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Burns

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6 papers 0 to 25 followers
https://www.readbyqxmd.com/read/27600122/the-physiologic-basis-of-burn-shock-and-the-need-for-aggressive-fluid-resuscitation
#1
REVIEW
Lisa Rae, Philip Fidler, Nicole Gibran
Burn trauma in the current age of medical care still portends a 3% to 8% mortality. Of patients who die from their burn injuries, 58% of deaths occur in the first 72 hours after injury, indicating death from the initial burn shock is still a major cause of burn mortality. Significant thermal injury incites an inflammatory response, which distinguishes burns from other trauma. This article focuses on the current understanding of the pathophysiology of burn shock, the inflammatory response, and the direction of research and targeted therapies to improve resuscitation, morbidity, and mortality...
October 2016: Critical Care Clinics
https://www.readbyqxmd.com/read/27600131/protocolized-resuscitation-of-burn-patients
#2
REVIEW
Leopoldo C Cancio, Jose Salinas, George C Kramer
Fluid resuscitation of burn patients is commonly initiated using modified Brooke or Parkland formula. The fluid infusion rate is titrated up or down hourly to maintain adequate urine output and other endpoints. Over-resuscitation leads to morbid complications. Adherence to paper-based protocols, flow sheets, and clinical practice guidelines is associated with decreased fluid resuscitation volumes and complications. Computerized tools assist providers. Although completely autonomous closed-loop control of resuscitation has been demonstrated in animal models of burn shock, the major advantages of open-loop and decision-support systems are identifying trends, enhancing situational awareness, and encouraging burn team communication...
October 2016: Critical Care Clinics
https://www.readbyqxmd.com/read/27600130/fluid-creep-and-over-resuscitation
#3
REVIEW
Jeffrey R Saffle
Fluid creep is the term applied to a burn resuscitation, which requires more fluid than predicted by standard formulas. Fluid creep is common today and is linked to several serious edema-related complications. Increased fluid requirements may accompany the appropriate resuscitation of massive injuries but dangerous fluid creep is also caused by overly permissive fluid infusion and the lack of colloid supplementation. Several strategies for recognizing and treating fluid creep are presented.
October 2016: Critical Care Clinics
https://www.readbyqxmd.com/read/27600129/complicated-burn-resuscitation
#4
REVIEW
David T Harrington
More than 4 decades after the creation of the Brooke and Parkland formulas, burn practitioners still argue about which formula is the best. So it is no surprise that there is no consensus about how to resuscitate a thermally injured patient with a significant comorbidity such as heart failure or cirrhosis or how to resuscitate a patient after an electrical or inhalation injury or a patient whose resuscitation is complicated by renal failure. All of these scenarios share a common theme in that the standard rule book does not apply...
October 2016: Critical Care Clinics
https://www.readbyqxmd.com/read/27600124/monitoring-end-points-of-burn-resuscitation
#5
REVIEW
Daniel M Caruso, Marc R Matthews
This article discusses commonly used methods of monitoring and determining the end points of resuscitation. Each end point of resuscitation is examined as it relates to use in critically ill burn patients. Published medical literature, clinical trials, consensus trials, and expert opinion regarding end points of resuscitation were gathered and reviewed. Specific goals were a detailed examination of each method in the critical care population and how this methodology can be used in the burn patient. Although burn resuscitation is monitored and administered using the methodology as seen in medical/surgical intensive care settings, special consideration for excessive edema formation, metabolic derangements, and frequent operative interventions must be considered...
October 2016: Critical Care Clinics
https://www.readbyqxmd.com/read/27600123/colloids-in-acute-burn-resuscitation
#6
REVIEW
Robert Cartotto, David Greenhalgh
Colloids have been used in varying capacities throughout the history of formula-based burn resuscitation. There is sound experimental evidence that demonstrates colloids' ability to improve intravascular colloid osmotic pressure, expand intravascular volume, reduce resuscitation requirements, and limit edema in unburned tissue following a major burn. Fresh frozen plasma appears to be a useful and effective immediate burn resuscitation fluid but its benefits must be weighed against its costs, and risks of viral transmission and acute lung injury...
October 2016: Critical Care Clinics
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