A Hospital in Another World?
Author: 加兰2020
Chapter 442: How can I know if heâs fainting under anesthesia?
Garrettâs hands were steady.
His heart was also calm.
A 20ml syringe, filled with saline solution, was inserted smoothly into the cut end of the brachial artery. His right handâs index and middle fingers held the syringe while his thumb pressed on the plunger, slowly pushing it forward.
In his past life, syringe needles used for flushing blood vessels were supposed to be blunt-ended to avoid damaging the inner lining of the vessels. Unfortunately, Garrett had not considered this when making the needles earlier.
All the needles were beveled! It was too late to have new ones made and sterilized on the spot. Limb transplantation required racing against time to minimize damage...
He had to rely on his steady technique to keep the needle parallel to the axis of the vessel, preventing the sharp tip from piercing the vessel wall. Then, he slowly and steadily pushed the liquid forward, allowing the saline to enter the artery and flow along the vessel pathway.
It couldnât be too fast or too slow. Too fast, and the jet of fluid would damage the delicate inner lining; too slow, and the saline wouldnât reach the end of the limb before returning via the veins.
The limb was severed, there was no heartbeat or arterial contraction, only the pressure from the syringe pushed the saline forward in the vessel. It had to reach the end to wash out accumulated metabolic waste and blood clots, expanding spasmed, closed-off capillaries and small blood vessels.
In his previous life, Garrett hadnât performed limb reattachment or organ transplants. He had to estimate the correct speed of injection, testing it bit by bit. "Firstly, thereâs no resistance, which means there are no clots nearby, thatâs good..."
"Ah, if only I had a pump... Using a syringe always makes it hard to maintain even pressure... This should be heparinized saline..."
"Heparin?" The silver dragon girl suddenly chimed in. She sat on a floating disc turned into a stool right next to him, watching intently. Hearing Garrettâs muttering, she immediately asked:
"Is heparin something squeezed out of a liver?"
"Did you hear that!" Elder Brockâs voice boomed from behind the operating table, his feathered crown rustling:
"Lord Healer needs a liver! Who will fetch a fresh one!"
Under his heavy gaze, someone immediately turned and dashed out. Garrett broke out in a sweat:
"No!"
Heparin, indeed, was discovered in the liver, but that doesnât mean you can just take a piece of liver, squeeze it, and get heparin!
Whether itâs regular heparin or low-molecular-weight heparin, the production process is quite complex and precise! Giving me a piece of liver wouldnât be useful!
Moreover, nowadays, heparin is mainly extracted from cow lungs or pig intestinal mucosa, nothing to do with actual livers...
The elder who dashed out skidded to a halt. Serila, sitting at the far end of the operating table, asked softly through her arcane eye focused on the limb:
"What do we do then?"
"Nothing much, if we donât have it, we donât have it..."
Garrett responded dully through his mask. Ultimately, saline flushing was a physical method to remove thrombi, while the use of heparin was to prevent blood from clotting again.
As long as he reconnected the vessels quickly enough and threw enough healing spells, he wouldnât have to worry about clots!
"Garrett, what are these red, blue, and yellow things?"
"Ah, those are the vessels and nerves Iâve marked... Red is the arteries, blue is the veins, yellow is the nerves..."
"So later, itâs red to red, blue to blue, yellow to yellow, right?"
"Exactly. Thatâs roughly it..."
Garrett explained softly, staring at the limb. Mage tricks were so convenientâif this were in his past life, heâd have to tie threads to mark them during debridement. Not to mention the difficulty of the procedure, how fragile vessels and nerves are, any physical damage is certain with a tie!
Behind the refuge cabin, the gathered elders sighed in relief, almost ready to kneel in gratitude.
Miss Elf, you truly understand us so well! Your question, and Lord Healerâs casual response, saved us so much research effort! Hmm, after reattaching the limb, we must send her gifts! Lots and lots of gifts!
Garrett responded softly, carefully maintaining his actions. Seeing the reddened flushing fluid flowing out, he finally breathed a slight sigh of relief:
Ah, the bone marrow cavity has started to drain the flushing fluid, good;
The cephalic vein, the basilic vein, the brachial
vein, all had flushing fluid coming out, indicating the saline had reached the ends of the limb, flowing back along the capillary network;
These three spots were previously marked, likely the radial collateral artery, the middle collateral artery, and the ulnar collateral artery, also all showing outflow, great!
Of course, some areas were still bruised and swollen, having been bitten by a black cloud leopard. Garrett cleaned what he could, and what he couldnât, he had to let it be.
After flushing the vessels, he assessed the situation, turning to the trembling, continuously observing Sevi:
"Lie down, Iâm about to start connecting!"
