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QUEMADURAS
2010
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2º SU¿PERFICIAL 2º PROFUNDO
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FLAMAZO FUEGO DIRECTO
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SEGUNDO GRADO
DOLOR FLICTENAS PUNTILLEO ROSA O ROJO
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Tercer Grado- Hipodermis – Fuego, escaldadura por inmersión, alto voltaje.
– Exposición a químicos concentradas.
– Contacto con objetos calientes. – Color blanco, perla o carbonizado. – Vasos trombosados – Anestesia obligatoria.
– Sensación de presión profunda - MANEJO QUIRÚRGICO OBLIGATORIO.
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TERCER GRADO
Indoloras Blancas No flictenas Aspecto sereo con trombosis secas
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Curación de las Heridas por Quemaduras
Quemaduras de Iº : No requiere de tratamiento específico.
Quemaduras de IIº Superficial: Re epitelización espontánea dentro de 2 semanas. No dejan cicatríz
Quemaduras de IIº Profundo: cura por granulación, contracción y epitelización de los bordes y remanentes epidérmicos
- 2 a 4 o> semanas. Asociado a cicatríces hipertróficas y contracturas.
- Frecuentemente requieren de injertos
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¨La Desbridación de flictenas deberá realizarse debido al alto contenido de mediadores inflamatorios los cuales incrementan la isquemia por quemadura, además de constituir un excelente medio para crecimiento bacteriano¨
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Tratamiento del quemado no extenso.
1) control del dolor 2) limpieza y desbridamiento de la
quemadura 3) uso de agentes tópicos 4) cobertura de la lesión 5) elevación del área quemada 6) profilaxis anti-microbiana 7) controlar el prurito 8) rehabilitación (en caso de ser precisa).
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Quemadura de vía aérea
Quemaduras Faciales, Cabeza y Torso.
Quemaduras de Cejas y Vibrisas Nasales.
Cambios Inflamatorios en Orofaringe.
Esputo Carbonáceo.
Estridor Respiratorio (INTUBACION INMEDIATA).
Manejo con O2 al 100 %.
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HOSPITAL GENERAL DEL ESTADO UNIDAD DE QUEMADOSFicha Identificación
Nombre______________________ , Sexo____, Edad___ .
No. Expediente:______________________
Etiología de la quemadura______________
Lugar del accidente ___________________
Lugar Cerrado SI NO
Fecha y hora del accidente: ________________________
Fecha y hora de Ingreso a la Unidad de Quemados:_____________________________________
Via Aérea afectada : SI NO
Lesiones agregadas_______________________________
Valoración de APACHE______________
T/A.-______, Fc,____ Fr,____, Temp._____, Glasgow,____
Manejo Recibido ____________________________________________________________________________________________________________________________
____________________________________________________________
Porcentaje de Superficie Corporal Quemada: __________
Clasificación de la quemadura:
(en porcentaje)
2º.- Superficial, _________
2º.- Profundo, __________
3er. Grado, _____________
Médico Tratante:__________________________
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ExtensiónExtensión
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MANEJO DE LÍQUIDOS
Quemaduras de + 20 % (S.C.T.) Niños – 2 años. Adultos + 60 años Quemaduras + 10 % (S.C.T.) Quemaduras + 50 % / canalizar 2 vías. Quemaduras + 60 % ( U . C. I . A. )
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MANEJO DE LÍQUIDOS
1.- Evans(Fisiológica) 1.0 ml / kg / % S.C.T.
2.- Brooke(Hartmann) 1.5 ml / kg / % S.C.T.
3.- Slater(Hartmann) 2 lts / 24 hrs.
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MANEJO DE LÍQUIDOS
PARKLAND
( Hartmann ) 4 ml / Kg / % S.C.T.- ½ en las primeras 8 hrs.
- ½ en las siguientes 16 hrs.
*- Albúmina 0.1 cc/kg/SCT
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EJEMPLO MASCULINO 42 años
( 70 kg. Aprox.) Quemadura x Fuego 60 % SCT Parkland
4 ml/ kg/ S.C.Q.
(4ml/ 70kg/ 60 %)
R= 16,800 ml.
* 8,400 ml ( 8 hrs ) –1050 x hr
* 8,400 ml (16 hrs) – 526 x hr.
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CONCLUSIONES LA RESUCITACIÓN CON LÍQUIDOS ES CLAVE
PARA EL INICIO DEL TRATAMIENTO TEMPRANO DEL PACIENTE QUEMADO.
LA RESUCITACIÓN CON LÍQUIDOS DEBE DE BASARSE EN EL TIEMPO EN EL QUE OCURRIÓ LA LESIÓN.
LA FORMULA PARKLAND ES LA MÁS COMUNMENTE UTILIZADA.
EL PARAMETRO NO INVASIVO QUE MEJOR REFLEJA LA PERFUSIÓN DE LOS ORGANOS ES LA DIURESIS, (que se considera aceptable cuando alcanza un mínimo de 0.5-1 ml/kg/h en adultos (más de 1 ml/kg/h si la quemadura es eléctrica) y 1 ml/kg/h en niños (para niños menores de 30 kg).
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CONCLUSIONES SOMOS HUMANOS NO MAQUINAS CADA ENFERMO ES DIFERENTE*ES IMPORTANTE RESALTAR QUE LAS
DIFERENTES FÓRMULAS SON SIMPLEMENTE GUÍAS PARA INICIAR LA REANIMACIÓN, SIENDO LO FUNDAMENTAL LA MONITORIZACIÓN DEL PACIENTE A FIN DE AJUSTAR EL TRATAMIENTO A LAS NECESIDADES DEL MÍSMO DURANTE SU EVOLUCIÓN*
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WW II: AUSCHWITZ. 1944. Cámara de gáses con ácido clorhídrico
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Quemaduras Eléctricas
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