Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

Anestesia para paciente quemado pediatrico

6,337 views

Published on

  • DOWNLOAD THAT BOOKS INTO AVAILABLE FORMAT (2019 Update) ......................................................................................................................... ......................................................................................................................... Download Full PDF EBOOK here { http://bit.ly/2m6jJ5M } ......................................................................................................................... Download Full EPUB Ebook here { http://bit.ly/2m6jJ5M } ......................................................................................................................... Download Full doc Ebook here { http://bit.ly/2m6jJ5M } ......................................................................................................................... Download PDF EBOOK here { http://bit.ly/2m6jJ5M } ......................................................................................................................... Download EPUB Ebook here { http://bit.ly/2m6jJ5M } ......................................................................................................................... Download doc Ebook here { http://bit.ly/2m6jJ5M } ......................................................................................................................... ......................................................................................................................... ................................................................................................................................... eBook is an electronic version of a traditional print book that can be read by using a personal computer or by using an eBook reader. (An eBook reader can be a software application for use on a computer such as Microsoft's free Reader application, or a book-sized computer that is used solely as a reading device such as Nuvomedia's Rocket eBook.) Users can purchase an eBook on diskette or CD, but the most popular method of getting an eBook is to purchase a downloadable file of the eBook (or other reading material) from a Web site (such as Barnes and Noble) to be read from the user's computer or reading device. Generally, an eBook can be downloaded in five minutes or less ......................................................................................................................... .............. Browse by Genre Available eBooks .............................................................................................................................. Art, Biography, Business, Chick Lit, Children's, Christian, Classics, Comics, Contemporary, Cookbooks, Manga, Memoir, Music, Mystery, Non Fiction, Paranormal, Philosophy, Poetry, Psychology, Religion, Romance, Science, Science Fiction, Self Help, Suspense, Spirituality, Sports, Thriller, Travel, Young Adult, Crime, Ebooks, Fantasy, Fiction, Graphic Novels, Historical Fiction, History, Horror, Humor And Comedy, ......................................................................................................................... ......................................................................................................................... .....BEST SELLER FOR EBOOK RECOMMEND............................................................. ......................................................................................................................... Blowout: Corrupted Democracy, Rogue State Russia, and the Richest, Most Destructive Industry on Earth,-- The Ride of a Lifetime: Lessons Learned from 15 Years as CEO of the Walt Disney Company,-- Call Sign Chaos: Learning to Lead,-- StrengthsFinder 2.0,-- Stillness Is the Key,-- She Said: Breaking the Sexual Harassment Story That Helped Ignite a Movement,-- Atomic Habits: An Easy & Proven Way to Build Good Habits & Break Bad Ones,-- Everything Is Figureoutable,-- What It Takes: Lessons in the Pursuit of Excellence,-- Rich Dad Poor Dad: What the Rich Teach Their Kids About Money That the Poor and Middle Class Do Not!,-- The Total Money Makeover: Classic Edition: A Proven Plan for Financial Fitness,-- Shut Up and Listen!: Hard Business Truths that Will Help You Succeed, ......................................................................................................................... .........................................................................................................................
