1) Electrical injuries can cause severe tissue destruction and require aggressive fluid resuscitation and monitoring for complications like myoglobinuria and compartment syndrome.
2) For high-voltage injuries, early surgical debridement may be needed to remove necrotic tissue and reduce risks of organ dysfunction. Further debridement over subsequent days may also be required.
3) Electrical contact sites often have deeper tissue damage than apparent from external burns. Exposed bones and muscles may require debridement to remove non-viable tissue. The goal is to conserve salvageable tissue while removing dead tissue.
This document discusses various environmental emergencies, beginning with snake envenomations. It provides statistics on snake bites in the US and describes the clinical effects of different snake species. It discusses the signs and symptoms of envenomation as well as the treatment, including antivenin administration. It also covers spider bites from black widows and brown recluses. For marine envenomations, it describes jellyfish and echinoderm stings and their treatments. It concludes with sections on drowning, discussing the pathophysiology and emphasizing the importance of immediate resuscitation.
An electrical injury occurs when an electric current passes through the body, interfering with organ function or burning tissue. The type and severity of damage depends on factors like current type (AC vs DC), voltage, resistance, duration, and pathway. AC current is generally more dangerous than DC as it can cause cardiac arrhythmias. Electrical injuries require aggressive fluid resuscitation to prevent complications like renal failure. Management involves stabilizing vital functions and treating burns based on their depth and extent. Prognosis depends on the severity and site of injury.
This document provides an overview of environmental emergencies, including thermal injuries, burns, electrical injuries, hypothermia, frostbite, and heat-related illness. It discusses the epidemiology, presentation, assessment, treatment, and management of these conditions. Key points include that burns can be classified based on depth and size, inhalation injury increases mortality, and fluid resuscitation follows the Parkland formula. Hypothermia ranges from mild to severe based on core temperature, with cardiovascular and neurological impacts. Rewarming techniques include passive external rewarming and active external or internal rewarming depending on severity.
The document summarizes the pathophysiology of burns in three phases. The initial ebb phase occurs in the first 24 hours and involves hypotension, low cardiac output, and hypoventilation. The flow phase follows and involves increases in cardiac output and oxygen consumption. A hypermetabolic hyperdynamic response peaks at 10-14 days. Systemic effects include metabolic, cardiac, renal, blood, immunologic, lung, GI, and infectious responses. Burn-induced inflammatory mediators cause widespread vascular permeability and organ dysfunction. Successful resuscitation is needed to avoid multi-organ failure from hypovolemia and infection risk due to impaired immunity and skin barrier function.
This document discusses burns, including types, fluid considerations, nursing priorities, assessments, determining severity, depth of burns, treatment, and fluid resuscitation formulas for the first and second 24 hours. Burns can cause fluid shifts and hemoconcentration. Nursing priorities include maintaining airway, assessing respiratory and circulatory status, and determining burn severity using the rule of nines. Treatment focuses on respiratory status, wound care, pain management, infection prevention, and nutrition. Fluid resuscitation formulas are provided to guide fluid administration.
Burns are caused by direct contact with or exposure to thermal, chemical, electrical or radiation sources. The document discusses the classification, pathophysiology and clinical manifestations of burns. It covers the different types of burns according to etiology, depth and severity. Assessment methods like the Rule of Nine and Palm Method are also described. Common signs include pain, fluid loss, edema, respiratory issues and potential psychological impacts.
This document provides an overview of burns, including definitions, classifications, pathophysiology, management, and complications. It defines burns as thermal injuries to the skin and tissues. Burns are classified based on depth and extent of damage. First, second, and third degree burns are described. Hospitalization is generally recommended for burns over 10% of total body surface area. The pathophysiology involves fluid shifts, cardiac, metabolic, immunologic, and renal effects. Burn management includes airway control, fluid resuscitation, wound care, infection prevention, pain relief, and nutrition. Complications can include shock, infection, renal failure, and scarring.
WARNING: VERY VISUAL PRESENTATION. My first presentation on burns and their various medical, surgical and nursing interventions. It's a total crash course. Pardon me for forgetting the references. PS: All images are from Google.
