the first-aid job at hand, but he also helps deal with some troublesome areas. At the same time, he also has to coordinate the work of Albaran and Payon. It’s amazing, this guy is still so young.”
As he spoke, he looked at Cediyo meaningfully, his eyes filled with some unspeakable meaning.
"What's wrong?"
"Are you the surgeon for rectal cancer this afternoon?"
"yes."
"Kavi Issuke?"
".right."
Kaushik glanced at the operating area: "By then, aren't you going to be like him?"
Cediyo finally understood what he meant and nodded: "Rectal cancer surgery is much more complicated. He alone can't handle an operation of that scale. Besides, I'm more capable than Hujir, so what's there to be afraid of?" of!"
"I hope that's the case." Kaushik suddenly asked, "By the way, will it still be this theater then?"
"After all, major surgery must be done here."
"Okay, I'd better come over and take a look."
Kawei indeed broke out in his usual scheduling ability.
The little girl was in shock and had lost a lot of blood. His usual hands were no longer available. He had to seize the opportunity from the source. While seizing the time, he also felt as if he had returned to the Municipal General Hospital half a year ago.
The nurse lacked awareness, the assistant could not keep up with the thinking, and the surgeon's surgical procedures were confusing.
If this is an elective surgery and the patient is still healthy, the doctor can take his time. Now that the situation was critical, he could only reveal his domineering temper a little to reduce the chance of surgical failure as much as possible.
"Don't be stunned. We agreed to report your heart rate every three minutes. My scalpel is almost cutting into the peritoneum. Can you be more diligent?"
The nurse had never experienced such an atmosphere before. She was stunned for a while before she remembered to check for a pulse: "Now. It seems a bit fast now."
"What I want is data! Heart rate per minute, reported every three minutes!" The abdominal skin and muscles in front of him have been completely opened. Kawei quickly said to Albaran beside him, "Go and get a bottle of medicine in my box. , the label says sodium citrate, hurry up!”
"good."
"You can see that the patient's peritoneum is also blue-purple like her periumbilicus. If you are lucky enough to see the internal mesosomes, you may still be able to see this color."
Cullen's sign was so obvious that Kawei basically guessed that the blood loss situation was not optimistic, but he still hoped to use autoblood transfusion to save the person: "Teacher Peang went to prepare two wide-mouth bottles, needles and matching rubber tubes. .”
Payon has long been trapped in Kawei's speed vortex.
He had no time or thought to think about it, so he automatically said "hmm" after hearing the request. When he put down the retractor in his hand, his mind came to his senses: "Rubber tube? I remember that there didn't seem to be any rubber tubes in the surgical preparation room."
"It's such a big place in Paris, you said there are no hoses?"
The rubber tube needs to connect the bottle and the needle. If it is not available, another solution must be used. For patients who have lost a lot of blood, whether they choose the thankless injection or switch to fixed metal pipes is not ideal or even realistic.
"Wait a minute, why do I remember it?" Kawei turned around and found Guyon on the stage. "Teacher, don't you have rubber tubes in your urology department? Teacher Mosier told me that he has used them before."
"Rubber hose" Ju Yong was also mobilized by him, and he quickly got up and got out of the auditorium, "Yes! I'll get it now!"
"Is it this bottle?" Albaran hurried over from a distance, "It says"
"Sodium citrate, I use Latin!" Kawei saw that what he brought was a ball of methylene blue with German written on it, and shook the pituitary extract on the side of the operating table, "Like this Yes, bring them all!"
"oh oh."
"113 times." The nurse finally found a chance to speak and suddenly said, "Her heart rate is 113 beats per minute."
"Okay, it will automatically report every three minutes. If it exceeds 120, you must tell me."
"knew."
"Teacher Hujir, we are entering the abdominal cavity now." Kawei pulled the skin with a retractor in one hand and held the suction device in the other. "Albaran, are you okay?"
"I'm coming."
"Put the medicine aside for later use. Come and shake the pole." Kawei became more and more anxious as he spoke, omitting some titles that could be ignored. "Nurse, bring a basin over here to collect the blood."
"Blood?" The nurse looked confused, but her body and mind had long been separated. Her mind was still thinking about why she needed to collect the blood, but her hand was on its own and handed over a basin, "Here."
