The smooth and barely surviving shock has a great impact on later treatment. How to deal with the volatile shock period of severe burns directly reflects the skill of the burn doctor.

There are only two days that determine the success or failure of the shock period. During these two days, there is no need to consider whether the debridement is clean and complete. If the shock is severe, the debridement work can be put aside. The doctor only needs to solve one problem at this stage, fluid resuscitation.

【1】

Kawei’s method to combat burn shock is very simple: strict fluid infusion + sodium bicarbonate as an acid antacid + methylene blue as an anti-infection.

The structure of rehydration in the shock stage of simple burns is very simple. It does not require high sugar and nutrients, nor other therapeutic drugs. Even hemofiltration and hemodialysis are not necessary. [2]

What the injured's body needs now is simplicity and stability.

The shock patient was placed in another room

"The burn area is .23%, the unilateral infusion is not enough, and your rubber tube is tied too tight." Kawei noticed something was wrong just by looking at the physical signs, "What's her blood pressure?"

"91/66."【3】

"The lips are chapped and the blood pressure is unstable." Kawei only gave the most basic explanation, "Open another channel for her immediately, and you are giving the fluid too slowly. Don't tie the rubber tube too tightly, loosen it a little."

"knew."

"Wait, where's the urinary catheter? Why isn't it inserted?" Kawei looked at the empty sheets, "Kalien never taught you how to insert a urinary catheter?"

"Teaching means teaching."

"As soon as you have been taught, insert it as soon as possible. Don't be afraid of bleeding. By the way, remember to be careful when injecting the water bag and withdrawing it. Calculate the distance to avoid bursting the urethra."

Unexpected disasters are like wars. Although they are cruel, they can forcibly train doctors' abilities. In such a high-pressure environment, as long as you bite the bullet and do it, no matter how bad your skills are, you can hone your skills. Under relatively more relaxed medical conditions,

Under the circumstances, other minor mistakes can be forgiven as long as there are no problems of principle.

Just like the more advanced catheterization technology, the rubber quality and technology itself are not mature enough. The operating specifications are only taught orally, and it is difficult to do well without practice.

Pain and bleeding will inevitably occur during the actual intubation operation, but this is a trivial matter when it comes to calculating the intake and output of shock rehydration. As long as it is not a serious tear, it will heal on its own in a day or two.

"Dr. Carvey, someone here is out of breath!"

"coming!"

The second leading cause of death from burns is suffocation.

High temperature burns not only the surface skin, but also the respiratory tract inside the body. Every time you breathe, a large amount of hot smoke powder will be mixed in the air and enter the casualty's respiratory tract. This is why you must cover your mouth and nose with a wet towel during a fire.

The first is to prevent choking, and the second is to cool and humidify the air to protect the respiratory tract.

Many burn patients have no serious problems and the proportion of wounds is not high. They just inhale a large amount of high-heat gas, which causes rapid tissue edema due to throat damage, eventually blocking the airway and suffocating them to death.

The cause of asphyxia is actually similar to shock, which involves massive necrosis of cells and overflow of tissue fluid.

Shock means water leaves the place where it should be, resulting in insufficient blood perfusion. Asphyxia means water goes to places it shouldn't go, causing local or even systemic edema.

It is impossible to relieve the edema at this time. All that can be done is to reopen the blocked airway: "Where is my instrument kit? Prepare the scalpel, gauze and syringe."

"We've run out of syringes."

"Forget it, just cut the airway, quick!"

"Ah? Do you want to cut the airway?"

"Just cut it open? Isn't that too hasty?"

The success rate of tracheotomy in France is very low, and it is usually only used on patients with severe diphtheria and is not used easily. When encountering a truly life-threatening airway obstruction, it is already remarkable to be able to tell that it is airway obstruction. Here are the general treatment methods

It also starts with nasal and oral tube placement.

In fact, the method was almost the same as that of Ignatz, but with real throat edema, he was running against time and there was no time to make other choices.

The injured person with edema now has more than 30% burn area and is extremely weak. He is not the healthy Laszlo in his prime. He was already in shock and had blood circulation problems. If oxygen can no longer enter, he may die in an instant.

It will kill you.

Kawei didn't have time to put on his coat and gloves, and he didn't even bother to perform meticulous disinfection. He soaked his hands in carbolic acid washing solution and picked up the scalpel that was handed to him.

Without waiting for the other doctors around him to raise objections, he found a position to perform the operation directly, and at the same time began to issue orders: "You, go to the instrument box to find the airway horn and straps; you, go to find ether; is there anyone else? Come again.

An assistant!"

"."

As of 11 p.m., more than 60 injured people had been sent to the Main Palace Hospital, most of which were concentrated in the vacated special ward and the room used for debridement. The entire surgery was overloaded, and even the internal medicine department was called in

To help, the two people who performed the tracheotomy on Kawei were physicians.

Kawei's ears were full of crying and noise, and everyone was so busy that they wished that one person could be used as three people.

There must be no idlers, but the wounded are still being sent to the ward one after another.

"The car is coming! Someone help me!!!"

"Why are you still here?" Kawei seemed to have found the state of doing emergency surgery again. When he heard someone coming to the car, he quickly turned around and said, "Tell the people over there that there are not enough staff here, let them go to other hospitals to try

Try, don’t send it here again!”