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • DOWNLOAD THAT BOOKS INTO AVAILABLE FORMAT (2019 Update) ......................................................................................................................... ......................................................................................................................... Download Full PDF EBOOK here { http://bit.ly/2m6jJ5M } ......................................................................................................................... Download Full EPUB Ebook here { http://bit.ly/2m6jJ5M } ......................................................................................................................... Download Full doc Ebook here { http://bit.ly/2m6jJ5M } ......................................................................................................................... Download PDF EBOOK here { http://bit.ly/2m6jJ5M } ......................................................................................................................... Download EPUB Ebook here { http://bit.ly/2m6jJ5M } ......................................................................................................................... Download doc Ebook here { http://bit.ly/2m6jJ5M } ......................................................................................................................... ......................................................................................................................... ................................................................................................................................... eBook is an electronic version of a traditional print book that can be read by using a personal computer or by using an eBook reader. (An eBook reader can be a software application for use on a computer such as Microsoft's free Reader application, or a book-sized computer that is used solely as a reading device such as Nuvomedia's Rocket eBook.) Users can purchase an eBook on diskette or CD, but the most popular method of getting an eBook is to purchase a downloadable file of the eBook (or other reading material) from a Web site (such as Barnes and Noble) to be read from the user's computer or reading device. Generally, an eBook can be downloaded in five minutes or less ......................................................................................................................... .............. Browse by Genre Available eBooks .............................................................................................................................. Art, Biography, Business, Chick Lit, Children's, Christian, Classics, Comics, Contemporary, Cookbooks, Manga, Memoir, Music, Mystery, Non Fiction, Paranormal, Philosophy, Poetry, Psychology, Religion, Romance, Science, Science Fiction, Self Help, Suspense, Spirituality, Sports, Thriller, Travel, Young Adult, Crime, Ebooks, Fantasy, Fiction, Graphic Novels, Historical Fiction, History, Horror, Humor And Comedy, ......................................................................................................................... ......................................................................................................................... .....BEST SELLER FOR EBOOK RECOMMEND............................................................. ......................................................................................................................... Blowout: Corrupted Democracy, Rogue State Russia, and the Richest, Most Destructive Industry on Earth,-- The Ride of a Lifetime: Lessons Learned from 15 Years as CEO of the Walt Disney Company,-- Call Sign Chaos: Learning to Lead,-- StrengthsFinder 2.0,-- Stillness Is the Key,-- She Said: Breaking the Sexual Harassment Story That Helped Ignite a Movement,-- Atomic Habits: An Easy & Proven Way to Build Good Habits & Break Bad Ones,-- Everything Is Figureoutable,-- What It Takes: Lessons in the Pursuit of Excellence,-- Rich Dad Poor Dad: What the Rich Teach Their Kids About Money That the Poor and Middle Class Do Not!,-- The Total Money Makeover: Classic Edition: A Proven Plan for Financial Fitness,-- Shut Up and Listen!: Hard Business Truths that Will Help You Succeed, ......................................................................................................................... .........................................................................................................................
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • DOWNLOAD THAT BOOKS INTO AVAILABLE FORMAT (2019 Update) ......................................................................................................................... ......................................................................................................................... Download Full PDF EBOOK here { http://bit.ly/2m77EgH } ......................................................................................................................... Download Full EPUB Ebook here { http://bit.ly/2m77EgH } ......................................................................................................................... Download Full doc Ebook here { http://bit.ly/2m77EgH } ......................................................................................................................... Download PDF EBOOK here { http://bit.ly/2m77EgH } ......................................................................................................................... Download EPUB Ebook here { http://bit.ly/2m77EgH } ......................................................................................................................... Download doc Ebook here { http://bit.ly/2m77EgH } ......................................................................................................................... ......................................................................................................................... ................................................................................................................................... eBook is an electronic version of a traditional print book that can be read by using a personal computer or by using an eBook reader. (An eBook reader can be a software application for use on a computer such as Microsoft's free Reader application, or a book-sized computer that is used solely as a reading device such as Nuvomedia's Rocket eBook.) Users can purchase an eBook on diskette or CD, but the most popular method of getting an eBook is to purchase a downloadable file of the eBook (or other reading material) from a Web site (such as Barnes and Noble) to be read from the user's computer or reading device. Generally, an eBook can be downloaded in five minutes or less ......................................................................................................................... .............. Browse by Genre Available eBooks .............................................................................................................................. Art, Biography, Business, Chick Lit, Children's, Christian, Classics, Comics, Contemporary, Cookbooks, Manga, Memoir, Music, Mystery, Non Fiction, Paranormal, Philosophy, Poetry, Psychology, Religion, Romance, Science, Science Fiction, Self Help, Suspense, Spirituality, Sports, Thriller, Travel, Young Adult, Crime, Ebooks, Fantasy, Fiction, Graphic Novels, Historical Fiction, History, Horror, Humor And Comedy, ......................................................................................................................... ......................................................................................................................... .....BEST SELLER FOR EBOOK RECOMMEND............................................................. ......................................................................................................................... Blowout: Corrupted Democracy, Rogue State Russia, and the Richest, Most Destructive Industry on Earth,-- The Ride of a Lifetime: Lessons Learned from 15 Years as CEO of the Walt Disney Company,-- Call Sign Chaos: Learning to Lead,-- StrengthsFinder 2.0,-- Stillness Is the Key,-- She Said: Breaking the Sexual Harassment Story That Helped Ignite a Movement,-- Atomic Habits: An Easy & Proven Way to Build Good Habits & Break Bad Ones,-- Everything Is Figureoutable,-- What It Takes: Lessons in the Pursuit of Excellence,-- Rich Dad Poor Dad: What the Rich Teach Their Kids About Money That the Poor and Middle Class Do Not!,-- The Total Money Makeover: Classic Edition: A Proven Plan for Financial Fitness,-- Shut Up and Listen!: Hard Business Truths that Will Help You Succeed, ......................................................................................................................... .........................................................................................................................
