Chapter 313 309. I am indeed interested in antiques

In general, the amount of cerebral hemorrhage in Sebasto was very small, and the estimated value was only between 10-15ml. If according to modern standards, as long as conditions permit, you can choose to rest and wait for the blood clot to be absorbed.

Of course, the requirements are absolute rest and long-term monitoring of vital signs, and repeated imaging examinations are also required to confirm that the hematoma has not grown larger and is indeed being absorbed by the body.

Once vital signs become unstable and the hematoma further increases, surgical intervention is required.

None of these existed in the 19th century.

Originally, the main hospital did not have a blood pressure monitor, and it was impossible to ask nurses to measure heart rate day and night. And the imaging examination was blank. No one knew whether the hematoma would increase. Even the location of the operation was determined by Kawei.

I guessed it by luck.

In the eyes of Peang and Sediyo, Sebasto was indeed in a coma before and woke up after the hole in the skull was opened. As they had seen the intracranial hemorrhage with their own eyes, and they understood the principle of fixed volume in the skull, it was easy to figure it out.

Cerebral hemorrhage and coma are linked.

Therefore, Kawei's surgery indeed saved Shebasto's life.

If someone else had performed the surgery, he might have been very satisfied with having performed such a difficult craniotomy in the 19th century. Even if there were some flaws, human effort could not make up for them. Moreover, the operation itself was a success, and Shebasto survived.

Come down.

However, from an objective perspective, especially when looking at the entire treatment process after incorporating Kawei's modern medical concepts, the timing of the surgery is not so accurate.

The harsh requirements made him very dissatisfied with his own judgment.

The operation was successful, and the patient was alive, but his decision failed, because no matter how you looked at it, it was better for Shebasto not to have surgery. Even judging from the ruptured veins found during the operation, his cerebral hemorrhage was completely

There is a tendency for deterioration, and surgery should be performed after deterioration rather than risking surgery at an early stage.

This includes errors in differential diagnosis, possible omissions in physical examination, and deficiencies in various hardware conditions.

A big hole was made in the human brain for no reason, and 12 thin screws and 6 iron pieces were screwed in. Not only that, but after the operation, you have to bear all kinds of risks of craniotomy, including possible postoperative bleeding, edema, and infection.

Kawei really can't be as free and easy as Shebasto.

Therefore, after confirming that the hematoma was removed, there was no subsequent bleeding, and the patient's condition was stable, Kawei began to perform cranial closure while reflecting on the entire diagnosis and treatment process.

Putting aside other symptoms and possible diagnoses, Kawei himself is satisfied with the surgical treatment of cerebral hemorrhage. In particular, the various surgical preparations for cerebral hemorrhage are already "perfect" and difficult to achieve at the current level.

Find a better alternative.

Before the operation, the patient was given concentrated sugar water to ensure osmotic diuresis. During the operation, cotton pads were placed on the head and shoulders to ensure a head-high and feet-down position. A blower was also selected for moderate hyperventilation. All three methods tried their best to achieve the brain relaxation effect.

1】

As for postoperative external ventricular drainage, which is common for intracranial hemorrhage, Shebasto was in good condition and did not need it.

The entire operation was performed without ether inhalation anesthesia, preserving the human body's own cerebral blood flow-cerebral perfusion pressure regulation mechanism. [2]

The mastery of surgical conditions has reached the top level. Even the best director of neurosurgery in the hospital where Kawei worked at that time may only be able to do this. Because of this, Kawei is more concerned about the timing of surgery.

.

One misjudgment made all the preparations for surgery in vain.

Shebasto's health was second to none, and the clinical situation was full of flukes. The main reason was that he had no way to judge whether these measures were really effective through surgery. If he encountered the next brain injury surgery, he would

A successful experience may not lead to success.

"Is the bone flap ready?"

"Okay." Peang brought the bone flap, which already had eight more holes. "I've also added the middle two."

"good."

Kawei used scissors to cut the suture between the dura mater flap and the skin flap, then passed the suture through the bone hole in the center of the bone flap and sutured: "The outside of the dura mater should also be suspended from the edge of the bone window.

."【3】

"What about the dura mater? Continuous and interrupted sutures?"

"Yes." Kawei said, "Use the thinnest silk thread, and then the stitch spacing is 2mm apart."

“So thin”

"Ensure the watertightness of the meninges." Kawei explained, "Any cracks left on the meninges may produce a valve effect, causing one-way overflow of cerebrospinal fluid in the brain, eventually leading to effusion." [4]

Suturing the meninges was time-consuming and labor-intensive, and even Cedillo, who had practiced suturing repeatedly for abdominal surgeries, felt troubled.

"Work harder." Kawei didn't have much to say, "Dr. Payon, please bring the nail plates and fix the bone flap immediately."

In fact, the bone flap can be fixed with the thickest silk thread by ligation. However, in the 19th century, the silk thread was not strong enough and it was difficult to prevent slipping. Kawei still preferred to use screws and iron plates. The next step was a completely mechanized operation.

