BURN , COLD INJURY - PowerPoint PPT Presentation

Loading...

PPT – BURN , COLD INJURY PowerPoint presentation | free to view - id: 7f4f2-NTZmY



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

BURN , COLD INJURY

Description:

Estimate burn size, and determine presence of associated injuries. ... 2nd, 3rd degree burns to face, eyes, ears, hands, feet, genitalia, perineum, and ... – PowerPoint PPT presentation

Number of Views:374
Avg rating:3.0/5.0
Slides: 48
Provided by: elcSk
Category:
Tags: burn | cold | injury | burns

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: BURN , COLD INJURY


1
BURN , COLD INJURY
  • 90-02-24
  • ?????
  • ??? ??

2
  • INJURY DUE TO BURN AND COLD

3
OBJECTIVES
  • Estimate burn size, and determine presence of
    associated injuries.
  • Outline innitial stabilization, treatment
    measures, and transfer criteria.
  • Identify special problems and methods of
    treatment.

4
BURN / COLD INJURIES
  • Management Principles
  • Timely application
  • Maintain
  • Airway
  • Hemodynamic stability
  • Fluid / electrolyte balance
  • Normal body temperature
  • Prevent complications

5
  • Injury Due To Burn

6
LIFE-SAVING MEASURES
  • Establish airway
  • Identify signs of distress
  • Initiate supportive measures
  • Obtain history

7
  • CLINICAL INDICATIONS
  • Carbonaceous sputum
  • Facial burns
  • Hair singeing
  • Carbon deposites
  • Inflamed oropharynx
  • History
  • Inhalation Injury

8
LIFE-SAVING MEASURES
  • Remove all
  • Injurious material
  • Clothing, jewelry
  • Prevent hypothermia
  • Two, large-caliber Ivs
  • Ringers lactate

9
ASSESSMENT
  • History
  • Mechanism of ijury
  • Associated illness
  • Allergies
  • Tetanus status

10
  • Rule of Nines

11
ASSESSMENT
  • Estimate Burn Size
  • Surface of patients palm represents 1 body
    surface area

12
  • Second-degree Burn

13
  • Third-degree Burn

14
MANAGEMENT
  • Airway
  • Assess for injury
  • Establish and maintain patient airway early

15
  • Inhalation Injury
  • Early Management

16
MANAGEMENT
  • Breathing
  • Assume CO exposure
  • Inhalation of toxic fumes or carbon particles
  • Direct thermal injury

17
MANAGEMENT
  • Breathing
  • Oxygen / ventilate
  • Endotracheal intubation
  • ABGs
  • Carboxyhemoglobin levels

18
MANAGEMENT
  • Circulation
  • Monitor vital signs
  • Hourly urinary outputs
  • Adult 30 50 mL / hr
  • Child 1.0 mL / kg / hr

19
MANAGEMENT
  • Circulation Estimate of Fluid Needs
  • 2 4 mL Ringers lactate / kg / BSA in first
    24 hours
  • One-half in first 8 hours
  • One-half in next 16 hours
  • Based on time from injury
  • Monitor patient response

20
MANAGEMENT
  • Develop Treatment plan
  • Estimate burn size / depth
  • Identify associated injuries
  • Weigh patient
  • Baseline blood analyses
  • Chest films
  • Document on flow sheet

21
MANAGEMENT
  • Maintain Peripheral Circulation
  • Remove all connstricting devices
  • Assess distal circulation
  • Escharotomy surgical consultation

22
Escharotomy Sites
23
Escharotomy
24
MANAGEMENT
  • Nasogastric Intubation
  • Nausea, vomiting, distention
  • Burn gt 20 BSA
  • Medications
  • Narcotics Spare use, IV only
  • Antibiotics Not indicated early

25
MANAGEMENT
  • Wound Care
  • Cover with clean linen
  • Do not
  • Break blisters
  • Apply antiseptics
  • Apply cold water

26
MANAGEMENT
  • Acid / Alkali Burns
  • Duration, concentration, and amount
  • Flush with copious amount of water for 20 30
    minutes
  • Brush away dry chemical before irrigation

27
Chemical Burns
28
Fasciotomy Electrical Burn
  • Electrical burn result in damage to the fascia
    and muscle, and may spare the overlying skin

29
MANAGEMENT
  • Electrical Burn
  • ABCs
  • Myoglobinuria
  • ?Fluid 100 mL urine / hr
  • Mannitol 25 g IV
  • Metabolic acidosis
  • Maintain adequate perfusion
  • Sodium Bicarbonate

30
TRANSFER CRITERIA
  • 2nd, 3rd degree burns gt 10 BSA in age lt 10 and gt
    50 years
  • 2nd, 3rd degree burns gt 20 BSA
  • 2nd, 3rd degree burns to face, eyes, ears, hands,
    feet, genitalia, perineum, and major loints

31
TRANSFER CRITERIA
  • 3rd degree burns gt 5 BSA
  • Electrical and chemical burns
  • Inhalation injury
  • Pre-existing illness, associated injuries
  • Children
  • Special situations

32
TRANSFER PROCEDURE
  • Coordinate with burn-center physician
  • Transfer with all
  • Documentation / information
  • Laboratory results

33
Injury Due To Cold
34
COLD INJURY FACTORS
  • Temperature
  • Duration of exposure
  • Enviromental conditions
  • Immobilizzation
  • Moisture
  • Vascular disease
  • Open wounds

35
TISSUE-FREEZING INJURY FROSTBITE
  • 1st Degree Hyperemia, edema
  • 2nd Degree Vesicles, parttial-thickness
  • skin necrosis
  • 3rd Degree Full-thickness skin necrosis
  • 4th Degree Skin, muscle, bone necrosis

36
Second-degree Frostbite
37
Fourth-degree Frostbite
38
MANAGEMENT
  • Do nor delay
  • Remove clothing
  • Warmed blankets
  • Rewarm frozen part

39
MANAGEMENT
  • Preserve damaged tissue
  • Prevent infection
  • Elevate and expose injured part
  • Analgesics / tetanus / antibiotics

40
HYPOTHERMIA
  • Core temperature lt 35 degrees
  • Rapid / slow drop in core temperature
  • Elderly and children at greater risk
  • Low-range thermometer required

41
HYPOTHERMIA
  • Clinical Findings
  • Core temperature lt 35 degrees
  • Depressed level of consciousness
  • Gray, cyanotic, variable vital signs
  • Absence of cardiorespiratory activity

42
MANAGEMENT
  • ABCs, IV access
  • Oxygenate and ventilate
  • Prevent heat loss and rewarm
  • Assess for associated disorders
  • Blood analyses

43
MANAGEMEN
  • Passive External Rewarming
  • Warm enviroment
  • Warmed blankets and IV fluids
  • Active Core Rewarming
  • Surgical rewarming techniques
  • Do not delay transfer
  • Not dead until warm and dead

44
?
45
SUMMARY
  • Burn Injury
  • Recognize inhalation injury
  • Establish airway
  • Fluid resuscitation
  • Rremove all clothing

46
SUMMARY
  • Burn Injury
  • Identify extend, depth of burn
  • Establish fluid guidelines
  • Initiate burn flow sheet
  • Obtain baseline lab / radiology
  • Maintain peripheral circulation
  • Identify burns requiring transfer

47
SUMMARY
  • Cold Injury
  • Diagnose type
  • History
  • Clinical finding
  • Measure core temperature
  • Rewarming techniques
  • Monitor and support vital signs
About PowerShow.com