Since 1981 Health School Chapter 634

  Chapter 634 Two hospitals are fighting

  Chongqing Formula was founded in 1962 by Southwest Hospital of Third Military Medical University.

  They advocated that the amount of rehydration in the first 24 hours after injury should be 1.5mL of fluid per kilogram of body weight and per 1% TBSA (the burn area is calculated according to the actual burn area).

  Infuse 1/2 of the total fluid infusion in the first 8 hours, and infuse the other 1/2 at a constant speed in the next 16 hours; the fluid infusion in the second 24 hours after injury is 1/2 of the actual fluid infusion in the first 24 hours.

  Shanghai formula was jointly established by Shanghai Dongshan Hospital and other hospitals in 1965.

  They claim that the first 24 hours after injury, the volume of rehydration should be 1.5mL of fluid per kilogram of body weight and per 1% TBSA (the burn area is calculated according to the actual burn area).

  The amount of rehydration in the second 24 hours after injury is 1/2 of the actual amount in the first 24 hours, plus 3000-4000 mL of water.

  Nanjing formula is mainly suitable for wartime and batch burns, so it has not become the mainstream rehydration formula in China.

   Having written so much, the main difference between the Chongqing formula and the Shanghai formula is that the Chongqing formula has less rehydration fluid, while the Shanghai formula has more fluid rehydration. In addition, the ratio of crystal gel is also different, one advocates 2:1, and the other advocates 1:1.

   Don't look at the small difference in the numbers, but the treatment effect is a world of difference.

  The main difference between the Chongqing formula and the Shanghai formula and the mainstream formulas recognized by later generations is that

  Chongqing formula is the most effective for rehydration of patients with small and medium-sized burns below 50%, and it is also the closest to the rehydration formula of later generations. The clinical evidence of later generations has shown that Chongqing formula is relatively the most scientific

   But the disadvantage is that the rescue effect of the burn area exceeding 50% is very large, or the rescue effect of severe burns is not good

  The reason is that the Chongqing formula rigidly believes that severe burns can only be supplemented with less than 50% of the infusion volume.

  Here is a big problem. How can the amount of infusion be the same for a patient with 30% burns and a patient with 90% burns?

  Chongqing model originally had a small amount of fluid replacement, and now the amount of fluid replacement for severely burned patients is even less.

  The formula with a small amount of fluid replacement often cannot maintain the circulating blood volume well, resulting in the persistence of ischemic and hypoxic damage, which will cause the patient's hypovolemia, renal failure and other deaths.

   There is another misunderstanding, the ratio of crystal to glue is 2:1, which is correct, but for patients with large area and severe burns, the ratio of crystal to glue should be adjusted to 1:1.

  In fact, Southwest Hospital's research is already at the forefront of the country, much more advanced than the Shanghai and Nanjing formulas, but why are there so many misunderstandings?

   It's not that Southwest Hospital's level is not good, it's just that the conditions in China in the 1970s and 1980s were so poor, most of the medical equipment was lacking, and there was no first-hand experimental data. How to carry out this clinical research work?

   Not everyone has golden fingers like Chen Qi, has the insights of later generations, and can look at problems from the perspective of God.

   Later, with the development of science and technology, all kinds of instruments were fully equipped. The burn department of Southwest Hospital was still very good, and there were many very good experts in it.

  But now...

  Chen Qi just wants to cut off the future of Hu Southwest Hospital, and first grab the No. 1 burn injury in the country.

  As for the disadvantages of the Shanghai formula, there is still too much rehydration, and they do not require how to replenish 8 hours before the burn, how to replenish 16 hours, how to replenish 24 hours.

  This way the rehydration is very rough.

  Although the formula with a large amount of fluid infusion theoretically maintains a good circulating blood volume, this is a major advantage.

  However, due to excessive fluid load, it often aggravates the patient's edema and even causes complications such as fascial compartment syndrome, heart failure, pulmonary edema, and cerebral edema.

   When the time comes, will you save people or kill them?

  The most important thing is that both formulas have a biggest problem, that is, the implementation is too mechanical and rigid.

  That is, the doctor strictly calculates the amount of fluid infusion according to the formula, and then infuses the patient regardless of the amount calculated.

   It doesn't matter if you lose more or less.

  Then, let's go back to an old question. Rehydration is a thing that saves lives if it's done well, but kills it if it's not done well.

  So in the 1970s and 1980s, this unhealthy trend in the domestic burn industry was also called "the stage of mechanically executing fluid resuscitation formulas".

  Phenomenon that blindly and mechanically following the calculated volume of the formula while ignoring the clinical manifestations and resuscitation effects, and patients with large area burns strictly follow the formula to calculate the amount of fluid replacement.