This document discusses various environmental emergencies, beginning with snake envenomations. It provides statistics on snake bites in the US and describes the clinical effects of different snake species. It discusses the signs and symptoms of envenomation as well as the treatment, including antivenin administration. It also covers spider bites from black widows and brown recluses. For marine envenomations, it describes jellyfish and echinoderm stings and their treatments. It concludes with sections on drowning, discussing the pathophysiology and emphasizing the importance of immediate resuscitation.
An electrical injury occurs when an electric current passes through the body, interfering with organ function or burning tissue. The type and severity of damage depends on factors like current type (AC vs DC), voltage, resistance, duration, and pathway. AC current is generally more dangerous than DC as it can cause cardiac arrhythmias. Electrical injuries require aggressive fluid resuscitation to prevent complications like renal failure. Management involves stabilizing vital functions and treating burns based on their depth and extent. Prognosis depends on the severity and site of injury.
This document provides an overview of environmental emergencies, including thermal injuries, burns, electrical injuries, hypothermia, frostbite, and heat-related illness. It discusses the epidemiology, presentation, assessment, treatment, and management of these conditions. Key points include that burns can be classified based on depth and size, inhalation injury increases mortality, and fluid resuscitation follows the Parkland formula. Hypothermia ranges from mild to severe based on core temperature, with cardiovascular and neurological impacts. Rewarming techniques include passive external rewarming and active external or internal rewarming depending on severity.
The document summarizes the pathophysiology of burns in three phases. The initial ebb phase occurs in the first 24 hours and involves hypotension, low cardiac output, and hypoventilation. The flow phase follows and involves increases in cardiac output and oxygen consumption. A hypermetabolic hyperdynamic response peaks at 10-14 days. Systemic effects include metabolic, cardiac, renal, blood, immunologic, lung, GI, and infectious responses. Burn-induced inflammatory mediators cause widespread vascular permeability and organ dysfunction. Successful resuscitation is needed to avoid multi-organ failure from hypovolemia and infection risk due to impaired immunity and skin barrier function.
This document discusses burns, including types, fluid considerations, nursing priorities, assessments, determining severity, depth of burns, treatment, and fluid resuscitation formulas for the first and second 24 hours. Burns can cause fluid shifts and hemoconcentration. Nursing priorities include maintaining airway, assessing respiratory and circulatory status, and determining burn severity using the rule of nines. Treatment focuses on respiratory status, wound care, pain management, infection prevention, and nutrition. Fluid resuscitation formulas are provided to guide fluid administration.
Burns are caused by direct contact with or exposure to thermal, chemical, electrical or radiation sources. The document discusses the classification, pathophysiology and clinical manifestations of burns. It covers the different types of burns according to etiology, depth and severity. Assessment methods like the Rule of Nine and Palm Method are also described. Common signs include pain, fluid loss, edema, respiratory issues and potential psychological impacts.
This document provides an overview of burns, including definitions, classifications, pathophysiology, management, and complications. It defines burns as thermal injuries to the skin and tissues. Burns are classified based on depth and extent of damage. First, second, and third degree burns are described. Hospitalization is generally recommended for burns over 10% of total body surface area. The pathophysiology involves fluid shifts, cardiac, metabolic, immunologic, and renal effects. Burn management includes airway control, fluid resuscitation, wound care, infection prevention, pain relief, and nutrition. Complications can include shock, infection, renal failure, and scarring.
WARNING: VERY VISUAL PRESENTATION. My first presentation on burns and their various medical, surgical and nursing interventions. It's a total crash course. Pardon me for forgetting the references. PS: All images are from Google.
The document discusses the structured approach to presenting burn cases including relevant anatomy, classification of burns, complications affecting various organ systems, and the three phases of burn management with a focus on the priorities in the resuscitative phase including airway management, breathing, circulation, fluid resuscitation, and endpoints of successful resuscitation. Specific formulas for fluid resuscitation and indications for endotracheal intubation are also outlined.
Burns Fluid Resuscitation
The first 24 hours for burns management is crucial.
The ability to deliver just the right amount of fluid in a patient with burns is the holy grail.
From #CodaZero Claire Seiffert presents on Burns Fluid Resuscitation.
Claire covers fluid overloaded with compartment syndrome, to underdone with an AKI and extension of burns.
