Chapter 126 123. Three answers

Since Kawei successfully completed the cesarean section last time, Lakeside Theater has been preparing for the next cesarean section.

The main goal of the work is Kawei, price and operation success rate have become important bargaining chips for both parties to talk. After several contacts, the Riverside Theater recognized Kawei's ability and promised that as long as Kawei's cesarean section was successful, he would give a 5% share.

5% is neither high nor low. After all, Kavi is too young and cannot give too high proportions at one time.

But for Kawei, this is not a matter of how much money is. The value of his own surgery is about life and should not be measured with money. If you really have to use money to give a certain value, then 5% is too low. After all, this is not a modern day where you can almost become an assembly line operation if you scratch your stomach.

He did not get entangled with the other party, and he had never signed any written agreement with the theater from beginning to end. After the cesarean section was over, Kawei would suggest that the hospital again, and the hospital would open the surgical theater on its own.

As for whether the hospital management supports Kawei or stands in the theater to maintain the same status, it depends on the result of the operation.

The lower the success rate, the more economic value the surgery will bring, once it succeeds, it cannot be calculated by simple mathematical formulas. The fare price has already shown some of the problems. If Kawei's surgery can eventually succeed, his value should not be a pitiful 5%.

Lakeside Theatre is not a fool either, and it has also changed after seeing the huge income of tens of thousands of kroners in just a few days.

The theater venue cannot be changed, but the internal facilities can be updated. The original candle lamps on the wall have been replaced with wall-mounted oil lamps, and the candlesticks used to lighting the surgeon have also been replaced with more advanced hand lanterns.

The types of food sold have also changed, from simple snacks to staple foods such as fried bacon, roasted pork elbow, and steak. The food is cut into small pieces in advance and provided with small forks, which is more humane. The corresponding desserts, fruits, and wine will naturally not be missing.

This time, the theater also took into account the experience of the back row audience and specially set up a temporary sale point for high-power telescopes for surgical theaters at the entrance.

Not expensive, priced at 150 kroner. If the operation is successful, you can use a telescope to ask the surgeon for your signature. [1]

These are all changes to the audience's experience. The theater did not forget Kavi's habits for the surgery center area. They made changes to the rest area and made room for disinfection preparations by the tap water, including salt, baking soda, kettle and stove.

In addition, the operating table was also redone as Kawei's wishes.

The upper end has a movable pad that is close to the acromation clavicle, and the lower end can be bent downward to place the patient's legs. [2]

These changes have attracted the attention of the audience from the beginning and have made the highest glorious moment since the completion of the Lakeside Surgical Theater.

At 11 o'clock in the afternoon, the host slowly walked into the venue in a gorgeous dress and calmed the noise in the venue with his unique smile and posture: "Ladies and gentlemen, welcome you to the most famous surgical theater in Europe, no one

Today we have the honor to invite the youngest surgeon in Vienna, a young man who is well-known in Vienna for successfully performing several abdominal surgeries.

His reputation may not be comparable to famous surgeons such as Ignaz, Watman, Olgi, Masimov, etc., but his cesarean section is destined to bring you a completely different stimulating experience."

As soon as he finished speaking, the door opened and Kavi walked into the theater in his black coat.

"Good noon for everyone, thank you for taking the time to support you."

Kawei asked the little assistant beside him to put on a surgical leather skirt, then stepped forward and patted the host's shoulder, and said, "It's getting late, everyone is an old audience, so there is no need to be polite. The assistant is still the old faces of Herman, Bergert, Meren and Salson. Let's introduce today's patients as soon as possible."

Just as Kavi got the right to speak and attracted all his attention, four assistants entered one after another and began to prepare for the pre-operative work they had discussed before.

The water was boiled and disinfected in the morning, and now it needs to be increased to use. According to the ratio of Kavi, 1L water + 9g of salt. Sodium bicarbonate was not used this time, because the mother is in good health and has no blood loss and shock now, and there is no risk of acidosis.

