RESUMO
Volume resuscitation of patients with high-voltage electrical injuries (>1000 V) is a more complex challenge than standard burn resuscitation. High voltages penetrate deep tissues. These deep injuries are not accounted for in resuscitation formulae dependent on percentage of cutaneous burn. Myonecrosis occurring from direct electrical injury and secondary compartment syndromes can result in rhabdomyolysis, compromising renal function and urine output. Urine output is the primary end point, with a goal of 1 mL/kg/h for adult patients with high-voltage electrical injuries. As such, secondary resuscitation end points of laboratory values, such as lactate, base deficit, hemoglobin, and creatinine, as well as hemodynamic monitoring, such as mean arterial pressure and thermodilution techniques, can become crucial in guiding optimum administration of resuscitation fluids. Mannitol and bicarbonates are available but have limited support in the literature. High-voltage electrical injury patients often develop acute kidney injury requiring dialysis and have increased risks of chronic kidney disease and mortality. Continuous venovenous hemofiltration is a well-supported adjunct to clear the myoglobin load that hemodialysis cannot from circulation.
Assuntos
Injúria Renal Aguda/terapia , Queimaduras por Corrente Elétrica/terapia , Ressuscitação/métodos , Injúria Renal Aguda/induzido quimicamente , Adulto , Queimaduras por Corrente Elétrica/complicações , Queimaduras por Corrente Elétrica/metabolismo , Cuidados Críticos/métodos , Hemodinâmica , Humanos , Ácido Láctico/metabolismo , MasculinoRESUMO
In 2009, the JMS Burn Centers network opened as the only organized inpatient burn unit in Mississippi. Initial predictions of total annual state burn admissions (431 patients) and total annual state burn center admissions (239 patients) were made by extrapolating from national burn and census data. Actual JMS admissions for 2 years totaled 1016 patients, exceeding predicted total state burn admission by 18% and total predicted state burn center admissions by 113%. Demographic and professional characteristics may have contributed to the substantial inaccuracy of the original estimates of burn patients in this state.
