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Burn Cold Injury
Burn Cold Injury
Burn Cold Injury
Burn Cold Injury
Burn Cold Injury
Burn Cold Injury
Burn Cold Injury
Burn Cold Injury
Burn Cold Injury
Burn Cold Injury
Burn Cold Injury
Burn Cold Injury
Burn Cold Injury
Burn Cold Injury
Burn Cold Injury
Burn Cold Injury
Burn Cold Injury
Burn Cold Injury
Burn Cold Injury
Burn Cold Injury
Burn Cold Injury
Burn Cold Injury
Burn Cold Injury
Burn Cold Injury
Burn Cold Injury
Burn Cold Injury
Burn Cold Injury
Burn Cold Injury
Burn Cold Injury
Burn Cold Injury
Burn Cold Injury
Burn Cold Injury
Burn Cold Injury
Burn Cold Injury
Burn Cold Injury
Burn Cold Injury
Burn Cold Injury
Burn Cold Injury
Burn Cold Injury
Burn Cold Injury
Burn Cold Injury
Burn Cold Injury
Burn Cold Injury
Burn Cold Injury
Burn Cold Injury
Burn Cold Injury
Burn Cold Injury
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Burn Cold Injury

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INJURY DUE TO BURN AND COLD

INJURY DUE TO BURN AND COLD

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  • 1. BURN , COLD INJURY
  • 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
    • Ringer’s lactate
  • 9. ASSESSMENT
    • History
      • Mechanism of ijury
      • Associated illness
      • Allergies
      • Tetanus status
  • 10.
    • Rule of Nines
  • 11. ASSESSMENT
    • Estimate Burn Size
      • Surface of patient’s 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 Ringer’s 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 > 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 > 10% BSA in age < 10 and > 50 years
    • 2nd, 3rd degree burns > 20% BSA
    • 2nd, 3rd degree burns to face, eyes, ears, hands, feet, genitalia, perineum, and major loints
  • 31. TRANSFER CRITERIA
    • 3rd degree burns > 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 < 35 degrees
    • Rapid / slow drop in core temperature
    • Elderly and children at greater risk
    • Low-range thermometer required
  • 41. HYPOTHERMIA
    • Clinical Findings
      • Core temperature < 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

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