Since 1981 Health School Chapter 629

  Severe trauma, infection, poisoning and mental trauma can all cause excessive stress in the human body.

  The principle is that a large amount of adrenal cortex hormone and adrenaline are released, causing a large amount of glycogen to be decomposed, a large amount of energy consumption and metabolism, and a strong contraction of small arteries, resulting in circulatory ischemia, and multiple organs will suffer from dysfunction due to insufficient blood volume.

  If the fork is too strong and lasts for a long time, the body may enter a state of exhaustion, causing physiological and psychological dysfunction.

   The milder ones are gastrointestinal ulcers, which directly put a hole in you, or mental problems.

  If it is more serious, it will cause disseminated intracapillary coagulation, that is, DIC, renal failure, etc., and the consequences are very serious.

  The stress response conflicts with the current debridement work, and if you want to treat burns, debridement is only the first step.

  If you can't even complete the first step, the only thing waiting for the mother and daughter is death.

  The newly established burn surgery department of Yuezhong People's Hospital will also become a joke. You must know that although Chen Qi is famous in Yuezhong, how many doctors are waiting to see his jokes all over the country.

  The debridement work of Ding Xinjuan and Song Yanzi's mother and daughter had to stop, and everyone was trying to find a way,

  The little doctor Wu Guonan weakly suggested:

   "Dean Chen, Teacher Zhu, can we use general anesthesia, so that the patient will not feel pain when changing the dressing and reduce the stress response."

   Zhu Huoyan sighed:

"No, you don't need to look at the vital signs to know that the mother and daughter are already on the verge of shock. If you go to general anesthesia, the shock will be aggravated. There is another difficulty. Their respiratory tract has been damaged in the fire and they can't stand it at all. Endotracheal tube."

   This debridement operation cannot be performed within three or four hours. Without the cooperation of endotracheal intubation, general anesthesia cannot be used.

  Head nurse Liu Min made a suggestion: "Why don't you try sleeping pills? Let the patient fall asleep?"

  This proposal was rejected by Zhu Huoyan again: "Such severe pain, any sleeping pills and sedatives are useless. Once we do it, they will wake up immediately."

   Sedatives?

  Chen Qi's eyes lit up when he heard these three words:

   "Mr. Zhu, I thought of a way, we can use artificial hibernation therapy."

   "What hibernation?"

  Many doctors in the ward are you look at me, I look at you, obviously have not heard of this concept.

   Seeing everyone's clear and stupid eyes, Chen Qi knew that the concept of "artificial hibernation therapy" had been published earlier by him, so he quickly explained:

"Artificial hibernation, this is actually easy to understand. You think why animals can survive the whole winter by hibernating, and they won't die without eating or drinking for a few months. That's because animals enter hibernation in winter, and their metabolic rate will increase significantly reduce.

   This means that their body temperature drops and their breathing and heartbeat slow, reducing energy expenditure. At the same time, the immune system will be regulated, so that the animal's immunity is improved, so as to fight the risk of disease and infection.

In the same way, artificial hibernation is our artificial imitation of animal hibernation, so that patients are also in a hibernation state. The benefits of this are to reduce the body's excessive stress response, reduce metabolism, reduce cell oxygen consumption, improve microcirculation, and protect cells from damage. Suffering severe damage buys time for doctors to heal. "

  The eyes of several nurses and doctors are still confused.

  Zhu Huoyan is a senior old director after all, he understands and understands the principle, but he still has a question in his mind.

   "Chen Qi, I understand what you said, so here comes the question, how can we put patients into hibernation mode?"

  Yang Xiuxiu next to him also burst out laughing: "Dean, we humans are not bears, we don't know how to hibernate."

   Zhang Xing interjected at this time: "Others can't do it, Chen Tou must have a way!"

  Everyone looked at the young deputy director of the department in unison, and almost gave him a thumbs up.

  Chen Qi also thought in his heart that this honest boy would learn to flatter after entering the officialdom, and finally grow up.

  Everyone likes to hear good things, and Chen Qi is no exception, so he continued to explain in a good mood:

"Actually, artificial hibernation therapy has been studied abroad. When I went abroad to study and study, I had colluded with foreign doctors. They didn't have a complete theoretical system, but who I am, the international double director, had already secretly used their skills. Learned."

  Zhu Huoyan gave Chen Qi a white look:

   "Stop bragging, the patient is still waiting to be rescued, so hurry up and talk about how to artificially hibernate."

