Since 1981 Health School - Chapter 482

Chapter 482 Urgent need for advanced antibiotics

Infusion for burn patients is not just hanging a few bottles of salt water as ordinary people think.

Don’t worry about the nurse coming to change the bottle in a short while. There are all kinds of colorful bottles and cans. In fact, there is a very, very complicated calculation formula in it.

It is not acceptable to infuse too little or too much liquid. The ratio of saline and sugar water must not be changed incorrectly. If you are not careful, it is easy to cause the treatment to fail and even the patient to die.

Leaving aside those who died on the spot, there are two most common causes of death for burn patients who can be sent to the hospital and survived:

One is “shock” and the other is “infection”.

When the body of a severely burned patient is insufficient to compensate for the rapid loss of body fluid, the circulating blood volume will drop significantly, leading to changes in hemodynamics and hypovolemic shock.

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

The Army Commander Z was in severe burn shock, and from the burn to being sent to the China-Africa Friendship Hospital, 3 hours have passed, a very precious 3 hours.

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

If your department doesn’t often deal with patients with burns or dehydration, then the doctor basically recites it during the exam, and forgets everything later.

What’s more, in 1987, even the relevant formulas in textbooks were not as perfect as decades later.

So now Chen Qi is about to prescribe rehydration fluid, his head is about to explode, and his face is flushed from holding back.

Because he had almost forgotten the formula about the rehydration in his impression, and he really couldn’t remember it completely for a while. The more anxious he was, the less he could remember it.

The rescue work that was still advancing rapidly just now suddenly stopped. Everyone in the rescue room looked at the attending doctor Chen Qi in surprise.

Qi Yunming was in a hurry: “Xiao Chen, what’s wrong? Hurry up and save me, why are you standing there stupidly?”

Dean Bagley asked in a panic: “Doctor Chen, is it possible that the patient is hopeless?”

Hearing this, the family members outside the window were about to start howling again.

Chen Qi raised his hand and made a quiet movement:

“Don’t quarrel, don’t quarrel, I’m memorizing the formula, damn, why is it so complicated, this thing can’t be wrong, absolutely can’t be wrong, a patient who gets it wrong is sure to die.”

Everyone looked at each other in blank dismay. Many people began to have a firm belief in Chen Qi. Why did they start to have a little doubt?

Shouldn’t this genius doctor come here casually, with a calm and calm mood?

How can there be someone like him who is still reciting textbooks while the patient is lying there waiting for emergency treatment?

But some other doctors don’t think so. Isn’t it just infusion? You can use whatever salt water, sugar water, or sugar salt water. Anyway, you can infuse whatever you have. Why is it so complicated?

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

They are from regular undergraduates, and they are more rigorous in clinical practice, so they can understand why Dean Chen Qi and Chen are so cautious.

I saw Chen Qi rolling his eyes while looking at the sky at this time, and muttering to himself, just like a blind man telling a fortune, but in fact his mind is almost lost.

“Parkland formula? No, no, no, no, no, no, no, no, no, no, this is a large amount of fluid replacement, and improper use may cause fluid overload. It can only be used when plasma supply is difficult or when batches of burns are treated on the spot at the early stage, and it is obviously not suitable for hospitals.

What about the Monafo formula? This does not seem to work. 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. It is necessary to closely monitor blood sodium and osmotic pressure. How can this condition be met?

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

Chen Qi’s surgery teacher in his previous life probably couldn’t even 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 with heaven and man in his heart. He has added a lot of scenes to himself, and at the same time, his brain is searching one by one like a computer.

Suddenly he slapped himself and cursed in a low voice:

“Stupid, why do you have to learn from foreign countries? Isn’t there a set of formulas developed by ourselves in China?”

In the textbooks of later generations of universities, there is a set of formulas from 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, a white cat and a black cat catch mice is a good cat, let’s use it first, if it doesn’t work, we can adjust it later.

Everyone in the emergency room looked at Chen Qi’s face turning white and black, and he would slap himself from time to time, all for no reason, wondering if he was stupid after eating seafood?

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

“Come on, everyone, come here, I will memorize the principle of rehydration first, write it down, I am afraid I will forget it in a while: salt first, then sugar, first crystallization, then glue, first fast, then slow, rather acid than alkali, rather less More, see urine potassium supplement, startle calcium supplement.”

Chen Qi was still a little uncertain after memorizing, thinking that the order could not be wrong, if it was changed to glue first, then crystal, sugar first, then salt, maybe something would go wrong.

So I thought about it again, and felt that there should be nothing wrong with this. After all, it was the most basic medical mantra back then, and it belonged to the kind that had to be opened.

A group of young doctors in the emergency room immediately became flustered after hearing the dean’s order.

Those with a strong memory use their brains to memorize directly, while some timid people are busy looking for paper and pen to write down.

With this principle of rehydration, Chen Qi followed his train of thought step by step, and it really went much smoother.

“Chen Li, Yang Xiuxiu, you put the saline on the patient first, and I will calculate the exact amount of infusion. Then whoever, lend me your pen and paper.”

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

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

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

They know the importance of hydration in theory, but they don’t pay much attention to it clinically.

Now seeing how much fluid the burn patients need to replenish, and what kind of fluids need to be strictly calculated, everyone is surprised and at the same time admires Chen Qi’s rigor.

