Appendix. Sedatives and Pain Medications. Gabapentin ( mg po q8h) or Pregabalin ( mg po q8h)

Transcription

1 Appendix Sedatives and Pain Medications Non-intubated patients Non-opioid analgesics Acetaminophen (500 1,000 mg po q6h) NSAID (Ibuprofen, Naprosyn, Celebrex) Gabapentin ( mg po q8h) or Pregabalin ( mg po q8h) Opioid analgesics Morphine (5 20 mg po q4h prn) Hydromorphone (1 4 mg po q4h prn) Add long acting opioid analgesics (introduced once 24 h requirements are determined and exceed 30 mg/24 h of morphine or 9 mg/24 h of hydromorphone) MS-Contin mg po bid/tid Hydromorphone Contin 3 9 mg bid/tid Consider adjuncts specially in those with history of illicit drug abuse and those not responsive to opioids Ketamine (10 20 mg po tid) Clonidine ( mg po tid) Nabilone (1 2 mg po bid) Intubated patients Non-opioid analgesics Acetaminophen (500 1,000 mg po q6h) NSAID (Ibuprofen, Naprosyn, Celebrex) Gabapentin ( mg po q8h) or Pregabalin ( mg po q8h) Opioid analgesics IV infusion or prn depending pt requirements Morphine ( 15 mg IV q1h prn) Hydromorphone (0.2 1 mg IV q1 2h prn) Add long acting opioid analgesics (once IV infusion has been discontinued and 24 h oral requirements are determined and exceed 30 mg/24 h of morphine or 9 mg/24 h of hydromorphone) MS-Contin mg po bid/tid Hydromorphone Contin 3 9 mg bid/tid Consider adjuncts specially in those with history of illicit drug abuse and those not responsive to opioids Ketamine (10 20 mg po tid) Clonidine ( mg po tid) Nabilone (1 2 mg po bid) Procedural analgesia/sedation Consider Fentanyl IV(up to 1,000 mcg) + Midazolam IV (1 2 mg) for conscious sedation Or Fentanyl (up to 1,000 mcg) IV + Ketamine IV (0.5 2 mg/kg) or Propofol IV (0.5 mg/kg bolus ± mg IV incremental boluses) for deep sedation M.G. Jeschke et al. (eds.), Burn Care and Treatment, DOI / , Springer-Verlag Wien

2 Index A Abdominal compartment pressure, 69, 81 Abdominal hypertension, 6 ACTH, 77, 83, 84 Acute burn care, Acute period care burn dressings, 134 burn wound care, 134 pain management, 134 surgical care, 134 Adrenal hormone, Aetiology, Albumin infusion, 70 Allogeneic skin, 59, 64 Allograft, 35 37, Anabolic agents, 102 Antibiotics, 44, 45, 48, 51 Antifungals, 45 Antioxidants, 6 7, 82 Autograft, 35, 37, 38 B Bacteria flora, 44 gram negative, 44 gram positive, 44 multi-drug resistant, 44 Bacterial colonization, 43, 45 Bacterial levels, 43 Base deficit, 5 Blood pressure, 68 69, 71, 76 Bloodstream infection, 50 Bone demineralization, 86 Bronchoscopy, 68, 74 Burn etiology, 15 first degree, 14 fourth degree, 15 second degree, 14 shock, 5, 7, 116, 117 size determination, third degree, 4 Burn depth definition, 14 first degree, 3 second degree, 3 third degree, 3 Burn eschar, 45 excision, 45 Burn size Lund-Browder, 3, 17 Burn wound conversion, 47 management, 7 10 pathophysiology, 16 C Calcium, Cardiac burn induced changes, 19 Cardiac long-term, 79 Cardiac output/index, 19 Catheter colonization, 50 Central line infection (CLI), 49 Central nervous system, 78 Central venous pressure (CVP), 68, 71, 76 Chemical burns acid, 154 alkali, 154 inorganic solutions, 154 management, 154 organic solutions, 154 Chloride, 74, 85 Classification, 112, 114 CLI. See Central line infection (CLI) CO, 71, 73, 75 Coagulation, Cold injury first degree, 154 fourth degree, 154 second degree, 154 third degree, 154 M.G. Jeschke et al. (eds.), Burn Care and Treatment, DOI / , Springer-Verlag Wien

3 186 Index Colloids, 5 7 Compartment syndrome, 2, 6, 57 Compression therapy, 161 Current, 151, 152 CVP. See Central venous pressure (CVP) Cyanide (CN), 73 Cytokine, 32, 36, 38 D Decompressive laparotomy, 6 Depth, , 118, 127, 130, 140 zones of injury, 116 Dermal replacement, Dobutamin, 69 Donor sites, 130, 134, 137, 138, , 144 E Early excision, 99, 104 Ebb-phase, 92 Edema, burn induced, 17, 18 Electrical injury arc, 151 contact, 151 flash, 151 management, Electro-conformation, 151 Electrolyte disorders, 84 Electroporation, 151 Emergent period care admission care, 127 airway management, 124, 126 fi rst aid at the scene, 126 fluid resuscitation, 128 wound care, 124 Empiric therapy early phase, 46 late phase, 46 Endotracheal tube, 48 Endpoints, 5 6 Environmental support, 99 Epidermal replacements, 64 Epinephrine/norepinephrine, 69, 71, 83 Ergotherapy, 64 Escharotomy, 2, 6, 9 10, Exercise, Extent Lund and Browder, 112 pediatric estimation, 116 rule of nines, 112 Extracellular matrix (ECM), 32, 33, 36, 38 Extubation criteria, 73 F Facial burn, 61 Fasciotomy, Fat metabolism, 94 Fenofibrate, 104, 105 Flow phase, 93 Fluid creep, 6, 69, 78 Fluid loss wounds, 13 Fluid maintenance after 48 hours post-burn, 70 Fluid resuscitation, 4 7, 69, 75, 77, 78, Frostbite, treatment, 155 G Gastrointestinal burn induced changes, 23 GI complications, GLP-1, 104 Glucose metabolism, 21, 26, 93, 94, 102, 104 Glutamine, 96, 98 Gonadal hormones, Growth hormone, 100, 105 H Hand burn, 62 Heart, 102 Hemodynamic burned induced changes, Hyperglycemia, 93 95, 98, 100, 103, 104, 160 Hypermetabolic response, 160 Hypermetabolism, 21, 26 post-burn, Hypertonic saline, 6 7 I ICU-weakness, 78 Immune burn induced responses, 25 Incidence, , 146 Infections bacterial, 43, 45 fungal, invasive, 43, 44 systemic, 43, 44, 46, 47 virus, 44 wound, yeast, 44, 47 Inhalation injury, diagnostics, 73 grading, 74 management, 75 Initial assessment, 1 4 Initiation of nutrition, 95 97