This short update will provide an overview of how to achieve the “just right” fluid balance and targets for resuscitation, ultimately enhancing patient outcomes.
This document provides guidelines for the initial management of burn injuries including from fire, electricity, and lightning. It discusses assessing the airway, breathing, circulation, disability, and exposure (ABCDE). Burns should be classified by depth (superficial, partial-thickness, full-thickness) and total body surface area calculated. Fluid resuscitation is based on the Parkland formula. Electrical injuries can cause cardiac issues so monitoring is recommended for certain criteria. Patients meeting referral criteria based on burn depth, size, or location should be referred to a burn center.
Shock is a physiological state characterized by a significant systemic reduction in perfusion resulting in decreased tissue oxygen delivery. The causes of shock include hypovolumic, cardiogenic, neurogenic, anaphylactic, septic, and obstructive shock. The management of shock involves initial assessment of vital signs, resuscitation focusing on airway, breathing, and circulation, urgent investigation to identify the underlying cause, and appropriate treatment of the cause such as fluids for hypovolumic shock, inotropes for septic shock, and adrenaline with antihistamines for anaphylactic shock. The mortality from septic and cardiogenic shock remains high.
Every year children are involved in accidents or born with conditions requiring specialized medical care. Shriners Hospitals for Children in Cincinnati treats burn injuries, including providing comprehensive care regardless of ability to pay. In the US, there are about 486,000 burn injuries annually requiring medical attention and 3,275 deaths. The most common causes of burns are fire/flame, scalds, and hot object contact. Burn severity is based on the percentage of total body surface area affected and depth of the burn, with deeper burns having more serious effects on the body. Initial clinical effects include fluid shifts between body compartments that can cause hypovolemia, acid-base imbalances, and respiratory issues.
1) Burns can result from direct contact with flames, hot liquids, gases, chemicals, electricity, or radiation. They cause tissue injuries by denaturing proteins.
2) Burn injuries affect the skin, which acts as a protective barrier and regulates temperature and fluid balance. Deeper burns extend beyond the epidermis into the dermis.
3) Proper evaluation and treatment of burn injuries requires assessing burn depth, size, inhalation injury, and associated complications affecting various organ systems. Early fluid resuscitation is critical.
This document provides information on burns and sudden death. It defines burns and classifies them based on depth. It describes the pathophysiology of burns including effects on the skin, cardiovascular, renal and immune systems. Common causes of burns and initial first aid measures are outlined. Criteria for hospitalization, standard hospital management including fluid resuscitation and infection control are summarized. Complications of burns and causes of sudden death involving various body systems like cardiovascular, respiratory and gastrointestinal are also reviewed.
The document provides guidance on the initial management of burns in pediatric critical care. It discusses the key points regarding airway, breathing, and circulation. For the airway, early intubation may be needed due to inhalational injury and potential airway edema. For breathing, patients require oxygen and may need ventilation support due to chest wall compliance issues or lung injury from smoke inhalation. Signs of inhalational injury include findings in the upper and lower respiratory tract. For circulation, fluid resuscitation is crucial using the modified Parkland formula and frequent re-evaluation is needed due to the risk of shock.
This document provides information on burn depth classification and burn severity. It discusses:
1. Classification of burn depth from first to fourth degree based on the extent of skin layer involvement and expected healing time. Second degree burns are divided into superficial and deep partial thickness burns.
2. Factors used to determine burn severity including total body surface area (TBSA) affected, location of burns, and presence of inhalation injuries. Minor burns affect less than 15% TBSA while major burns affect over 25% TBSA or involve special areas.
3. Common causes, presentations, and complications of different types of burns including thermal, chemical, electrical and inhalation injuries. Inhalation injuries can cause pulmonary
Carbon monoxide poisoning by dr Yasser DiabYasser Diab
This document describes two cases of carbon monoxide poisoning. In the first case, a 67-year-old man was admitted to the hospital multiple times with symptoms before being diagnosed with carbon monoxide poisoning from a faulty furnace. His wife also had carbon monoxide poisoning. In the second case, a 69-year-old man was admitted to the hospital with confusion and other symptoms, and his sister and daughter-in-law later came to the emergency room with carbon monoxide poisoning from his faulty water heater. The document then provides details on carbon monoxide, sources, effects on the body, signs and symptoms, treatment, and differential diagnosis.
