Page 251 - Critical Care Notes

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■ Carboxyhemoglobin level within 1 hr after injury
■ CK and myoglobin levels possibly helpful
■ PT and PTT
■ Urinalysis (especially specific gravity, pH, glucose, acetone, protein, and
myoglobin)
■ ABGs or pulse oximetry and carboxyhemoglobin (COHgb)
■ ECG
■ Type and crossmatch for blood
■ Drug and alcohol toxicology screens
■ Pregnancy test for women of childbearing age
■ X-rays specific to injury (e.g., chest, abdomen and pelvis, extremity)
■ CT scan of abdomen (ultrasound if indicated)
■ Bronchoscopy if inhalation injury is present
Management
Management of burns depends on the location of the burn and the extent of the
burn injury.
■ Maintain patent airway. Intubate or perform tracheostomy as needed.
Administer 100% humidified O 2 by nasal cannula, mask, or mechanical
ventilation/CPAP.
■ Assess respiratory status. Encourage the use of incentive spirometer,
coughing and deep breathing, suctioning, or bronchodilators. Note
respiratory distress.
■ Monitor ABGs or pulse oximetry for hypoxemia and metabolic acidosis.
Monitor COHgb levels.
■ Monitor for and prevent pneumonia and other nosocomial infections.
■ Immobilize the spine until assessment can be made of injury.
■ Irrigate chemical burns immediately.
■ Assess for inhalation injury.
■ Control active bleeding if associated injuries.
■ Assess TBSA burned and depth of burn injuries. Provide IV analgesics
(opioids) for pain.
■ Maintain good pain control. Consider ketamine and benzodiazepines before
procedures.
■ Initiate aggressive but cautious IV fluid resuscitation to replace fluid and
electrolytes:
■ Consensus Formula (Parkland Formula) recommendation is to give 4 mL/kg
per percentage TBSA of lactated Ringer’s solution in first 24 hr after burn
injury.
■ One half of the calculated total is given over the first 8 hr after burn
injury, and the other half is given over the next 16 hr.
MULTISYS