But the next steps are not understood by many people.

"The one who came on stage today for a cesarean section was the brave Ms. Brenda, the wife of a baker. She had yd bleeding three weeks ago and was diagnosed by an obstetrician at Graz Hospital and was designated as placenta preposition.

The operation was very dangerous, and the surgeon at Graz Hospital refused the operation.

This is normal and not something to regret, because it is rare for doctors to actively choose surgery even though they know that the surgery will fail.

As we all know, cesarean section is a problem all over the world, and placenta previa is a major problem for cesarean section. Today I will use some new devices and new drugs to try to solve this problem. I hope that in addition to bringing you visual experience, it can also pave the way for future cesarean section surgery."

Brenda was pushed into the venue quietly in a wheelchair, but the focus of everyone was not on her, but on an iron rack next to the wheelchair, or rather a glass bottle filled with liquid on the iron rack.

The bottle connects into her arm through a long brown tube. [3]

Kawei is no longer a surgical assistant who has just joined the company for less than two days. Several successful surgeries and successful regular surgical sessions have gained a lot of popularity and prestige.

The young medical students immediately took out paper and pen, hoping to learn some new knowledge from this operation. The doctors prepared early on the difficulties, shortcomings and causes of death that may arise during the operation, hoping to get answers during the operation.

The glass bottle and rubber tube on the wheelchair are the first answer given by Kawei.

"What is this?"

"I don't know if it might be a new gadget from abroad."

"I saw that the rubber tube was pierced into my arm. Should I pour the medicine from the bottle in it?"

"Filling water into the blood? Is this OK?"

"Actually, it has happened a long time ago. This is how someone did it when the cholera broke out more than 30 years ago."

Kawei cleared his throat and explained the principle of the infusion device. The principle is very simple, and the real important thing is the purpose of infusion, because it is strange to directly inject normal saline into a normal person's body in any era.

"Cataleal section of the placenta previa causes heavy bleeding, and I have been thinking about a problem since I performed surgery on Dr. Olgi for severe abdominal bleeding."

Kavey helped Brenda onto the operating table and explained: "When facing heavy bleeding, since we cannot change the amount of bleeding, can we rely on injecting some fluid in advance to increase the total blood volume to achieve the purpose of increasing the remaining blood volume after bleeding in disguise."

This is a long and tangled sentence. Anyone who understands it will feel like he has opened the door to a new world and has written all his thoughts in his notebook.

"I have injected 500ml of saline into Brenda's body, and the concentration is 0.9%. Please remember this concentration." Kawei tapped the glass bottle on the infusion rubber tube with his finger. "I used various concentrations of saline into the blood vessels of voles and rabbits. The safest concentration is this concentration. It doesn't work if there is too much or less."

The concentration is actually related to plasma osmotic pressure. These knowledge points will eventually be integrated into the paper and published. Let's skip it for now.

"0.9%, this concentration is necessary?"

"Please make sure to maintain this concentration," Kawei said. "This is supported by actual experimental data."

After explaining the preoperative infusion, Brenda was already lying on the brand new operating table. Half of her clothes were lifted, revealing her round belly.

"This is my improved operating table. It no longer uses the conventional horizontal plane operation method. It uses a combination of adjustable height and height to achieve the purpose of changing the patient's position during surgery."

Kawei introduced: "There are pedals at the end, and the legs can be folded at the knees. There are several grooves on the front end, and the removable soft cushion can support the patient's shoulders according to their height to prevent them from sliding down."

If you are rich people without a medical foundation, you will only look for something new when you see the modified operating table, and you may forget it after taking a look. But those surgeons who often come on stage are different. The brand new operating table immediately attracted their attention, and many sketches have appeared on many notebooks.

After the infusion bottle, the operating table was his second answer.

While giving the answer, he did not forget to continue to throw out his own opinions. Of course, Kawei hid many physiological and pathological concepts and brought the filter of the times to these views related to shock.

