CURRENT Essentials of Critical Care.pdf

Chapter 2 ICU Supportive Care for Specific Medical Problems 25■■Burn PatientsEssential Concepts• Assess burn depth: first-degree burns red, dry, painful; seconddegreeburns red, wet, very painful; third-degree burns leathery,dry, insensate• Assess extent of total body surface area (TBSA) involved: inadults each body segment assigned 9%: head and neck; anteriorchest; posterior chest; anterior abdomen; posterior abdomen includingbuttocks; each upper extremity; each thigh; each leg andfoot; genitals assigned 1%• Attention to surrounding circumstances important to identify potentialtoxic exposures; evaluate for associated injuries: neurologicand musculoskeletal examinations• Patients sustaining serious burns should be transferred to burncenter based on American Burn Association criteria: any burn 10% TBSA in patients 10 or 50 years of age; burns involving 20% TBSA; second- and third-degree burns involvingface, hands, feet, genitalia, perineum, major joints; thirddegreeburns 5% TBSA; significant electrical, chemical, inhalationalburnsEssentials of Management• Maintenance of cardiopulmonary function including intubationand mechanical ventilation if airway compromised or breathingappears insufficient• Immediate fluid resuscitation with half estimated needs administeredwithin first 8 hours; use formulas based on body size,depth, extent of burn to estimate fluid needs; most recommendavoiding colloid during first 24 hours and using crystalloid solutions• Escharotomy may be necessary to prevent secondary ischemictissue necrosis and to relieve elevated tissue pressures• Topical antimicrobial therapy with mafenide, silver sulfadiazine,silver nitrate may decrease incidence of invasive infection• Increased metabolic rates in postburn period increase caloric andprotein needs; require early nutritional support■ PearlBurns involving more than 25% of the total body surface area requireintravenous fluid resuscitation because ileus precludes oral resuscitation.ReferenceSheridan RL: Burns. Crit Care Med 2002 Nov;30:S500. [PMID: 12528792]