Curlings ulcer Bacterial translocation Gastric distention NV Abdominal

Curlings ulcer bacterial translocation gastric

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Curling’s ulcer Bacterial translocation
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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
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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
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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
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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
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  • Spring '16
  • CamilleA.Baldwin
  • Burn Injury

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