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دپارتمان سوختگي امام رضا(ع)سوختگي مردان
نوشته شده در تاریخ 1396/10/7 و در ساعت : 08:34 - نویسنده : departman-burn
Resuscitation burnResuscitation
Along with early excision and grafting, one of the central tenets of current burn care is fluid resuscitation of the burn victim. Many different methods have been proposed, all valid, but with no universal acceptance for one formula. They vary in their use of crystalloid and colloid components and are in continuing evolution as we understand the pathophysiology of the burn wound better. The most important principle in burn resuscitation is that any of these formulas are only guidelines and individual fluid requirements are to be judged by clinical and hemodynamic parameters as endpoints. Without adequate resuscitation, tissue perfusion suffers and the burn shock cascade is perpetuated. Delay to adequate resuscitation is one of the factors identified with increased mortality. One of the many functions of the skin is to maintain fluid and electrolyte hemostasis. After burn injury, the integrity of skin is lost and leakage of plasma occurs. This is complicated by edema secondary to loss of endothelial integrity and further sequestration of fluid in tissues not directly affected by the burn itself. Thermal injuries of greater than 30% have been demonstrated to initiate a cascade of inflammatory mediators leading to capillary leak that lea ds to the anasarca in unburned areas and pulmonary edema. These mediators include histamine, bradykinin, and serotonin but the exact mechanism to initiate the cascade has not been elucidated. Attempts at modulation of the cascade are reported, but have not been successfully applied in a clinical setting. Adequate resuscitation aims to counter these effects and reduce this process of postburn shock. Intravenous access should be established early in the initial evaluation of the burn patient after the airway has been secured according to standard trauma protocols. Peripheral, large bore IVs provide excellent access and can actually administer greater volumes of fluid due to diminished resistance of the catheter secondary to a shorter length. Central venous access may be difficult to establish with the crowding of people around the torso of a newly arrived trauma victim, and also carry risks of pneumothorax or inability to control bleeding from inappropriate placement. In children it can be particularly difficult to establish intravenous access, and the intra-osseous route can be used emergently for fluids and medicines. Calculations of fluid requirements are based on the amount of body surface involved in second or third degree burns (not first-degree burns). The “Rule of Nines” has been used to estimate the body surface area burned (Fig. 3.1), but this does have limitations in the pediatric population where the head is proportionally larger than the body when compared to the adult. Modifications of this burn diagram are available (Fig 3.2) or nomograms are available as well (Fig 3.3) to calculate body surface area and percent burn. On a more practical note, knowing that the patient’s palm (not the examiner’s) is equal to 1% of total body surface, body surface area (BSA) burned can be estimated by “patting out” the burned areas when a quick evaluation is needed. برچسب ها : دفعات بازدید : 348
نوشته شده در تاریخ 1391/10/20 و در ساعت : 11:40 - نویسنده : departman-burn
(Total Burn Care)کتاب جامع اطلاعات در زمینه سوختگی در پزشکی (لاتین)
برچسب ها : دفعات بازدید : 88
نوشته شده در تاریخ 1391/8/27 و در ساعت : 20:52 - نویسنده : departman-burn
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