First, anti-shock treatment: 1, the principle of treatment: immediately start effective fluid resuscitation treatment, pay attention to the combined poisoning, consciousness disorder and inhalation injury to strengthen the monitoring, while taking dehydration treatment. That is, “supplementation and dehydration”. Treatment plan: total fluid intake in the first 24 hours was 12550ml, of which 4750ml was crystalloid, 4250ml was colloid, 4250ml was water, and the average urine output was 233ml/h. In the second 24 hours, the total fluid intake was 9905ml, of which 3525ml was crystalloid, 2250ml was colloid, 2600ml was water, and the average urine output was 259ml/h. Mannitol 250ml was given every 8 hours, of which 259ml/h was given. Mannitol 250ml was given every 8 hours and albumin was given. Second, the treatment of inhalation injury: 1, the principle of treatment: unobstructed airway, relief of obstruction, reasonable fluid replacement, correction of hypoxemia, prevention and treatment of infection. 2, treatment program: strict implementation of post-tracheotomy nursing routine (including: turning, patting the back, nebulized drip, sputum, etc.), according to the patient’s respiratory monitoring situation successively apply catheter oxygen, oxygen therapy device oxygen, mechanical ventilation, give anti-infection treatment. Third, poisoning treatment: 1, the principle of treatment: close observation of changes in the condition, intravenous rehydration and diuretics to make the poison as soon as possible out of the body, to give important organ function protection and support. Further tracking to clarify the nature of the poison, choose the appropriate antidote or antagonist treatment. 2, treatment program: combined with the resuscitation of the development of liquid therapy program (see anti-shock treatment), immediately given to ustekin, Foday, Kesile (thiopronin), Tate (reduced glutathione), Goshuda, anti-visceral failure and other organ support therapy. Fourth, other treatments: 1, give systemic hormone therapy (48 hours dexamethasone total 160mg), respiratory tract local hormone therapy (lipolytic hormone pramipexole added to ultrasonic nebulizing solution). 2.Alkaline drug treatment: 5% sodium bicarbonate was given. 3.Sedation therapy: Valium and isoproterenol were applied successively. V. Therapeutic effect: the patient successfully passed the shock period and gradually recovered his mental state after one week. Consultation and discussion of the clinical characteristics of this case: the patient is a young woman, severe burns combined with inhalation injury, poisoning, the presence of impaired consciousness, and heavy damage to vital organs. Burn physician: the patient’s severe burns combined with inhalation injury, poisoning, the presence of impaired consciousness, important organ damage, resuscitation treatment can not be mechanically in accordance with the rehydration formula to formulate a plan to take into account the treatment of inhalation injury, intoxication and impaired consciousness, liquid resuscitation treatment is relatively complex, uncertainty increased, to strengthen the monitoring measures during the shock period. At the same time, inhalation injuries are treated aggressively and different modes of respiratory support measures are given when appropriate. General detoxification measures should be given immediately until the nature of the poison is clear and organ protection should be strengthened, while the nature of the poison should be traced and symptomatic treatment should be sought. Further investigations (e.g. fundus, CT, NMR, EEG, etc.) should be performed while treating the patient’s impaired consciousness in order to clarify its extent, cause and prognosis. Occupational toxicologist: The patient was injured in a building construction fire, with a clear history of mixed gas inhalation. At present, the patient is in a shallow coma, and the laboratory results show that there are injuries to the liver, myocardium, kidneys, and according to the national Diagnostic Criteria for Respiratory Diseases of Toxicity of Occupational Acute Chemical Substances (GBZ73-2002), the patient can be diagnosed with mixed gas inhalation intoxication (severe). It is difficult to clarify the nature of the poison, so we agree with the treatment of the burns physician, and hormone therapy can be used if the condition permits. Surgical ICU physician: At present, the patient’s lung function is OK from the chest X-ray and blood gas results, and respiratory care should be strengthened in the future to prevent lung infection. Regarding the central nervous system, at present the patient is comatose, the pathological reflexes are all positive (the second 24 hours), it is estimated that cerebral edema exists, and albumin and mannitol have been used in the treatment, and tachyphylaxis can be added during the application of mannitol, and the mannitol can be decreasing to Q12H or discontinuing after the consciousness is fully awake. At the same time, patients with cerebral edema are highly susceptible to complications of peptic ulcers and severe hyperglycemia; omeprazole can be given, and if blood glucose is too high it indicates excessive dehydration. Hepatic impairment is present in the patient, which is exacerbated by hypoxia, lack of energy and insulin, and should be avoided. Coagulation factors and bilirubin should be observed; there is currently a decrease in bilirubin, indicating appropriate measures. If the patient is not cooperative can be applied isoproterenol pumping. Related knowledge 1, the prevention and treatment of burn shock: the prevention and treatment of burn shock emphasizes “early” and “effective”. The so-called early, not only do not lose time, as soon as possible to start the treatment of hemodynamics for shock, to prevent the occurrence of tissue ischemia, hypoxia; the so-called effective, that is, to make the patient’s effective circulating blood volume and tissue