Critical Care of Burn Victims Including Inhalation Injury
There is no greater trauma than major burn injury, which can be classified according to different burn causes and different depths. More than 500,000 burn injuries occur annually in the USA per year [1]. Although most of these burn injuries are minor, app
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Critical Care of Burn Victims Including Inhalation Injury Marc G. Jeschke
6.1
Introduction
There is no greater trauma than major burn injury, which can be classified according to different burn causes and different depths. More than 500,000 burn injuries occur annually in the USA per year [1]. Although most of these burn injuries are minor, approximately 40,000–60,000 burn patients require admission to a hospital or major burn center for appropriate treatment. The devastating consequences of burns have been recognized by the medical community, and significant amounts of resources and research have been dedicated, successfully improving these dismal statistics [2–4]. Specialized burn centers and advances in therapy strategies, based on improved understanding of resuscitation, protocolized and specialized critical care, enhanced wound coverage, more appropriate infection control, improved treatment of inhalation injury, and better support of the hypermetabolic response to injury, have further improved the clinical outcome of this unique patient population over the past years [4, 5]. However, severe burns remain a devastating injury affecting nearly every organ system and leading to significant morbidity and mortality [2–6]. Of all cases, nearly 4,000 people die of complications related to thermal injury [2]. Burn deaths generally occur either immediately after the injury or weeks later as a result of infection/sepsis, multisystem organ failure, or hypermetabolic catabolic responses [5, 7]. Therefore, this chapter is divided into critical care during the early
M.G. Jeschke, MD, PhD, FACS, FCCM, FRCS(C) Division of Plastic Surgery, Department of Surgery and Immunology, Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, University of Toronto, Rm D704, Bayview Ave. 2075, M4N 3M5 Toronto, ON, Canada e-mail: [email protected] M.G. Jeschke et al. (eds.), Burn Care and Treatment, DOI 10.1007/978-3-7091-1133-8_6, © Springer-Verlag Wien 2013
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phases and later phases. The quality of the complex care of burn patients is directly related to the outcome and survival of burn patients. The key aspects for the care are: 1. Initial care at the scene and prehospital: adequate and timely response, evaluation of the burns, treatment of the burn patient, resuscitation, initial pain, and transport 2. Early hospital phase: admission to a burn center, escharotomies/fasciotomies, resuscitation, treatment of inhalation injury, and critical care to maintain organ perfusion and function 3. Later hospital phase: wound care including burn surgeries, infection control, attenuation of hypermetabolism, and maintaining organ function In this chapter, we focus on critical care components that have been shown to contribute to increased postburn morbidity and mortality and are typical hallmarks of critical care responses. As Chap. 1 delineated prehospital, fluid, and early management, we will focus on early hospital phase and later hospital phase.
6.2
Initial and Early Hospital
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