Critical care nursing clinics of North America
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Crit Care Nurs Clin North Am · Jun 1991
ReviewInitial management of a patient with extensive burn injury.
During the resuscitation period, a knowledge of burn pathophysiology assists the nurse in conducting thorough assessments and providing effective nursing interventions in the acutely ill patient. The many variables associated with the burn injury contribute to the presentation of each burn patient as one with a unique injury that requires the most vigilant nursing care and expertise. The total dedication required of health care workers as members of a multidisciplinary burn team provides a significant professional challenge. Meeting that challenge appreciably strengthens the chances of burn patient survival.
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Cold-water submersion results in rapidly induced hypothermia. The body's physiologic response to this insult is, in some ways, similar to that of controlled hypothermia employed in the hospital setting, with the time sequencing being greatly enhanced. The application of hypothermic techniques employed with extracorporeal heat exchange on cardiopulmonary bypass to those of cold-water submersion requires careful differentiation, especially during rewarming phases. ⋯ A child who appears asystolic, apneic, and with absence of central nervous system activity after cold-water submersion, requiring intensive resuscitative efforts, may have a favorable outcome. This does not absolutely suggest a devastating outcome as we have seen in those children "frozen alive," who are hypothermic but have been effectively resuscitated, rehabilitated, and allowed to return to normal life activities. Although combined intensive and rehabilitative efforts of the medical team are essential in the care of these children, foremost in our minds should be prevention of these accidents.
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Crit Care Nurs Clin North Am · Jun 1991
Pathophysiology of near-drowning and treatment of the child with a submersion incident.
The overall prognosis for children who have had a submersion incident is directly related to several variables including length of submersion, initial neurologic evaluation, time to first breath, initial pH, and others. Resuscitation after near drowning is unsuccessful in terms of death and neurologic deficit in 30% of those children who present to our institution. ⋯ Therefore, skilled attempts at resuscitation and management are mandatory. The understanding of the sequence of events that occur during the drowning process and the pathophysiologic consequence make it possible for health care personnel to provide aggressive therapeutic interventions that will enhance the likelihood of a normal recovery.
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The continued investigation and ultimate understanding of the pathophysiologic response to thermal injury and resuscitation will potentially open new avenues of fluid management. The ultimate goal of any resuscitation regimen is the preservation of organ perfusion and function. Assurance of a smooth and adequate burn resuscitation in combination with advances in wound care and coverage, inhalation injury management, and nutritional support will continue to improve the outcome of the thermally injured patient.