Chapter 228 225. Surgery Case Seminar at Ormitz Fortress General Hospital [1]

People make mistakes, especially surgery, which requires choice in every move, even Kavi is no exception.

In order to make excellence, Kawei used to work in the emergency surgery department with routine meetings every week, mainly discussing the gains and losses of emergency surgery.

Each operation will be analyzed from the surgical record and will be discussed until the patient's postoperative complications and physical recovery. There are praises and criticisms, but more importantly, I hope that I and my team can learn from it.

Before in Vienna, he was only a surgeon who was a surgeon who was able to take surgery at most, and he didn't have that much authority.

But his super surgical ability, coupled with the outbreak of war, has now regained this special "power".

On September 29, at 7 a.m., except for the surgeons who are still in the operating room, he sent almost all the surgeons in the fortress hospital into the conference room. It sounds quite large, but he can really target.

In fact, there are only more than 20 people.

There is only one purpose, to review the work situation in the past few days by discussing cases and prepare for the upcoming war.

The meeting took case discussion as the main axis and mainly analyzed several injured soldiers with serious conditions. During this period, some reviews of education were interspersed.

"At that time, I will ask some surgeons to come on stage and describe the operation process carefully." Kawei looked down at the medical records and list in his hand, with no expression on his face, and said coldly, "You don't have to worry about the subsequent injured soldiers.

The treatment, because I allowed me to go to the operating room, are all doctors who don’t need to go on stage.”

The first thing to discuss is Ronalne's trauma of the brain firearm.

The main reason is that his injury is the most difficult of the past few days, but even without Ronalne, Kavi will choose some other brain injury as teaching examples. However, doing so will lack some sense of reality.

The teaching significance and effect are worse.

Because except for Ronalne, all the soldiers who could be examples were dead.

Cranial firearm injuries are not uncommon in the battlefield. Bullets and shrapnel do not have eyes. Once they attack the head, the ending will often not be very good. In addition to luck and his physical fitness, Ronalne must also live to this day.

Thanks to the first debridement of the frontline ambulance and the second debridement of Kawei last night.

Since the first Ronalne survives, Kavi hopes to have a second and third place

"The wounds of the brain firearm are divided into three categories: soft tissue contusion on the scalp, extra-brain penetration injuries and craniocerebral penetration injuries." Kawei gave a brief introduction, "The first two conditions are not serious, and are usually minor injuries," he said.

Just simply debride and bandage.

What I want to focus on is the penetration injury of the craniocerebral injury, which is divided into tangent injury, blind tube injury, rebound injury and penetration injury. Ronalne is a typical penetration injury."

A white cloth was pulled out in front of the conference room, with roughly the injuries and surgical images drawn on it, including the entrances and exits of the bullets and the broken bones.

"The bullet enters from the left forehead and shoots out from the top of the left temporal, and a large amount of fragmentation occurs on the lateral skull of the pathway."

Kavey said the general situation: "I was seriously injured, and there was also brain tissue overflow. When I encountered such wounded people, the doctors of the army, the surgeons in the ambulance center and the surgeons in our central hospital had to do different things. We

What we need to complete is a closed loop of treatment, and no mistakes can be made, otherwise the injured will die at any time.

The case of Ronalne explains this very well.

I need to focus on praising the frontline Doctor Suijun. This doctor played his role very well and knew what to do at this time." Seeing that there was no atmosphere in the audience, Kawei began to ask, "Do you know what he did?"

".Did he be injected with hemostatic drugs?"

"It's a bandage to stop bleeding. When I came, I saw several layers of bandages."

"It should be a blood pressure booster drug. This kind of patient is prone to lose blood pressure in a short time and die. I have encountered several cases, but the blood pressure was no longer measured when it was sent."

Kawei listened to these answers and said, "It was indeed bandage to stop bleeding, because such a serious craniocerebral injury has a lot of bleeding. Seeing the wounded's head bleeding, anyone would do bandage, but."

"But" is late, but what Kawei wants to emphasize is not just bandaging and stopping bleeding, but how to bandage and stop bleeding.

"So, bandaging and stopping bleeding, how do you bandage and stop bleeding? Is it the same as bandaging the limbs? Press the bleeding point tightly to stop bleeding?"

This is a very serious issue, because no matter how strong the surgical ability in the rear is, the first level the wounded encounter is the front-line doctor. If this doctor in charge of this wound is improperly treated, there is no need for subsequent treatment.

It's right.

The problem stumped them.

"Generally, bleeding from brain trauma requires gauze filling and pressurization treatment." Kawei gave several examples, "Bed 65, scalp laceration caused by shrapnel, it looks like there is only one long wound, but the amount of bleeding exceeds 500ml

.The front-line military doctors loosened the filling, so the amount of bleeding was quite large.

But let's look at beds 112. The same scalp laceration is about the same length and depth as beds 65. However, because the pressure of the stuffing is enough, the wound has basically stopped when we arrive at the hospital. The surgeon only needs to do this at this time.

Simple sutures, or even take care of other wounds first, and don’t deal with them for the time being.”

After listening to the audience, someone asked, "So Ronalne's head bandage is tightly pressed?"

"But I heard that he was still bleeding when he came. If it weren't for the rehydration, he would probably have died."