Hujir made a slight incision on the peritoneum that Kaviti had pulled up, and then used his fingers to separate a small opening into the abdominal cavity. He felt a bloody smell rushing towards his face: "Suction device."
The nurse now knows what the so-called blood collection means.
A large amount of non-coagulable blood was like an unscrewed faucet. With the efforts of Albaran's hands, he kept pouring into the jar. In just a short while, the first 500ml was filled: "Where is the wide-mouth bottle?" [2]
"I'm coming!"
"Change the bottle, and then put the sodium citrate in." Kawei controlled the suction head to move between the organs, sucking out the remaining blood as quickly as possible, and said for Hujir, "After the blood is drained, we will You need to expand the peritoneum and find the bleeding point."
Hujir quickly followed his request and incised the peritoneum, followed by Kawei's hand reaching into the abdominal cavity.
First touch the uterus, and then use the uterus as a starting point to move to the possible location of the lesion: "Let's use another retractor with Dr. Payon to open the abdominal cavity a little more, and then prepare the hemostats."
Ectopic pregnancy is different from ordinary elective abdominal surgery. Everything depends on seizing the time. It was impossible for Kawei to do the separation slowly, nor could he leave this matter to Hujir. He had to separate the appendages and surrounding tissues with his bare hands at the first time, especially the adhesions in the rectal recess.
The girl's situation is exactly as Kawei imagined. The right fallopian tube is enlarged and a 5*6cm mass can be felt: "Sure enough, I guessed it right, it's an ectopic pregnancy! The fertilized egg that should have entered the uterus is stuck in the fallopian tube. .Heart rate?”
"The test I just took was 117 times/minute."
"Where's the rubber hose?"
Kawei looked out the door and didn't see Juyong, so he could only open the channel first: "How is the sodium citrate mixture going?"
"It looks about right."
"Who can do intravenous injection?" Kawei made a rare request, but no one dared to answer, "No one can do intravenous injection?"
The nurses at the Main Hospital are still at the primary stage of simple bed care and delivering items. In fact, their professionalism is better than that of the Municipal General Hospital when Kavi first arrived in Vienna, but now, there is no comparison.
In the end, Peang, who was the second assistant, helped: "I'll do it."
“The basilic veins of the left and right arms, the cephalic vein, or the middle of the elbow are also acceptable.”[3]
Kawei told the puncture location. Payon's technique was a bit clumsy, but relying on the experience accumulated through experimental work, he still managed to get it in after several more attempts. This is not easy for a general surgeon. After all, the patient is still in shock and the veins are deflated.
"Dr. Carvey, the heart rate has risen again, 124 beats/min."
"What should we do now?"
"Where's the salt and water I asked for earlier?"
"It's ready, but it will take some time to heat up."
Kawei found the rupture in the fallopian tube mass, blocked the blood vessels with his fingers, then pulled them out, and then used a hemostat to clamp: "No matter what, let's inject it inside first. Professor Hugill, let's..." 【4】
Hugier turned his back on the shock and just performed the surgery himself: "Dr. Kavey should just handle the assistant's work, and I'll do the mass removal (I understand)."
While talking, he also used hemostatic forceps to make a cut around the mass. After seeing Kawei nodding, he took over the surgical part, and Kawei could also have his hands free to deal with intravenous infusion problems.
Just when others were wondering whether they should listen to Kawei’s words and just do the injection, or consider whether it is safe to inject water into the human body, the door of the surgical theater was finally pushed open by Juyong: “The tube is here, the tube is here!!! "
Now is not the time to worry about whether these two rubber tubes have been cleaned or not. Even if they were just pulled out from someone else's body, they still need to be used.
Two 500ml wide-mouth bottles sent blood into the girl's body again, and then added 500ml of normal saline into her body.
In fact, as long as the main battlefield of shock is overcome, as a lateral surgery to directly attack the cause of the disease, it is not difficult and the surgical process is not complicated.
Before the mass appeared, Hujir had no idea about surgery and could only take it one step at a time. But when the mass and break appear, the purpose of the surgery becomes clear, which is to cut off the fallopian tube where the mass is located, ligate the blood vessels, and stop the bleeding.
The second half of the operation went very smoothly according to Hugier's instructions. In the end, only the remaining blood in the abdominal cavity needed to be removed.
(End of chapter)
