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

Don't look at the nurse coming to change bottles in a short while. There are all kinds of colorful bottles. In fact, there is a very, very complex calculation formula inside.

It is not enough to infuse too little fluid, nor too much fluid. The proportion of salt water and sugar water must not be changed wrong. If you are not careful, it is easy for the treatment to fail, or even the patient's death.

Not to mention those who died at the scene, the most common causes of death for burn patients who survived being sent to the hospital are:

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

When the body of a patient with severe burns is not able to compensate for the rapid loss of body fluids, the circulating blood volume will decrease significantly, leading to changes in hemodynamics and hypovolemic shock.

Extremely severe burns can cause severe shock within 2-4 hours after injury, and severe burns can occur within 4-8 hours.

Commander Z of the Army was in severe burn shock, and from the moment he was burned to being transferred to the China-Africa Friendship Hospital, 3 hours had passed, a very precious 3 hours.

Therefore, rehydration has become another very, very important rescue measure after tracheal intubation.

If your department does not often deal with patients with injuries, fevers or dehydration, then the doctor will basically have forgotten everything except reciting it during the exam.

What's more, it was still 1987, and even the relevant formulas in textbooks were not as complete as they would be a few decades later.

So now Chen Qi has to prescribe rehydration fluids, his head is about to explode, and his face is red from holding back.

Because he had almost forgotten the formula for rehydration in his mind, and he really couldn't remember it completely at the moment. The more anxious he was, the less he could remember, which made him anxious to death.

The rescue work that had been progressing rapidly just now suddenly stopped. Everyone in the rescue room looked at the attending doctor Chen Qi in surprise.

Qi Yunming was anxious: "Xiao Chen, what's wrong? Hurry and save me. Why are you just standing there?"

Dean Bagri asked in a panic: "Dr. Chen, is the patient hopeless?"

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

Chen Qi raised his hand and made a quiet gesture:

"Don't argue, don't argue. I'm memorizing formulas. Damn it, why is it so complicated? You can't make mistakes with this thing. You absolutely can't make mistakes. If you make a mistake, a patient will be dead."

Everyone looked at each other, and many people began to have doubts about Chen Qi's firm belief.

Shouldn't this miracle doctor just come here casually and calmly?

How can there be a patient like him, lying there waiting for emergency treatment, while he is still carrying textbooks?

But other doctors disagree. It's just infusion. You can just give it any salt water, sugar water, or sugar-saline solution. Anyway, just infuse whatever you have. Why is it so complicated?

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

They have undergraduate backgrounds in formal majors and are more rigorous in clinical practice. They can understand why Dean Chen Qi and Chen are so cautious.

I saw Chen Qi looking at the sky, rolling his eyes, and mumbling to himself, just like a blind man telling fortunes. In fact, his mind was almost broken.

"Parnd formula? No, no, it doesn't work. This fluid replenishment volume is large. Improper use may cause fluid overload. It can only be used when plasma supply is difficult or for early on-site treatment of batch burns. It is obviously not suitable for hospitals.

What about the Monafo formula? This doesn’t seem to work either. Although the amount of fluid replacement is small, the fluid load is light, and the volume expansion is rapid, the adverse reactions are also obvious, and blood sodium and osmotic pressure need to be closely monitored. How can this condition be met?.

What else is there? Evans formula? Brooke formula? But what is the content of this formula? Oh, why did I forget it? It’s over.”

Chen Qi's former surgery teacher probably couldn't cover the coffin at this time, so he wanted to get up and beat this unscrupulous student to death.

No one knows that Chen Qi is currently at war between heaven and man. He has added a lot of drama to himself, and at the same time, his brain is searching one by one like a computer

Past.

Suddenly he slapped himself in the face and cursed:

"Idiot, why do you have to learn from abroad? Doesn't China also have a set of formulas that we have developed ourselves?"

In later university textbooks, there is a set of formulas of the Third Military Medical University to estimate the amount of fluid replacement, but it is generally only used for moderate and large-area burns.

Now Chen Qi doesn't care anymore. A white cat or a black cat is a good cat if it catches mice. Let's use it first. If it doesn't work, we can adjust it later.

Everyone in the emergency room looked at Chen Qi, whose face turned pale and dark, and slapped himself from time to time. They were all inexplicable. They suspected that he was stupid after eating seafood?

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

"Come on, come on, everyone, come over. Let me memorize the principles of rehydration first. Write them down, I'm afraid I'll forget them later: salt first, then sugar, first crystals, then glue, first fast, then slow, prefer acid to alkali, prefer less to less.

If there is too much, supplement potassium when you see it in the urine, and supplement calcium when you are shocked."

Chen Qi was still a little unsure after memorizing it, thinking that the order must be wrong. If it were changed to glue first and then crystallization, and sugar first and then salt, there might be some trouble.

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 time, and it was the kind that had to be spoken.

A group of junior doctors in the emergency room immediately became confused after hearing the director's order.

Those with strong memories just use their heads to memorize, while some who are timid are busy looking for paper and pen before writing them down.

With this principle of rehydration in mind, Chen Qi followed the idea step by step, and it turned out to be much smoother.