"The problem lies here," Kavey said. "It can cause bleeding even if the bandage is too loose, but what if the bandage is too tight?"

There was no basic knowledge of neurosurgery in the audience, and there was no sound when I heard it here: "."

"First of all, we need to clarify two points. First, there will be two inevitable situations in the brain tissue after severe trauma. One is swelling and the other is bleeding." Kavey explained, "The second, the brain tissue is very tender, and any damage may occur.

Destroy its function.”

These are two pre-aware conditions given. As for why these two situations occur, why brain tissue destroys functions with a slight touch, and what functions are destroyed, Kawei did not give a clear reason.

What he wants to do is to let these doctors respond as they should under existing conditions.

"They are now the military doctors, and there are such wounded people around them. After knowing this, what should we do? How to bandage it?"

"The bandage cannot be too tight or too loose?!"

The first response was Hills's help Golam. The answer was good, but he lacked confidence in himself. Kawei nodded and affirmed his answer: "I would rather not stop bleeding than ensure that the bandage cannot be too tight.

.Because bleeding can be maintained by infusion, but if bandaging is too tight, it will further compress the swollen brain and form a brain hernia!”

This is a concept briefly mentioned in the training, and Kawei took it out again.

"I said at the beginning that if the brain injury and severe headache and vomiting are combined, the skull needs to be cut open to relieve stress of the brain. This is also the best and most direct way to maintain stable blood pressure and breathing, no doubt about it."

Kawei took two related cases from hand and continued: "During the previous training, I had no examples in my hand, you may not understand. But now, there are 122 beds that were just announced to die this morning, and yesterday morning

Bed 37, I have read the medical record, but it is because I did not undergo timely decompression surgery."

From the serious injuries to deaths and cases with clear bed numbers, the atmosphere in the conference room became sharp and even the surrounding temperature seemed to have fallen by one or two degrees.

They have all learned more or less about Kavi's current temper. After all, he is the youngest, most capable and most powerful surgeon in Austria, and his temper is naturally not much better. But compared to the chief surgeon of the same status, Yi, who is the chief surgeon of the same status,

Gnaz and Edinson, director of the Military Medical Department, were even more merciless.

"Dr. Delvo."

The light voice was like a signpost, bringing everyone's eyes to the rear right of the venue. There was a doctor under 40 years old, wearing a military uniform and wearing a pair of black-framed glasses in front of him, which seemed to be right.

This title doesn't respond much.

"I'm."

"You are the surgeon of the two injured, beds 37 and beds 122?"

"Yes." Delvo stood up and answered very concisely.

"Please come on stage." Kawei's request was also very concise, so concise that the other party had no response. "I didn't explain it clearly? Or do you not understand German?"

"I don't know what the meaning of going on stage is?" Delvo pointed out the door. "I have nearly a hundred beds in my hand, and I didn't even do the rounds in the morning."

"You don't usually check the rounds, and there are already people doing it now." Kawei asked his assistant to bring a small chair from the audience, took away the information from his hand, and then sat on it, "Don't worry,

Not a casual surgeon, but Ignaz, chief surgeon.”

The chief surgeon's role is to coordinate all surgeons, rating their performance, and to preside over some very difficult surgical procedures.

According to conventional rules, he should appear in the rear, such as the Military Medical Office in Vienna, drinking tea and reading telegrams with Aidinson. Or he may appear at the military headquarters, that is, staying with Brecht, the commander-in-chief of the Northern Line, and coordinating all surgical corporations.

Medical scheduling work.

But now that I am here, in addition to seeing how the general hospital built by Kawei works, I also want to stand up for her. After all, an excellent surgeon like Kawei also has weaknesses, that is, it is "too young"

It's right.

"The chief surgeon was actually checking rounds just to get me, a little surgeon, to the stage." Delvo seemed to hear some news and took the lead in attacking, "I can't compare with this interpersonal relationship."

"This is not something you should care about." Kavi pointed to the podium, "Please! You! Go on the stage!"

Delvo seemed to have his own confidence and opposed it on the spot: "What if I say no?"

"Then you will deduct all your basic points by 20 points, and immediately take the carriage with the army and go to the front line to be an emergency doctor." Kawei buried his head and said the points system he founded, "In this case, your salary will be from

1 kroner per day is reduced to 30 hles per day, and you must be with those bullets and bombs at any time."

Points are a system similar to "reward and punishment" that Kawei came up with in order to improve their skills and postoperative management capabilities.

The surgeon has a basic score of 20 points, and the assistant has a basic score of 10 points. He will deduct 1 point for every mistake and get 3 points for every praise. If the assistant has a few points higher than the surgeon, then their work can be done with each other.

Change.

Of course, this kind of exchange is not mandatory, it also depends on the assistant's qualifications and surgical procedures.

The treatment of the military doctor and the frontline first aid is not available, but in contrast, they are more likely to get in touch with the frontline commanders. Commanders can recommend qualified doctors to Kawei in the form of a letter of recommendation, but how many commanders are willing to transfer.

Being an excellent doctor who thinks he is qualified is a matter of luck.

"Okay, okay, I'll go on stage." Delvo finally walked onto the podium, turned on the familiar medical record in front of him, and said, "The two wounded soldiers fell down after being shot or being hit by an explosion.

The ground, the head was hit hard."
To be continued...