Nineteenth Century Medical Guide

Chapter 497, page 493: Guess what's inside?

Entering the 19th century, under the influence of Napoleonic wars, Spain, the first British Empire, was completely reduced to a second-rate power. Power changed hands repeatedly, internal affairs were in chaos, and development lagged behind other European powers across the board.

San Sebastián is located in northern Spain and is the capital city of the province of Gipuzkoa in the Basque Country, but it is still a small city compared to other major European cities.

The town's economy is underdeveloped, and the spread of culture and science is even more lagging behind, so you can imagine how poor its medical standards are.

Patients like Ugo, whose rib fractures developed into pneumothorax due to trauma, would be difficult to treat in Vienna, but there would always be a way if they went to the Municipal General Hospital. In Spain, however, it would unsurprisingly become an incurable disease that no one could treat.

Kavi's appearance saved his life, but it will take a long time for him to fully recover.

Modern closed-loop drainage differs from modern methods; it lacks suction pumps and manual suction devices, thus lacking a stable and continuous external force to draw air out. Drainage relies solely on the pressure difference during respiration to remove excess air from the body.

In this situation, maintaining a sufficient pressure difference is not easy, and there is definitely a possibility of poor traffic flow.

In addition, Ugo's injury was external, with a rib fracture. Fractures can cause bleeding, which can turn a simple pneumothorax into a hemopneumothorax.

The rubber tubing used in the 19th century was already considered a high-tech product, making it very prone to aging and damage, and there were no conditions for long-term anticoagulation treatment. With prolonged drainage, the thickened blood would clot and block the lumen, thus affecting the drainage effect.

Given these combined factors, it's not surprising that Ugo developed breathing problems.

Kavi had anticipated that Ugo's traffic generation would run into problems, but the problems appeared much earlier than he expected.

In his original plan, the drainage should last for a day or two, or at least until the evening. Now the nurse rushed over, only reporting difficulty breathing, without mentioning heart rate or respiratory rate, or any other details, so Kavi had to go there himself.

Fortunately, Anders' condition is relatively stable, and the diagnosis is basically clear. In recent years, Bergert's technology has also made great progress.

After all, suturing the intestines was a required skill for Cavie's assistants, something they had been practicing for three years, so it posed no difficulty for Bergert. The only problem was Antonio and his two assistants; their ability to cooperate with Bergert was the key to the surgery.

Kavi said he was not entirely reassured, but before leaving, he still gave a few words of advice: "Examine the intestines carefully and pay attention to the blood supply at the rupture site."

“I understand. If the blood supply is good, sew it up; if the blood supply is too poor, cut it off and reconnect it.” Bergert responded without even looking up. “You should think about how to handle the diversion.”

Kavi had a plan in mind, but putting it into practice was a bit difficult. He took off his surgical gown, gloves, and mask, rummaged through the two boxes he had brought, and took out a lot of thin glass tubes and rubber tubes: "Director Antonio, do you have any large-capacity glass bottles here?"

Antonio asked, puzzled, "Large capacity? How large?"

"Ideally, it should be more than 5 liters."

"If it's 5 liters, we'll have to go to the warehouse; there should still be a few left there."

Kavi nodded and continued, "What about the pliers?"

"pliers?"

Antonio's first thought was of the hemostat in his hand, which was from Kavi's instrument case and was much more sophisticated than the set he had copied from Kavi's diagrams: "What kind of hemostat are you asking about?"

“Oh, I need to improve your IV stand.” Kavi pointed to the small metal rings on the stand. “A 5L wide-mouth bottle filled with water will be very heavy, so we need to ensure safety.”

"There should be some."

"That's good."

Because he received approval from the hospital director, Alvaro, Hugo was placed in the surgical ward and cared for one-on-one by a nurse.

She's the acting head nurse here, temporarily filling in for the retiring head nurse, and she's also Antonio's trained scrub nurse. If it weren't for this bullfight, she'd be standing by the operating table distributing surgical instruments right now.

Unfortunately, just in case, Kavi left her in the ward.

Not long after making the arrangements, Kavi regretted it. In his eyes, the "excellent" nurse Antonio spoke of was no different from any other ordinary nurse.

Lacking both experience and skills, and without basic nursing care knowledge, all we could do was provide Ugo with emotional support and keep basic records, such as whether the drainage was smooth, whether he was experiencing any discomfort, how much water he had drunk, and how much urine he had produced.
When Ugo felt like she couldn't breathe, all she could do was find a doctor.

