Acute and Perioperative Care of the Burn-injured Patient · ACUTE AND PERIOPERATIVE CARE OF THE...
Transcript of Acute and Perioperative Care of the Burn-injured Patient · ACUTE AND PERIOPERATIVE CARE OF THE...
![Page 1: Acute and Perioperative Care of the Burn-injured Patient · ACUTE AND PERIOPERATIVE CARE OF THE BURN-INJURED PATIENT ... Lund–Browder burn diagram. Lund–Browder burn table. Classification](https://reader031.fdocuments.us/reader031/viewer/2022022602/5b58fb4f7f8b9a527f8cda01/html5/thumbnails/1.jpg)
B I T T N E R E A , E T A L ,
ACUTE AND PERIOPERATIVE CARE OF THE BURN-INJURED PATIENT
A N E S T H E S I O L O G Y , 1 2 2 ( 2 ) , 4 4 8 - 6 4 F E B 2 0 1 5 .
Dr. Jacobs Aurélie Krans Anesthesie 16/10/2015
Kliniek St.-Jan, Brussel
![Page 2: Acute and Perioperative Care of the Burn-injured Patient · ACUTE AND PERIOPERATIVE CARE OF THE BURN-INJURED PATIENT ... Lund–Browder burn diagram. Lund–Browder burn table. Classification](https://reader031.fdocuments.us/reader031/viewer/2022022602/5b58fb4f7f8b9a527f8cda01/html5/thumbnails/2.jpg)
BURN INJURY PATHOPHYSIOLOGY
![Page 3: Acute and Perioperative Care of the Burn-injured Patient · ACUTE AND PERIOPERATIVE CARE OF THE BURN-INJURED PATIENT ... Lund–Browder burn diagram. Lund–Browder burn table. Classification](https://reader031.fdocuments.us/reader031/viewer/2022022602/5b58fb4f7f8b9a527f8cda01/html5/thumbnails/3.jpg)
Pathophysiologic Changes in the Early Phase (24-48 hrs) of Burn Injury
![Page 4: Acute and Perioperative Care of the Burn-injured Patient · ACUTE AND PERIOPERATIVE CARE OF THE BURN-INJURED PATIENT ... Lund–Browder burn diagram. Lund–Browder burn table. Classification](https://reader031.fdocuments.us/reader031/viewer/2022022602/5b58fb4f7f8b9a527f8cda01/html5/thumbnails/4.jpg)
(>48 hrs)Pathophysiological Changes During Hypermetabolic/hyperdynamic Phase of Burn
![Page 5: Acute and Perioperative Care of the Burn-injured Patient · ACUTE AND PERIOPERATIVE CARE OF THE BURN-INJURED PATIENT ... Lund–Browder burn diagram. Lund–Browder burn table. Classification](https://reader031.fdocuments.us/reader031/viewer/2022022602/5b58fb4f7f8b9a527f8cda01/html5/thumbnails/5.jpg)
Pathophysiologic Changes During Early and Late Phases of Major Burn Injury
Harbin KR, Anesthetic management of patients with major burn injury, AANA J., 80(6), 430-9, Dec 2012.
![Page 6: Acute and Perioperative Care of the Burn-injured Patient · ACUTE AND PERIOPERATIVE CARE OF THE BURN-INJURED PATIENT ... Lund–Browder burn diagram. Lund–Browder burn table. Classification](https://reader031.fdocuments.us/reader031/viewer/2022022602/5b58fb4f7f8b9a527f8cda01/html5/thumbnails/6.jpg)
INHALATION INJURY
![Page 7: Acute and Perioperative Care of the Burn-injured Patient · ACUTE AND PERIOPERATIVE CARE OF THE BURN-INJURED PATIENT ... Lund–Browder burn diagram. Lund–Browder burn table. Classification](https://reader031.fdocuments.us/reader031/viewer/2022022602/5b58fb4f7f8b9a527f8cda01/html5/thumbnails/7.jpg)
Respiratory injury from Burns
![Page 8: Acute and Perioperative Care of the Burn-injured Patient · ACUTE AND PERIOPERATIVE CARE OF THE BURN-INJURED PATIENT ... Lund–Browder burn diagram. Lund–Browder burn table. Classification](https://reader031.fdocuments.us/reader031/viewer/2022022602/5b58fb4f7f8b9a527f8cda01/html5/thumbnails/8.jpg)
Symptoms of Acute Carbon Monoxide Toxicity Based on Blood Carboxyhemoglobin Level
Harbin KR, Anesthetic management of patients with major burn injury, AANA J., 80(6), 430-9, Dec 2012.
