Care for critically ill patients on the example of patients with severe burns

Abstract

Background. More than 200,000 patients with burns in Europe and the United States need inpatient treatment every year. In Ukraine, 35,000 people suffer thermal injuries each year. Medical care for burns in Ukraine is provided on 1,060 specialized beds (875 – for adults, 175 – for children). Indications for transporting people to the burn center include burn area >10 % of the body surface in adults; burns of the face, hands, feet, perineum, genitals, large joints; deep burns >3 %; electrical or chemical burns; inhalation burns; circular burns of the extremities or chest; burns in pregnant women, children, the elderly, patients with severe comorbid conditions; burns in combination with polytraumas. Objective. To describe the management of critically ill patients with burns. Materials and methods. Analysis of literature sources on this issue. Results and discussion. Care for patients with burns is divided into general and special. The use of specialized beds “Clinitron” and air-insolating complexes is of paramount importance. Since the heat loss from the burn wound is 580 kcal/h, the temperature in the burn rooms should be maintained at 26-30 °C. Wound surfaces are easily infected with nosocomial microorganisms, so it is necessary to carefully maintain hand hygiene of healthcare workers (HCW). The latter are the cause of the hospital infections in 50-80 % of cases, so when caring for different patients and before the transition from a bacteria-contaminated area of the body to a clean one, the gloves should be changed. All works near the patient must be carried out in the nitrile gloves without powder, as the latter increases the risk of infection and allergies. It is advisable to use high-strength gloves with an elongated cuff. After removing the gloves, hand hygiene must be carried out. To disinfect the hands of HCW in order to prevent the spread of transient microflora, you can use Gorosten (“Yuria-Pharm”) – a solution based on decamethoxine. Gorosten has antibacterial, antifungal, antiviral, anti-inflammatory and desensitizing properties. Hand hygiene should be performed before the contact with the patient, before clean/aseptic procedures, after contact / risk of contact with the patient’s biological fluids, after contact with the patient and his surroundings, after contact with him-/herself and personal protective equipment. In case of big burn area, bandages are changed under general anesthesia, in some cases after a bath with 0.05-0.1 % potassium permanganate solution. Improper care of patients with burns and other patients with severe conditions can cause the following complications: contractures, bedsores, infectious processes in the lungs, injuries and more. For the prevention and treatment of bedsores, it is advisable to use modern dressings: hydrocolloid, semi-permeable film, sponge, and silicone. Conclusions. 1. Indications for the transporting people to the burn center include the area of the burn >10 % of the body surface in adults; burns of the face, hands, feet, perineum, genitals, large joints; deep burns >3 %; electrical or chemical burns; inhalation burns; circular burns of the extremities or chest; burns in pregnant women, children, the elderly, patients with severe comorbid conditions; burns in combination with polytraumas. 2. Wound surfaces are easily infected with nosocomial microorganisms, so it is necessary to carefully maintain hand hygiene of HCW. 3. All works near the patient should be carried out in nitrile gloves without powder. 4. After removing the gloves, hand hygiene should be carried out. 5. Gorosten can be used for disinfection of HCW hands in order to prevent the spread of transient microflora.