Chapter 186: Artificial Pneumothorax Technique

Having an idea is a good thing, but how much confidence one can have does not depend on the doctor himself, but on another group of people whose hair volume has suffered a huge blow during this period.

After reporting the work progress of the past two weeks to the Duke and understanding the condition, Kraft took a piece of bread from his lunch plate and went straight to the workshop without stopping to check the craftsmen's work results.

The jeweler, whose complexion was not very good, showed him something unexpected.

"How was this done?" Kraft carefully picked up a thin silver tube from the velvet pad with two fingers and examined it against the light.

The light passing through the middle showed that it was indeed a hollow tube, with thin and uniform walls, one end sharpened, and the surface polished bright. The few remaining hammering marks indicated that it might have been processed from a beaten silver sheet.

He thought he would never see such a fine thing in his life. He had narrowly escaped the terrible fate of using feathers or thin bones as needles. Although this thing had too high a requirement for the patient's blood vessel diameter if used as a syringe, by the standard of a thoracentesis needle, it had barely met the mark.

The only concern was material strength; bending would be fine, but breaking would be a real big trouble.

The needle was fixed on a wooden plug, matching the rubber tube connection required by Kraft. They made this tube from rolled thin leather, treating the overlapping surfaces with some kind of adhesive. Compared to a rubber tube, the texture was tougher and inconvenient to bend, but the airtightness was trustworthy.

"Will this glue dissolve?"

"You can even use it to blow bubbles underwater."

The craftsman's assurance made Kraft feel much more at ease, almost unable to imagine what the situation would be like if the tube fell apart halfway through the operation.

As for the gas storage device, it was simply simplified into a large leather bag. After all, the lung and thoracic cavity volume was only a few liters, so it was not worth the trouble to make a multi-component air pump that could not guarantee airtightness and was difficult to make. It was just that this way tested the operator's technique to some extent.

These few items basically met Kraft's minimum requirements for operation, artificially creating a pneumothorax state under controllable conditions.

The specific operating steps were not complicated, basically reversing the thoracentesis procedure.

He needed to pierce the Duke's chest wall with the needle connected to the rubber tube, penetrate the pleura layer attached to the rib cage, and reach the space between the two layers of pleura. Then the next step was to pump air in, using air pressure to "flatten" the lungs.

This process would not be accomplished in one go; air would have to be injected in several stages, which also meant the patient would have to endure several more needle pricks. The experience without anesthesia, even if euphemistically put, was not good at all, but since the Duke had survived enemas and bloodletting, it was reasonable to place some trust in his tolerance.

Looking back now, the original plan basically met the current needs. Under the increased air pressure, the lungs would be gradually compressed, and the cavities within the lungs would also shrink synchronously and tend to heal, leaving less and less space for the Fungus Spirit to live comfortably, until it voluntarily gave up this dwelling where the environment was increasingly deteriorating.

Theoretically, that was correct.

However, this brought up another question: how would it move?

Under the most ideal circumstances, the Fungus Spirit would control the main mycelial ball it inhabited, enter the bronchi and main bronchi from the tuberculous cavity, and go all the way up into the trachea. Then it would crawl through the longest section in the trachea, a period of time that would probably not be too short.

It was best to ensure the airway remained open and not be blocked by the expanding mycelial mass. Coincidentally, there was something ready to use.

"The rubber tube is well made. Make another one, add a few metal rings inside to prop it up, make it harder, but not too hard." Toughness also had its benefits, perfect for making a tracheal intubation tube.

"Ah?"

"Your Grace, before everything begins, I must inform you of the purpose of this operation and the risks involved."

"As mentioned before, this is a treatment measure to temporarily alleviate your lung disease symptoms; it cannot completely cure the disease, and may not even make you feel better." Kraft unpacked the instrument kit layer by layer and wiped it with high-concentration alcohol.

The craftsman's guarantee did not include the ability to use it after boiling water disinfection; in the end, manual wiping was required, and the effect would be worse. The strong, almost pungent smell of alcohol spread through the room.

The Duke closed his eyes and nodded, indicating he was listening, and his expression was actually much more relaxed than the doctor's, like a completely unrelated bystander. "This smell reminds me of when I was young; after getting lung disease, I could only quit drinking."

No, that was unlikely; drinking such wine, one probably wouldn't live long enough to get lung disease, Kraft thought to himself.

