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TREATMENT OF BURIAL SHOCK AT THE STAGE OF QUALIFIED AND SPECIALIZED MEDICAL CARE
Therapy of burn shock should be complex. Its main directions:
1. Struggle with afferent impulse.
Treatment of a burn wound is not performed. Precise determination of the depth and area of the lesion is performed after removal of the victim from shock.
To combat the pain, narcotic analgesics (morphine, omnopon, promedol) were widely used before. However, due to their side effects (depression of the respiratory center, stimulation of the vomiting center), combinations of non-narcotic analgesics (analgin, baralgin) with neuroleptics (relanium, droperidol, rohypnol) are currently preferred. A good effect is provided by neuroleptanalgesia.
2. Oxygen therapy.
The patient should provide constant inhalation with moistened oxygen for the entire period of excretion from shock, if necessary - ventilation, imposition of a tracheostomy.
3. Reimbursement of the volume of circulating blood (BCC) and fluid retention in the vascular bed.
The solutions administered during the infusion therapy of burn shock can be divided into three groups:
1) replenishing the vascular volume - plasma, albumin, colloids;
2) replenish the entire extracellular volume, i.e. BCC and extracellular fluid - solutions of salts;
3) increasing the volume of all body fluids - glucose solutions.
4. Prevention and treatment of violations of water-salt metabolism and excretory function of the kidneys.
To the greatest extent, the patient loses sodium and chlorine ions as more osmotically active than potassium, calcium, and magnesium ions. To compensate for their losses, along with isotonic (0.9%) and hypertonic (10%) solution is used. There are special preparations (chlosol) containing more chlorine ions. To correct the excretory function of the kidney, various diuretics (lasix) are used.
5. Struggle with metabolic acidosis.
Apply as alkaline solutions (4% sodium hydrogen carbonate solution, disul, trisol), and buffer solutions (trisamine).
6.Correction of disorders of coagulation and anticoagulation systems, control of hypercoagulability.
1) the appointment of heparin - 5 thousand units every 4 hours under the control of the time of blood coagulation;
2) the use of drugs that reduce the viscosity of the blood - antiaggregants (reopoliglyukin, curantil, trental)
3) the creation of moderate hemodilution - the "dilution" of blood by the infusion of large quantities of fluid
Activation of the anticoagulant system is automatically blocked when hypercoagulability is eliminated, in addition, protease inhibitors can be used - counterlines for 10-50 thousand.
units, gordoks for 100 - 300 thousand units 1 - 2 times a day, 5% solution of epsilonaminocaproic acid (currently withdrawn because of frequent allergic reactions) - 100 ml 1 - 2 times a day.
7. Correction of violations of energy metabolism.
The energy losses of a patient with burns are very high and reach 4,000-5,000 kcal / day. The development of paresis of the gastrointestinal tract does not allow to compensate them by the enteral route, in connection with which there is a need for parenteral nutrition. The basis of it is a solution of glucose in a concentration of 5 to 20% (1 gram of glucose during oxidation in the body gives 4 kcal).
To compensate for protein loss - solutions of human albumin (5 or 10%) and protein (5%). A new generation of drugs for parenteral nutrition are solutions of amino acids (polyamine, alvezin, amnion).
Fats are also essential nutrients. Their caloric value is twice that of carbohydrates - 8 kcal / g. For parenteral nutrition, special drugs (lipofundin) are used, which are the thinnest fat emulsions that do not cause fat embolism.
Compensate for energy losses can also be done with solutions of ethyl alcohol at a concentration of up to 30%.
8. Prevention of the development of infectious complications - the use of antibiotics. Antibiotics are prescribed since the development of the fever, which indicates the onset of the absorption of toxins into the blood. Apply a wide spectrum of action, combining several antibiotics or with other antibacterial substances.
The duration of the burn shock with timely and properly administered treatment is from several hours to three days
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TREATMENT OF BURIAL SHOCK AT THE STAGE OF QUALIFIED AND SPECIALIZED MEDICAL CARE
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