Burns injury - PACT - ESICM

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In patients with large burns, the mean stay in a burns unit is about 1 day per %TBSA. Onarheim H, Jensen SA, Rosenberg BE, Guttormsen AB. The epidemiology of patients with burn injuries admitted to Norwegian hospitals in 2007. Burns 2009; 35(8): 1142–1146. PMID 19748742 2011 National Burn Repository: provides reports with demographic data, injury information and outcomes from US burn centres. 2
1/ PRE-HOSPITAL/IMMEDIATE CARE Priorities including the primary survey The main responsibilities in the pre-hospital setting are safety for the patient(s) and the rescue crew, to stop the burning process and to perform ABCDEF (airway, breathing, circulation, disability, environment, fluid) assessment and treatment. Thereafter a gross estimation of the burned surface (%TBSA) should be carried out. Pre-hospital estimation of %TBSA is difficult and frequently an overestimation of smaller burns and an underestimation of larger burns takes place. For detail of the estimation of the %TBSA burned, see Task 2. Hettiaratchy S, Papini R. Initial management of a major burn: I--overview. BMJ 2004; 328(7455): 1555–1557. PMID 15217876 Allison K, Porter K. Consensus on the prehospital approach to burns patient management. Emerg Med J 2004; 21(1): 112–114. PMID 14734397 Collis N, Smith G, Fenton OM. Accuracy of burn size estimation and subsequent fluid resuscitation prior to arrival at the Yorkshire Regional Burns Unit. A three year retrospective study. Burns 1999; 25: 345–351. PMID 10431984 Cooling Most textbooks advocate cooling of the burn injury until pain relief with 12–15 C (never ice) clean water. It is claimed that cooling stops the thermal injury, reduces oedema and relieves pain. Studies have shown that the most significant reduction of temperature in burned tissue takes place within few minutes after the start of cooling. Cooling beyond two to three minutes is therefore of questionable value. Remember that cooling often causes hypothermia in patients with large burns. Herndon DN, editor. Total Burn Care. 3rd edition. Edinburgh: Saunders-Elsevier; 2007. ISBN 978-1416032748 Trupkovic T, Hoppe U, Kleinschmidt S, Sefrin P. Correspondence (letter to the editor): benefits of cooling are not known. Dtsch Arztebl Int 2010; 107(6): 101. PMID 20204125 Hypothermia Hypothermia, defined as a core body temperature 70% TBSA) the incidence may increase to 35%. Hypothermia is associated with increased fluid requirement, coagulopathy, depressed cardiac function, dysrhythmias, ventilatory depression, decreased oxygen delivery, acidosis, and a higher mortality. 3
Page 1 and 2: AN ESICM MULTIDISCIPLINARY DISTANCE
Page 3 and 4: Pathophysiology ...................
Page 5: INTRODUCTION Most emergency medical
Page 9 and 10: Intravenous cannulae/needles and fl
Page 11 and 12: Fluid resuscitation (0-24 hrs) Burn
Page 13 and 14: Fluid resuscitation in patients wit
Page 15 and 16: Electrical burn injury is addressed
Page 17 and 18: Haberal M. Guidelines for dealing w
Page 19 and 20: Early tangential excision was first
Page 21 and 22: performed for these individuals and
Page 23 and 24: 4/ MANAGING CONCURRENT INJURIES AND
Page 25 and 26: Clinical signs of CO poisoning rela
Page 27 and 28: Although diagnosing CN poisoning is
Page 29 and 30: Electrical injuries Electrical inju
Page 31 and 32: 5/ CRITICAL CARE CONSIDERATIONS SPE
Page 33 and 34: Pruitt BA Jr. The diagnosis and tre
Page 35 and 36: Lam NN, Tien NG, Khoa CM. Early ent
Page 37 and 38: Sheridan RL, Yu YM, Prelack K, Youn
Page 39 and 40: hydromorphone) is preferred. In the
Page 41 and 42: 6/ PERIOPERATIVE MANAGEMENT OF INTE
Page 43 and 44: Know your hospital guidelines for t
Page 45 and 46: 7/ BURNS IN CHILDREN Epidemiology a
Page 47 and 48: One can also use a modified Parklan
Page 49 and 50: 8/ OUTCOME, ETHICS & RESEARCH In a
Page 51 and 52: CONCLUSION In patients with burns c
Page 53 and 54: Initial resuscitation specific to b
Page 55 and 56: With due preparation and skilled as
Page 57 and 58:
After wound debridement and escharo
Page 59 and 60:
Sepsis diagnosis Catheter-related i
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