Wolfram von Eschenbach

Medical Technology:Battlefield Medicine in Wolfram von Eschenbach’s

“Parzival”

Die Doppelwegstruktur

Gahmuret/Parzival: Books 1 - 6

Parzival: Book 9 Gawan: Books 7 – 8, 10 - 13

Reunified storyline: Parzival, Gawan, Feirefiz Books 14 - 16

“Gawain and the Wounded Knight”

Normal Chest:

Hemothorax: blood accumulating in the pleural space

Hemothorax: X Ray Blood accumulation: MRI

Empyema

Traditional EmpyemaEmpyema and Mucocele of the gallbladder

The Greeks: Hippocrates, Galen & Paul of Ægina

Mundinus of Bologna & Munro Secundus

Tension Pneumothorax

CT (Computerized Tomography) Scan

The Breathing Mechanism

Gas Exchange in Human BreathingNegative Pressure Breathing: Change of pressure within the lung cavity relative to the air pressure outside.

The exchange of oxygen and carbon dioxide between the air and the blood in the lungs.

Although fractured ribs are not necessary for tension pneumothorax to occur, they are often associated with disruption of either the visceral or parietal pleura.

Image depicting multiple fractures of the left upper chest wall. The first rib is often fractured posteriorly (black arrows). If multiple rib fractures occur along the mid-lateral (red arrows) or anterior chest wall (blue arrows), a flail chest (dotted black lines) may result.

Chest Tube Insertion

Placement of Thoracostomy

Tube Thoracostomy:

Skin Preparation: Local Anesthesia:

Tube Thoracostomy:

Skin Incision:Blunt dissection down to the intercostal muscle:

Tube Thorocostamy:Palpation of the selected intercostal space and the superior margin of its inferior rib:

A closed and locked Kelly clamp is used to enter the chest wall into the pleural cavity. Make sure to guide the clamp over the upper margin of the rib:

Tube Thoracostamy:A finger is used to palpate the tract and feel for adhesions before insertion of the chest tube:

The proximal end of the chest tube is held with a Kelly clamp that is used to guide the chest tube through the tract. The distal end of the chest tube should always be clamped until it is connected to the drainage device:

Tube Thoracostamy:Connection of the chest tube to a drainage system:

A 0 or 1-0 silk or nylon suture is used to secure the chest tube to the skin:

Apply petrolatum (eg, Vaseline) gauze over the skin incision:

Apply support gauze dressing around the chest tube and secure it to the chest wall with 4-in adhesive tape:

Chest Tube Thoracostomy from GSW:

Re-inflation

The Patient

Fasciculo di medicina, Venice, 1493

René Laennec & Jean Marc Gaspard Itard

Wolfram’s Milieu: Schildes ambet ist mîn art

Wolfram von Eschenbach