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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.
Clinical experience with power injectable peripherally inserted central catheters in intensive care patients Introduction In intensive care units (ICU), peripherally inserted central catheters (PICC) may be an alternative option to standard central venous catheters, particularly in patients with coagulation disorders or at high risk for infection. Some limits of PICCs (such as low flow rates) may be overcome by the use of power-injectable catheters . Method We have retrospectively reviewed all the power injectable PICCs inserted in adult and pediatric patients in the ICU during a 12-month period, focusing on the rate of complications at insertion and during maintenance. Results We have collected 89 power injectable PICCs (in adults and in children), both multiple and single lumen. All insertions were successful. There were no major complications at insertion and no episodes of catheter-related blood stream infection. Non-infective complications ...
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