1) Burns can result from heat, chemicals, electricity, or radiation and cause damage to the skin and underlying tissues. The very young, old, and careless are at high risk of severe burns.
2) Initial burn management involves assessing the airway, giving oxygen, establishing IV access, giving fluids resuscitation based on the Parkland formula, monitoring vitals and urine output, and giving pain medications.
3) Providing anesthesia for burn patients poses challenges due to potential airway issues, pulmonary insufficiency, fluid shifts, and altered drug metabolism. Careful attention to the airway, adequate vascular access and fluid resuscitation, temperature control, and effects of medications are important.
This document discusses the pathophysiology and immediate care of burn injuries. It covers how burns damage the skin and can also affect the airway/lungs through inhalation of hot gases. Major metabolic effects include carbon monoxide poisoning and circulatory changes like fluid shifts from blood vessels into burned tissue. Immediate care focuses on airway control, respiratory support, fluid resuscitation based on burn size, and wound assessment to determine depth. Superficial and deep partial thickness burns may heal on their own while full thickness burns require skin grafts.
Burns are caused by thermal injury and result in skin and tissue damage. They are classified by depth and extent of body surface area affected. Common types include scalds, flames, chemicals, electricity, and radiation. Management involves assessing airway/breathing, fluid resuscitation to prevent shock, wound care, pain relief, and infection control. Resuscitation aims to stabilize the patient and replace fluid losses using formulas like Parkland or Brooke, followed by acute wound management and later rehabilitation.
Pediatric burn injuries require specialized management due to children having limited physiologic reserves. Scald burns are most common in young children and abuse must be ruled out. Fluid resuscitation follows the Parkland formula and aims to maintain blood pressure, heart rate, and urine output. Wounds are debrided and covered to prevent infection while excision and grafting are used for deeper burns. Inhalation injuries require pulmonary support and burn patients are at high risk for infections due to immunosuppression. Hypermetabolism persists for months requiring aggressive calorie and protein supplementation.
The document provides information on burn injuries, including definitions, types, classifications, and management. It discusses that burns are caused by heat, chemicals, electricity or radiation and injure the skin and underlying tissue. The incidence of burns is high in India, especially among young females and children. Burns are classified based on depth and percentage of total body surface area affected. Management involves emergent care like airway management, fluid resuscitation, wound care and prevention of infection. The goal in the initial period is to prevent shock and organ dysfunction until fluid mobilization begins.
This document provides information on burns, including definitions, types, classification, pathophysiology, assessment, and management. It defines burns as thermal injuries to the skin and tissues. Burns are classified based on depth and extent of damage. First and second degree burns involve the epidermis and dermis, while third degree burns extend deeper. Burn severity is also classified according to percentage of total body surface area affected. Management involves fluid resuscitation, wound care, pain control, and nutrition support. Complications can impact various organ systems. The goal is to prevent infection, contractures, and other issues through proper acute care and rehabilitation.
This document provides information on nursing management of patients with burns. It discusses assessment of burns including determining burn depth, size, and severity. It outlines management of minor burns including cleaning, dressing, and ensuring analgesia. Management of major burns involves establishing airway, ensuring breathing and circulation, administering intravenous fluids, and transferring patients to a burn center for specialized care. Immediate steps include stopping the burning process, assessing for inhalation injuries, and providing fluid resuscitation.
This document summarizes various environmental emergencies and injuries. It discusses electrical injuries including types of current, mechanisms of injury, cutaneous injuries, musculoskeletal injuries, and complications. It also covers high altitude illnesses like acute mountain sickness and pulmonary edema. Diving injuries like decompression sickness, air embolism, and barotrauma are explained. Radiation injuries, animal bites, snake envenomations, and spider bites are also summarized. For each topic, the document discusses signs, symptoms, diagnosis, and management.
- Burns and scalds account for 6% of pediatric injuries, most commonly affecting preschool-aged children through hot drinks, baths, and cooking oils. House fires are a major cause of fatal burns through smoke inhalation.
