Curlings ulcer bacterial translocation gastric

Curling’s ulcer
 Bacterial translocation

 Gastric distention: N/V
 Abdominal compartment syndrome
 Systemic Response to Burn Injury
o Immunologic
 High risk for infection/sepsis
 Skin is largest barrier to infection
 Immunosuppression
 At risk for multiple organ dysfunction syndrome
o Thermoregulatory
 Inability to regulate body temperature
 Hypothermic even in absence of infection
 Systemic Response to Burn Injury: Pulmonary
 Pulmonary Alterations
o 10-20% of patient admitted to burn centers have inhalation injury
 Increases LOS
 Increased M & M
o Inhalation of heated air and/or noxious gas
o May occur without obvious evidence of smoke inhalation
 Pulmonary Alterations
o Bronchoconstriction
 Release of histamine, serotonin, thromboxane: vasoconstriction
o Chest constriction secondary to circumferential full-thickness chest burns
o Hypoxia
 Classification of Inhalation Injury
o Upper Airway (Above the glottis)
 Inhalation of direct heat
 150° to the epithelium
 Severe upper airway edema
 Causes obstruction of airway
 Early intubation
o Below the glottis
 Results from inhaling noxious gases
 Source of death at scene
 Tissue hypoxia secondary to carbon monoxide, cyanide
 Pulmonary Alterations
o Carboxyhemoglobin
 Affinity for hemoglobin is 250 times greater than that for oxygen
 Alveolar damage occurs
 Loss of ciliary action
 Hypersecretion
 Severe mucosal edema
 Possible bronchospasm

 Clinical Manifestations
o Enclosed space
o Burns of the face or neck
o Singed nasal hair
o Hoarseness, high-pitched voice change
o Dry cough, stridor
o Sooty (carbonaceous sputum) or bloody sputum
o Labored breathing or tachypnea
o Hypoxemia
o Erythema/blistering of oral or pharyngeal mucosa
 Diagnosis & Complications
o Diagnosis
 Monitor ABG
 Carboxyhemoglobin level
 Direct observation: Fiberoptic bronchoscopy
 Complications
o ARDS
o Acute respiratory failure
 Atelectasis
 Airway obstruction
 Pulmonary edema
 Tissue hypoxia
 Management
o 100% FI02
o Early intubation
o Mechanical ventilation
o Hyperbaric chamber
 Injury Requiring Intubation
 Airway Edema: One Hour Later

 Phases of Burn Management:
 Emergent/Resuscitative Phase
o Airway, breathing, circulation, disability
o Lifesaving measures immediately instituted
o Remove clothing/jewelry
o Check for contact lenses
o Comorbidities/history
o Large bore IV
o NGT: > 20%
o Non-sterile gloves, caps, mask, gown
o Clean sheets
o Foley catheter
o Lab/EKG
o Tetanus prophylaxis
o Transfer
 Transfer Criteria
 Inhalation Injury
 Partial thickness > 10%
 Full-thickness burns in any age group
 Face/hands/fee/genitalia/joints
 Chemical or electrical burns
 Additional trauma
 Pediatric patients
o Fluid Resuscitation
 Gauged by patient response
 u/o (0.5-1.0 mL/kg)
 Hematocrit and hemoglobin

 Serum sodium
 Calculated by extent of burn
 Initially isotonic fluids, then may use combination (plasma
expanders; theories requiring further testing)
 TBSA > 20% associated with increased capillary permeability and
intravascular shifts
