Downloaded 46 times
Uploaded bySMACC Conference
Holley on Burns
The document discusses critical aspects of burn care management at a tertiary ICU, emphasizing early assessments, resuscitation formulas, and the importance of debridement and coverage. It details various resuscitation protocols, fluid management, and complications associated with intensive care in burn patients. Additionally, the document provides practical tips for early management and feeding protocols to optimize patient outcomes.
More Related Content
Holley on Burns
- 1. Burns Anthony Holley Intensivist RBWH Bedside Critical Care 2012
- 2. Acknowledgement Prof. Jeff Lipman Bedside Critical Care 2012
- 3. Large tertiary ICU Only burns referral centre 40 months n = 158 Bedside Critical Care 2012
- 4. Patient % Bu 10 15 20 25 30 35 40 0 5 rn :0 -9 Bu % rn :1 0- 19 % Bu rn :2 0- 29 Bu rn :3 0- 39 Bu rn :4 0- 49 Bu rn :5 Bedside Critical Care 2012 0- 59 Bu rn Burn % :6 0- n =158 69 Bu rn :7 0- 79 Body Surface Area Burn Distribution Bu rn :8 0- 89 Bu rn :9 Bu 0- rn 10 of 0 o ro ph ar ynx
- 5. Mortality 8.22% mortality But …….0.68% in those with intention “to cure” Bedside Critical Care 2012
- 6. Wallace’s Rule ofNine Bedside Critical Care 2012
- 7.
- 8. First 24 HOURS A Airway assessment B Burn assessment C Circulation assessment Bedside Critical Care 2012
- 9. AIRWAY 60% of flame facial burns will have inhalational injury Bedside Critical Care 2012
- 10. Early Bronchoscopy Nebulised heparinfor inhalation injury and to ??prevent VAP Bedside Critical Care 2012
- 11. Alveolar Ridge/Maxillary Screwsfor ETT Fixation Bedside Critical Care 2012
- 12. •Resuscitation •Assessment •Heated rooms •Theatre Bedside Critical Care 2012
- 13. Adult Burn ResuscitationFormulae (first 24 h) Formula Crystalloid Colloid Other Evans (1952) 1 ml/kg/%burn(N/S) 1 ml/kg/%burn 2000ml D5W Brooke (1953) 1.5ml/kg/%burn(LR) 0.5 ml/kg/%burn 2000ml D5W Parkland (1968) 4 ml/kg/%burn(LR) — — Modified Brooke (’71) 2 ml/kg/%burn(LR) — — Hypertonic saline1 250 mEq Na/L — Titrate to UO Modified hypertonic2 180 mEq Na/L — Titrate to UO (first 8 h) then LR Dextran3 LR (titrate to UO) 2 ml/kg/h 0.5 ml/kg/h (first 8 h) then… FFP 1Monafo (1970) 2Warden (1992) 3Demling (1985) Bedside Critical Care 2012
- 14. FORMULAE Formulas should be regarded as a resuscitation guideline Lactated Ringer’s (Hartmans) solution most closely resembles normal body fluids, note NaCl -> hyperchloraemia The Parkland formula - renamed the Consensus formula - because it is the most widely used guideline 4 mL/kg/% TBSA ½ in first 8 hrs rest over the next 16 hrs Bedside Critical Care 2012
- 15. RESUSCITATION Hypovolaemic State: 0-48 hours Rapid fluid shifts Metabolic acidosis Intense inflammatory response Protein loss Capillary permeability Oliguria 3rd spacing Haemoconcentration Fluid loss deep in wounds Hyponatraemia circulating blood Hyperkalaemia volume Bedside Critical Care 2012
- 16. Consequences of fluidoverload Airway oedema Compartment syndromes Bedside Critical Care 2012
- 17. Dulhunty et alBurns 2008;34:1090-7 Bedside Critical Care 2012
- 18. ESCHAROTOMIES Bedside Critical Care 2012
- 19. ESCHAROTOMIES How notto do it! Bedside Critical Care 2012
- 20. THE THREE MOSTIMPORTANT ISSUES IN BURNS CARE 1. Debridement and get early coverage 2. Debridement and get early coverage 3. Debridement and get early coverage Bedside Critical Care 2012
- 21. Coverage Xenograft (Pigskin) Allograft (cadarver skin) Biosynthetics and Synthetics (biobrane, integra) Cultured epithelial autograft Bedside Critical Care 2012
- 22. Intensive Care Complications Ventilator associated pneumonia TACO/TRALI/ARDS CRBSI Pancreatitis Acalculous cholecystitis Ischaemic enterocolitis Gastritis Cardiomyopathy Bedside Critical Care 2012
- 23. OTHER EARLY MANAGEMENTTIPS 1. Head position to reduce oedema 2. Ears: avoid pressure/chondritis 3. Graft tracheostomy site and central line sites first Bedside Critical Care 2012
- 24. Nose: avoid notchingfrom NG tube Bedside Critical Care 2012
- 25. Eyes: avoid cornealulceration Bedside Critical Care 2012
- 26. EARLY ENTERAL FEEDING Repeated theatre trips don’t require cessation of feeds. “Do not stop feeds....” unless: a) prone position b) airway manipulation Bedside Critical Care 2012
- 27. RBWH FEEDING PROTOCOL 10-20% FTB/DPT: 125 - 145kJ/kg and 1.2 - 1.5g/kg protein >20% FTB/DPT: 145 - 160kJ/kg and 20% energy as protein Bedside Critical Care 2012
- 28. Principles of BurnManagement: Secondary survey The ultimate distracting injury Bedside Critical Care 2012
- 29. The ultimate distractinginjury Bedside Critical Care 2012
- 30. RBWH PEARLS 1. Nebulised heparin for inhalation injury and to ??prevent VAP 2. ETT wiring 3. Feeding throughout 4. 1st area grafted is over trachea Bedside Critical Care 2012
- 31. Thank you Thank you Bedside Critical Care 2012