episode_0030

Episode 30. Severely Traumatized Patient (2)

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The patient’s suspected symptom is splenic rupture.

Internal bleeding due to trauma is usually caused by organ damage. Usually, the liver or spleen is ruptured at the time of trauma.

If it’s a liver rupture, you need to have a surgery called a hepatectomy, but I can’t have that surgery. Fortunately, the organ that was damaged this time is thought to be the spleen, considering the location of the injury.

This is much easier. You just take out the entire spleen. You can live without it.

The surgery I’m about to have is a splenectomy.

It is not an impossible surgery, nor is it a minor surgery. The risks are high, but if we leave it like this, the patient will probably die.

I have no choice but to take up the sword.

****

“The first principle of Hippocrates. Istina, do you know what it is?”

“Hippo… … . What? What is that? ”

“Do not harm.”

“Aha. Well, that’s the most important thing. There’s no bigger problem than a patient getting hurt because of our hands.”

It’s nothing else. It’s a thought that we, who are about to undergo surgery now, must definitely think about.

I cannot be certain of this diagnosis with the given equipment alone, nor can I guarantee the success of the surgery, nor can I guarantee the results after the surgery. That is the unavoidable reality.

One thing is certain.

Despite the best efforts prior to surgery, the patient’s blood pressure continued to drop and his level of consciousness continued to decline.

His heart rate has now risen to around 120, and his respiratory rate is 30 beats per minute. If this continues, he will go into hypovolemic shock within a few hours.

I don’t know if it’s because of the medicine, the healing magic, or some other reason that I’ve held out until now, but I’m going to die soon.

I have no choice but to have surgery.

What you need for surgery.

Disinfected mask. Since there isn’t one, a plague doctor mask. Covers the mouth and stops hair from falling. Disinfected gloves. Hands. Purification magic.

A hot soldering iron. This is something I’m working on.

[purification.]

[purification.]

Waiting next to Istina.

Two ward nurses were also dispatched. They went through a similar disinfection process.

But this is only an imitation of a modern operating room, because we can’t even stop the dust from flying around in this space.

The anesthesia is the same as last time.

General anesthesia is not about drugs, it’s about machines. It uses gaseous sleeping pills, anesthesiologists, and in the case of major surgeries, even respirators. It’s not something I can do.

It is questionable whether you can wake up after general anesthesia.

Propofol in a sedative dose. Fentanyl patches to block the pain, lidocaine local anesthesia for the surgical site. It is unrealistic to go beyond this.

“Nurse. Please cover the patient’s surgical site with something like a sheet so they can’t see it.”

Anesthetics, three types administered.

“Will this work?”

“It’s possible.”

It’s possible. Can I do it here?

That’s a completely different matter.

Oh, this is really horrible.

The entire surgical process is problematic. Splenectomy is usually diagnosed through laparoscopy.

“Hey, are you doing okay?”

“Get as much sleep as possible.”

“Why are you pressing my arms and legs?”

Well, that’s because you never know what might happen if you move while the knife is in.

The usual procedure involves using a special machine, injecting carbon dioxide into the abdominal cavity, and wiping the area around the organ with saline solution to remove the fluid.

Well… … these are all things I don’t have.

There is only one way.

Open it and go in.

Skin incision. Subcutaneous fat incision. And muscle incision. Now the connective tissue inside the abdominal cavity is revealed. Since we don’t know where the blood vessels are, we carefully incise the connective tissue.

The location of the internal organs of the abdominal cavity is visible.

No, I can’t see it.

What the hell.

I hadn’t thought of that. There’s one thing that students and novice doctors (like me) easily forget when seeing patients: we’re not dealing with normal human bodies.

It’s about treating patients, the human body that is sick.

In this patient’s case, the spleen ruptured, and because of the spleen rupture, there was massive blood loss. I think about a liter was lost.

Where did it all go?

The inside of the patient’s abdominal cavity looked as if someone had smeared it with red paint.

Inside the abdominal cavity, there are thin membranes called mesenteries, but they are soaked with blood, so I can’t see anything. What should I do?

Should I sew it up and say I can’t do it now?

What… … . If you don’t have teeth, use your gums.

There is one possible way.

Put your hand in and feel the organ to find the location of the spleen, which is the target point. Be gentle so as not to damage the blood vessels or nerves along the way.

How difficult, complicated, and painful does a surgery have to be for someone to be better off dead? But if everything is normal at the end of the surgery, does it matter?

“Please hold on to him.”