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here

Anestesia para paciente quemado pediatrico

  1. 1. JUAN MANUEL VELASCO QUIJANO RESIDENTE II AÑO UNIVERSIDAD EL BOSQUE HOSPITAL SIMON BOLIVAR
  2. 2. ETIOLOGIA
  3. 3. PIEL ORGANO MAS GRANDE EPIDERMIS DERMIS HIPODERMIS 5 CAPAS
  4. 4. EPIDERMIS ESTRATO BASAL O GERMINATIVO ESTRATO ESPINOSO O DE MALPIGHI. ESTRATO GRANULOSO. ESTRATO LUCIDO. ESTRATO CORNEO.
  5. 5. DERMIS E HIPODERMIS DERMIS  DERMIS RETICULAR  DERMIS PAPILAR  VASOS  COLAGENO I – III  NERVIOS  GLAND SUDORIPARA HIPODERMIS  ADIPOCITOS
  6. 6. CLASIFICACION PRIMER GRADO SEGUNDO GRADO TERCER GRADO
  7. 7. QUEMADURA - PRIMER GRADO LIMITADA EPIDERMIS SIGNOS  ERITEMA  DOLOR  EDEMA
  8. 8. QUEMADURA - SEGUNDO GRADO EPIDERMIS DERMIS SUPERFICIAL  1/3 SUPERIOR PORFUNDA  > 2/3
  9. 9. QUEMADURA 3 GRADO AFECTA TODO EL ESPESOR DE HIPODERMIS
  10. 10. QUEMADURA 4 GRADO COMPROMETE  HUESOS  MUSCULOS  TEJIDOS PROFUNDOS  AMPUTACION
  11. 11. CLASIFICACION X GRAVEDADGRAVE MODERADA LEVE- HASTA 25% SCT - 15 - 25 % SCT - HASTA 15 % SCT- GRADO 2 – 3 - 2 GRADO - 2 GRADO,- 0 – 14 AÑOS - 14 AÑOS. SUPERFICIAL- HASTA 35 % - 20 y 31 % - 14 AÑOS.- ADULTOS - ADULTOS - Hasta 10 % de SCT de 2do grado, profundo y hasta 20% de SCT de 2 grado superficial en adultos.QUEMADURA QUEMADURAPEQUEÑA CON : PEQUEÑA POR ALTO- LESION X VOLTAJE. INHALACION- CARA- OJOS- PERIEN- MANO
  12. 12. QUEMADURAS MAYOR QUEMADURAS MENORES- Quemadura >25% SCT. - Quemadura < 15% de SCT.- Niño < 10 años con quemaduras > 20%SCT - Niño < 10 años con < 10 % SCT- Más de 10% de SCT con quemaduras quemadode tercer grado.- Cualquier lesión por inhalación de - Quemadura de tercer grado < 2% SCT.humo.- Quemaduras con corriente de altovoltaje.- Quemaduras complicadas (traumamayor, enfermedades asociadas,lesiones inhalatorias)- Quemaduras que involucran cara,ojos, manos, pies y perineo que resultanen daños funcional o Cosmético
  13. 13. REGLA DE LA PALMA DE LA MANO PLAMA DEL PACIENTE 1% SCT PRACTICA SENCILLA
  14. 14. REGLA DE LOS 9
