severe burns by andrew udy
TRANSCRIPT
Severe Burns
Andrew Udy
The Alfred Intensive Care Unit
54 year old man, no known medical history
Rescued from a smoke-filled room in a burning house
Patient is conscious, agitated, and coughing
He appears to have extensive torso burns
Stop the burning!
Assess the patient’s ABCs
A B D EC
Hoarseness + Stridor
Hypoxia
Inflamed oropharynx
History of closed space
Carbonaceous sputum
HbCO > 10%
Singeing of hair, eyebrow, eyelashes
SpO2 82%
ETCO2 65
FiO2 1.0
PEEP 10
P peak 55
VT 500ml
RR 16
I:E ratio 1:2
55 cmH2O
No Flow
HR 165
BP 88/40
UO – minimal
CRT – 6 sec
2 x 18 G IV
2000 ml by AV
65% TBSA Full thickness burns
~ weight 95 Kg
95 x 65 x 4 = 24,700 ml
12,350ml in the first 8hrs
- from the time of burn
Remainder in the next 16hours
Hb Concentration
Lactate
UO (0.5 – 1 ml/kg/hr)
MAP
Increased capillary permeabilityRelative hypovolaemiaReduced COImpaired organ perfusion
Increased tissue oedemaLung injuryAbdominal compartment syndromeAcute kidney injury
pH 7.03
PaCO2 49
PaO2 75
FiO2 1.0
HCO3- 9
Lactate 12
Hb 178
Lung protective ventilation
- rescue therapies
Regular bronchial toilet
Nebulised heparin
Potential inhalation of toxic gases
24-48 hours
Weeks to months
TempHRCOVO2
Tissue healingProtein catabolismWeight lossMuscle wastingWeakness
= Complete grafting
Feeding
Analgesia
Sedation
Thromboembolic prophylaxis
Head up
Ulcer prophylaxis
Glucose control
Fluids
Infectious Diseases
Drugs
Dialysis
Lines
Electrolytes
MAJORBURNS
ALTERED PHARMACOKINETICS
INFERIOR DRUG EXPOSURE
TREATMENT FAILURE
‘STANDARD’ANTIBIOTIC DOSES
TimeCo
nce
ntr
atio
n
MIC
Repeated surgery and dressing changes (waiting for donor sites)
- early tracheostomy
Delirium / BOC / Psychosocial issues
B-blockade
Physiotherapy and occupational therapy
Scarring and contractures
Thank You
A/Prof Andrew UdyThe Alfred Intensive Care Unit
School of Public Health & Preventive Medicine, Monash University
Email: [email protected]