The family members stretched their necks to watch the bustle from the window, and the more they watched, the more uncomfortable they became. Okay, let you cure the disease and save lives, why are you **** writing and drawing?

This is an emergency room, not a cultural salon. Doctors, be yourself.

Regardless of what others think, Chen Qi has been silently chanting:

“In the first 24 hours after injury, the estimated fluid volume (mL) = total burn area (% body surface area) x body weight (kg) x 2.6mL (the ratio of colloid to electrolyte is 1:1, each is 1.3mL) + 2000mL moisture.

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

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

This set of formulas is available in both Chinese and English. Not to mention that black doctors can’t understand it, even Hua Guo’s doctor is confused.

After Chen Qi finished writing, he looked at the draft and was very satisfied. He hadn’t memorized these things for many years, but he still remembered them. He really is a genius in surgery.

Yi Zewen couldn’t bear it anymore, and asked out 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 what experts have explored in long-term clinical and experimental studies, and it is definitely impossible to be wrong anyway.

“Don’t worry about these, just follow this principle and treat quickly. If you really don’t understand, I’ll give you a make-up lesson later. You guys measure the area of ​​​​the burn, and you can calculate the area? Yes, a palm accounts for 1%.”

The little doctor from Ham City next to him asked unwillingly:

“Dean Chen, can you give an example, how do you understand this crystal first and then glue? You don’t explain clearly how we use medicine in clinical practice?”

Chen Qi complained in his heart, what time is it, the patient is dying, why don’t you rush to rescue him?

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

“Okay, let me give you a few simple examples. The “crystal” of the first crystal and then the glue refers to the 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, plasma substitutes, blood products, etc.

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

The solubility of crystalloid solution is better than that of colloid solution, the resistance of blood running is small, and the speed of blood running is fast. Colloidal substances will increase the viscosity of the blood, and the resistance of the blood to run is large. Therefore, when we need to supplement the amount of blood solution, it is very important to use crystalloid first. ”

While writing the doctor’s order, Chen Qi gave on-the-spot teaching to the young doctors around him.

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

The three venous channels were opened, and the fluid was infused quickly. The speed was so fast that some young doctors were worried.

Another little doctor from Lishui reminded me weakly:

“Dean Chen, this, this infusion is too fast, three infusions are given at the same time in one breath. Too fast infusion may easily cause heart failure and pulmonary edema. Isn’t it too dangerous?”

In clinical practice, the medical staff strictly controls the speed of the drip. If they really don’t know, they would rather slow than fast, for fear of accidents.

Chen Qi had already stood up at this time, while removing the catheter, working non-stop in his hands, he continued to explain:

“That depends on when. You see, the black commander is already in shock, that is to say, he is about to die. What is the principle of our rehydration at this time? That is to quickly replenish blood volume and increase the height as quickly as possible. Blood pressure, correct shock.

It is equivalent to hanging his life first. Only after passing the shock level can you talk about follow-up treatment, right? After all, this shock is not good, and the mortality rate is quite high. No matter what time it is, life preservation must always be the first priority.

For example, the kidneys, if blood volume decreases, renal vasospasm, hemolysis, and toxins, etc., lead to oliguria, hemoglobinuria, and even acute renal failure. If this problem is not prevented in advance, you will be disabled after being rescued.

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

Zhang Xing took the catheterization bag and looked at the base of Commander Z’s thigh in embarrassment, and suddenly felt sorry for the black commander.

If it wasn’t for the missing position, otherwise you wouldn’t be able to see what that black mass was?

The little birds have turned into roasted birds, okay?

This requires insertion of a urinary catheter, just like opening a blind box or a “beggar’s chicken”. First, the coke on the outside must be crushed and removed, and then carefully search for the opening of the urethra.

Thinking of this, Zhang Xing shuddered, thinking that everyone is like this, it is better to die, what else can be saved, it will be his father-in-law.

Chen Qi’s clinical orders went down one by one, and the scene became busy again.

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

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

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

“Mr. Dean, can this Commander Z survive? You must know the danger of infection, so antibiotics are very important now. I need the best antibacterial drugs. I wonder what stocks you have?”

Bagri is also very anxious. This is related to his position as dean, so of course he attaches great importance to it.

“Doctor Chen, what kind of antibacterial do you need?”

Chen Qi thought about it for a while: “Burn infections are mainly caused by Staphylococcus aureus and anaerobic bacteria, so it is best to use third-generation cephalosporins. In addition, quinolone antibacterial drugs, the higher the better.”

Headmaster Bagley was in a dilemma, and the beard on his chin was ripped off one by one.

A poor and backward country in Africa that doesn’t even have a single pharmaceutical company, what high-end drugs do you expect it to have?

Dean Bagley said in shame:

“To tell you the truth, we have antibiotics, but we all have the most basic penicillin, tetracycline, gentamicin and so on. We also have the advanced antibacterials you mentioned, but only a small amount is preserved, at most Can handle emergencies.”

“As the largest public hospital in Sierra Lean, you don’t have a few high-end antibacterial drugs?”

Chen Qi was very surprised, while Baghri blushed:

“No way, who said we are 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 all wearing Patek Philippe on their wrists, thinking:

“Poor? Not poor at all.”

(end of this chapter)