severe burns by andrew udy

Severe Burns

Andrew Udy

The Alfred Intensive Care Unit

54 year old man, no known medical history

Rescued from a smoke-filled room in a burning house

Patient is conscious, agitated, and coughing

He appears to have extensive torso burns

Stop the burning!

Assess the patient’s ABCs

A B D EC

Hoarseness + Stridor

Hypoxia

Inflamed oropharynx

History of closed space

Carbonaceous sputum

HbCO > 10%

Singeing of hair, eyebrow, eyelashes

SpO2 82%

ETCO2 65

FiO2 1.0

PEEP 10

P peak 55

VT 500ml

RR 16

I:E ratio 1:2

55 cmH2O

No Flow

HR 165

BP 88/40

UO – minimal

CRT – 6 sec

2 x 18 G IV

2000 ml by AV

65% TBSA Full thickness burns

~ weight 95 Kg

95 x 65 x 4 = 24,700 ml

12,350ml in the first 8hrs

- from the time of burn

Remainder in the next 16hours

Hb Concentration

Lactate

UO (0.5 – 1 ml/kg/hr)

MAP

Increased capillary permeabilityRelative hypovolaemiaReduced COImpaired organ perfusion

Increased tissue oedemaLung injuryAbdominal compartment syndromeAcute kidney injury

pH 7.03

PaCO2 49

PaO2 75

FiO2 1.0

HCO3- 9

Lactate 12

Hb 178

Lung protective ventilation

- rescue therapies

Regular bronchial toilet

Nebulised heparin

Potential inhalation of toxic gases

24-48 hours

Weeks to months

TempHRCOVO2

Tissue healingProtein catabolismWeight lossMuscle wastingWeakness

= Complete grafting

Feeding

Analgesia

Sedation

Thromboembolic prophylaxis

Head up

Ulcer prophylaxis

Glucose control

Fluids

Infectious Diseases

Drugs

Dialysis

Lines

Electrolytes

MAJORBURNS

ALTERED PHARMACOKINETICS

INFERIOR DRUG EXPOSURE

TREATMENT FAILURE

‘STANDARD’ANTIBIOTIC DOSES

TimeCo

nce

ntr

atio

n

MIC

Repeated surgery and dressing changes (waiting for donor sites)

- early tracheostomy

Delirium / BOC / Psychosocial issues

B-blockade

Physiotherapy and occupational therapy

Scarring and contractures

Thank You

A/Prof Andrew UdyThe Alfred Intensive Care Unit

School of Public Health & Preventive Medicine, Monash University

Email: a.udy@alfred.org.au