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Curling’s ulcerBacterial translocation
Gastric distention: N/VAbdominal compartment syndromeSystemic Response to Burn InjuryoImmunologicHigh risk for infection/sepsisSkin is largest barrier to infectionImmunosuppressionAt risk for multiple organ dysfunction syndromeoThermoregulatoryInability to regulate body temperatureHypothermic even in absence of infectionSystemic Response to Burn Injury: PulmonaryPulmonary Alterationso10-20% of patient admitted to burn centers have inhalation injuryIncreases LOSIncreased M & MoInhalation of heated air and/or noxious gasoMay occur without obvious evidence of smoke inhalationPulmonary AlterationsoBronchoconstrictionRelease of histamine, serotonin, thromboxane: vasoconstrictionoChest constriction secondary to circumferential full-thickness chest burnsoHypoxiaClassification of Inhalation InjuryoUpper Airway (Above the glottis)Inhalation of direct heat 150° to the epitheliumSevere upper airway edemaCauses obstruction of airwayEarly intubationoBelow the glottisResults from inhaling noxious gasesSource of death at sceneTissue hypoxia secondary to carbon monoxide, cyanidePulmonary AlterationsoCarboxyhemoglobinAffinity for hemoglobin is 250 times greater than that for oxygenAlveolar damage occursLoss of ciliary actionHypersecretionSevere mucosal edemaPossible bronchospasm
Clinical ManifestationsoEnclosed spaceoBurns of the face or neckoSinged nasal hairoHoarseness, high-pitched voice changeoDry cough, stridoroSooty (carbonaceous sputum) or bloody sputumoLabored breathing or tachypneaoHypoxemiaoErythema/blistering of oral or pharyngeal mucosaDiagnosis & ComplicationsoDiagnosisMonitor ABGCarboxyhemoglobin levelDirect observation: Fiberoptic bronchoscopyComplicationsoARDSoAcute respiratory failureAtelectasisAirway obstructionPulmonary edemaTissue hypoxiaManagemento100% FI02oEarly intubationoMechanical ventilationoHyperbaric chamberInjury Requiring IntubationAirway Edema: One Hour Later
Phases of Burn Management:Emergent/Resuscitative PhaseoAirway, breathing, circulation, disabilityoLifesaving measures immediately institutedoRemove clothing/jewelryoCheck for contact lensesoComorbidities/historyoLarge bore IVoNGT: > 20%oNon-sterile gloves, caps, mask, gownoClean sheetsoFoley catheteroLab/EKGoTetanus prophylaxisoTransferTransfer CriteriaInhalation InjuryPartial thickness > 10%Full-thickness burns in any age groupFace/hands/fee/genitalia/jointsChemical or electrical burnsAdditional traumaPediatric patientsoFluid ResuscitationGauged by patient responseu/o (0.5-1.0 mL/kg)Hematocrit and hemoglobin
Serum sodiumCalculated by extent of burnInitially isotonic fluids, then may use combination (plasma expanders; theories requiring further testing)TBSA > 20% associated with increased capillary permeability and intravascular shifts