![Page 10: Acute and Perioperative Care of the Burn-injured Patient · ACUTE AND PERIOPERATIVE CARE OF THE BURN-INJURED PATIENT ... Lund–Browder burn diagram. Lund–Browder burn table. Classification](https://reader031.fdocuments.us/reader031/viewer/2022022602/5b58fb4f7f8b9a527f8cda01/html5/thumbnails/10.jpg)
INITIAL EVALUATION
![Page 11: Acute and Perioperative Care of the Burn-injured Patient · ACUTE AND PERIOPERATIVE CARE OF THE BURN-INJURED PATIENT ... Lund–Browder burn diagram. Lund–Browder burn table. Classification](https://reader031.fdocuments.us/reader031/viewer/2022022602/5b58fb4f7f8b9a527f8cda01/html5/thumbnails/11.jpg)
Wallace Rule-of-Nine Method for the Assessment of Total Body Surface Area Burned
Harbin KR, Anesthetic management of patients with major burn injury, AANA J., 80(6), 430-9, Dec 2012.
![Page 12: Acute and Perioperative Care of the Burn-injured Patient · ACUTE AND PERIOPERATIVE CARE OF THE BURN-INJURED PATIENT ... Lund–Browder burn diagram. Lund–Browder burn table. Classification](https://reader031.fdocuments.us/reader031/viewer/2022022602/5b58fb4f7f8b9a527f8cda01/html5/thumbnails/12.jpg)
Lund–Browder burn diagram
![Page 13: Acute and Perioperative Care of the Burn-injured Patient · ACUTE AND PERIOPERATIVE CARE OF THE BURN-INJURED PATIENT ... Lund–Browder burn diagram. Lund–Browder burn table. Classification](https://reader031.fdocuments.us/reader031/viewer/2022022602/5b58fb4f7f8b9a527f8cda01/html5/thumbnails/13.jpg)
Lund–Browder burn table
![Page 14: Acute and Perioperative Care of the Burn-injured Patient · ACUTE AND PERIOPERATIVE CARE OF THE BURN-INJURED PATIENT ... Lund–Browder burn diagram. Lund–Browder burn table. Classification](https://reader031.fdocuments.us/reader031/viewer/2022022602/5b58fb4f7f8b9a527f8cda01/html5/thumbnails/14.jpg)
Classification of Burn Depth
![Page 15: Acute and Perioperative Care of the Burn-injured Patient · ACUTE AND PERIOPERATIVE CARE OF THE BURN-INJURED PATIENT ... Lund–Browder burn diagram. Lund–Browder burn table. Classification](https://reader031.fdocuments.us/reader031/viewer/2022022602/5b58fb4f7f8b9a527f8cda01/html5/thumbnails/15.jpg)
American Burn Association Burn Injury Severity Grading System
Harbin KR, Anesthetic management of patients with major burn injury, AANA J., 80(6), 430-9, Dec 2012.
![Page 16: Acute and Perioperative Care of the Burn-injured Patient · ACUTE AND PERIOPERATIVE CARE OF THE BURN-INJURED PATIENT ... Lund–Browder burn diagram. Lund–Browder burn table. Classification](https://reader031.fdocuments.us/reader031/viewer/2022022602/5b58fb4f7f8b9a527f8cda01/html5/thumbnails/16.jpg)
FLUID RESUSCITATION
![Page 17: Acute and Perioperative Care of the Burn-injured Patient · ACUTE AND PERIOPERATIVE CARE OF THE BURN-INJURED PATIENT ... Lund–Browder burn diagram. Lund–Browder burn table. Classification](https://reader031.fdocuments.us/reader031/viewer/2022022602/5b58fb4f7f8b9a527f8cda01/html5/thumbnails/17.jpg)
Fluid Resuscitation Formulas
Harbin KR, Anesthetic management of patients with major burn injury, AANA J., 80(6), 430-9, Dec 2012.