It was then that she realized all the doctors who were supposed to stay in the ward had gone to the operating room. And what seemed like a simple routine medical communication, which she thought would only require one-sided statements, eventually turned into a direct dialogue with Kavi.

This was a conversation that even Antonio envied and felt uneasy about, but unfortunately the result was not good.

"Don't you know whether the drainage is smooth or not?" Kavi was somewhat speechless. "I told you before that you just need to check if there are any bubbles in the water in the second bottle."

"Probably, probably not."

The nurse stayed close to Kavi, moving nimbly on her feet and constantly flipping through her notebook, which contained details of Kavi's instructions and notes she had made later.

But when she finally managed to put all of this into words, she became hesitant and stammered: "I've been staring at the bottle the whole time, never taking it out of my sight, afraid something might go wrong. I just thought about it, and I'm sure the bottle has been bubbling non-stop."

"Perhaps I misspoke," Kavi said, simplifying the problem by removing a layer of logic. "Is the amount of bubbles normal compared to the beginning?"

"The amount of bubbles."

"Is the amount of bubbles all the same?" Kavi opened and closed his fingers repeatedly, imitating the sound of bubbles.

"."

"Forget it, you should be able to tell whether the liquid's color has changed or not, right?"

"Red, it's turned red."

In just a few words, they were back in the surgical ward.

Perhaps due to insufficient experience, this nurse lacks the ability to think deeply and is disorganized when dealing with matters, but fortunately, her expression is quite accurate.

Ugo began to have difficulty breathing, and the liquid in the drainage bottle did indeed turn red.

"Mr. Ugo, how are you feeling?"

"I can't breathe! I'm trying so hard to breathe, but... but it's no use." Ugo's face turned red; he was indeed trying very hard. "Please help me!"

“I understand.” Kavi looked down at the drainage bottle. “The amount of bubbles has decreased significantly; there’s a problem with the drainage.”

He squeezed the rubber tube back and forth and squeezed out some blood clots: "The blood congealed in the tube, blocking the lumen, so the air in his chest cavity couldn't escape, and naturally he couldn't breathe."

The nurse had almost no knowledge of anatomy and was completely confused, only managing to reply, "Okay, I understand."

“Next time this happens,” Kavi looked at her. “...Next time this happens, I’ll do it the same way you just did.” The nurse leaned closer and did it again, “If it doesn’t get better, I’ll come back to you.”

Kavi took out a syringe and vial from his pocket, quickly prepared a simple injection of sodium citrate, and nodded as he listened to her answer. Perhaps Antonio hadn't made a mistake; she was indeed the best nurse here: "What's your name?"

“Hermana,” the nurse said, “was originally a nun from the church next door, and later became a nurse here.”

“Miss Hermana, if you find the lumen blocked by blood clots again, remove the tube, clamp the end, and inject the medication I prepared.” Kavi pushed the entire plunger into the syringe. “After sealing and flushing the tube, you can reconnect it and it will last for a while.”

“I understand.” Hermana didn’t memorize it by rote, but took out a notebook from her pocket and wrote down the whole process.

Kavi reconnected the rinsed rubber hose: "Mr. Ugo, how are you feeling now?"

"I feel so much better now that you've pulled out that tube." Ugo pumped the muscles on both sides of his chest, enjoying the pleasure of the air entering his body. "I wish it could stay like this forever, it's so awful not being able to breathe!"

Kavi patted him on the shoulder: "Don't worry, everything will be alright."

"Oh, by the way, how is Mr. Anders?"

“He’s in surgery,” Kavi replied simply, his eyes fixed on the liquid in the drainage bottle, before steering the conversation back to him, “Did you pee?”

Ugo shook his head: "No, I don't feel anything."

“The bullfight starts at 2 PM, and it’s 5 PM now.” Kavi glanced at the time. “You received 200 ml of IV fluids, and you drank quite a bit of water. Did you drink any water before the bullfight?”

"Of course I've drunk it."

Do you sweat a lot?

"It's alright." Ugo gave a helpless bitter laugh. "As you can see, I was carried off after only a few rounds of movement. Even if I was sweating, it was cold sweat."

At this point, Kavi had a bad feeling: "Mr. Ugo, I don't remember this being the first time I've asked you this question, have I?"