"After starting, there is a probability of some situations occurring that are not subjectively controllable. Long-term ones include exudative fluid, persistent fever, Pain intensified, and difficulty breathing. Short-term ones may include subcutaneous emphysema. In severe cases, blood vessels may be damaged, causing vascular embolism and endangering life."

Actually, the probability was not high; both puncture and air injection would be conducted under the guidance of spiritual senses, but the notification process had to be followed.

Hearing the last item, the old Duke's eyelids lifted slightly. "May I ask rudely, have there been any patients scared away by this set of things before?"

"This is absolutely not made up, but a real existing risk."

"If you are fortunate or unfortunate enough to go to the battlefield in the future, be sure to remember not to speak to your soldiers like this." As required, he lay on his left side, lifted his robe, and exposed the right chest where the treatment was to be performed. "Duke Westmin agrees to the conduct of this treatment. You may begin, Doctor Kraft."

"Thank you for your trust."

His fingers moved from top to bottom, counting down to the eighth intercostal space, extending to the side towards the armpit, choosing the upper edge of the rib as the needle entry point, avoiding the nerves and blood vessels running along the lower edge of the costal groove as much as possible.

A cold thing pressed against the skin.

"Please relax a bit; now we are just cleaning the skin." The alcohol-soaked cotton ball expanded in concentric circles centered on the puncture point; one could feel a large cold circle appearing on the back ridge.

"Now, you need to endure for a while and try to reduce movement as much as possible." Kraft laid down a fenestrated drape, took out the puncture needle connected to the rubber tube, and temporarily clamped and sealed the tube with small forceps. "I suggest having the guards hold you down, otherwise unnecessary damage may occur."

Of course, this suggestion was not adopted.

Confirming the preparations were complete, he connected his spiritual senses, fixed the skin at the puncture point, pressed the needle tip against it for a few seconds to ensure the patient was mentally prepared, and then began to insert the needle.

Since he was standing on the back side, he could not see the Duke's expression, but he could clearly feel the change in the body from relaxation to tension as the needle tip pierced the epidermis; muscles contracted and bulged, and breathing stopped.

Except for the slight creaking sound of tightly clenched teeth grinding, the only thing he could smell was the heartbeat.

Spiritually "seeing" how the metal passed through the subcutaneous tissue, easily poking out a slippery path in the not-thick fat layer, stabbing into the tense muscles, encountering a little resistance there, and then continuing to break through the chest wall and intercostal muscles, passing through a thin film attached to the rib cage in a restrained manner.

The feeling of falling into emptiness was simultaneously fed back to his hand, indicating that he had successfully entered the pleural cavity. The needle tip was now stopped in front of the lung, a distance of less than three fingers from the cavity where the Fungus Spirit resided.

The fungal body adhered to the necrotic hyperplastic tissue and the cavity wall woven with granulation tissue by its hyphal feet, as peaceful as a field mouse hibernating in its nest, completely unaware of what was happening.

Connecting the rubber tube to the airbag nozzle, Kraft tried to loosen the clamping forceps, allowing gas to flow into the pleural cavity at a speed as uniform and slow as possible. "You can continue breathing now, Your Grace."

With the rhythm of breathing rising and falling, gas that was not very obvious compared to the inflow and outflow volume mixed into this process, and the lung's expansion began to be restricted.

The current situation was not yet obvious. If a chest X-ray could be taken here, it would probably manifest as a narrow peripheral dark band that needed to be magnified to find, with a very low degree of distinction from the lung field, and the fine lung textures terminating at the translucent boundary before the dark area.

Every time a small amount of gas was injected, Kraft would pause for two breathing intervals to observe and evaluate the compression degree and the state of the Fungus Spirit.

Probably because it was used to the periodic changes in air pressure and airflow within the lungs, it currently seemed that this thing's sensitivity to pressure changes was far less than its sensitivity to other stimuli. Until the injected air volume approached half of the Duke's quiet breathing volume, it still had not made a violent reaction.

At this time, the compression had already shown initial results. The elastic lung tissue had a difference in expansion during inhalation compared to the scarred lesion tissue, producing a preliminary compression effect on the cavity. The fungal ball's velvet felt the activity space shrinking vaguely and stirred, seeming about to wake up.

Kraft stopped the gas injection in time, withdrew the syringe, and pressed the puncture point with a cotton cloth dressing, ending the first air injection.

"Your Grace, please lie flat and rest for a while. At least before the next main meal, I do not wish to see you display extraordinary courage."