   There was a wrong consensus that "acting according to the formula can resist shock", which laid a hidden danger for the occurrence of sepsis.

  Later generations advocated the "individualized rehydration stage".

  It means that different individuals require different fluid volumes to achieve good resuscitation goals, so the fluid resuscitation formula for burns is considered to be only a guideline for clinical resuscitation treatment.

  During treatment, attention should be paid to the observation of clinical indicators of patients, the effect of resuscitation can be judged by the changes of indicators, and the amount of fluid replacement should be adjusted.

  Fluid resuscitation during burn shock requires not only "individualized rehydration", but also specific resuscitation goals, which is called "targeted resuscitation".

   means that the ultimate goal of fluid resuscitation is:

Maintain good blood perfusion, provide effective oxygen supply, eliminate oxygen debt, restore normal aerobic metabolism, stop cell death, stabilize vital signs, blood gas analysis base residual (+BE) 500mL/m2, gastric mucosal pH returned to normal.

  So rehydration is very complicated. In addition to calculating the amount of infusion and the type of infusion, all aspects must be considered, so as to save patients with severe burns.

  Medicine is not something you can save people by saying "man will conquer nature". To save people, you must pay attention to scientific methods.

  This is also the reason why in the 1980s the burn area exceeded 60% and it was impossible to save it.

  The camera continues to return to the burn surgery ward of Yuezhong Hospital.

  Just as Chen Qi was leaning against the door frame, wishing he could eat melon seeds while watching the excitement, Deng Changle also finished the debridement and came out of the ward. The two met face to face for the first time.

  Chen Qi knew that the other party was an expert from Shanghai, so he nodded with a smile.

  Deng Changle had already passed by, and then stepped back, asking a little uncertainly, "Hi, are you Comrade Chen Qi?"

   "Uh, yes, I am Chen Qi."

  Chen Qi thought he had met another fan of his, so he continued to smile and nodded:

   "Are you from Shanghai Dongshan Hospital? May I ask your surname!"

  Deng Changle couldn't help but sigh when he saw that this legendary "enemy" was so young.

   "My surname is Deng, Deng Changle, and I am the deputy director of the Burn Surgery Department of Dongshan Hospital. Dean Chen, this is..."

  Chen Qi thought, Deng Changle? The name sounded very familiar, but I couldn't remember it for a while, so I said awkwardly:

"I don't want to see how Shanghai experts rescue patients. Originally, we were responsible for the workers of the Yue Steel Plant. Now you are here. So I also want to see the treatment methods in Shanghai. What's the difference between us."

  Deng Changle wanted to laugh in his heart, thinking that the young man was really arrogant when he said that he actually put Yuezhong Hospital and Dongshan Hospital side by side?

"Uh, I heard that there were 38 wounded in the Yuegang Plant this time. We took care of the three seriously wounded, and your Yuezhong Hospital took care of the rest of the lightly wounded. But the treatment plan for the seriously wounded and the lightly wounded is different. Yes, you learned it for nothing, it's too complicated.”

  Chen Qi blinked:

"No, no, we also have two patients with severe and extremely large area burns, one with 83% of second-degree and third-degree burns, and one with 90% of second-degree and third-degree burns. to our hospital."

  Deng Changle thought you thought I was a fool? Such a severe burn and lying at home for a month did not die?

   "Hehe, Dean Chen is really good at joking. How can there be no accident for a month with such severe burns? I have never heard of this at home and abroad."

  Chen Qi gestured with his mouth:

"Nao, I'm just lying in the ward. The patient who was just admitted yesterday was covered in pot bottom ash and Chinese herbal medicine all over his body when he came in. He just stayed at home for a month and didn't die, so the current condition is worse than that of the Yuegang in your hands. Factory workers are more complicated."

  Deng Changle followed Chen Qi's prompt and walked to the door of the other two wards, and saw two patients, one big and one small lying on the bed.

  He is a professional doctor, and he can tell at a glance that what Chen Qi said is true. The burn area is indeed huge, but he doesn't quite believe that he hasn't died for a month.

  Suddenly he thought of why Chen Qi wanted to "peek" at their rescue at Dongshan Hospital. Did he want to compare?

  Thinking of this, Deng Changle is really happy. Fortunately, Liang Jingru is only 11 years old and has not debuted this year, otherwise he would definitely sing "Courage" for Chen Qi.

   "Dean Chen, are you planning to compete with us on who can save the patient's life? Oh, I understand. It seems that Dean Chen is quite dissatisfied with the appointment of doctors from other hospitals by the Yuegang Plant."

  Deng Changle's tone of voice was condescending, which made Chen Qi very disliked.

