- Whoa. Where's the Nose?
(beep)
Operating theaters, burr holes
and what the heck is cat gut?
Today we are reacting to and breaking down all sorts
of old school medical procedures and devices from The Knick.
Fair warning medicine has come a long way
since these practices and it might get a little messy.
Alright, let's dive right in.
- When you wake up,
you'll be cured.
(bell dings)
- Oh, what is he doing?
They're wearing like crazy all white,
at least they're wearing gowns back in this time,
but taking place in like the 19th century I believe.
Later on they realize like, hey, you know, the bright lights
of the OR plus everything else, it was causing eye strain
and so they actually changed colors.
So it actually would be less strainful on the eyes.
He's not wearing a mask, not covering his hair.
Nobody else is.
Oh, what the heck is this?
(intake of breath)
Where's his gloves?
Okay, so obviously not wearing gloves back then,
and look at his arms he actually has the
what we call track marks.
Not sure if he's rubbing an alcohol, like cleaning agent.
Not exactly sure.
Oh, don't do this.
So hopefully that was a topical anesthetic.
Oh cool. He did probably
some sort of Venous cutdown.
Normally we would like be able to stick an IV
in the vessel, tubing and get it to it.
He was able to get directly
into the blood vessel that he needed.
As a surgeon in a hospital
you're not gonna do these type of blood transfusions.
We have blood stored and we have emergent blood.
In the military or out in the middle of nowhere
this is probably still happening
to where people can actually transfuse themselves
if needed with somebody else's blood.
- Pulse is rapid.
Pulse is weak now.
- Pulse is rapid.
It could be related to blood pressure is starting
to go down so your heart rate's starting,
trying to increase and then if there's not
any good enough blood volume going around
in your system, the pulse is gonna potentially be weak
and then that basically means your blood pressure is low.
As that continues to happen, you basically can lose pulses.
Ooh. Alright, so those are different clamps.
Just to stop everything from flowing.
- [Lucy Elkins] What's happening?
- [Dr. John Thackery] Obviously its not working.
- It's not working.
(intense music)
- I have no pulse.
- Whoa body rejection. That's so sad.
Hopefully they have the ability to test back then.
Maybe not, and they're just taking a risk
that this is going to be okay and compatible.
- As you can see, my assessment is correct
as the brain's fluid is immediately being forced
out through the opening syringe.
- Oh my gosh, that's called a burr hole.
There are different clinical ways to check
for intercranial pressure.
We have CAT Scan machines that help us,
but back then imaging wise was limited.
Had to use their clinical judgment and then it's kind
of like, I hope I'm right.
What is this?
Oh he's sucking it out?
Oh, super cool. You got everybody watching.
So this is like surgical theater.
Obviously we don't have these anymore except sometimes
in an OR they'll be like a glass case high up
where people can sit and watch to learn.
- I know I'm supposed to cut something, but what?
- But they're outside of the area because it's sterile
- In order to keep the intracranial pressure at bay-
- Cool.
- it is my opinion that the hole I just created
should remain open even after the operation.
- So super cool.
Yes, so there is called craniotomy and a craniectomy.
Craniotomy open a hole, you take off a piece of the skull
and then you put it back on
versus a craniectomy, you remove the bone
you could save it for later, you can preserve it.
Just relieving the pressure
at that point may help instantaneously
but the brain might still be swollen
for a multitude of different reasons,
so it needs time to have the swelling go down.
Whoa, where's the nose?
- Is the light still too much?
- What?
- You've got good capillaries on the bridge
and healthy skin on the edges.
- Looking at the nose, looking at the blood supply
because if you give a new nose that area
and there's not blood supply-
- Ahh you've got my nose.
- to profuse that new tissue
the new tissue won't take it and it's going to die.
It's gonna rot off.
It needs to have good blood flow to the area.
Obviously the nose is super important
for multiple different reasons.
Experts believe that the sympathetic
and the parasympathetic nervous systems are affected
by the tissue within the nose.
- You're a good candidate for restoration
but it won't be an easy go.
- Very little has been.
- When it means restoration,
meaning like trying to fix it with something new.
You know, there are different ways that you can do this.
You can use your own tissue as a tissue flap
but you need a structure there.
You need cartilage.
This is all what plastic surgeons do nowadays they do a lot
of reconstructive surgery versus just cosmetic surgeries.
- The surgeon selects a piece of skin from your arm here.
He then makes a flap, which stays partially afixed
to your arm to keep the skin alive
and provide blood flow from that end.
He then attaches the other end of the flap
to the bridge of your nose
attempting as best he can to connect a good blood supply.
- Oh my gosh.
Describing a, basically a procedure where you don't totally
take the tissue off and then attaching it to your nose.
I'm assuming you bring it up
and as you're trying to make sure
that you have good blood supply and tissue adherence.
That's actually pretty interesting.
I've seen procedures where somebody has missing tissue skin
and they need skin,
they'll open up a wound in the abdomen, put it in,
so it actually can get nutrition and blood flow,
and then when they have time in the enough tissue
they'll actually take that off.
- Vacuum.
- Vacuum. Alright, what are they gonna suck out of there?
So it's on the lateral aspect.
Distal femur, we have the thigh.
The major blood vessels are running right
behind the femur bone on that side.
- Christ, the bullets lodged in the tunica.
That's the only reason he hasn't already bled to death.
The Tunica Intima is the innermost layer of the veins.
Maybe it's actually lodged in that.
So he's found a bullet in there.
If the bullet is causing a problem like this, yes
you're trying to get it out of there.
You can't just leave the bullet in a vein.
If the bullet was just in the muscle itself
probably just leave it in there if you couldn't get to it.
- It's already showing signs of necrosis.
- Showing signs in necrosis.
Decreased blood flow to the tissue, whitening of the tissue.
Tissue kind of swelling a little bit, dying.
There's multiple different stages
but the biggest thing is probably lack
of blood flow to that area.
- His pulse is eccentric. We need to amputate now.
- So describing that his pulse is abnormal
is a sign potentially that he is getting worse,
that's why they're suggesting the dramatic nature
of doing an amputation-
- Tis but a scratch.
- to save him even though you can't save the leg.
Ooh.
Those are like bone cutters I guess.
So he cut off pieces of the bone.
So sometimes we'll do that.
Fingertips that have come off
and the bone is actually sticking
out further than the tissue.
You can't close the tissue.
You need to cut the bone pieces off,
and we call that Rongeuring,
and the tool is called the Rogeur.
- Throw me up a line for the catgut.
- He is requesting catgut sutures
which is suture material strings made
from twisted intestine from sheep.
Catgut sutures have pretty much been replaced
by synthetic forms of it.
Still really cool that they were able to figure
out how to use that
and that they're absorbable because it's mostly collagen.
Very impressive. Now he's able to sew the wound up.
Hopefully he saved his leg.
I loved this.
I need to watch this show more often.
So if you guys really enjoy this, you want me to do more
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Thank you so much for watching and stay healthy my friends.