Sevi turned pale. Despite being mentally prepared, lying down to be operated on was still quite terrifying, especially since he wasnât lying on a table but on three connected, slippery, translucent discs that moved at a touch...
Circumstances forced compliance. With his tribeâs elders signaling him and a group of spellcasters watching intently, he had no choice but to obediently climb up and lie flat. A binding spell fell, instantly rendering him speechless and immobile, rigidly frozen in place.
"Uh, that wasnât really necessary..."
Garrett wanted to say that, but swallowed the words back:
Replanting a limb, theoretically, anesthetizing the brachial plexus should suffice. However, considering the patientâs tolerance for the surgery, to avoid the patient jumping off the table and running away mid-procedure, better use general anesthesia!
Itâs simpler!
Besides, divine anesthesia doesnât involve drug metabolism or burden on the liver and kidneys, so why not...
He summoned a silver skeleton, maneuvered it to cut open Seviâs skin, retracted the muscles, and clamped the proximal vessels. Then, lifting the severed limb, he aligned the trimmed bone ends.
Ah, a break in the upper arm is easier to reconnect, just a single humerus. If it were the forearm that was broken, that would be two bones, the radius and ulna. I once had a colleague in orthopedics complain that aligning both bones was a tearful, heartbreaking task.
Garrett, with a pair of his own hands and the silver skeletonâs pair, plus five or six mage hands, was busy non-stop. Clamping vessels, trimming the shape of the bone ends, using bone nippersâsnap, snap, snap...
Earlier, during the debridement, Garrett had already trimmed the bone ends. Now, having cut open the proximal skin and seeing the bone ends with his own eyes, he took extra care to smooth them out, ensuring they could mesh well together.
"Is it okay now? Can I cast the healing spell now?"
Serila peeked out, eager to try. Between her fingers, a clump of white light was already forming, ready to be pressed down. Hmm, Garrett was just a level-five priest, with only so much spiritual energy. His energy should be conserved for more important tasks!
Iâll handle the healing!
"Shh!"
Garrett quietly signaled her to keep quiet. Ah, not shaping the fracture surfaces into a dovetail joint and securing them without Kirschner wires or screws felt so unusual...
But shaping them into a dovetail would noticeably shorten the bone and the entire arm. Here, bone healing didnât take too long, so there was no need for dovetail joints and internal and external fixations for added strength...
He calculated and operated. The heavy bone nippers, light as a feather in the hands of the silver skeleton. Snap, snap, snap, snap, aligning perfectly, then covering the bone ends with the previously peeled periosteum.
Be careful!
Even more careful!
The delicate periosteum was best not damaged! With the periosteum in place, the bone ends would heal easily. Although the healing spell was powerful, it was best to save wherever possible...
"Alright! Serila!"
"Here it comes!"
A clump of white light, as solid as reality, descended. Garrett stared intently at the humerus fracture, watching the periosteum tightly wrap around the bone ends, watching the bone gaps gradually close together.
Lean down a bit more, using Serilaâs headgear to light it up, looking at the distal end bitten by the black cloud leopard, following the healing spell, filling up, leaving no cracks...
Awesome!
Healing spell, Serila, awesome!
This healing spell, strong enough to be considered for serious injuries, focused entirely on a single bone. No wonder the bone immediately sealed perfectly, just like it had never been injured!
Garrettâs face lit up with joy, giving Serila a thumbs up, and continued working. Ah, the bone was secured, now onto the vessels. If the vessels successfully joined, this arm would live, then it was just a matter of how much function would recover.
Garrett stowed away the silver skeleton, closed his eyes, and concentrated for a moment. Then
, making a circle with his right thumb and index finger, he signaled to the silver dragon girl:
"Spell magnifying glass, come~~~"
"Too close! Move it further! Even further!"
"Increase the magnification! No, Iâm not asking you to make the magnifying glass bigger, make the magnification larger!"
"Itâs tilted! Lift the left side a bit!"
"Raise it a bit, youâre about to touch it! Youâll contaminate the lens!"
It turned out that Garrett and the silver dragon girlâs rapport still needed some work...
Up and down, stumbling along. The magnifying glass finally adjusted to a comfortable position for Garrett, who then focused entirely on joining the vessels. Brachial artery, cephalic vein, basilic vein. One artery, two veins, all three vessels joined, ready to release the vascular clampsâ
"Serila, prepare the healing spell! If he feels dizzy, palpitations, or sees darkness, cast it immediately!"
Blood volume hadnât been replenished, blood pressure hadnât risen back, and once the artery was opened after connecting the limb, the patient was very likely to have a sudden drop in blood pressure!
At that moment, only the healing spell could save the day!
"...But heâs bound there, how would I know if he feels dizzy or has palpitations?"
"..."
"..."
Thatâs a good question... How would you know if someone under general anesthesia is fainting!