perfusion is always maintained in a good state, to minimize the patient’s body systems, organs metabolism and dysfunction, and to smooth over the period of shock. Under the current level of treatment and medical conditions, the number of burn patients who die during the shock period is already small. However, if the shock period is not smooth, tissue ischemia, hypoxia and reperfusion injury will seriously weaken the patient’s defense and repair ability, and the chance of serious systemic infections and multiple organ failure in the subsequent course of the shock period will be greatly increased, and the latter is the main cause of death of burn patients nowadays. Clinically, formulas are applied to guide early fluid resuscitation treatment, and these formulas are generally based on the regularity of body fluid loss after burns and consider burn area and body weight as the core factors of the formulas; however, the generation of each formula has its own specific conditions and locality, different empirical backgrounds and theoretical bases, coupled with the individual differences and complexity of the condition of burned patients, so flexibility is required in the selection and implementation of the formulas Therefore, the formula should be flexible when choosing and implementing, and the clinical and monitoring indexes should be closely observed during the treatment process, and timely adjustments should be made according to the patient’s response to the treatment. Reasonable rehydration therapy when combined with inhalation injury: Clinical inhalation injury is often combined with surface burns, and may even be a large area of burns. Therefore, how to master the quality and quantity of shock resuscitation rehydration fluid is the key issue of treatment. In the past, most of the advocates of limiting the amount of rehydration fluid, the purpose of which is to prevent the occurrence of pulmonary edema. At present, it is believed that excessive restriction of fluid volume is not only difficult to correct shock, resulting in increased pulmonary ischemia, but also can promote the occurrence and development of pulmonary edema. The volume of rehydration fluid for this type of casualty should be increased or decreased according to the specific condition, and at the same time, attention should be paid to preventing excessive rehydration fluid, which can appropriately increase the amount of colloid intake, improve plasma colloid osmolality, reduce the hydrostatic pressure of the pulmonary capillaries, and reduce the water content of the lungs. Such casualties shock recovery, Su during the period should closely monitor cardiopulmonary function. Such as the application of hemodynamic monitoring to guide the infusion volume and infusion rate, at the same time, arterial blood gas analysis to understand the ventilation and ventilation function of the lungs, as well as changes in the body’s acid-base metabolism, so as to effectively correct the shock in a timely manner, to protect the visceral function, reduce the occurrence of pulmonary edema. 3, burns combined with the treatment of poisoning: the modern crowd more living in a more confined space, at the same time the increase in chemical products, such as plastics, chemical fibers, paints, coatings, etc. have been widely used in daily life, these items are not only easy to burn to cause fires, but also produces a variety of poisonous gases, increasing the severity of inhalation injury. Short-term inhalation of a large number of poisons can cause acute poisoning, the onset of acute, severe symptoms, rapid changes, if not actively treated, can be life-threatening. Treatment includes the following points: (a) Immediately stop poison contact: when poison is invaded by the respiratory tract or skin, the patient should be immediately evacuated from the scene of poisoning. Immediately remove the contaminated clothes and wash the skin of the contact area. (ii) Remove unabsorbed poison from the body. (iii) Promote the elimination of absorbed poisons: diuresis, oxygenation, dialysis therapy (including peritoneal dialysis and hemodialysis) and hemoperfusion can be utilized to eliminate poisons. (d) Application of special antidotes: every possible effort should be made to clarify the nature of the poison and seek special antidotes. (e) Symptomatic treatment: Many acute poisonings have no specific antidote. Symptomatic treatment is important to help critically ill patients to tide over their difficulties, and it is important to protect vital organs and restore their functions. When poisoning is severe, with coma, pneumonia, pulmonary edema, and circulatory, respiratory, and renal failure, appropriate and effective resuscitation measures should be taken. Comatose patients must pay attention to keep the airway open to maintain respiratory and circulatory functions. In case of convulsions, anticonvulsant drugs should be used and patients should be protected from injuries. When there is cerebral edema, dehydration therapy should be applied. Expert commentary on the case is complex and critical. Both severe skin burns and severe inhalation injury, combined with chemical poisoning, cerebral edema, the patient is in a deep coma. What kind of poison poisoning, it is difficult to determine. There are many contradictions in resuscitation. In the complex contradictions need to be decisive, find out the main line, seize the main contradiction, but also to take into account both the symptoms and the root cause, break the routine, using the “side of replenishment, side off” rehydration method, comprehensive treatment. Both rapidly improve tissue perfusion, reduce ischemic and hypoxic injury, and at the same time through diuresis to exclude a large number of toxic substances and protect organs to reduce cerebral edema and other tissue damage. In the resuscitation to win the time, so that the patient through the dangerous period, for further treatment to lay the foundation.