- The severity of the burn is related to the temperature and duration of contact - even low temperatures can cause damage with prolonged exposure. Burns are classified as partial thickness, deep partial thickness, or full thickness depending on the depth of tissue damage.
- Burn assessment tools like the Rule of Nines and Lund & Browder chart are used to estimate the percentage of total body surface area burned to guide management. Large burns require extensive resuscitation, wound care, surgery, nutrition support,
1) Environmental emergencies can involve submersion, hypothermia, or hyperthermia. Submersion can cause drowning or near-drowning through asphyxiation or laryngospasm.
2) Hypothermia occurs when the body loses heat faster than it can produce it, leading to a core body temperature below 95°F. It has mild, moderate, and severe stages associated with different symptoms. Rewarming methods range from passive to active external to active internal depending on severity.
3) Hyperthermia is elevated body temperature due to failed thermoregulation, usually from environmental factors like heat or humidity that prevent cooling. It progresses from heat cramps to
- Burn shock is driven by derangements in microvascular permeability and pressure caused by inflammatory mediators released after injury. Over-resuscitation can lead to complications like orbital compartment syndrome, extremity compartment syndrome, abdominal compartment syndrome, and acute respiratory distress syndrome due to fluid shifts and increased pressures. Modern resuscitation aims to optimize fluid delivery through monitoring and use of adjuncts like colloids to reduce complications from excessive fluids.
The document discusses sepsis and the importance of early recognition and treatment. It outlines the sepsis screening criteria and bundles that should be implemented, including lactate measurement, IV fluids, antibiotics within 1 hour, and hemodynamic monitoring to guide resuscitation. The 3-hour and 6-hour bundles are aimed at rapid restoration of tissue perfusion and prevention of organ dysfunction to reduce mortality in patients with severe sepsis or septic shock. Early goal-directed therapy and completion of bundles within time targets are emphasized.
The document discusses the structured approach to presenting burn cases including relevant anatomy, classification of burns, complications affecting various organ systems, and the three phases of burn management with a focus on the priorities in the resuscitative phase including airway management, breathing, circulation, fluid resuscitation, and endpoints of successful resuscitation. Specific formulas for fluid resuscitation and indications for endotracheal intubation are also outlined.
Burns Fluid Resuscitation
The first 24 hours for burns management is crucial.
The ability to deliver just the right amount of fluid in a patient with burns is the holy grail.
From #CodaZero Claire Seiffert presents on Burns Fluid Resuscitation.
Claire covers fluid overloaded with compartment syndrome, to underdone with an AKI and extension of burns.
This short update will provide an overview of how to achieve the “just right” fluid balance and targets for resuscitation, ultimately enhancing patient outcomes.
This document provides guidelines for the initial management of burn injuries including from fire, electricity, and lightning. It discusses assessing the airway, breathing, circulation, disability, and exposure (ABCDE). Burns should be classified by depth (superficial, partial-thickness, full-thickness) and total body surface area calculated. Fluid resuscitation is based on the Parkland formula. Electrical injuries can cause cardiac issues so monitoring is recommended for certain criteria. Patients meeting referral criteria based on burn depth, size, or location should be referred to a burn center.
Shock is a physiological state characterized by a significant systemic reduction in perfusion resulting in decreased tissue oxygen delivery. The causes of shock include hypovolumic, cardiogenic, neurogenic, anaphylactic, septic, and obstructive shock. The management of shock involves initial assessment of vital signs, resuscitation focusing on airway, breathing, and circulation, urgent investigation to identify the underlying cause, and appropriate treatment of the cause such as fluids for hypovolumic shock, inotropes for septic shock, and adrenaline with antihistamines for anaphylactic shock. The mortality from septic and cardiogenic shock remains high.
Every year children are involved in accidents or born with conditions requiring specialized medical care. Shriners Hospitals for Children in Cincinnati treats burn injuries, including providing comprehensive care regardless of ability to pay. In the US, there are about 486,000 burn injuries annually requiring medical attention and 3,275 deaths. The most common causes of burns are fire/flame, scalds, and hot object contact. Burn severity is based on the percentage of total body surface area affected and depth of the burn, with deeper burns having more serious effects on the body. Initial clinical effects include fluid shifts between body compartments that can cause hypovolemia, acid-base imbalances, and respiratory issues.