  I am a double director and vice president of the International Medical Association, and the other side is a small deputy director of the burn department. What can I do? Where did the inexplicable sense of superiority come from?

  So Chen Qi was not polite anymore, and said with a smile:

"Yeah, Dongshan Hospital's burn surgery is quite famous in China, otherwise, Yue Steel Factory wouldn't look far away, but I don't think Yuezhong Hospital is so bad. It just so happens that I have this opportunity, and I want to see Dongshan too. How is the level of the hospital."

  Deng Changle waved his hands as he walked: "Then Yuezhong Hospital should study hard."

  Chen Qi thought to himself: This guy is really impolite, he is afraid that he will slap his face swollen later.

  Deng Changle also thought: This guy is really crazy, so let me use my strength to swell Chen Qi's face.

  The two exchanged a silly X in their hearts, and then started the rescue work.

  After Deng Changxi returned to the ward, his assistant Zeng Chu came over and asked:

   "Teacher Deng, what fluid should we replenish first?"

   "First add isotonic saline, and then hang 500ml of 0.9% sodium chloride solution first."

  Dongshan Hospital's rehydration solution is opened and closed. If the dose is large, I'm afraid that if the supplement is too small, the circulating blood volume will not be enough.

  Chen Qi returned to the ward and began to give the doctor's order, "Zhang Xing, first give 100ml of 3% sodium chloride solution..."

  There was a disagreement between the two in the first round of treatment. Dongshan Hospital used isotonic saline, while Yuezhong Hospital advocated hypertonic saline.

  Who is right and who is wrong?

   Needless to say, Chen Qi used the rehydration solution developed by countless medical scientists, and it has been proven by countless clinical trials, so how could it be wrong?

  Isotonic saline is an input crystal solution based on 154mmol/L of Cl- and N. When the input amount is too large, hypochloremic acidosis or hyponatremia is very likely to occur, so it cannot be used as the first choice.

  Even if crystalloid solutions are used, sodium lactate Ringer injection is mainly used, and later sodium pyruvate injection is mainly used.

   Isotonic saline solution has long been eliminated in later generations, but in 1989, Dongshan Hospital still used this old prescription. It can only be said that the rescue of patients really got off to a bad start.

  The reason why Chen Qi used hypertonic saline was because the early use of hypertonic saline can reduce the total amount of fluid input, which is conducive to the disappearance of systemic edema.

   At the same time, it can also reduce the occurrence of hyponatremia, reduce the content of inflammatory factors in the blood, and reduce the edema and oxidative damage of lung, intestinal tract, liver, kidney and other visceral tissues.

  So if there is God to be the referee, in the first round, Chen Qi +1 point, Deng Changle -1 point.

   Then comes the second round: disinfection.

  Such a large area of ​​wound is exposed there, if the disinfection work is not done well, once an infection occurs, it will be completely finished, so the reason why severe burn patients need a sterile ward is also here.

  In the 1980s, the main force of domestic disinfection was alcohol, iodine, and hydrogen peroxide.

  These three kinds of disinfectant are used to clean the wound, good guy, it really hurts like hell.

   Alcohol ranks first in pain, followed by iodine containing alcohol.

  The alcohol content in medical alcohol reaches at least 75% or more, so it is very irritating.

  Applying alcohol on the wound will cause the alcohol to quickly enter the blood of the human body, thereby stimulating the muscles and blood vessels at the wound, inducing contraction and spasm symptoms, and causing severe pain.

  So when the doctors at Dongshan Hospital began to disinfect the wounds with iodine, the three seriously wounded were in excruciating pain, that scream.

  Chen Qi leaned against the door frame, listening to the voices inside, he made a tsk tsk sound:

   "Too brutal, too heartless."

  Many small doctors and nurses in Yuezhong Hospital ran out to watch the scene when they heard the screams.

   "Dean Chen, why are the two female patients able to bear it when we are disinfecting, and why are the three elders in the steel plant shouting? They are too useless, right?"

  Chen Qi easily explained:

   "We first used hibernation therapy, and the patient's response was already very slow. In addition, we used iodophor, which not only has better curative effect, but also has less stimulation because it does not contain alcohol, so the patient suffers less pain.

Look at Dongshan Hospital, they use iodine, and alcohol deiodine after disinfection, such a large burn area, and then use alcohol, tsk tsk tsk, this is really killing the patient, maybe it will happen again I'm going to make a fool of myself. "

  Chen Qi's crow's mouth worked again.

  Unable to bear the strong stimulation of alcohol, Chi Shanjun once again suffered cardiac and respiratory arrest due to painful shock.

   For a while, Dongshan Hospital was in a hurry.

  (end of this chapter)

Chapter end