Acute care
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The choice of colloid or crystalloid solutions for fluid resuscitation of critically ill patients remains controversial. Marked reduction of extracellular water is considered an important defect in shock by proponents of crystalloid fluid therapy. Large volumes of crystalloid replenish this extracellular deficit. ⋯ This is of greatest moment in the fluid resuscitation of patients in whom circulatory shock follows volume depletion. Crystalloid fluid repletion which requires between 2- and 4-fold as much volume as colloidal fluid is of little risk in the young, traumatically injured patient. However, in older patients, the risk of pulmonary edema is increased.
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The pathophysiologic changes demonstrated by a burn patient basically cover the entire spectrum of surgical critical care. Management of the particular disease state is based more on the principles of prevention rather than on the treatment of complications, as the latter are frequently fatal. Although extremely complex, most of the physiological, biochemical, metabolic and immunological changes leading to these complications are predictable with reasonable knowledge of the time course of burn injury and repair. The objective of this review was not to present a detailed treatment plan, but rather knowledge of the mechanism behind postburn pathology so as to allow one to predict and in turn prevent mortality and morbidity.