1) Burns can result from direct contact with flames, hot liquids, gases, chemicals, electricity, or radiation. They cause tissue injuries by denaturing proteins.
2) Burn injuries affect the skin, which acts as a protective barrier and regulates temperature and fluid balance. Deeper burns extend beyond the epidermis into the dermis.
3) Proper evaluation and treatment of burn injuries requires assessing burn depth, size, inhalation injury, and associated complications affecting various organ systems. Early fluid resuscitation is critical.
This document provides information on burns and sudden death. It defines burns and classifies them based on depth. It describes the pathophysiology of burns including effects on the skin, cardiovascular, renal and immune systems. Common causes of burns and initial first aid measures are outlined. Criteria for hospitalization, standard hospital management including fluid resuscitation and infection control are summarized. Complications of burns and causes of sudden death involving various body systems like cardiovascular, respiratory and gastrointestinal are also reviewed.
The document provides guidance on the initial management of burns in pediatric critical care. It discusses the key points regarding airway, breathing, and circulation. For the airway, early intubation may be needed due to inhalational injury and potential airway edema. For breathing, patients require oxygen and may need ventilation support due to chest wall compliance issues or lung injury from smoke inhalation. Signs of inhalational injury include findings in the upper and lower respiratory tract. For circulation, fluid resuscitation is crucial using the modified Parkland formula and frequent re-evaluation is needed due to the risk of shock.
This document provides information on burn depth classification and burn severity. It discusses:
1. Classification of burn depth from first to fourth degree based on the extent of skin layer involvement and expected healing time. Second degree burns are divided into superficial and deep partial thickness burns.
2. Factors used to determine burn severity including total body surface area (TBSA) affected, location of burns, and presence of inhalation injuries. Minor burns affect less than 15% TBSA while major burns affect over 25% TBSA or involve special areas.
3. Common causes, presentations, and complications of different types of burns including thermal, chemical, electrical and inhalation injuries. Inhalation injuries can cause pulmonary
Carbon monoxide poisoning by dr Yasser DiabYasser Diab
This document describes two cases of carbon monoxide poisoning. In the first case, a 67-year-old man was admitted to the hospital multiple times with symptoms before being diagnosed with carbon monoxide poisoning from a faulty furnace. His wife also had carbon monoxide poisoning. In the second case, a 69-year-old man was admitted to the hospital with confusion and other symptoms, and his sister and daughter-in-law later came to the emergency room with carbon monoxide poisoning from his faulty water heater. The document then provides details on carbon monoxide, sources, effects on the body, signs and symptoms, treatment, and differential diagnosis.
1) Burns can result from heat, chemicals, electricity, or radiation and cause damage to the skin and underlying tissues. The very young, old, and careless are at high risk of severe burns.
2) Initial burn management involves assessing the airway, giving oxygen, establishing IV access, giving fluids resuscitation based on the Parkland formula, monitoring vitals and urine output, and giving pain medications.
3) Providing anesthesia for burn patients poses challenges due to potential airway issues, pulmonary insufficiency, fluid shifts, and altered drug metabolism. Careful attention to the airway, adequate vascular access and fluid resuscitation, temperature control, and effects of medications are important.
This document discusses the pathophysiology and immediate care of burn injuries. It covers how burns damage the skin and can also affect the airway/lungs through inhalation of hot gases. Major metabolic effects include carbon monoxide poisoning and circulatory changes like fluid shifts from blood vessels into burned tissue. Immediate care focuses on airway control, respiratory support, fluid resuscitation based on burn size, and wound assessment to determine depth. Superficial and deep partial thickness burns may heal on their own while full thickness burns require skin grafts.
Burns are caused by thermal injury and result in skin and tissue damage. They are classified by depth and extent of body surface area affected. Common types include scalds, flames, chemicals, electricity, and radiation. Management involves assessing airway/breathing, fluid resuscitation to prevent shock, wound care, pain relief, and infection control. Resuscitation aims to stabilize the patient and replace fluid losses using formulas like Parkland or Brooke, followed by acute wound management and later rehabilitation.
