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Burn Care: Results of Technical and Organizational Progress

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Title: Burn Care: Results of Technical and Organizational Progress


1
Burn Care Results of Technical and
Organizational Progress
  • Sheridan, Robert L.
    MD
  • JAMA. 290(6)719-722,
    August 13, 2003

92-09-03 Reporter ????? Instructor ?????
2
Fluid Resuscitation
  • Diffuse capillary leak syndrome that
    characterizes the early period following a burn
    is unique and will lead to cardiovascular
    collapse
  • Patients with injuries covering more than 20 of
    the total body surface generally will require
    fluid resuscitation using primarily isotonic
    crystalloid

3
Monitor
  • Peripheral temperature and perfusion, vital
    signs, and urine output. Selected laboratory and
    invasive parameters, such as hemocrite, base
    deficit, and central venous pressure, can be
    helpful. Pulmonary artery catheterization or
    cardiac ultrasonography less frequently are
    valuable, except in the setting of coexisting
    cardiac conditions.

4
Inhalation Injury
  • Inhalation injury remains a major source of
    morbidity and mortality
  • early airway obstruction and bronchospasm and
    later pulmonary infection and respiratory
    failure.

5
CO intoxication
  • Provision of 100 oxygen constitutes reasonable
    treatment. No clear beneficial effect on burn
    wound healing has been demonstrated with use of
    hyperbaric oxygen treatments
  • Hyperbaric oxygen treatment only after severe
    carbon monoxide poisoning in otherwise stable
    patients

6
Support of Hypermetabolism
  • An effective surgical procedure for burn wounds
    remains the most powerful modulator of the
    inflammatory response.
  • Support of this physiological state, through
    provision of adequate quantity and quality of
    nutrient solutions, is an important component of
    burn critical care

7
Surgical Treatment of the Wound
  • Topical antimicrobial agents play a supportive
    role in the treatment of burn wounds, preventing
    desiccation, improving pain control, and slowing
    bacterial proliferation. None of the many agents
    available can prevent infection or eliminate the
    need for surgical treatment of full-thickness
    injuries

8
Surgical Treatment of the Wound
  • Temporary skin substitutes are designed to foster
    healing of partial-thickness burns or donor
    sites, or to provide temporary coverage of
    full-thickness injuries while donor sites heal
  • No specific membrane has emerged as clearly
    superior

9
Pain and Anxiety Control
  • Burn units increasingly have implemented explicit
    pain and anxiety protocols based on opiate and
    benzodiazepine synergy, titrating doses to
    comfort, and monitoring effectiveness with a
    variety of objective scales

10
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11
Guidelines for Emergency Tracheal Intubation
Immediately after Traumatic Injury
  • Dunham, C. Michael MD et.
  • ournal of Trauma-Injury Infection Critical
    Care. 55(1)162-179, July 2003.

12
Inhalation injury
  • acute respiratory system insufficiency can be
    caused by carbon monoxide toxicity and thermal or
    combustion-product tissue injury
  • Carbon monoxide can create central nervous system
    hypoxia and tissue injury can lead to
    supraglottic, glottic, or infraglottic airway
    obstruction

13
Incidence
  • Tracheal intubation is needed at some time in
    16.6 (range, 427) of burn patients
  • Incidence of smoke inhalation injury for patients
    who have burn injury is 10.7 (range, 360).

14
Indication for intubation
  • Close-space injury
  • Facial burn
  • Singed nasal vibrissae
  • Soot in oropharynx
  • Oropharyngeal burn
  • Horseness
  • Airway obstruction
  • Wheezing
  • carbonaceous sputum
  • Unconsciousness
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