  15. 15. FX MORTALIDAD EDAD EXTENSION COMORBILIAD OBESIDAD MORBIDA ABUSO ALCOHOL TRAUMA 20 % INHALACION 40% NEUMONIA 60% AMBAS
  16. 16. FISIOPATOLOGIALESION INICIAL REACCION LOCAL REACCION CELULAR HUMORAL Y SISTEMICA SIRS SDR DISFUNCION MULTIORGANICA
  17. 17. SISTEMA RESPIRATORIO LESION X TOXINAS COSNTRICCION PARED TORAX EDEMA VIA RESPIRATORIA
  18. 18. LESION X INHALACION DAÑO TERMICO DIRECTO MONOXIDO DE CARBONO
  19. 19. 0 – 12 HORAS HOLLÍN EN LA VÍA RESPIRATORIA VIBRISAS CARBONIZADAS. NASOFARINGOSCOPÍA Y BRONCOSCOPÍA, ERITEMA Y EDEMA, Y MATERIAL CARBONIZADO EN LAS VÍAS RESPIRATORIAS. CIRCUITOS ANORMALES DE FLUJO-VOLUMEN. CONCENTRACIONES DE CO > 15 %. RADIOGRAFÍA DE TÓRAX PUEDE SER NORMAL. EL ANÁLISIS DE LOS GASES SANGUÍNEOS PUEDE SER NORMAL.
  20. 20. 12 – 24 HORAS ENFERMEDAD PULMONAR PROGRESIVA. APARICIÓN DE ANOMALÍAS RADIOGRÁFICAS. DETERIORO DE LOS VALORES GASOMÉTRICOS CON POSIBLE ACIDOSIS METABÓLICA, AUMENTO DE CORTOCIRCUITO Y AUMENTO DEL GRADIENTE ALVEOLO/ARTERIAL.
  21. 21. MONOXIDO DE CARBONO
  22. 22. QUEMADURA DE TORAX AFECCION RESPÍRATORIA DIMINUCION DISTENSIBILIDAD TORNIQUETE HIPOVENTILACION ATELECTASIA CFR DISMINUIDA
  23. 23. CARDIOVASCULARES Y HEMATOLOGICO FASES I – II – III FASE TIEMPO FASE I EMERGENCIA RECUCITASION 0 – 48 HRS FASE II AGUDA O HIPERMETABOLICA 48 HRS – 3 SS FASE III REHABILITACION
  24. 24. CARDIOVASCULARES FASE I  FASE II  GC HASTA 50%  GC  DAÑO ENDOTELIO  ESTADO  EXTRAVASACION HIPERMETABOLICO  HIPOTENSION  HTA  SCT > 30%  SISTEMA R – A -A
  25. 25. HEMATOLOGICOS ERITROCITOS 8% DIA ANEMIA HEMOLITICA TROMBOCITOPENIA TROMBOCITOSIS COAGULOPATIA FACTORES V, VIII Y FBRINOGENO
  26. 26. RENAL FG NECROSIS TUBULAR OLIGURIA IRA MIOGLOBINURA  EELCTRICAS 5 – 10 DIAS SEPSIS
  27. 27. HEPATICA FUNCION  HIPOTENSION DAÑO HEPATOCELL EZ HEPATICAS BILIRRUBINA PRODUCCION PTS FARMACOCIENTICA
  28. 28. ALTERACIONES METABOLICAS HIPERMETABOLISMO  > CATABOLISMO  CONSUMO O2 > 1- 2 VECES  ADRENALINA  GLUCAGON  CORTICOIDES  TSH
  29. 29. METABOLISMO FIEBRE TAQUICARDIA LIPOLISIS GLUCONEOGENESIS PROTEOLISIS RESISTENCIA INSULINA