![Page 18: Acute and Perioperative Care of the Burn-injured Patient · ACUTE AND PERIOPERATIVE CARE OF THE BURN-INJURED PATIENT ... Lund–Browder burn diagram. Lund–Browder burn table. Classification](https://reader031.fdocuments.us/reader031/viewer/2022022602/5b58fb4f7f8b9a527f8cda01/html5/thumbnails/18.jpg)
Indicators of Adequate Circulating Volume and/or Resuscitation
![Page 19: Acute and Perioperative Care of the Burn-injured Patient · ACUTE AND PERIOPERATIVE CARE OF THE BURN-INJURED PATIENT ... Lund–Browder burn diagram. Lund–Browder burn table. Classification](https://reader031.fdocuments.us/reader031/viewer/2022022602/5b58fb4f7f8b9a527f8cda01/html5/thumbnails/19.jpg)
ANESTHETIC MANAGEMENT
![Page 20: Acute and Perioperative Care of the Burn-injured Patient · ACUTE AND PERIOPERATIVE CARE OF THE BURN-INJURED PATIENT ... Lund–Browder burn diagram. Lund–Browder burn table. Classification](https://reader031.fdocuments.us/reader031/viewer/2022022602/5b58fb4f7f8b9a527f8cda01/html5/thumbnails/20.jpg)
Major Preoperative Concerns for Burn Patients
![Page 21: Acute and Perioperative Care of the Burn-injured Patient · ACUTE AND PERIOPERATIVE CARE OF THE BURN-INJURED PATIENT ... Lund–Browder burn diagram. Lund–Browder burn table. Classification](https://reader031.fdocuments.us/reader031/viewer/2022022602/5b58fb4f7f8b9a527f8cda01/html5/thumbnails/21.jpg)
- Airway Management - Vascular Access - Ventilatory Management
Intraoperative Management
![Page 22: Acute and Perioperative Care of the Burn-injured Patient · ACUTE AND PERIOPERATIVE CARE OF THE BURN-INJURED PATIENT ... Lund–Browder burn diagram. Lund–Browder burn table. Classification](https://reader031.fdocuments.us/reader031/viewer/2022022602/5b58fb4f7f8b9a527f8cda01/html5/thumbnails/22.jpg)
Anesthetic Considerations for Patients With Burn Injuries
Harbin KR, Anesthetic management of patients with major burn injury, AANA J., 80(6), 430-9, Dec 2012.
![Page 23: Acute and Perioperative Care of the Burn-injured Patient · ACUTE AND PERIOPERATIVE CARE OF THE BURN-INJURED PATIENT ... Lund–Browder burn diagram. Lund–Browder burn table. Classification](https://reader031.fdocuments.us/reader031/viewer/2022022602/5b58fb4f7f8b9a527f8cda01/html5/thumbnails/23.jpg)
Dose–response curves and time to maximal effect of rocuronium in adult burned and nonburned patients
![Page 24: Acute and Perioperative Care of the Burn-injured Patient · ACUTE AND PERIOPERATIVE CARE OF THE BURN-INJURED PATIENT ... Lund–Browder burn diagram. Lund–Browder burn table. Classification](https://reader031.fdocuments.us/reader031/viewer/2022022602/5b58fb4f7f8b9a527f8cda01/html5/thumbnails/24.jpg)
Burn injury–induced tolerance to narcotics and sedatives
![Page 25: Acute and Perioperative Care of the Burn-injured Patient · ACUTE AND PERIOPERATIVE CARE OF THE BURN-INJURED PATIENT ... Lund–Browder burn diagram. Lund–Browder burn table. Classification](https://reader031.fdocuments.us/reader031/viewer/2022022602/5b58fb4f7f8b9a527f8cda01/html5/thumbnails/25.jpg)
- Regional Anesthesia- Metabolic and Nutritional Management
Pharmacological Considerations
![Page 26: Acute and Perioperative Care of the Burn-injured Patient · ACUTE AND PERIOPERATIVE CARE OF THE BURN-INJURED PATIENT ... Lund–Browder burn diagram. Lund–Browder burn table. Classification](https://reader031.fdocuments.us/reader031/viewer/2022022602/5b58fb4f7f8b9a527f8cda01/html5/thumbnails/26.jpg)
POSTOPERATIVE CARE
![Page 27: Acute and Perioperative Care of the Burn-injured Patient · ACUTE AND PERIOPERATIVE CARE OF THE BURN-INJURED PATIENT ... Lund–Browder burn diagram. Lund–Browder burn table. Classification](https://reader031.fdocuments.us/reader031/viewer/2022022602/5b58fb4f7f8b9a527f8cda01/html5/thumbnails/27.jpg)
PAIN MANAGEMENT
![Page 28: Acute and Perioperative Care of the Burn-injured Patient · ACUTE AND PERIOPERATIVE CARE OF THE BURN-INJURED PATIENT ... Lund–Browder burn diagram. Lund–Browder burn table. Classification](https://reader031.fdocuments.us/reader031/viewer/2022022602/5b58fb4f7f8b9a527f8cda01/html5/thumbnails/28.jpg)
Sedation and Analgesia Guidelines for Acute Burns
![Page 29: Acute and Perioperative Care of the Burn-injured Patient · ACUTE AND PERIOPERATIVE CARE OF THE BURN-INJURED PATIENT ... Lund–Browder burn diagram. Lund–Browder burn table. Classification](https://reader031.fdocuments.us/reader031/viewer/2022022602/5b58fb4f7f8b9a527f8cda01/html5/thumbnails/29.jpg)
SUMMARY
- Pathophysiological Changes: Ebb – Flow - Airway and/or Lung edema: fast and unpredictable - Electrical Burns: high morbidity - Formulae for Fluid Resuscitation: physiologic endpoints- Intraoperative Management - Pain Management: higher opioid and sedative doses