"You asked me that before in the church basement."

"Ah."

Kavi pulled out a stethoscope from his pocket and examined Ugo's chest again: "Come on, listen to my instructions, inhale, exhale, keep exhaling."

"Breathing like this is so tiring, and my injury hurts a lot," Ugo complained.

"Don't speak yet, I can't hear you." Kavi then ordered him to take two more deep breaths before stopping.

"How about it?"

“It’s hard to say.” Kavi removed his stethoscope and his pillow. “Come on, sit forward, yes, further forward, good, lie down. Lift up your clothes, expose your stomach, and bend your knees and put your feet on the mattress.”

After a brief percussion examination, Ugo lay down in a semi-lateral position as instructed, and Kavi tapped his stomach several more times: "Your stomach seems normal, but does your back hurt?"

“Waist? It should be above the waist.” Ugo pointed to his back. “It hurts here, I told you before.”

The pain area was about the size of a fist, extending from the fifth rib to the diaphragm. This was some distance from the abdominal cavity, contrary to Kavi's guess. However, the fluid in the first drainage bottle had indeed increased, its color ranging from pale red to bright red, indicating that other fluids had been drained along with it.

A surgical team without imaging examinations is like an army without scouts; everything must be carefully considered, and actions become hesitant and timid, for fear of being ambushed and suffering heavy losses.

Therefore, Kavi dared not be negligent at the slightest sign of trouble.

Ugo is currently in relatively good condition, with stable vital signs, and there's still time for him to consider several contingency plans. If we don't take this seriously now, it won't be so easy to find an accurate solution immediately when his life is truly in danger.

"Dr. Kavi, I'm in so much pain, could you give me some painkillers?"

Kavi removed the drainage bottle and poured some of the liquid out: "Didn't you drink YP tincture? Are you still in pain?"

“Sitting like this definitely won’t hurt, but you told me to breathe deeply.” Ugo demonstrated again, “It hurts when I try to breathe deeply, it hurts a lot. I can bear it now, but I’m afraid I won’t be able to hold it in and my breathing will stop. What would I do if you weren’t here!”

It was all because the lack of a suction device resulted in insufficient drainage, which is why Ugo had to increase the pressure in his chest cavity himself.

Since we'll have to replace the drainage device sooner or later anyway, we might as well replace it now and let the nurses learn how to control the drainage as soon as possible. Besides, it's better than them coming to knock on the hotel room door in the middle of the night, which is not only troublesome but also dangerous.

"Two of the largest glass bottles, with a scale exceeding 5L." Kavi instructed the other nurses to go to the warehouse to fetch the equipment they wanted. "We also need a metal rack, at least 1 meter tall, preferably as tall as you all."

"Metal frame?"

"You've seen the ones in the surgical theater, right? Something similar will do." Kavi gestured briefly. "If the warehouse doesn't have them, go to your director's lab; they should have them there."

"understood."

"You have half an hour," Kavi calculated the time. "Come find me at the operating room when everything is ready."

"Ok."

“Hemana, you shouldn’t go.” Kavi specially pulled up a chair for her. “You sit here and keep a close eye on Mr. Ugo. If he has any health problems, please write them down immediately.”

After assigning the tasks, Kavi gave Ugo a few more instructions before picking up the drainage fluid he had just removed and returning to the operating room.

The round trip took more than ten minutes. Bergett was lucky and had already made a discovery: "You came back as soon as we found the breach."

"On the intestinal tract? How big is it?"

"It's about 3cm long, torn to the blood vessels, and still bleeding." Bergert spread out a wet gauze, took the intestine out of the abdominal cavity, and used intestinal forceps to fix it at both ends. "The tear isn't too big, I'll repair it first and then check further."

"Where's the blood? Is all the blood collected?" Kavi asked Antonio across from him. "How much blood was drawn?"

“I took about 300ml,” Antonio explained, “but there are intestinal contents mixed in, so it’s probably unusable.”

“If it really comes to a bad situation, we have to use it even if we can’t. Add more methylene blue to it.” Kavi came to the table and felt his carotid pulse. “His heart rate is okay now, around 100. The fluid resuscitation is effective.”

"How's it going on your end?" Bergett asked curiously, speeding up his work. "The new drainage device was installed so quickly?"

"It won't be that fast." Kavi opened the glass bottle in his hand, shook it, and held the drainage fluid in front of him. "Guess what's in here?"