Steven E. Wolf now talks about #PedsICU #airway #burns

Airway burns is something I always worry about. Looking forward to his insights in this topic

#WFPICCS20 #PedsAnes
Airway probs can occur from:
- direct burns
- inhalation injury (10-20% of all burns pts)
- trauma from other injuries
- 3rd spacing oedema during fluid resuscitation
- long term intubation (eg subglottic stenosis)

#PedsICU #PedsAnes #WFPICCS20
Don’t forget carbon monoxide poisoning in airway burns!

#PedsICU #PedsAnes #WFPICCS20
Airway burns can occur above or below the glottis.

Key history points:
- in enclosed space?
- trapped?
- lost consciousness?

Key examination features:
- signs of airway obstruction
- facial burns
- respiratory distress
- altered voice

#PedsICU #PedsAnes #Burns #WFPICCS20
Plan for a difficult intubation.
Then look at airway with bronchoscopy.
Protect the lungs (ARDSNet)
Extubate as soon as possible.
If you can’t think of tracheostomy.

Airway tips from Steven Wolf in #burns children.

#PedsICU #WFPICCS20

• • •

Missing some Tweet in this thread? You can try to force a refresh
 

Keep Current with Michael Griksaitis

Michael Griksaitis Profile picture

Stay in touch and get notified when new unrolls are available from this author!

Read all threads

This Thread may be Removed Anytime!

PDF

Twitter may remove this content at anytime! Save it as PDF for later use!

Try unrolling a thread yourself!

how to unroll video
  1. Follow @ThreadReaderApp to mention us!

  2. From a Twitter thread mention us with a keyword "unroll"
@threadreaderapp unroll

Practice here first or read more on our help page!

More from @MJGriksaitis

2 Dec
Sharon Y Irving on ‘early enteral #nutrition: timing is more important than initial volume’

Starting with what is early enteral nutrition... definitions are vague 👇 but generally within 24hrs is recommended

#PedsICU #WFPICCS20 Image
Need to consider the metabolic response of critical illness on #nutrition - this is multi factorial

But it’s key to remember that this response is not predictable, will vary with the illness and hard to assess

#PedsICU #WFPICCS20 Image
The blood flow to the splanchnic & GI tract circulation can be varied during resuscitation and critical illness - all this can lead to impact to the ability to tolerate enteral #nutrition

#PedsICU #WFPICCS20 ImageImage
Read 6 tweets
2 Dec
Suchitra Ranjit discusses multimodal monitoring during #sepsis to help decode the physiological diagnosis and personalise therapy

Opening message is that cardiac output is difficult to assess at the bedside

#PedsICU #WFPICCS20
MAP is often used as a proxy of CO - is this reasonable?

There is not a strong relationship between them in post-cardiac surgical children

#PedsICU #WFPICCS20 Image
What happens when fluid is given in #sepsis?

Again: v weak correlation between CI & MAP

Interestingly almost 50% of patients did not respond to fluid & significant % of patients had a fall in BO/CI!

48% of children needed more inotrope after the fluid

#PedsICU #WFPICCS20 ImageImageImageImage
Read 5 tweets
2 Dec
Hector Wong discusses the clinical application of biomarkers in #sepsis

Starts with how can biomarkers help us...

#PedsICU #WFPICCS20
A great picture showing how the aim of biomarkers is to allow precision medicine - but you need to understand the concept of enrichment first!

#PedsICU #WFPICCS20 #Sepsis
The development of AKI is independently associated with morbidity and mortality in #sepsis

Combining this with additional biomarker activity is helpful

#PedsICU #WFPICCS20
Read 5 tweets
2 Dec
Joe Carcillo discusses clinical phenotypes & outcomes of #sepsis

He says mortality was reduced in the emergency department by protocols using early antibiotics/fluids

Yet some children who end up on #PedsICU develop multiorgan failure despite following protocols

#WFPICCS20
Four clinical phenotypes have been associated with progressive multiorgan failure in #sepsis

All of these phenotypes end with macrophage activation syndrome.

Research is going on to target therapies against each phenotype (eg, TAMOF with plasma exchange)

#PedsICU #WFPICCS20
Children can have one or more of these phenotypes and some are more common than others.

This data is important when planning #research trials for targeted #sepsis therapies

But also this data has implications for clinical outcomes...

#PedsICU #WFPICCS20
Read 5 tweets
2 Dec
Prof. Bettina Vom Dessauer now talks about the #burns patient as a critically ill patient with systemic problems.

#PedsICU #WFPICCS20
Outcomes in #burns patient associated with:
- early admission to hospital
- care in a specialised burns unit
- control of infections
- early nutrition

These children are often healthy before the injury and this results in the whole homeostasis being altered

#PedsICU #WFPICCS20
The pathophysiology of #burns patients is multi systemic and occur at a cellular level

What we see clinically is distributive shock.

#PedsICU #WFPICCS20 #physiology
Read 7 tweets
2 Dec
Catching up on #burns patients on the #PedsICU - first up Steven E. Wolf discussing specialised burns care by the surgical team

He starts by discussing the ultimate goals of paediatric burn care:
- no deaths
- no scars
- no pain

We are improving but not there yet

#WFPICCS20
‘Burns are as bad as they are going to get at the start; they can only get better - burns are different to chronic diseases’ - Steven E. Wolf, burns surgeon/Intensivist

#PedsICU #WFPICCS20
What are the strategies for management of the #burn wound?

The key is fix and heal the wound. Then de-intensify the patient as soon as possible.

Remember: #burns wounds will have organisms cultured - but are they causing infection?

#PedsICU #WFPICCS
Read 8 tweets

Did Thread Reader help you today?

Support us! We are indie developers!


This site is made by just two indie developers on a laptop doing marketing, support and development! Read more about the story.

Become a Premium Member ($3/month or $30/year) and get exclusive features!

Become Premium

Too expensive? Make a small donation by buying us coffee ($5) or help with server cost ($10)

Donate via Paypal Become our Patreon

Thank you for your support!

Follow Us on Twitter!