Infusion of burn patients, it is not just a matter of hanging a few bottles of saline as the common people think.

Don't look at the nurse who comes to change the bottle after a while, there are all kinds of colorful bottles and cans, in fact, there is a very, very complex set of calculation formulas.

If you don't have less fluid, you can't infuse too much, and the ratio of saline and sugar water must not be changed wrongly, and if you are not careful, it is easy to make the treatment fail and even the patient dies.

Not to mention those who died on the spot, the most common causes of death for burn patients who can survive in the hospital are two:

One is "shock" and the other is "infection".

When patients with severe burns are not strong enough to compensate for the rapid loss of fluids, circulating blood volume decreases significantly, leading to hemodynamic changes that lead to hypovolemic shock.

Severe burns occur 2 to 4 hours after injury, and severe burns can fall into severe shock within 4 to 8 hours.

And this Army Commander Z is in severe burn shock, and from the burns to the transfer to the China-Africa Friendship Hospital, 3 hours have passed, which is a very precious 3 hours.

Therefore, fluid regeneration has become another very, very important rescue measure after endotracheal intubation.

If your department doesn't often deal with patients with injuries or dehydration, then the doctor basically forgets everything except for the memorization during the exam.

Not to mention that in 1987, even the relevant formulas in textbooks were not as perfect as they were decades later.

So now Chen Qi is going to prescribe rehydration, his head is about to explode, and his face is red.

Because he has almost forgotten the formula about rehydration in his impression, he really can't fully remember it for a while, and the more anxious he is, the more he can't remember, and he is anxious to die.

The rescue work, which was still advancing rapidly, suddenly stopped, and everyone in the rescue room looked at the attending doctor Chen Qi in surprise.

Qi Yunming was anxious: "Xiao Chen, what's wrong? Hurry up and save it, why are you standing stupidly?"

Dean Bagri asked in horror, "Dr. Chen, is the patient hopeless?"

Hearing this, the family members outside the window began to howl again.

Chen Qi raised his hand and made a quiet movement:

"Don't make a noise, don't argue, I'm memorizing a formula, damn, why is it so complicated, this thing can't be wrong, absolutely can't be wrong, if you make a mistake, a patient will die."

Everyone looked at each other, and many people began to have a trace of doubt about Chen Qi's firm belief?

Shouldn't this miracle doctor come casually, the wind is clear?

How can there be a patient like him, lying there waiting for first aid, and still memorizing textbooks here?

And some other doctors don't think so, isn't it just an infusion, you can take any saline, sugar water, sugar saline at will, anyway, what you have to infuse, why is it so complicated?

Chen Qi's brainless fans like Yi Zewen and Zhang Xing are also trying to recall the rehydration methods they taught in college to see if they can help.

They are from regular undergraduate classes, and they are more rigorous in clinical practice, which can just understand why Dean Chen Qi Chen is so cautious.

I saw Chen Qi rolling his eyes while looking at the sky at this time, muttering to himself, just like a blind fortune teller, in fact, his brain was about to burst.

"Parnd's formula? No, no, this rehydration volume is large, and improper use may cause fluid overload, and it can only be used when plasma supply is difficult or when a batch of burns is treated on site in the early stage, and it is obviously not suitable in the hospital.

What about the Monafo formula? This doesn't seem to work, although the amount of fluid rehydration is small, the fluid load is light, and the expansion is rapid, but the adverse reactions are also more obvious, and it is also necessary to closely monitor blood sodium and osmolality.

What else? Evans formula? Brooke's formula? But what is the content of this formula? Ahh It's over, it's over."

Chen Qi's surgery teacher in his previous life, at this time, it was estimated that the coffin board could not be covered, and he wanted to get up and kill this unscrupulous student.

No one knew that Chen Qi's heart was now at war between heaven and man, and he had added a lot of drama to himself, and at the same time, his brain searched one by one like a computer

Past.

Suddenly, he slapped himself and cursed in a low voice:

"Stupid, why do you have to learn from abroad, isn't there a set of formulas that you have researched in China?"

In later university textbooks, there was a set of formulas for the Third Military Medical University to budget the amount of fluid rehydration, but it was generally only used for moderate and large-scale burns.

Now Chen Qi doesn't care, the white cat and the black cat are good cats when they catch mice, let's use it first, and then adjust it later.