Let’s remember the location of the organs. When looking down, the liver is on the left. Next is the stomach. The spleen should be on the right side, behind the stomach.

There are two major blood vessels that need to be blocked. The splenic artery and the splenic vein. Can we do this?

“Soldering scissors. Are your soldering scissors ready?”

“Yes? A pair of soldering iron scissors?”

“Ah, ready!”

“What are soldering iron scissors!?”

This kid, what kind of insomnia is this? I took three different kinds of medicine, but he’s still listening to me. Couldn’t he just be the type that sleeps well?

“Press hard on the patient. It will hurt so much that you will die. If you move because it hurts, you will die.”

“Yes!?”

After the horrible, sloppy sound of sticking your hand into the mud, your finger enters the abdominal cavity. First, the large organ, the stomach. There are blood vessels, and the mesentery is torn wherever your finger moves.

“Eww! Ewww! ”

The scream I expected. Ugh.

But I didn’t struggle. No, I couldn’t struggle because of the propofol.

From the viewer’s perspective, the spleen is at the upper right end. I need to cut it out… … . If I just cut the blood vessel, blood will spurt out. I can’t do that.

You need a pair of fire-hot scissors.

Still, I’m glad the spleen is visible now. I’ve removed as much of the bloody mesentery as possible.

“Open the incision as wide as possible. Now, insert the scissors.”

“Hey, what the heck are these soldering iron scissors!?”

What the heck, a pair of fire-heated scissors.

Fortunately, this process does not directly cause pain in the internal organs. The internal organs do not hurt directly.

“Splenic artery. Vein. Needle.”

First, I cut the splenic artery and splenic vein with scissors. Just in case, I finished them with stitches. What should I do with the small blood vessels attached to the spleen?

I cut off the small blood vessels with scissors, then burned the cut surface with the side of the scissors. I wonder if this helped stop the bleeding?

I don’t know.

Now it’s time to take out the spleen.

The spleen was solid, but blood was leaking out from various places, like acorn jelly that had been hit by someone. It didn’t seem like it would come out easily.

Also, if you put your hand in and swing it around, you can damage blood vessels or nerves, and there is a possibility that the patient will struggle and get hurt more.

well.

I’m going to throw away the spleen anyway.

There was no need to take the risk. I just stuck my finger into the spleen and carefully pulled it out.

Let’s see. Is the patient alive?

“Istina. Grab the Mac.”

“Patient, there is still a pulse in the neck.”

You’re alive.

“All done. Now just close it. Thank you for your hard work, patient.”

I’d like to check to see if there’s any remaining bleeding, but I can’t think of a way to do that. Maybe just take a good look… ?

first.

There is no bleeding from the blood vessels I cut. Isn’t that okay? There is no other way to treat microvessels, and they are likely to block on their own.

I guess I should close it now.

Although cutting into multiple layers is done, the academic world has concluded that the results do not improve by separating the layers and sewing them together.

I’m not saying that there’s no need for that though.

Now the surgery is over with the sutures.

****

It took a long time. The inside of my mask was sweaty and sticky, and my hands were sweaty inside my gloves and burning.

The surgery was finally completed.

A patient with severe bleeding like this should normally receive a blood transfusion. I don’t even know this patient’s blood type, and I don’t feel comfortable taking blood from someone else and giving it to them.

Assuming that you lost about 1 liter of blood, you can survive without a blood transfusion. First, connect the IV and give oral fluids.

I shook the patient awake again.

“Can I sleep now?”

“If you sleep you’ll die?”

“Okay, I understand.”

◦Never until the %◦ is done.”

This patient can’t possibly be fine. Of course, his complexion is still pale, but he’s been speaking relatively normally since a while ago. Why?

Is it adrenaline?

I don’t know why this patient is fine.

Before the surgery, he was unconscious and on the verge of hypovolemic shock. The anesthetics probably hadn’t taken effect yet, but he’s fine now. It’s not like the surgery will make blood appear out of nowhere.

Until then, I don’t know.

Some people have a strange constitution. Or they could blame it on healing magic. If that’s why they’re so twisted, then I have nothing to say.

[cure.]

It’s fortunate that he looks okay now. Wouldn’t it be okay to observe him at the hospital for about a week? I don’t know when it’ll be okay to go, though.

“Don’t fall asleep, get some rest.”

This patient, whose name was Kailas? The patient was sitting blankly on the bed. Next to him was a modern IV set dripping drops one by one.

I feel like I’ve forgotten something.