We should have produced a sphygmomanometer sooner!
---------------
His heart was also calm.
A 20ml syringe, filled with saline solution, was inserted smoothly into the cut end of the brachial artery. His right handâs index and middle fingers held the syringe while his thumb pressed on the plunger, slowly pushing it forward.
In his past life, syringe needles used for flushing blood vessels were supposed to be blunt-ended to avoid damaging the inner lining of the vessels. Unfortunately, Garrett had not considered this when making the needles earlier.
All the needles were beveled! It was too late to have new ones made and sterilized on the spot. Limb transplantation required racing against time to minimize damage...
He had to rely on his steady technique to keep the needle parallel to the axis of the vessel, preventing the sharp tip from piercing the vessel wall. Then, he slowly and steadily pushed the liquid forward, allowing the saline to enter the artery and flow along the vessel pathway.
It couldnât be too fast or too slow. Too fast, and the jet of fluid would damage the delicate inner lining; too slow, and the saline wouldnât reach the end of the limb before returning via the veins.
The limb was severed, there was no heartbeat or arterial contraction, only the pressure from the syringe pushed the saline forward in the vessel. It had to reach the end to wash out accumulated metabolic waste and blood clots, expanding spasmed, closed-off capillaries and small blood vessels.
In his previous life, Garrett hadnât performed limb reattachment or organ transplants. He had to estimate the correct speed of injection, testing it bit by bit. "Firstly, thereâs no resistance, which means there are no clots nearby, thatâs good..."
"Ah, if only I had a pump... Using a syringe always makes it hard to maintain even pressure... This should be heparinized saline..."
"Heparin?" The silver dragon girl suddenly chimed in. She sat on a floating disc turned into a stool right next to him, watching intently. Hearing Garrettâs muttering, she immediately asked:
"Is heparin something squeezed out of a liver?"
"Did you hear that!" Elder Brockâs voice boomed from behind the operating table, his feathered crown rustling:
"Lord Healer needs a liver! Who will fetch a fresh one!"
Under his heavy gaze, someone immediately turned and dashed out. Garrett broke out in a sweat:
"No!"
Heparin, indeed, was discovered in the liver, but that doesnât mean you can just take a piece of liver, squeeze it, and get heparin!
Whether itâs regular heparin or low-molecular-weight heparin, the production process is quite complex and precise! Giving me a piece of liver wouldnât be useful!
Moreover, nowadays, heparin is mainly extracted from cow lungs or pig intestinal mucosa, nothing to do with actual livers...
The elder who dashed out skidded to a halt. Serila, sitting at the far end of the operating table, asked softly through her arcane eye focused on the limb:
"What do we do then?"
"Nothing much, if we donât have it, we donât have it..."
Garrett responded dully through his mask. Ultimately, saline flushing was a physical method to remove thrombi, while the use of heparin was to prevent blood from clotting again.
As long as he reconnected the vessels quickly enough and threw enough healing spells, he wouldnât have to worry about clots!
"Garrett, what are these red, blue, and yellow things?"
"Ah, those are the vessels and nerves Iâve marked... Red is the arteries, blue is the veins, yellow is the nerves..."
"So later, itâs red to red, blue to blue, yellow to yellow, right?"
"Exactly. Thatâs roughly it..."
Garrett explained softly, staring at the limb. Mage tricks were so convenientâif this were in his past life, heâd have to tie threads to mark them during debridement. Not to mention the difficulty of the procedure, how fragile vessels and nerves are, any physical damage is certain with a tie!
Behind the refuge cabin, the gathered elders sighed in relief, almost ready to kneel in gratitude.
Miss Elf, you truly understand us so well! Your question, and Lord Healerâs casual response, saved us so much research effort! Hmm, after reattaching the limb, we must send her gifts! Lots and lots of gifts!
Garrett responded softly, carefully maintaining his actions. Seeing the reddened flushing fluid flowing out, he finally breathed a slight sigh of relief:
Ah, the bone marrow cavity has started to drain the flushing fluid, good;
The cephalic vein, the basilic vein, the brachial
vein, all had flushing fluid coming out, indicating the saline had reached the ends of the limb, flowing back along the capillary network;
These three spots were previously marked, likely the radial collateral artery, the middle collateral artery, and the ulnar collateral artery, also all showing outflow, great!
Of course, some areas were still bruised and swollen, having been bitten by a black cloud leopard. Garrett cleaned what he could, and what he couldnât, he had to let it be.
After flushing the vessels, he assessed the situation, turning to the trembling, continuously observing Sevi:
"Lie down, Iâm about to start connecting!"
Sevi turned pale. Despite being mentally prepared, lying down to be operated on was still quite terrifying, especially since he wasnât lying on a table but on three connected, slippery, translucent discs that moved at a touch...