Everyone in the rescue room looked at Chen Qi's face white for a while and black for a while, and from time to time they slapped themselves with a big mouthful, all of which were inexplicable, suspecting that this was a stupid seafood eater?

Suddenly, Chen Qi had a direction in his heart and shouted:

"Come on, come on, everyone come here, I'll memorize the principle of rehydration first, write it down, I'm afraid I'll forget it for a while: salt before sugar, crystal before gelatin, fast first and then slow, rather acid than alkali, rather less than more, see urine to replenish potassium, startling calcium supplementation."

Chen Qi was still a little unsure after memorizing, thinking that this order could not be wrong, if it was changed to glue first and then crystal, sugar first and then salt, there might be some mess.

So I thought about it again and felt that this should not be wrong, after all, it was the most basic medical mantra at the beginning, and it belonged to the kind that had to come with your mouth open.

When a group of young doctors in the emergency room heard the director's order, they immediately became scrambled.

People with strong memories use their brains to memorize directly, and some timid people are busy looking for paper and pen to write them down.

With this principle of rehydration, Chen Qi continued to follow the train of thought step by step, and it was indeed much smoother.

"Chen Li, Yang Xiuxiu, you first hang the saline for the patient, and I will calculate the specific amount of infusion. Who, then, lend me your pen and paper."

Seeing Chen Qi lying on the table, he began to bite the pen and try to calculate, and everyone gathered around.

Even the doctors at Freetown State Hospital are eager to try it, because in their minds, the amount of fluid you need to give is related to the number of injections you need.

For example, if you want to use 5 bells of medicine, then hang 5 bottles of water, and the liquid is just used as a fusion medium.

They are aware of the importance of hydration in theory, but in practice they do not pay much attention to it clinically.

Now seeing how much fluid burn patients need to replenish, and what kind of fluid needs to be strictly calculated, they are all surprised and at the same time, they also admire Chen Qi's rigor.

The family members stretched their necks to look at the excitement at the window, and the more they looked, the more unhappy they became, okay, let you heal and save your life, what the hell are you writing and drawing?

This is an emergency room, not a cultural salon, doctors, you should be individuals.

Chen Qi didn't care what others thought, and kept chanting silently in his mouth:

"In the first 24 hours after injury, the estimated amount of fluid to be rehydrated () = total burn area (% body surface area) body weight (kg) 2.6 (the ratio of colloids to electrolytes is 1:1, 1.3 each) + 2000 water.

In the first 2~3 hours of resuscitation, 1/2 of the total fluid volume in the first 24 hours can be quickly replenished according to the situation, and the other 1/2 can be evenly replenished in the remaining time.

Estimated fluid volume in the second 24 hours after injury () = total burn area (5% body surface area) body mass (kg) 1 (colloid-to-electrolyte ratio is 1:1, 0.5 each) + 2000 water, evenly replenished within 24 hours."

This set of formulas is available in both Chinese and English, not to mention that the black doctors can't understand it, and even the Chinese doctors are confused.

After Chen Qi finished writing, he looked at the draft and was very satisfied, he hadn't memorized these things for many years, and he could still remember it, he was indeed a genius in dry surgery.

Yi Zewen couldn't help it, and asked the doubts in his heart on behalf of everyone.

"Dean Chen, how did you come up with this formula?"

Chen Qi thought to himself, how do I know why this is happening? This is all explored by experts in long-term clinical and experimental studies, and it is certainly impossible to be wrong anyway.

"Don't worry about this, just treat it quickly according to this principle, if you really don't understand, I'll make up for it for you later." A few of you measure the area of the wounds, how can the area be calculated? Yes, one palm accounts for 1%."

Next to it is from the city of ham

The little doctor asked reluctantly:

"Dean Chen, can you give an example of what you mean by crystallization and then glue? Don't you explain how we use drugs in the clinic?"

Chen Qi slandered in his heart, when is it, the patients are dying, why don't you hurry up and rescue them?

But if his subordinates, or "half of the students" have questions, he, the teacher, still has to answer patiently:

"Okay, then let me give you a few examples, the "crystal" of crystal first and then gel refers to crystal solutions, including glucose solutions, isotonic electrolyte solutions, alkaline solutions, hypertonic solutions, etc. And this "glue" naturally refers to colloidal solutions, such as dextran solution, ***, blood products, etc.