  30. 30. INMUNOLOGICAS 1 CAUSA MUERTE LINFOCITOS T NEUTROFILO BARRERA ENDOTELIO SISTEMA HUMORAL SISTEMA CELULAR
  31. 31. OTRAS ALTERACIONES GASTROINESTINALES  ILEO PARALITICO  ULCERA GASTRICA NEUROLOGICO  ENCEFALOPATIA HIPOXICA  CONVULSION  PIC HORMONAL  HORMONAS DE STRESS  TSH . T3 Y T4  HIPERGLICEMIA
  32. 32. VIA AEREA EVALUACION  EXTERNA  INTERVENCION  RONQUIDO TEMPRANA  ESTRIDOR  TAQUIPNEA  MUSCULOS ACCESORIOS  PAO2 < 70  PAFI < 200
  33. 33. INTUBACION PROFILACTICA SECUENCIA RAPIDA EDEMA FIBROBRONCOSCOPIO TIEMPO DESPIERTO TODOS LOS IMPLEMENTOS
  34. 34. OIT INMEDIATA INESTABILIDAD C/V APNEA OBSTUCCION VA DEPRESION SNC
  35. 35. MANEJO DE LIQUIDOS
  36. 36. LIQUIDOS FORMULA PARKLAND  4MLX SCQ 2 – 3 GRADO  ½ 8 HRS  ½ 16 HRS MENOR 30 KG 0 < 1 AÑO  SOLUCION GLUCOSADA
  37. 37. CRISTALOIDES O COLOIDES??? EVITAR COLOIDES EN LAS PRIMERAS 24 HORAS
  38. 38. REANIMACION GUIADA X METAS GASTO URINARIO LACTATO BEF CONSUMO DE OXIGENO
  39. 39. FARMACOLOGIA DE PTE QUEMADO AFECTA > 10% SCT FARMACOCINETICA FRAMACODINAMICA RTA METABOLICA SISTEMAS ALTERADOS
  40. 40. BENZODIACEPINAS ALBUMINA ALFA 1 GLP LIPO – PTS METABOLISMO  OXIDOREDUCCION  CONJUGACION MENOR METABOLISMO DEL FARMACO
  41. 41. RELAJANTES MUSCULARES DENERVACION RECEPTORES ACH SUCCINIL COLINA  SALIDA MASIVA K  PRECURARIZACION  48HR POST INJURIA  SEGURIDAD ??????
  42. 42. SUCCINILCOLINA
  43. 43. RMND HIPOSENSIBILIDAD RESISTENCIA SCT > 40% > DOSIS 2 – 2.5
  44. 44. ANALGESICOS OPIDES  RTA STRES  DOSIS > HIPERMETABOLICA  TITULACON  EXCRESION PROLONGADA
  45. 45. KETAMINA CONTROVERTIDA RTA SIMPATICA EFECETOS CONTRARIOS PROCEDIMIENTOS CORTOS FENOMENO DE TOLERANCIA  2 – 25 DIAS POST QUEMADURA  > DOSIS
  46. 46. VALORACION PREOPERATORIA RESPIRACION VOLUMEN CORRECCION TRASTORNOS METABOLICOS EVALUAR VA EXPANSION TORACICA ACCESOS VASCULARES
  47. 47. VALORACION PREOPERATORIA LABORATORIOS  HEMOGRAMA  TIEMPOS DE COAGULACION  IONOGRAMA  GLICEMIA  GASES  PROTEINAS  RX TORAX
  48. 48. PREMEDICACION ANTICOLINERGICOS - ANTISIALOGOGO ANTI H2 90 MIN ANTES METOCLOPRAMIDA 30 MIN ANTES NARCOTICOS SEGÚN FUNCION RESPIRATORIA
  49. 49. MANEJO ANESTESICO

×