Circumstances forced compliance. With his tribeâs elders signaling him and a group of spellcasters watching intently, he had no choice but to obediently climb up and lie flat. A binding spell fell, instantly rendering him speechless and immobile, rigidly frozen in place.
"Uh, that wasnât really necessary..."
Garrett wanted to say that, but swallowed the words back:
Replanting a limb, theoretically, anesthetizing the brachial plexus should suffice. However, considering the patientâs tolerance for the surgery, to avoid the patient jumping off the table and running away mid-procedure, better use general anesthesia!
Itâs simpler!
Besides, divine anesthesia doesnât involve drug metabolism or burden on the liver and kidneys, so why not...
He summoned a silver skeleton, maneuvered it to cut open Seviâs skin, retracted the muscles, and clamped the proximal vessels. Then, lifting the severed limb, he aligned the trimmed bone ends.
Ah, a break in the upper arm is easier to reconnect, just a single humerus. If it were the forearm that was broken, that would be two bones, the radius and ulna. I once had a colleague in orthopedics complain that aligning both bones was a tearful, heartbreaking task.
Garrett, with a pair of his own hands and the silver skeletonâs pair, plus five or six mage hands, was busy non-stop. Clamping vessels, trimming the shape of the bone ends, using bone nippersâsnap, snap, snap...
Earlier, during the debridement, Garrett had already trimmed the bone ends. Now, having cut open the proximal skin and seeing the bone ends with his own eyes, he took extra care to smooth them out, ensuring they could mesh well together.
"Is it okay now? Can I cast the healing spell now?"
Serila peeked out, eager to try. Between her fingers, a clump of white light was already forming, ready to be pressed down. Hmm, Garrett was just a level-five priest, with only so much spiritual energy. His energy should be conserved for more important tasks!
Iâll handle the healing!
"Shh!"
Garrett quietly signaled her to keep quiet. Ah, not shaping the fracture surfaces into a dovetail joint and securing them without Kirschner wires or screws felt so unusual...
But shaping them into a dovetail would noticeably shorten the bone and the entire arm. Here, bone healing didnât take too long, so there was no need for dovetail joints and internal and external fixations for added strength...
He calculated and operated. The heavy bone nippers, light as a feather in the hands of the silver skeleton. Snap, snap, snap, snap, aligning perfectly, then covering the bone ends with the previously peeled periosteum.
Be careful!
Even more careful!
The delicate periosteum was best not damaged! With the periosteum in place, the bone ends would heal easily. Although the healing spell was powerful, it was best to save wherever possible...
"Alright! Serila!"
"Here it comes!"
A clump of white light, as solid as reality, descended. Garrett stared intently at the humerus fracture, watching the periosteum tightly wrap around the bone ends, watching the bone gaps gradually close together.
Lean down a bit more, using Serilaâs headgear to light it up, looking at the distal end bitten by the black cloud leopard, following the healing spell, filling up, leaving no cracks...
Awesome!
Healing spell, Serila, awesome!
This healing spell, strong enough to be considered for serious injuries, focused entirely on a single bone. No wonder the bone immediately sealed perfectly, just like it had never been injured!
Garrettâs face lit up with joy, giving Serila a thumbs up, and continued working. Ah, the bone was secured, now onto the vessels. If the vessels successfully joined, this arm would live, then it was just a matter of how much function would recover.
Garrett stowed away the silver skeleton, closed his eyes, and concentrated for a moment. Then
, making a circle with his right thumb and index finger, he signaled to the silver dragon girl:
"Spell magnifying glass, come~~~"
"Too close! Move it further! Even further!"
"Increase the magnification! No, Iâm not asking you to make the magnifying glass bigger, make the magnification larger!"
"Itâs tilted! Lift the left side a bit!"
"Raise it a bit, youâre about to touch it! Youâll contaminate the lens!"
It turned out that Garrett and the silver dragon girlâs rapport still needed some work...
Up and down, stumbling along. The magnifying glass finally adjusted to a comfortable position for Garrett, who then focused entirely on joining the vessels. Brachial artery, cephalic vein, basilic vein. One artery, two veins, all three vessels joined, ready to release the vascular clampsâ
"Serila, prepare the healing spell! If he feels dizzy, palpitations, or sees darkness, cast it immediately!"
Blood volume hadnât been replenished, blood pressure hadnât risen back, and once the artery was opened after connecting the limb, the patient was very likely to have a sudden drop in blood pressure!
At that moment, only the healing spell could save the day!
"...But heâs bound there, how would I know if he feels dizzy or has palpitations?"
"..."
"..."
Thatâs a good question... How would you know if someone under general anesthesia is fainting!
We should have produced a sphygmomanometer sooner!
---------------