Burns (Lightening-long term burn care)

• reverse triage
• direct vs side strike
• Identify contact points
• neuro exam and doc over time
• EKG
• Ortho
• internal injuries
• assess for compartment syndrome

• warm extremities slowly
• warm pt as much as possible
• narcotics (fentynil-->relax, pain/versed-->amnesia!) 
• can heal without surge
• TPA: Tissue plasminogen activator

• Keeps pt warm
• has a tub for rub-a-dub-dub
• Has water hoses from ceiling. 

• catecholamines--> release of local and systemic mediators
• --histamines
• --serotonin
• --kinins
• --o2 free rads
• --prostaglandins
• --thromboxanes
• --interleukens
• --something else

Increased cap permeability-->supply damaged area-->edema-->can lead to pulmonary edema

• Immediate vasoconstricution due to catecholamies
• arterial bp may be mainteained even in sever hypovolemia due to massive catecholamines.

• paralytic ileus due to stress
• ng tube decompress and enteral feeds
• prophylax for stress curlings ulcer)

• ATN caused by occlusion of tubules by hemoglobin. 
• use of renal toxic antibx and vasopressors
• fluid resuscitation to open up. 

• infammatory--> masssive response--> v WBC because they are actually depleted. (24-48hrs)
• WBCs will spike, then drop-->immunosupressed pt.

• increased morbidity mortality
• bronchosopcy
• supportive treatment

• wound care
• avoid nfxn.

• silver: moist, antibiotic action
• collagenase: soothing, breaks down collagen-->easy debridement. 
• Abx
• Abx impregnated dressings, ie Mepilex.

• OR and graft
• Autograft: pt's own skin from another location transplanted to wound area. 
• Mesh autograft: like autograft, but gets perforated to cover more area. 
• CEA: Grow pt's own skin in volume to graft. Very expensive.
• Allograft: cadaver skin
• Xenograft: pig skin
• Autograft is preferred because has higher chance of taking. 

• All the way through. 
• Requires OR
• May require amputation of burned limb. 

• Mortality is higher than burn of same size
• usually Rx reaction
• Mucosal involvment often severe
• 1-6 weeks recovery
• NGT, prevent nfxn, full fluid resuscitation.

• swelling-->blisters tissue-->death
• treat nfxn, then graft dead tissue. 

• caused by overaggressive fluids
• 3rd spaces into abd-->pressure on kidneys, bowel, lungs, and blood flow
• check bladder pressure q4h
• requires OR.

• PT OT to resume ADLs
• compression garments for scar and edema
• follow up in burn clinics.
• Follow up with burn psychologist for body image or job place anxiety r/t source of injury.

Smoke inhalation/CO2 poisoning.

The thickening of blood in response to fluid shift from vasculature to 3rd spacing and damage to small capillary beds.

Pneumonia.