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TREATMENT OF BURN SHOCK AT THE STAGE OF QUALIFIED AND SPECIALIZED MEDICAL CARE
Burn shock therapy should be comprehensive. Its main directions:
1. Fight against afferent impulsation.
Treatment of burn wounds do not produce. Accurate determination of the depth and area of the lesion is performed after removing the victim from shock.
Previously, narcotic analgesics (morphine, omnopon, promedol) were widely used to combat pain. 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. Neyroleptanalgeziya gives a good effect.
The patient must be provided with a constant inhalation with humidified oxygen for the entire period of removal from the shock, if necessary - mechanical ventilation, and the imposition of a tracheostomy.
3. The recovery of circulating blood volume (BCC) and fluid retention in the bloodstream.
Solutions introduced during burn shock infusion therapy can be divided into three groups:
1) compensating for vascular volume - plasma, albumin, colloids;
2) replenishing the entire extracellular volume, i.e. BCC and extracellular fluid - salt solutions;
3) increasing the volume of all body fluids - glucose solutions.
4. Prevention and treatment of disorders of water-salt metabolism and renal excretory function.
The patient loses sodium and chlorine ions to the greatest extent as being more osmotically active compared to potassium, calcium and magnesium ions. To compensate for their losses, it is used along with isotonic (0.9%) and hypertonic (10%) solution. There are special preparations (chlosol) containing a larger amount of chlorine ions. For the correction of renal excretory function, various diuretics (lasix) are used.
5. Fight against metabolic acidosis.
Used as alkaline solutions (4% sodium bicarbonate solution, disol, trisol), and buffer solutions (trisamine).
6. Correction of coagulation and anticoagulation systems, the fight against hypercoagulation.
1) the appointment of heparin - 5 thousand units every 4 hours under the control of blood clotting time;
2) the use of drugs that reduce blood viscosity - antiplatelet agents (reopolyglukine, chimes, trental)
3) the creation of moderate hemodilution - "dilution" of the blood by the injection of large quantities of fluid
Activation of the anticoagulant system is blocked automatically when hypercoagulation is eliminated, in addition, protease inhibitors can be used - a counter to 10-50 thousand each.
units, gordox 100 to 300 thousand units 1 to 2 times a day, 5% solution of epsilonamino-caproic acid (currently discontinued due to frequent allergic reactions), 100 ml 1 to 2 times a day.
7. Correction of violations of energy metabolism.
The energy loss of a patient with burns is very high and reaches 4-5 thousand kcal / day. The development of paresis of the gastrointestinal tract does not allow to compensate them enterally, and therefore there is a need for parenteral nutrition. It is based on glucose solutions at a concentration of from 5 to 20% (1 gram of glucose when oxidized in the body gives 4 kcal).
To compensate for the loss of protein - 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 as high as carbohydrates - 8 kcal / g. For parenteral nutrition use special preparations (lipofundin), which are the finest fat emulsions that do not cause fat embolism.
Energy losses can also be compensated by using ethyl alcohol solutions in concentrations up to 30%.
8. Prevention of the development of infectious complications - the use of antibiotics. Antibiotics are prescribed since the development of fever, which indicates the beginning of the absorption of toxins into the blood. Apply a broad-spectrum drugs, combining several antibiotics or with other antibacterial substances.
The duration of burn shock with timely and properly carried out treatment ranges from several hours to three days.
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TREATMENT OF BURN SHOCK AT THE STAGE OF QUALIFIED AND SPECIALIZED MEDICAL CARE
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