The crystalloid solution is infused first because the crystalloid solution will not improve the viscosity of the blood, which is conducive to blood circulation and prevents death from ischemic shock in the brain. It will not improve the viscosity of the blood, which is conducive to blood circulation and prevents death from ischemic shock in the brain.

The solubility of the crystal solution is better than that of the colloidal solution, the resistance of the blood is small, and the blood runs fast. Colloidal substances will increase the viscosity of the blood, and the blood will be more resistant. Therefore, when we need to replenish the amount of hemolysis, we need to use the lens first, which is very important."

While Chen Qi wrote the doctor's order, he gave on-site teaching to the young doctors around him.

Then a large group of young budding newcomers, and even middle-aged doctors, all lowered their heads and carefully wrote down the first sentence of Chen Qi, and their attitudes should be more upright.

Three intravenous channels were opened, and the fluid was injected quickly, so fast that some young doctors were worried.

Another little doctor from Lishui reminded a little weakly:

"Dean Chen, this, this drop is too fast, three infusions at the same time in one breath, too fast dripping rate can easily cause heart failure and pulmonary edema, isn't it too dangerous?"

In clinical practice, medical staff control the speed of infusion very strictly, and what they really don't know is that they would rather be slow than fast, for fear of accidents.

Chen Qi had already stood up at this time, and while dismantling the urinary catheter and keeping his hands moving, he continued to explain:

"It depends on when, you see, this black commander is already in shock, that is to say, he is dying, what is the principle of our hydration at this time? That is to quickly replenish blood volume, increase high blood pressure as quickly as possible, and correct shock.

It's equivalent to hanging his life first, and only after the shock level can you talk about follow-up treatment, right? After all, this shock is not good, the mortality rate is quite high, no matter what time, life must always be the first place.

For example, if the kidneys are reduced, renal vasospasm, hemolysis and toxin effects, etc., resulting in oliguria, hemoglobinuria, and even acute renal failure, if this problem is not prevented in advance, you will be a cripple if you are saved.

Come, Zhang Xing, insert the catheter for the patient, hurry up."

Zhang Xing took the catheterization bag and looked at the root of Commander Z's thigh with a little embarrassment, and suddenly felt a little sorry for the black commander.

If it weren't for the fact that the position hadn't run, otherwise you wouldn't have been able to see what that black mess was?

The birds have become roast birds, okay?

This requires the insertion of a urinary catheter, just like opening a blind box or opening a "flower chicken", first of all, the outside of the coke must be broken and removed, and then carefully look for where the urethral opening is.

Thinking of this, Zhang Xing shuddered, thinking that everyone is like this, it is better to die, what else to save, and it is also a father-in-law to save it.

Chen Qi's clinical doctor's orders went down one by one, and the scene was busy again.

The second-hand ventilator brought back from the moldy country has also started to work, and now there is a lack of a bedside ECG monitor, which has not yet been invented.

After the rescue, the next step is to enter the formal treatment link, and then encounter a key difficulty.

After discussing with the doctors in his team, Chen Qi walked up to the director of the Freetown National Hospital, Bagri:

"Mr. Dean, can this Commander Z survive, you must also know the danger of infection, so antibiotics are very important now, I need the best antimicrobials, I don't know you have them

What stock?"

Bagri was also anxious, and this was related to his dean's throne, which of course he attached great importance to.

"Dr. Chan, what kind of antimicrobials do you need?"

Chen Qi thought for a while: "Burn infections are mainly based on Staphylococcus aureus and anaerobic bacteria, so it is best to use third-generation cephalosporins, and quinolone antibacterial drugs, the more advanced the better."

Dean Barggri was embarrassed at this time, and the beard on his chin was torn off one by one.

A small African country that is poor and backward and does not even have a single pharmaceutical company in the country, what high-end drugs do you expect from him?

Dean Bagri said in shame:

"To tell you the truth, we have antibiotic drugs, but we all have the most basic penicillin, tetracycline, gentamicin or something, and the high-grade antibacterial drugs you mentioned also have them, but they are only stored in small amounts, and at most they can only be used for emergencies."

"As the largest public hospital in the Serralian, you don't have a few high-end antimicrobials?"

Chen Qi was very surprised, and Bagri blushed:

"No way, who called us a poor country, we can't afford too expensive medicines."

Chen Qi glanced at the family members of Army Z Commander Teodoro outside the window, all wearing gold and silver, silk and satin, and wearing Patek Philippe on their wrists, and thought:

"Poor? Not poor at all."