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The burn injuries affects multiple anatomical area with major physiologic consequences....
Below is the summary of the anatomical and physiological insults ....
1-Supraglottal
Loss of airway patency due to mucosal oedema
Loss of airway reflexes due to coma (e.g. blast Traumatic brain injury, intoxications such as carbon monoxide,)
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Tracheobronchial
Bronchospasm resulting from inhaled irritants
Mucosal oedema and endobronchial sloughing causing small airway occlusion, leading to intrapulmonary shunting.
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Pulmonary Parenchymal
Pulmonary (alveolar) oedema and collapse leading to decreased compliance, and further intrapulmonary shunting.
Loss of tracheobronchial epithelium and airway ciliary clearance contributing to tracheobronchitis and pneumonia.
Barotrauma, ARDS, pleural effusions, Ventilator associated pneumonia, TRALI and tracheobronchitis may all result from Intensive Care resuscitation, and treatments of the above.
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Mechanical
Circumferential full thickness burns of the chest and abdomen may cause reduced static compliance resulting in restrictive ventilator defect, made worse by large volumes of oedema with fluid resuscitation and capillary leak.
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Other
Toxic inhalation of carbon monoxide (CO) resulting in a left shift of the ODC and oxygen transport capacity (Carboxy Hb) and decreased cellular oxidative processes.
Other toxic gases NH3, HCL – pulmonary oedema,mucosal irritation and ALI
CN- poisoning, cellular hypoxia
Increased metabolic requirements may overwhelm a respiratory system already impaired by all the above.
Anesthesia for Pregnant woman with Pulmonary Hypertension is a real challenge for anesthesiologist. It is very crucial to remember the pathophysiology of pulmonary hypertension in pregnant women and to avoid some practices that will worsen the cardiac status. 1-Avoid single shot spinal anesthesia. Some authorities consider pulmonary hypertension as absolute contraindication for single shot spinal anesthesia specially in patients with NYHA III ,IV. Spinal anesthesia causes major hemodynamic instability(decrease SVR, decrease VR, decrease in CO) The preferred neuroaxial techniques are (epidural anesthesia and CSE with minimal spinal dose) 2-Avoid PAC. Pulmonary Artery catheters insertion may lead to pulmonary artery rupture or thrombosis. TEE is better cardiac monitor/Arteial line is mandatory. 3-Avoid Nitrous oxide in gas mixture.N2O increase the PVR 4-If MV to be started, avoid High TV and PEEP 5-Avoid Oxytocin Boluses, or rapid administration of Pitocin. Oxytocin causes ...
Most of the times victims of burn injuries have problems in breathing, especially when there are burn injuries in the neck, face and the mouth. The first priority is to see whether the victim can breathe properly.
ReplyDeleteRegards,
Arnold Brame