"Oh, that's right. The hibernation therapy is actually very simple. It is to use pethidine, chlorpromazine and promethazine to form an artificial hibernation agent. Promethazine can strengthen pethidine's sedative, analgesic, Respiratory depression and vasodilation can cause blood pressure drop, tachycardia and respiratory depression after use.

  According to the dose of 1 mg per kilogram of body weight, add it to the small infusion pot and infuse it intravenously. After half an hour, if the patient's breathing and pulse are stable, inject the same dose intramuscularly again, and the patient will enter a deep sleep state.

After the patient falls asleep, put ice packs on the groin and armpits. The trunk can be warmed and wetted with water 2°C to 3°C lower than the body temperature, and the body temperature can be maintained between 34°C and 35°C. Hours are most appropriate. "

  The little doctors listened to it as if they were listening to a bible.

  Maintain the human body to a state of hypothermia to treat diseases? This is unheard of for them, and although it makes sense in theory, no one dares to play like this.

  Zhu Huoyan understood, and his eyes became brighter and brighter:

"Chen Qi, if your method works, it can not only treat burn patients, but also those who suffer from febrile convulsions caused by severe infections, central high fever heatstroke, toxic or traumatic shock, severe traumatic brain injury, intractable pain, and high spirits. Nervousness seems to work."

  Chen Qi gave a thumbs up, "How else could Teacher Zhu become my teacher? Look at Zhang Xing and the others, they still look confused."

  Director Luo Yuyang also felt ashamed when he heard this:

"Dean Chen, don't mention Zhang Xing and others, I also look confused. If you say that this set of hibernation therapy is still in the theoretical research stage, but now we have two clinical patients waiting. Here, What should I do?"

  Medical theoretical research is only the first step. It needs a lot of laboratory data and clinical data to support its clinical application.

  People are not guinea pigs, death is a life.

  Others are others, and others are not time travelers. Our Dean Chen has personally applied hibernation therapy in his previous life.

  For liver and gallbladder surgery in China, Professor Wu Mengchao invented "low temperature therapy" for liver surgery, and it was even more ruthless, directly putting people in ice water.

   This is actually a kind of "sub-hibernation therapy", so hepatobiliary surgeons are more experienced.

"Nurse, please contact the pharmacy immediately and get mepethidine, chlorpromazine, and promethazine. Today I will demonstrate it first. Let's evaluate whether it is effective. Let's try to get it before foreign experts. The paper on hibernation therapy was published."

  As soon as we heard that today's operation can publish a paper, everyone's enthusiasm for work is even higher.

  Even an old expert like Zhu Huoyan is not immune.

  You said that you used money to buy him Zhu Huoyan, and you would probably be kicked out by him.

  But if you say that you have a surgical topic, which is the first in the world and can be published in an international medical journal with the highest SCI impact factor, this is also full of temptation for Director Zhu.

   "Okay, then I will see and see today."

  The medicine was brought quickly, and Chen Qi personally prepared the medicine according to the proportion. The head nurse was also preparing ice packs, and the temperature of the air conditioner in the operating room was also kept low.

   After a while, Ding Xinjuan and Song Yanzi's mother and daughter quickly responded.

  The two who were screaming in pain just now had already started to feel drowsy. Chen Qi tried to **** Ding Xinjuan's wound. Although Ding Xinjuan still had conditioned reflexes, his reaction was already very slow.

  Zhu Huoyan paid close attention to the whole process, and asked curiously: "Is that all right?"

  Chen Qi personally pressed ice packs on two patients, one big and one small, while smiling and nodding:

   "OK, let's hurry up and debride the wound."

   This debridement took a total of 4 hours to clean up. If it wasn't for multiple people taking turns to do it in the middle, otherwise Chen Qi's waist would be crippled again.

   "Hurry up, everyone calculate the amount of fluid needed."

   Burn patients have a complete set of infusion formulas, which Chen Qi has introduced in Africa. Zhang Xing immediately took out a pen and paper to convert it.

  Zhu Huoyan frowned as he watched the two patients change from black to pink.

"Chen Qi, Mao estimates that the burn area is almost 90% for the mother, of which more than 30% are third-degree burns, and the rest are deep second-degree burns; the child is light, and the total burn area is 83%. It is possible to recover. Sex is very slim."

  In the field of burns, there used to be such an unwritten law: if the burn area exceeds 60%, it is almost impossible to survive, and if the burn area exceeds 80%, it is almost certain to die.

