2.

100. 000
12. 000
(
)
ABA ( American Burn Association )


2 4
17 - 25
( 70 % )
( 50 % )

II III 50 %

10 - 30

1964.

50 %

1974.

30 %

1984.

< 10 %



I
II
II (
)
III (
)
IV


( B * )
. ( I , II 15 %
10 % , III 2 %
B. ( II 15 25 % 10 20 %
, III 2 10 % )
C. ( II 25 % 20 %
, III 10 %,
, , , , ,
, ,
)
B C
*AB ( American Burn Association )

5 - 10

II ( II )

24

( ) 7 - 14
,

II - ( II b )

,
,

III


III ( )

,


, ,

Zona
nekroze

IV

(
: , ,
... )

( , ,
, post mortem )

(
, )
(, ,
, , ,
)
, ,
(
)
: ,
,
,


( Lund Browder )


I.

( 36 )

II. ( 2. 6. )
III.
( 7. )
IV.

I ( 36 h )

( )

Histamin

Citokini ( interleukini, TNF )

Prostaglandini

Endotoksin

Bradikinin

Azot oksid

Azot oksid
Serotonin
Supstanca P

: , ,
, , MOF ( multiple organ failure )


36


1. ,

2.
3.
4.



,





Ringer - laktata, ,

 STOP, DROP & ROLL "



>

20 %
> 15 %

( III )
,
15 % 10 %

: 9 %
: 20 %

24

( Ringer l, Hartman - )

Ringer laktat: 24 -

Brooke Parkland

 Ringer
laktata 24 -
( P =
= )
Brooke - : 2

Parkland

l x % P x g

: 4 l x % p x kg

20 % + 20 %

80 kg

2 ml x % OP x kg TM
________________________

6400 ml za 24 h

( 3 l / % P / kg )

( H - 2 ,
)

( ,
, )

 24
( , )

0, 3 - 0, 5 ml / %
P / kg

5 %





( II III ):
( 1 - 2 mg , 10 - 15 mg )

, -


1 % -


,

( . )


: ,


: Biobrane, Duoderm,
Opsite


( )

II. 36
( 2 - 6 )

( )

( )
( H )

III. -




(
) ,
MODS ( MSOF )

III. -

ARDS



: ,

: ,
,
: , ( ,
), ,
( )
( SIRS )
( , )

MODS ( MOFS )

 SIRS ( Systemic Inflammatory Response

Syndrome )
1 - Temperatura > 38 C < 36 C
2 - Puls > 90 / min
3 - Respiracije > 20 / min Pa CO2 < 32 mm Hg
4 - Leukociti > 12, 000 / mm3,< 4,000 / mm3,
> 10 % nezrelih elija
= SIRS +



50%
1.
2. C
3.

, ,
, , -


90 -100 % 10 l /
> 90 %
PEEP -
20 30
:
( 300 mg )
:
( ;
)



Cardiac arest

, ,

Compartment

DIC




" ,

( , )



:
,

:

HF

I , , , ,

II

III ,
, , 2 - 3
. ,

IV , ,
, o
( Marjoli - )

: 70 80 %

: 1 g DTPA - 10 ml 2 %
100 ml

, , , , ,

: ,

IV.

0 C

34. 4

: cold induced
vasodilatation ( CIVD )

-,

( 37, 5 - 40 C )

( , Dextran .,
)

( )

 Crush Syndrome "

 Crush Syndrome "

 Crush Syndrome "

Crush syndrome

, , ,

 Crush Syndrome "

cardiac arest

 Crush Syndrome "

-

Glucose - saline > 300 ml / h

pH > 6, 5

CVP PAWP

( Ringer
laktat ) 500 ml / h 44, 5 q 2 h

,
6 h

300 ml 1g / kg

pH 7. 45 pH < 6. 5 250 mg

( 60 h )

 Crush Syndrome "

,

,