View
214
Download
0
Category
Tags:
Preview:
DESCRIPTION
trauma
Citation preview
Case Scenario
● A 54-year-old is rescued from a smoke-filled room in a burning house.
● He fell asleep on a couch while smoking.
● Patient is conscious, agitated, and coughing carbonaceous sputum.
● His upper body appears extensively burnt.
What are your priorities in managing this patient?
Objectives
● Outline the principles of initial assessment and treatment of thermal injuries.
● Discuss the importance of the size of burn injury and associated injuries.
● Identify special problems and methods of treatment.
● Specify criteria for transfer of patients with burns.
Priorities
Manage Airway and Breathing
●Consider direct thermal or inhalation injury.
●Establish and maintain patent airway early and consider early ET intubation.
●Oxygenate and ventilate.
●Obtain ABGs and CO levels.
Assessment and Management
●Carbonaceous sputum
●Carbon deposits
●CoHb > 10%
●Face and neck burns
●Hair singeing
●Inflamed oropharynx and hoarseness
How do I identify inhalation injury?
Assessment and Management
●Adequate venous access
●Monitor vital signs
●Hourly urine output●Adult: 0.5 – 1.0 mL / kg / hour
●Child: 1.0 mL / kg / hour
● Infant: 2.0 mL / kg / hour
Maintain Organ Perfusion
Assessment and Management
●4 mL warmed balanced crystalloid solution / kg / %BSA in first 24 hours (global only)
●Administer ½ in first 8 hours
●Administer ½ in next 16 hours
●Base calculations on time from injury
●Monitor heart rate and urinary output
What is the rate and type of fluids administered to patients with burns?
Assessment and Management
●AMPLE history
●Tetanus status
Other Information
Other Management●Baseline blood analyses and chest
x-ray
●Gastric intubation
●Narcotic analgesia
●Antibiotics
●Wound care
●Flow sheet documentation
Assessment and Management
Flush with copious amounts of water for 20 – 30 minutes
Management of Chemical Burns
Assessment and Management
Management of Electrical Burns
●Fascia and muscle damage; may spare overlying skin
●Myoglobinuria: Increase fluids, administer mannitol
●Maintain adequate perfusion
●Sodium bicarbonate
Transfer Criteria
Transfer Criteria for Second-Degree and Third-Degree Burns
●> 10% BSA in ages < 10 and > 50 years
●20% BSA (all ages)
●Unique areas (any size burn)●Face
●Eyes
●Ears
●Hands
●Feet
●Genitalia
●Perineum
●Major joints
Transfer Criteria
Transfer Criteria for Second-Degree and Third-Degree Burns
●Third-degree burns > 5% BSA (all ages)
●Electrical and chemical burns
●Inhalation injury
●Preexisting illnesses, associated injuries
●Children
●Special situations
Transfer Procedures
●Coordinate with burn center physician
●Transfer with:
● Documentation / information
● Laboratory results
Case Scenario
● A 72-year-old female is found lying in her garden outside her back door.
● It is winter, and the outside temperature is just above freezing.
● The patient’s right leg is shortened and externally rotated.
● She appears confused.
What factors should you consider in her early management?
Objectives
● Outline the principles of initial assessment and treatment of localized and systemic cold injuries.
● Identify special problems and methods of treatment.
● Discuss the importance of hypothermia in the resuscitation of the injured patient.
Local Tissue Effects
● Temperature
● Duration of exposure
● Environmental conditions
How does cold affect my patient?
●Immobilization
●Moisture
●Vascular disease
●Open wound
Treatment
● Do not delay
● Remove clothing
● Warmed blankets
● Rewarm frozen part
● Preserve damaged tissue
How do I treat a local cold injury?
●Prevent infection
●Elevate exposed part
●Analgesics, tetanus, and antibiotics
Recognition
● Rapid or slow drop in core temperature to < 35°C
● Elderly and children at greater risk
● Low-range thermometer required
How do I recognize hypothermia?
Recognition
How do I recognize hypothermia?
What are the clinical findings associated with hypothermia?
Recognition
● Depressed level of consciousness
● Gray, cyanotic
● Variable vital signs
● Absence of cardiorespiratory activity
How do I recognize hypothermia?
What are the clinical findings associated with hypothermia?
Treatment
● ABCDE
● Rewarm
● Assess for associated disorders
● Blood analyses, including K+ and Ca++
How do I treat a systemic cold injury?
Treatment
● Passive external rewarming: Warmed environment, blankets, and IV fluids
● Active core rewarming: Surgical rewarming techniques
● Do not delay transfer
Treatment of Hypothermia
Not dead until warm and dead
Summary
●Recognize and treat inhalation injury
●Appropriate fluid resuscitation
●Early identification of burn injuries requiring transfer
Burn Injuries
Recommended