Episode 101.0 – Major Burns

Описание: (https://coreem.net/podcast/episode-10...)






This week we dive into some of the initial considerations in the resuscitation of major burn patients.





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Tags: Carbon Monoxide (https://coreem.net/tag/carbon-monoxide/) , Cyanide (https://coreem.net/tag/cyanide/) , Major Burns (https://coreem.net/tag/major-burns/) , Trauma (https://coreem.net/tag/trauma/)







Show Notes



Take Home Points




• Be prepared to intubate early, the patency of the airway can decline quickly and without warning. If there is any concern for burns to face/neck or smoke inhalation, consider taking control of the airway early.


• Review the rule of 9s and the parkland formula to direct your large volume fluid resus.  Remember the parkland formula directs you to use 4 mL x %TBSA x weight (kg).  Half in the first 8 hours and the second half over the next 16 hours.  Given the large volume here it’s probably best to use LR or another balanced solution.


• Do a thorough trauma eval to make sure you don’t miss any other injuries and be sure to watch for developing compartment syndrome


• And last, consider the need to treat for CO and/or cyanide poisoning.  Poor cardiac function, cardiac arrest or a high lactate can be clues to cyanide poisoning and just start 100% O2 while you wait for a co-ox, since CO tox is pretty likely.




Rule of 9’s




Read More



MD Calc: Parkland Formula for Burns (https://www.mdcalc.com/parkland-formu...)



LITFL: Trauma! Major Burns (https://lifeinthefastlane.com/trauma-...)



LITFL: Releasing the Roman Breast Plate (https://lifeinthefastlane.com/trauma-...)



Parvizi D et al. The potential impact of wrong TBSA estimations on fluid resuscitation in patients suffering from burns: things to keep in mind. Burns 2014; 40: 241-5. PMID: 24050977 (https://www.ncbi.nlm.nih.gov/pubmed/2...)



Hettiaratchy S, Dziewulski P. ABC of Burns: Introduction. BMJ 2004; 328: 1366-8. PMID: 15178618 (https://www.ncbi.nlm.nih.gov/pubmed/1...)



Hettiaratchy S, Papini R. ABC of Burns: Initial Management of a Major Burn: I – Overview. BMJ 2004; 328: 1555-7. PMID: 15217876 (https://www.ncbi.nlm.nih.gov/pubmed/1...)



Hettiaratchy S, Papini R. ABC of Burns: Initial Management of a Major Burn II – Assessment and Resuscitation . BMJ 2004; 329: 101-3. PMID: 15242917 (https://www.ncbi.nlm.nih.gov/pubmed/1...)






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