"The important organs that maintain human body movement are in the abdominal cavity. After major bleeding, the organs will die only after severe bleeding. I know you must have many questions, but the reason is very simple, because people with broken hands and feet can still survive. People without internal organs will definitely not survive."

Many people don’t understand the true meaning of his words, but in the end Ignaz and Watman in the stands realized the key.

"No wonder you want to use such an operating table, which is to change the position to change the place where blood flow gathers!"

"They are now using high head and low feet. The blood is hidden in the blood vessels of the lower limbs due to gravity. When the bleeding is severe, it is changed to low head and high feet, so that the blood stored in the lower limbs will pour into the torso to protect the body. It's so wonderful!" [4]

Just when everyone wanted to block blood vessels to reduce intraoperative blood loss, no one ever thought about reducing the signs caused by large blood loss by changing posture.

Two answers in a row have made many people excited and have a lot of confidence in the surgery: "That may really be done to deal with bleeding from placenta previa."

But there are still many people who have maintained the objective as they should be, and do not think that these small routines can change the results of the surgery: "I am still conservative. The placenta previa often loses blood for thousands of milliliters, which cannot be corrected by simply 500ml of fluid replenishment."

"Don't forget the oxytocin I used last time, which has very good effect on uterine contraction and bleeding."

"That's just for ordinary cesarean section. If you really encounter the 'exaggerated' placenta previa, things are not that simple."

There were very few women who survived cesarean section in the 19th century, and the placenta previa was just a simple placenta previa and would not develop into a dangerous placenta previa that is only found in modern times [5]. Brenda was a man with a man, but before that he had had natural births and there was no possibility of a dangerous placenta previa, so in terms of difficulty, this surgery should be smaller.

However, due to the limitations of the times, Kavey lacks many supporting drugs for mothers, and general anesthesia such as ether is also a risk factor for children, so he dare not take it lightly.

The preparation work should be done as set rules. After the abdomen is disinfected, inhalation anesthesia will take effect and the operation will officially begin.

"Salson first prepared the oxytocin injection needle, and Meren prepared 30℃ warm saline water, a suction and a clean water basin." Kawei pointed to the area with his toes, "Put the water basin and suction on my feet, and after cutting the uterus, he came to draw blood."

"Okay, I get it."

Herman has previous experience as an assistant for cesarean section, and this time he stood in the position of I-suke, while Begter served as a II-suke, mainly pulling the hook and maintaining lighting and vision.

"Take the child out within 2 minutes and control bleeding within 5 minutes, hoping to succeed."

“The blocking belt is ready.”

"Let's get started."

After saying this, the scalpel had cut the skin and fat according to the incision position of the classical cesarean section. Further separation of the muscle fascia and then opening the peritoneum, Kawei had entered Brenda's abdominal cavity in just one minute.

Without special search, the enlarged uterus is just below the incision.

The stage couldn't help but secretly applauding the speed of the surgery, because in addition to the speed, Kawei also minimized bleeding at the incision, and the entire surgical area could be described as clean.

But just when everyone thought the operation was about to get to the point, Kawei stopped the knife in his hand. In front of him was a purple-red blood vessel that was like an earthworm, crawling on the uterus, which was not an ordinary placenta previa.

Kavey sighed and reported the operation to the audience on the stage: "I have entered Ms. Brenda's abdominal cavity. You can see that this is her uterus, and the placenta should be in front of it. However, the placenta is not in good condition, and these blood vessels that are growing wildly are deeply piercing into the myometrium. It's a little troublesome."

Now he is not just facing the problem of placenta preposition, but the real trouble is still these blood vessels. Modern medicine has a noun to call it this way: placenta implantation.

It seems that the third answer must be moved: "Salson, take my medicine box."

"Is it the one who releases oxytocin?"

"Yes, there's a small bottle in the corner." Kavey looked at the implanted placenta and frowned. "Meren, prepare gauze, stack each eight pieces together, prepare a few more, I'll use it later."
Chapter completed!