Clinics in plastic surgery
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The key to successful fluid resuscitation of the thermally injured patient is close monitoring of the clinical response. Individualized resuscitation based on the parameters described allows for approximation of this goal. ⋯ The goals of fluid resuscitation have been summarized and a variety of formulas have been described. We anticipate that our understanding of patient subsets outlined in this paper will undergo further evolution.
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The vast majority of respiratory disorders in thermally injured patients arise from associated inhalation injuries. The major forms of these injuries are carbon monoxide poisoning, injury to the upper airway, and pulmonary parenchymal damage. One hundred per cent oxygen, initiated at the scene of the accident, is the single most effective treatment of carbon monoxide toxicity, which must be assessed by carboxyhemoglobin determinations. ⋯ The compromised airway is protected by tracheal intubation, and respiratory failure is treated with assisted ventilation and supplemental oxygen. Pulmonary infection requires specific antibiotics based on isolated organisms and their sensitivities to antimicrobials. The upper respiratory tract of patients requiring long-term intubation should be assessed by fiberoptic bronchoscopy and other modalities to prevent fatal late airway occlusion.
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Burn wounds require coverage for healing to occur. Many techniques have been utilized to achieve such a closed wound, including biologic dressings, autologous skin, and skin substitutes. These and other methods are discussed.
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The anesthetic management of pediatric patients for plastic surgical procedures requires close cooperation and understanding between the surgeon and anesthesiologist. Success depends upon avoidance of psychological trauma, establishment and maintenance of a secure airway, and adequate access to the vascular system.