burn sepsis
Introduction
Introduction to burn sepsis Burn sepsis is a common complication after deep burns. It can be a mixed infection of single bacteria or most bacteria, and can even be caused by fungi. Generally, most of them are single bacteria in the early stage, and mixed infections in the late stage. It occurred mostly within 2 weeks after burn, and it occurred on the 2nd day at the earliest. There was less chance of granulation after wound formation. Common pathogens are Staphylococcus aureus, Pseudomonas aeruginosa, Proteus and Escherichia coli. The clinical manifestations of general sepsis are living, can be high fever (up to 42 ° C), but also low temperature (below 36 ° C), mostly relaxation heat. After the occurrence of sepsis, the tachycardia after the original burn is more significant, and toxic myocarditis, toxic hepatitis, shock, etc. may occur. Paralytic tympanic bowel is also a common symptom, which can be accompanied by changes in consciousness. The wound surface can be deteriorated for a short time, the color is dark, the necrotic tissue and secretions are increased, and bleeding is easy. basic knowledge The proportion of sickness: 0.00001% Susceptible people: no special people Mode of infection: non-infectious Complications: shock
Cause
Causes of burn sepsis
Bacterial infection (95%):
After deep second-degree and third-degree wound infection, it is often the main source of sepsis, especially the wounds infected with moist pressure, bacteria are more likely to invade the bloodstream, Gram-negative bacilli are mostly, up to 63% to 68%, Gram The proportion of positive coccidioemia increased, anaerobic bacteria and fungal sepsis also increased, Gram-negative pathogenic bacteria, in addition to E. coli, common with Klebsiella, Pseudomonas aeruginosa, Aerogen, Proteus, etc.; Candida albicans is more common, as is the case of Aspergillus and Cryptococcus.
Prevention
Burn sepsis prevention
Early prevention of sepsis; early diagnosis and treatment of sepsis, reducing burn mortality. Active care after burns, high-risk patients susceptible to sepsis should closely observe the changes in the condition, in the event of signs of sepsis or suspected condition, it is necessary to actively check the decisive treatment, sputum, sputum and other skin infections should avoid the use of extrusion therapy, indwelling the body If the catheter is infected, it needs to be removed in time. The burn ward and the blood disease patient should be strictly isolated when receiving chemotherapy or bone marrow transplantation. The ward of the infected ward who has lived or has lived with sepsis should strengthen disinfection and isolation measures to prevent drug-resistant gold. Staphylococcus, Pseudomonas aeruginosa and fungi spread, medical supplies (especially medical equipment) should be thoroughly disinfected. It is best to use disposable medical supplies. Those with chronic Staphylococcus aureus should be temporarily removed from the ward. It is also treated to protect patients with low resistance from infection. For some patients, immunopotentiators may be considered.
Complication
Burn sepsis complications Complications
Easy complicated with shock and systemic multiple organ failure.
Symptom
Symptoms of burn sepsis Common symptoms Signs of urinary alkaline sepsis, increased heart rate, irritability, loss of appetite
It relies mainly on clinical symptoms for early diagnosis. Therefore, it is necessary to closely observe changes in clinical symptoms, analyze the causes of the changes, and grasp the following early symptom changes:
1 body temperature swelled 39.5 ~ 400C or abnormally decreased.
2 The heart rate is accelerated by 140 beats/min or more, and the breathing is increased. It cannot be explained by other reasons.
3 mental symptoms such as proverbs, irritability, adolescence and so on.
4 loss of appetite, bloating or diarrhea.
5 The wound surface deteriorates, the eschar becomes damp or the deep II degree suede sees the tip point of the overflow point or the bleeding point, the number is increasing or gradually expanding, or the granulation wound is gray, uneven, with dark red dot necrosis Or the skin that has survived is invaded by silkworms, but it is reduced without expansion.
Examine
Examination of burn sepsis
Blood tests, especially white blood cell counts and classification tests, may indicate the degree of bacterial infection, but obtaining positive pathogens is essential for diagnosis and treatment. To improve the positive rate of pathogen culture, it is necessary to pay attention to the specimens in time. Fortunately, before the administration of antibiotics; to be repeated; to collect specimens (such as blood, urine, stool, bone marrow, sputum, secretions, etc.) in multiple parts; the amount of specimens to be inspected should not be too small (such as blood specimens for inspection) The blood volume should be at least 1/10 of the medium, that is, 5 to 10 ml). In combination with clinical characteristics, multiple suspected bacteria should be cultured at the same time (general bacteria, anaerobic bacteria, L-type bacteria, fungi, etc.) at the same time. After the isolation of the pathogen, the susceptibility test should be done. In the specific method of laboratory operation, it has been improved in recent years. In addition to the original culture method, it can also be used:
1 isotope culture instrument, gas phase spectrometer, Malthus culture instrument and other special instruments for blood culture, can early indicate the presence or absence of bacterial growth.
2 blood microporous membrane collection method, can remove antibiotics in serum, easy to grow bacteria.
3 Dissolved centrifugal blood culture method is conducive to the detection of yeast.
4 The gene amplification method (PCR) using molecular biology technology is more rapid, sensitive and specific in detecting pathogenic microorganisms. Now there are kits for detecting Escherichia coli, Mycobacterium tuberculosis, Staphylococcus aureus and fungi. For clinical use.
5 blood lysate test (LLT), used to detect blood, urine and pleural and ascites samples such as endotoxin to confirm whether it is Gram-negative infection.
6 immunofluorescence and ELISA antigen detection.
7 Indium labeled immunoglobulin detection.
In the case of enterococci sepsis, the lungs are infiltrated with shadows on the X-ray.
Diagnosis
Diagnosis and diagnosis of burn sepsis
Differential diagnosis
Septicemia: general onset of acute convulsions, after a sudden severe chill, there is a fever of up to 40 ~ °C, because the pathogens continue to exist in the blood and continue to multiply, high heat daily fluctuations around 0.5 ~ 1 °C, showing heat Eye conjunctiva, mucous membranes and skin often have blood stasis points, blood bacterial culture is often positive, but due to the application of antibiotics, sometimes negative, generally no metastatic abscess.
Sepsis: It is also a sudden high fever after intense chills, but because the bacterial emboli enters the blood circulation intermittently, the occurrence of chills and high fever is paroxysmal. The body temperature during the interval can be normal, so it is a fever, and the majority of the course is Subacute or chronic, metastatic abscess can occur continuously from the second week. Metastatic abscess occurs mostly in the subcutaneous or deep soft tissues of the lower back and limbs. The general reaction is mild, no obvious pain or tenderness, and it is not easy to attract the patient's attention. If transferred to other internal organs, there are corresponding clinical symptoms: lung abscess has odor sputum, hepatic abscess when the liver is tender, the diaphragm is elevated, etc., in the chills and high fever, blood culture is often positive.
Toxemia: no chills before high fever, pulse speed is more obvious, anemia occurs early, blood and bone marrow bacterial culture are negative.