   Director Burn Coro also echoed:

   "Director Zhu is right. At present, in international literature and related papers, there is no record of a patient with extensive burns surviving."

  Chen Qi was about to speak, but Zhang Xing refused to accept it:

   "Mr. Zhu, Director Luo, this statement is wrong. When we rescued a burn patient in Africa, the total burn area reached 90%, and the burn was only 3rd or deep 2nd degree. We saved it."

  Zhu Huoyan was a little surprised: "I thought you were bragging, and you really saved a patient with extensive burns. Why haven't you published a paper?"

   Chen Qi is a little embarrassed:

   "I submitted a manuscript, but it was rejected, because I only had such a patient at the time, and the isolated certificate was not counted, so the paper was not accepted, and my stinky tofu skin grafting was not promoted."

  The medical conditions in Africa are so poor that even bacterial culture cannot be completed, so the quality of papers cannot be improved.

  In addition, Chen Qi didn't think about developing into burn surgery at that time, so after a few months after sending it out, he learned that the paper had been shot, so he let it go and didn't continue to revise it before submitting it.

  Hearing Chen Qi's words, there was a chuckle in the ward. It turns out that the omnipotent Dean Chen also has his manuscript rejected.

  Zhu Huoyan laughed when he heard that, and asked:

   "Then how exactly did you perform the stinky tofu skin grafting?"

  Chen Qi pointed to Ding Xinjuan on the hospital bed and said:

"Look at this patient, who has extensive burns all over his body. The entire back, limbs, and part of the head and face skin have been burned away. While we are fighting infection and shock, the most important thing is how to protect the wound surface, which requires skin grafting. .

  But with such a large area of ​​burns, there is no whole piece of complete skin, what should I do? Look here, and here, these are fragmented normal skin, especially the abdomen with a lot of residue, then we can make use of this island-like skin.

In the past, we used postage stamp skin grafting, that is, the normal skin was scraped off, cut into small pieces in the shape of postage stamps, and then pasted on the burn wound, but this skin grafting has a disadvantage: that is, if the burn area is too large , The normal skin is too little and not enough, so there is no way to do skin grafting.

  Even if the skin graft is forced, after the scar tissue hyperplasia, the skin grafted skin will be dark red and hyperpigmented.

There is another one. The stamp-like skin graft is attached to the skin alone, without support around it, so it cannot be fixed well. Sometimes the normal skin will be displaced after a pack of gauze, and it will not stay in the intended place, so the prognosis will be poor. up.

   My stinky tofu skin grafting technique is amazing. I tried it on African Roast Duck Commander and it was completely successful. The specific method is to scrape off the normal skin, cut the horizontal and vertical slices into small pieces, and put them on a special gauze.

When skin grafting was needed, I evenly stretched the gauze to the four sides. As the area of ​​the gauze increased, the tight small pieces of skin were evenly dispersed, but they were all fixed on the gauze and pasted on the burn wound. From point to surface, connect into one piece.

One of the biggest advantages of this kind of skin grafting is that a small piece of normal skin can be enlarged to 3 times, 5 times the area, and the maximum can reach 9 times. In layman's terms, it is the skin with the least flower and the largest coverage. wound surface. "

  Everyone was fascinated, and then Chen Qi stopped.

  Zhu Huoyan asked in surprise: "Is that all right? So simple?"

  Chen Qi shrugged:

   "It's easy to say that stinky tofu skin grafting is very simple, but the key is creativity. Everyone didn't expect it, but I thought of it. This is my patent and the advantage of our Yuezhong Hospital.

   Everyone should pay attention, there are many hospitals in China that carry out burn surgery. For example, Dongshan Hospital in Shanghai is very strong. Our small prefecture-level hospital competes with these top hospitals in the country. How can we stand out?

  In fact, it is very simple to put it bluntly. To innovate, we will do the surgery they can do; we can do the surgery they can't do. Boldly breaking through the shackles of current medical literature, breaking superstition, daring to think and do, this is our advantage.

Just now Teacher Zhu said that over 60% of patients with super large area burns are rarely successfully rescued, and over 80% of burns are fatal, so we have to break this rule. burn patients.

   Think about it, our Yuezhong Hospital's burn department will be so good by then, won't it be the best department in the country, or even the world? All of you burn doctors here are afraid that you will not be famous? "

"well said!!"

  To be a good leader, you must be able to draw big cakes and fool around, so that your subordinates will follow you. (end of this chapter)

Chapter end