4 Index Insulin, 93 95, Insulin-like growth factor, Insulin resistance, 20, 23, 159, 160 Intestine, 98 Intralesional corticosteroids, 161 J Joule s law, 151 K Keratinocytes, 59, 61, 62 Kidney, 96 L Lactate, 5 6 Large burns, 59, 62 Lipid metabolism, 20, Lipolysis, 93, 94, 97, 102 Liver, 68, 77, 80 81, 94, 95, 98, 102 Lund and Browder chart, 2, 3 M Management early hospital phase, 68 Matrix metalloproteinases (MMP), 33, 34 Mean arterial pressure, 69 Medications, 125, 134, 135, 145, 146 Meek, 59, 60, 63 Mesh, 59, 60, 62, 63 Metabolism, 160 Metformin, Micronutrients, 82 Mobilisation, 64 Muscle catabolism, N NJ, NG feeding tubes, 95 Non-pharmacologic intervention for hypermetabolism, Nutrition, 64, amount, 97 composition, Nutritional options, 96 Nutritional route, 95 O Oncotic pressure, 70 Operative management, 10 Organ markers, 68, 77 Osteoporis, 86 Oxandrolone, 102, 105 P Parkland formula, 2, 5 Pathophysiology, Phoenix Society, 147 Phosphate, 85, 86 Physiotherapy, 64 PiCCO, 68, Primary survey, 1, 124 ABCDE, 1 Propranolol, 102, 105 Protein metabolism, 95, 100 Psychosocial support, 111, Pulmo long term, R Reconstruction composite tissue transplantation, 180 dermal substitutes, 174 distant flap, double opposing z-plasty, 176 excision techniques, 172 free flap, 180 geometric broken line closure (GBLC), 172 half z-plasty, pedicled flap, 180 perforator flap, 180 prosthesis, 181 reconstructive clockwork, reconstructive ladder, 169 reconstructive techniques, robotics, 181 serial excision, skin flaps, skin grafting, 174 tissue engineering, tissue expansion, w-plasty, 172 z-plasty, 176 3/4 Z-plasty-plasty, Rehabilitation period care burn contractures, 124 burn scars, 124 occupational therapy, 134 physiotherapy, 134 Renal, 70, 71, 80, Renal burn induced changes, 23 Respiration, Resting energy expenditure, 21 Resuscitation, 67 73, 75 78, 81 85

5 188 Index Risk factors, 48, 49, Room temperature, 99 Rule of 9 s, 2 S Sandwich technique, 59, 60 Scar hypertrophic scar, keloid, 33 Secondary survey, 1, 2, 123, 125 Sepsis APC, 52 bicarbonate therapy, 53 definition, 46 diagnosis, 51 fluid therapy, 52 glucose control, 53 inotropes, 52 resuscitation, 51 sedation, 52 shock, source, 51 steroids, 52 stress ulcer prophylaxis, 53 vasopressor, 52 ventilation, 52 Sequelae abdominal, 152 cardiovascular, 152 musculoskeletal, 153 neurologic, 152 psychological, 153 renal, 153 respiratory, 152 Severity factors, Skin, 31, grafts, 114, 116, 124, 130, 134, 138, substitutes, 134, 138, 142 temperature, 14 Sodium, 84, 85 Stem cells, 39 T TBSA, 2, 3, 5, 6 Techniques to determine burn depth, 4 TGF-b. See Transforming growth factor beta (TGF- b ) Therapy local, 45 systemic, 45 Thermal regulation, 79 Thyroid hormones, 84 Topical agents, 44, 45 Acticoat, 9 Aquacel Ag, 9 Bacitracin, 9 Biobrane, 9 Mafenide acetate, 9 Mupirocin, 9 Polymyxin B, 9 Silver sulfadiazine, 9 Topical antimicrobial agents, 130, 132 Topical dressings, 8 9 Topical negative pressure, 64 Trace elements, 98, 101 Transforming growth factor beta (TGF- b ), 32, 33 Transfusion, 69, 71, 85 Treatment VAP, 80 Types of burns chemical, 118 electrical, inhalation injury, 120, 121 radiation, 120 thermal/flame/scald, 118 U Under-and over-resuscitation signs, 70 Urinary output, 69, 71 V VAP. See Ventilator associated pneumonia (VAP) Vasopressors, 69, 71 Ventilation mode and setting, 68, Ventilator associated pneumonia (VAP), 48, 80 prevention, 48 Vitamin C, 7 Vitamins, 98, 101 Voltage high, 151, 152 low, 151, 152 X Xenografts, 61, 64