"Chen Li, Yang Xiuxiu, you first put the saline on the patient. I will calculate the specific amount of infusion later. Then, lend me your pen and paper."

Seeing Chen Qi lying on the table, biting his pen and working hard to calculate, everyone gathered around him.

Even the doctors at the Freetown National Hospital are eager to try it. After all, in their thinking, the amount of fluid replacement is related to the number of injections you need to inject.

For example, if you want to use 5 medicines, just hang 5 bottles of water. The liquid is only used as a melting medium.

They know the importance of rehydration in theory, but in fact they don’t pay much attention to it in clinical practice.

Now I see that burn patients need to strictly calculate how much liquid they need and what kind of fluids they need. Everyone is surprised and at the same time, they also admire Chen Qi's rigor.

The family members craned their necks to look at the excitement from the windows. The more they looked at it, the more unhappy they became. Well, I asked you to treat illnesses and save lives. Why the hell are you writing and drawing?

This is an emergency room, not a cultural salon. Doctors, just be your own person.

Chen Qi didn't care what others thought, he kept saying silently:

"In the first 24 hours after injury, the estimated amount of fluid replacement = total burn area (% body surface area) weight (kg) 2.6 (the ratio of colloid and electrolyte is 1:1, each is 1.3) 2000 water.

In the first 2 to 3 hours of recovery, 1/2 of the total fluid volume in the first 24 hours should be quickly replenished depending on the situation, and the other 1/2 should be replenished evenly during the remaining time.

Estimated fluid replenishment amount in the second 24 hours after injury = total burn area (5% body surface area) body mass (kg) 1 (colloid and electrolyte ratio is 1:1, 0.5 each) 2000 fluids, replenish evenly within 24 hours."
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This set of formulas is available in Chinese and English. Not to mention that the black doctors can't understand it, even the Chinese doctors are confused.

After Chen Qi finished writing, he looked at the draft and felt extremely satisfied. He hadn't memorized these things in many years, but he could still remember them. He was indeed a genius in surgery.

Yi Zewen couldn't help it anymore and asked his doubts 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 like this? This is something that experts have figured out through long-term clinical trials and experiments. It cannot be wrong anyway.

"Don't worry about it. Just treat it according to this principle. If you really don't understand, I'll give you some extra lessons later. Can you guys measure the area of ​​the burn? Do you know how to calculate the area? Yes, one palm accounts for 1%."
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Next to it is from Ham City

The little doctor asked unwillingly:

"Dean Chen, can you give an example? How do you understand the crystallization first and the glue later? If you don't explain this clearly, how can we use the medicine clinically?"

Chen Qi cursed in his heart, "What time has it been? The patient is almost dead, why don't we rescue him quickly?

But when his subordinates or "half-students" have questions, he, the teacher, still has to answer them patiently:

"Okay, let me give you a few examples. The "crystal" of "crystallization first and then colloid" refers to crystal solution, including glucose solution, isotonic electrolyte solution, alkaline solution, hypertonic solution, etc. And this "glue" naturally refers to colloid.

Solutions, such as dextran solution, antibiotics, blood products, etc.

The crystalloid solution is infused first because the crystalloid solution will not increase the viscosity of the blood, which is beneficial to blood circulation and prevents death from cerebral ischemic shock. It will not increase the viscosity of the blood, which is beneficial to blood circulation and prevents death.

Death from cerebral ischemic shock.

The solubility of crystalloid solution is better than that of colloid solution. The resistance of blood circulation is small and the speed of blood circulation is fast. Colloidal substances will increase the viscosity of blood and the resistance of blood circulation is large. Therefore, when we need to supplement the hemolysis volume, we must first use

It is very important to use crystalloid."

While Chen Qi was writing medical orders, he was also giving on-the-spot teaching to the young doctors surrounding him.

Then a large group of young newcomers, and even middle-aged doctors, all lowered their heads and carefully wrote down the first sentence of Chen Qi, with as correct an attitude as possible.

Three intravenous channels were opened, and fluids were quickly input, so fast that some junior doctors were worried.

Another young doctor from Lishui reminded a little weakly:

"Dean Chen, this, this drip is too fast. Three infusions are given at the same time. Too fast a drip rate can easily cause heart failure and pulmonary edema. Isn't it too dangerous?"

In normal clinical practice, medical staff control the speed of intravenous drip very strictly. For those who really don’t know, they would rather go slow than fast for fear of an accident.

Chen Qi had already stood up at this time, and while removing the catheter, he continued to explain:

"It depends on when. You see, this black commander is already in shock, which means he is about to die. What is our principle of rehydration at this time? That is to quickly replenish blood volume and increase the blood volume as quickly as possible.

Blood pressure, correct shock.

It's equivalent to hanging on to his life first. Only after passing the shock level can you talk about follow-up treatment, right? After all, shock is not a good thing, and the mortality rate is quite high. No matter what time it is, saving your life is always important.

Put it first.

For example, in the kidneys, if blood volume decreases, renal vasospasm, hemolysis, toxins, etc. can lead to oliguria, hemoglobinuria, and even acute renal failure, if this problem is not prevented in advance, you will be a cripple after you are saved.<
To be continued...