The suturing is done, and the bleeding is stopped, from the bone flap to the galea and then to the scalp.【5】

"Teacher Cediyo, let me take the next step," Kawei said. "The family members are waiting outside. Someone needs to explain."

"I go?"

"You are the director of the Main Palace Hospital, right?" Kawei tapped Peon's hand with a hemostatic forceps and said, "When you are a suturing assistant, you must help align the incisal edges and push the two sides together to facilitate the suturing.

Knot."

Normally, Cediyo would definitely accept it gladly, but today he just couldn't bear the old face: "Goodbye, you are the chief surgeon, and only the chief surgeon is qualified to report the results of the operation. I'd better sew my scalp with peace of mind."

"Then" Kawei said, "in that case, let's wait until the operation is completely over and then take Mr. Sebasto out with us."

The ending of Shebasto is naturally satisfying.

It's just that the operation itself went so smoothly that the mother and son were more or less doubtful about the operation itself. The main point of doubt was that Shebastow was no different from a normal person: "Why are you awake just after the operation?"

"Isn't it good that I'm awake?" Sebasto, who was lying on the wooden bed, was obviously more energetic than the people around him. "Do you know what I just went through?"

After saying that, he symbolically pointed to the still numb scalp, making his wife think it was just an ordinary scalp injury: "It turns out that you broke your head. To be honest, my dear, you look really good with your hair shaved off."

It’s strange, like a different person.”

"Hair, oh yes, hair!!!" Sebasto suddenly became excited, "I have no hair now!"

Fortunately, Kawei was able to control him quickly enough and immediately held down his hand: "The operation went well, but at the same time, I hope Mr. Director can exercise restraint as much as possible. The hair will grow back soon, but there is only one head.

Once it’s bad, it’s gone.”

"Yes, Mr. Sebasto, now is the most critical recovery period after the operation. You must not move around."

The two of them exhorted each other a few words, and then began to explain the operation process in detail.

Kawei is more "honest", or he is not interested in describing some details. He only briefly talks about the process, emphasizing more on the patient's condition before the operation. Sediyo, on the other hand, is more indifferent and only talks about the whole article.

Apart from the success of the operation and Kawei's boldness, little else was mentioned.

But in fact, anyone with a clear eye who has participated in the operation will know what this operation means.

The two nurses and Peon looked at Sedieu one after another, and their eyes became uncomfortable. Although they quickly looked away, Edward saw all this:

"Professor Sedillo, as the first French surgeon to witness Dr. Carvey's surgery at close range, after Dr. Mosier, you should be the second. What do you think of his performance?"

How’s the level?”

"Very good." Sediyo said with great care.

"Can you be more specific?"

"Specific?" Cediyo was a little embarrassed, but he quickly thought of an explanation that could "take the overall situation into consideration." "If Dr. Kawei is interested, I am very happy for him to come to Paris for further study. With his talent, he can definitely

Become a leader in the Department of Surgery at the Palace Hospital in the future.”

They were indeed praising Kawei, but secretly they were praising themselves.

Because it is not difficult to become a surgeon at the Cathedral Hospital, but if you want to become the head of surgery, that is, the chief director, you must be appreciated and taught by the current director. In other words, Cavede has been taught by Sediyo.

this opportunity.

This has nothing to do with surgical ability and technology, it is entirely the product of the involution of the small medical circle.

Edward could understand it, but the two sons of Shebasto could not. Especially the eldest son Leos, who had a sense of stupidity that was completely inconsistent with his dignified appearance: "Doctor Carvey is indeed amazing. I didn't expect that he was going to

My father, who slept all day to wake up, only took four hours to wake up."

"Dad is not drunk, he has a broken head!"

His younger brother Poluoduo immediately corrected his mistake and also offered an olive branch to Kawei: "Doctor Kawei is here for the first time. If you don't dislike it, why don't you come and stay at our house. In any case, it will definitely be better than the messy hotels on the street."

Before Kawei could react, his mother also said, "Yes, this way my husband can be taken care of at home."

"Don't worry, Dr. Kawei, we won't treat you badly."

The three of them made Kawei speechless. Fortunately, Edward handled it well: "Everyone, Dr. Kawei is not here for tourism, but for a surgical tour. The director's home is several kilometers away from the Medical Street, and he goes back and forth every day.

An hour or two of work."

Seeing that they wanted to say something else, Edouard Lianman added: "Besides, the hotel I chose is the best in Paris. It shouldn't be much worse than a noble house."

At this point, the meaning was quite obvious, but Leos kept rushing forward: "It doesn't matter what you said, it still has to be decided by Dr. Kawei himself."

"Okay, okay, brother, everyone else declined, what else is there to say." Poluoduo stopped him quickly and said, "It doesn't matter, my father is fine now. If there is any problem, we will go to the hotel to get a card."

Dr. Wei’s.”

After a brief greeting, Carvey, Edward and Slang, deputy president of the Bank of Paribas, left the main hospital.

In fact, the two of them were on different roads from Kawei. They got on the same carriage more because of the auction. Because no matter how you looked at it, Kawei's attendance seemed very abrupt, but it was full of topics.
To be continued...