"But this carload of patients came from other hospitals, and they were full."

"Are you kidding me? Is transferring to another hospital so easy?"

Just when Kawei turned around and wanted to curse, he realized that he was in France in the 19th century. Not to mention transferring to another hospital, having such an efficient carriage was already a blessing: "Forget it, let's stay. But the room is full

Let them stay in the garden for a while."

"good!"

Kawei looked up at the wall clock and couldn't help but curse in his heart: "It's already past 11 o'clock, what's going on with Cediyo?"

At this time, Cediyo was sitting in the living room of the Deputy Chief of Staff of the Logistics Support Department, listening to him keep talking about various reasons. In fact, it was just that "I don't have enough power", "It is not appropriate to use military supplies privately", "

The minister is very serious and can easily cause misunderstandings."

But the real reason is actually fear of taking responsibility.

"Sedyo, it's not that I don't want to help. I just have a job in the logistics department. It's good to be able to survive until now." Mansa ate the dessert and explained, "You have also been in the army.

, There is no use in taking a false position, the actual power is not mine at all."

"There is a fire in the Opera House. It is urgent to save lives now."

"The Opera House, it's a pity." Mansa was very emotional about this old building that was built nearly a century ago. "But I heard that His Majesty was planning to build a new grand opera house. I have always had this idea, but I just didn't have the chance.

"

Cediyo glanced at his pocket watch and said: "We are talking about people now, Mr. Chief of Staff."

"Wrong, it's the deputy chief of staff!" Mansa picked up a cup of black tea and finished the three-hour traditional French dinner. "Professor, please allow me to call you this. If you want to enter politics like me,

, you still have to have the necessary political sensitivity. If the title is slightly changed, the meaning will be completely different."

Cediyo did have the idea of ​​developing in this area before, but unfortunately he is no longer interested: "I don't understand this troublesome thing, I want a tent now!"

Seeing that the other party's tone began to be tough, Mansa was not used to it. Although he seemed calm, his attitude became increasingly cold: "I said, this thing is not my responsibility."

"Who's in charge of that?"

"My superior."

"Who is the superior?"

"Anyone who can order me." Mansa put down the tea cup and wiped the corners of his mouth with a clean handkerchief. "I know what you are going to ask next, but I don't know who is in charge, and I don't want to know."

"You are my old friend. You have the highest rank in the army. You can't even help me with this?"

"It doesn't matter whether I am a friend or not. The army has regulations. I just want to keep my current golden job." Mansa said, "As for other things, what do human lives, property, and political ambitions have to do with me? Burn it on fire.

After all, a new opera house will be built soon, and people will still go to the performances."

Cediyo is a typical aristocratic class. Even though he lost some of his privileges after the turmoil, he still has a deep sense of class.

But such an old-school European aristocrat could not agree with Mansa's indifference: "Forget it, I'll find someone else to think of a solution."

"If you please, I won't send you off." Mansa stood up and just walked up the stairs. Suddenly he remembered something and turned back to Sediyo who was about to leave and said, "I still want to advise you, doctors should have doctors.

Look, don’t do things that are not helpful or even harmful to you.”

"I'm just saving people."

"I have said before that in this case it is better to find nearby hotels and residences instead of asking for military tents."

"I have answered you before. The hospital is now severely short of manpower. It is much easier to have military tents in place as soon as possible than to slowly negotiate door to door."

Cediyo repeated his point of view, but Mansa immediately choked back: "Do you still think it's easy now?"

"It's indeed not simple." Sedillo looked at his old friend walking on the stairs and sighed, "It's just that I don't know why Paris is like this. Does human life seem so insignificant?"

Hearing that he raised the issue to such a high level, Mansa's face became much more solemn and asked: "What do you think is the probability of surviving a serious burn? Is it 10%?"

Cediyo shook his head slightly.

"I have also studied medicine, and I also want to save people, but the reality is not that simple. Today the army provides tents for free, and tomorrow it may provide medicine and food. The day after tomorrow, I am afraid that the target will not only be the army, but also

Your Majesty. Do you want Your Majesty to provide relief funds to the living or pensions to the dead? Or both?"

Cediyo: "."

"You held high the banner of saving people and said that saving lives is more important than anything else. Haha, I'm sorry. I'm really sorry."

The more Mansa thought about it, the funnier he became, but in the end he forced himself to endure it: "You have asked me such a stupid question in your life, so as a friend, I naturally have to stop you. If you don't stop me, will I just watch you do it again?"

Kick it to my immediate boss?"

Mansha had Mansha's considerations. After the explanation, Sediyo also realized that Kawei's casual request was actually very difficult to solve in Paris. This was due to the gap between the era and the country where he lived. Just two sentences could not be said.

It's clear, but with a little reminder, Kawei can still understand it.

After all, he himself is in such a social environment, and his status is much more noble than ordinary people.

What really made him unable to understand was not the political considerations and decisions, but the two people who appeared at the door of the debridement room at 11:14 in the evening. One was tall, one was short, one was fat, one was thin, and the other was broken.

One injured his leg, and one injured his arm.

"What are you doing?"

"Heal me quickly, oh no, it's us!" Alphonse's right hand and Li Ben's left hand were tied together with a hemp rope. "When he is cured, I will have a legitimate duel with him!"
Chapter completed!