Skip to main content

Burn injury...beyond the skin




  1. 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,)

  2. Tracheobronchial
    Bronchospasm resulting from inhaled irritants
    Mucosal oedema and endobronchial sloughing causing small airway occlusion, leading to intrapulmonary shunting.

  3. 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.

  4. 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.

  5. 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. 

Comments

  1. 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.

    Regards,
    Arnold Brame

    ReplyDelete

Post a Comment

Popular posts from this blog

The pressure volume loop...

In the pressure-volume loop below, cardiac work is best represented by:   the area of the curve  the slope of the line from points C to D  the distance of the line from points C to D  the slope of a line from points A to D .. .. ... .... ... .... .... .... In the pressure-volume loop below, cardiac work is best represented by:  the area of the curve Cardiac work is the product of pressure and volume and is linearly related to myocardial oxygen consumption. Cardiac work is best represented by the area of the curve of a pressure-volume loop.

Anaphylaxis updates part 2- Empty Ventricle Syndrome

Patients with anaphylaxis should not suddenly sit, stand, or be placed in the upright position. Instead, they should be placed on the back with their lower extremities elevated or, if they are experiencing respiratory distress or vomiting, they should be placed in a position of comfort with their lower extremities elevated. This accomplishes 2 therapeutic goals: 1) preservation of fluid in the circulation (the central vascular compartment), an important step in managing distributive shock; and 2) prevention of the empty vena cava/empty ventricle syndrome, which can occur within seconds when patients with anaphylaxis suddenly assume or are placed in an upright position. Patients with this syndrome are at high risk for sudden death. They are unlikely to respond to epinephrine regardless of route of administration, because it does not reach the heart and therefore cannot be circulated throughout the body

Steroids In Perioperative period...The Multi-purpose Drugs

1-Steroids are not Bronchodilator ,but have well established usefulness in hyper-reactive airway. They are also said to have a permissive role for bronchodilator medication. They can be administered orally, parenterally or in aerosol form 2- Steroids have been commonly used in chemotherapy for prevention of nausea along with other anti-emetic agents . Dexamethasone was found to be highly effective when given immediately before induction rather than at the end of anesthesia . 3- Steroids do exert analgesic effects. Various routes of administration of steroids include parentral, local infiltration at operated site , as an adjuvant in nerve blocks and central-neuraxial blockade. 4 - Steroids cannot be the mainstay of therapy in anaphylaxis because of the delayed onset of action, so they are used as adjunct after initial treatment with epinephrine. 5- Steroids (Dexamethsone) are of value in reduction or prevention of cerebral edema associated with parasitic infections and neopla...