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