I.C.U.Management of Burned Patients

Abstract

The patient with a major burn has suffered one of the most severe fom1s of trauma. Skin, the largest organ of the body, upon which we depend for thermal regulation, fluid and electrolyte homeostasis, and protection against bacterial infection is destroyed. Illness and death are related to the swface ru·ea and depth of the bw11 ii wy, the age ru1d prior state of health of the victim, the loca tion of the bum wound , and the severity of associated injmies.

When the integrity of the skin is breached by bmn injwy, profound pathophysiological changes occur. Tissue hypoxia will result from hypovolemia due to loss of large volumes of protein contaiiting fluid from the body, from hypoxemia caused by dan1age to the aiiway by heat and the initant products of combustion, together with the effects of carbon monoxide and cyanide poisonii1g. Following tlus, tl1e bw11ed patient is subjected to the damaging m etabolic conseq uences of severe trauma and the results of gross infection. ' '

The development of specialized bU111 cru·e centers and the close collaboration among members of multidisciplinruy team including surgeons, ii1tensivists, anesthetists, nmses, psychiatrists, therapists, and many others play an importru1t role in reducing the morbidity, m01tality and suffering in bumed patients.

A significant increase in sw·vival from massive bwn mjuries can be noted after the more aggressive approach toward preventing eru·I y cardiopulmonaty complications by early endotracheal