Since 1981 Health School

The Chongqing formula was established in 1962 by the Southwest Hospital of the Third Military Medical University.

They advocated that the amount of rehydration in the first 24 hours after injury should be 1.5 mL of liquid per kilogram of body weight and per 1% TBSA (calculated according to the actual burn area), the crystal-colloid ratio was 2:1, and 2000 mL of water was added.

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

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

They advocated that the first 24 hours after injury, the volume of rehydration should be 1.5 mL of liquid per kilogram of body weight and per 1% TBSA (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.

The Nanjing formula is mainly suitable for wartime and batch burns, so it has not become the mainstream formula for rehydration 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 two modes of Chongqing formula and Shanghai formula and the mainstream rehydration formula recognized by later generations is that

The 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 practice of later generations has proved that Chongqing formula is relatively the most scientific

But the disadvantage is that it is not effective for the super large burn area exceeding 50% or severe burns.

The reason is that the Chongqing formula rigidly believes that only 50% of the infusion volume should be used for severe burns.

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

In the Chongqing model, the amount of rehydration fluid is relatively small, so the amount of rehydration fluid for severely burned patients will be even less.

The formula with less fluid volume 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 also a misunderstanding, the ratio of crystal to gel is 2:1, which is correct, but for patients with large area and severe burns, the ratio of crystal to gel should be adjusted to 1:1.

In fact, the research of Southwest Hospital has been 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 because the domestic conditions in the 1970s and 1980s were too poor. Most medical instruments were lacking, so they couldn’t get 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, and the burn department of Southwest Hospital was still very good, and there were many very good experts in it.

But now...

Chen Qi just wanted 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 it 16 hours, and how to replenish it 24 hours.

This rehydration is very rough.

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

However, due to the overload of fluid, 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 recklessly injects the patient with fluid.

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

So let’s go back to an old question, the thing about rehydration, if it’s done well, it’s life-saving, if it’s not done well, it’s murder.

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

The phenomenon of blindly and mechanically following the calculated amount of the formula while ignoring the clinical manifestations and resuscitation effect, and patients with large area burns strictly following 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.

What later generations advocate is the "individualized rehydration stage".

This means that different individuals require different amounts of fluid 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 fluid rehydration", but also specific resuscitation goals, which is called "targeted resuscitation".

It 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)\u003c-6, restore normal cardiac output, oxygen Delivery \u003e500 mL/m2, gastric mucosal pH returned to normal.

Therefore, 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 that 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 could not be saved.

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 and watch 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, then stepped back, and asked a little uncertainly, "Hi, are you Comrade Chen Qi?"

"Uh, yes, I'm 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!"

When Deng Changle saw that this legendary "enemy" was so young, he couldn't help feeling emotional.

"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 brazen 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 could 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."

Following Chen Qi's prompt, Deng Changle 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 could tell at a glance that what Chen Qi said was true. The burn area was indeed huge, but he didn't quite believe that he hadn't died within a month.

Suddenly he thought of why Chen Qi wanted to "peek" at their rescue at Dongshan Hospital. Could it be that he wanted to compare?

Thinking of this, Deng Changle was really happy. Fortunately, Liang Jingru was only 11 years old and hadn't 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 Yue Steel Factory's hiring a doctor from another hospital."

Deng Changle's tone of voice was so condescending that Chen Qi didn't like it very much.

I am a double director and vice president of the International Medical Association, and the other side is a little deputy director of the burn department. What is there to prick? 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 would not 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 rude, 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 said a silly X to each other 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?"

"Isotonic saline first, and 500ml of 0.9% sodium chloride solution first."

The rehydration fluid of Dongshan Hospital is opened and closed. If the dose is large, it is afraid that the amount of circulating blood will be insufficient if the supplement is insufficient.

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

The two had a disagreement 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, what Chen Qi used was a rehydration solution researched by countless medical scientists, and it had been clinically proven, so how could it be wrong?

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

Even if crystalloid solutions are used, the main ones are sodium lactate Ringer injections, and later sodium pyruvate injections.

Isotonic saline has long been eliminated in later generations, but in 1989, Dongshan Hospital was still using 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 is because 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 God is the referee, in the first round, Chen Qi will get +1 point and Deng Changle -1 point.

Then came the second round: disinfection.

Such a large area of ​​wound is exposed there, and 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 has a very strong irritant.

Applying alcohol to 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, 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 on the door frame, listened to the voice inside, and made a tsk tsk sound:

"It was brutal, it was ruthless."

Many doctors and nurses from 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, why are the three elders in the steel plant shouting when it's their turn? Are they too useless?"

Chen Qi easily explained:

"We used hibernation therapy first, 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.