Quemaduras

Iniciación de la resucitación de los quemados A primer on burn resuscitation. Bacomo FK, Chung KK. U.S. Army Institute of Surgical Research, 3400 Rawley E. Chambers Avenue, Fort Sam Houston, TX 78234, USA. J Emerg Trauma Shock. 2011 Jan;4(1):109-13. Abstract Since the early 1900s, the scope of burn resuscitation has evolved dramatically. Due to various advances in pre-hospital care and training, under-resuscitation of patients with severe burns is now relatively uncommon. Over-resuscitation, otherwise known as "fluid creep", has emerged as one of the most important problems during the initial phases of burn care over the past decade. To avoid the complications of over-resuscitation, careful hourly titration of fluid rates based on compilation of various clinical end points by a bedside provider is vital. The aim of this review is to provide a practical approach to the resuscitation of severely burned patients http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3097558/?tool=pubmed   Protección temprana de las lesiones pulmonares inducidas por  quemaduras mediante supresión de Gen preprotakinina-A Early Protection from Burn-induced Acute Lung Injury by Deletion of Preprotachykinin-A Gene Selena W. S. Sio1, Shabbir Moochhala1, Jia Lu, and Madhav Bhatia1 Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; and 2Defence Medical and Environmental Research Institute, DSO National Laboratories, Singapore Am J Respir Crit Care Med Vol 181. pp 36-46, 2010  Rationale: Burn-induced acute lung injury (ALI) is a common clinical disorder associated with high mortality even in the absence of inhalational injury. Identification of endogenous triggers that mediate the early onset of remote ALI after burn represents an important goal but remains poorly defined. Objectives: We investigated the role of proinflammatory neuropeptide, substance P (SP), in instigating remote ALI and its effects on respiratory function early after severe local burn injury. Methods: A 30% total body surface area full-thickness burn was induced in wild-type (WT) mice, preprotachykinin-A (PPT-A) gene deficient mice, which encodes for SP, and PPT-A2/2 mice challenged with exogenous SP, followed by ALI and lung function analysis. Measurements and Main Results: Endogenous SP production was heightened in burn-injured WT mice, which induced significant elevation of proinflammatory cytokines, chemokines, and endothelial adhesion molecules concurrent with disruption of pulmonary permeability barrier, excessive e neutrophil infiltration, and severe ALI. Additionally, decreased neutral endopeptidase and elevated matrix metalloproteinase-9 were evident. Notably, disruption of respiratory function demonstrates a critical role of SP in lungs after burn. These effects were significantly attenuated in PPT-A2/2 mice, whereas the exogenous administration of SP to PPT-A2/2 mice restored the inflammatory response and ALI. Furthermore, analysis of neurokinin-1-receptor (NK1R), to which SP binds preferentially, revealed that SP in conjunction with burn injury regulates NK1R expression. Conclusions: We show that the absence of a single endogenous factor, SP, significantly provides early protection against burninduced ALI in mice with marked improvement in respiratory function. Thereby, the blockade of SP may be beneficial in preventing early inflammation and ALI in patients with critical burn injuries. Keywords: neuropeptide; respiratory function; substance P; thermal http://ajrccm.atsjournals.org/cgi/reprint/181/1/36    Guía Básica para el Tratamiento del Paciente quemado Carlos De los Santos En el siguiente enlace puede leer una herramienta comprensiva y sencilla para encarar el manejo de los pacientes quemados. Son datos y rutinas de manejo ya bien conocidas y que fueron recopiladas en 2002. http://www.quemados.com/

Atentamente Anestesiología y Medicina del Dolor www.anestesia-dolor.org