Pediatric burn injuries require specialized management due to children having limited physiologic reserves. Scald burns are most common in young children and abuse must be ruled out. Fluid resuscitation follows the Parkland formula and aims to maintain blood pressure, heart rate, and urine output. Wounds are debrided and covered to prevent infection while excision and grafting are used for deeper burns. Inhalation injuries require pulmonary support and burn patients are at high risk for infections due to immunosuppression. Hypermetabolism persists for months requiring aggressive calorie and protein supplementation.
The document provides information on burn injuries, including definitions, types, classifications, and management. It discusses that burns are caused by heat, chemicals, electricity or radiation and injure the skin and underlying tissue. The incidence of burns is high in India, especially among young females and children. Burns are classified based on depth and percentage of total body surface area affected. Management involves emergent care like airway management, fluid resuscitation, wound care and prevention of infection. The goal in the initial period is to prevent shock and organ dysfunction until fluid mobilization begins.
This document provides information on burns, including definitions, types, classification, pathophysiology, assessment, and management. It defines burns as thermal injuries to the skin and tissues. Burns are classified based on depth and extent of damage. First and second degree burns involve the epidermis and dermis, while third degree burns extend deeper. Burn severity is also classified according to percentage of total body surface area affected. Management involves fluid resuscitation, wound care, pain control, and nutrition support. Complications can impact various organ systems. The goal is to prevent infection, contractures, and other issues through proper acute care and rehabilitation.
This document provides information on nursing management of patients with burns. It discusses assessment of burns including determining burn depth, size, and severity. It outlines management of minor burns including cleaning, dressing, and ensuring analgesia. Management of major burns involves establishing airway, ensuring breathing and circulation, administering intravenous fluids, and transferring patients to a burn center for specialized care. Immediate steps include stopping the burning process, assessing for inhalation injuries, and providing fluid resuscitation.
This document summarizes various environmental emergencies and injuries. It discusses electrical injuries including types of current, mechanisms of injury, cutaneous injuries, musculoskeletal injuries, and complications. It also covers high altitude illnesses like acute mountain sickness and pulmonary edema. Diving injuries like decompression sickness, air embolism, and barotrauma are explained. Radiation injuries, animal bites, snake envenomations, and spider bites are also summarized. For each topic, the document discusses signs, symptoms, diagnosis, and management.
- Burns and scalds account for 6% of pediatric injuries, most commonly affecting preschool-aged children through hot drinks, baths, and cooking oils. House fires are a major cause of fatal burns through smoke inhalation.
- The severity of the burn is related to the temperature and duration of contact - even low temperatures can cause damage with prolonged exposure. Burns are classified as partial thickness, deep partial thickness, or full thickness depending on the depth of tissue damage.
- Burn assessment tools like the Rule of Nines and Lund & Browder chart are used to estimate the percentage of total body surface area burned to guide management. Large burns require extensive resuscitation, wound care, surgery, nutrition support,
1) Environmental emergencies can involve submersion, hypothermia, or hyperthermia. Submersion can cause drowning or near-drowning through asphyxiation or laryngospasm.
2) Hypothermia occurs when the body loses heat faster than it can produce it, leading to a core body temperature below 95°F. It has mild, moderate, and severe stages associated with different symptoms. Rewarming methods range from passive to active external to active internal depending on severity.
3) Hyperthermia is elevated body temperature due to failed thermoregulation, usually from environmental factors like heat or humidity that prevent cooling. It progresses from heat cramps to
- Burn shock is driven by derangements in microvascular permeability and pressure caused by inflammatory mediators released after injury. Over-resuscitation can lead to complications like orbital compartment syndrome, extremity compartment syndrome, abdominal compartment syndrome, and acute respiratory distress syndrome due to fluid shifts and increased pressures. Modern resuscitation aims to optimize fluid delivery through monitoring and use of adjuncts like colloids to reduce complications from excessive fluids.
The document discusses sepsis and the importance of early recognition and treatment. It outlines the sepsis screening criteria and bundles that should be implemented, including lactate measurement, IV fluids, antibiotics within 1 hour, and hemodynamic monitoring to guide resuscitation. The 3-hour and 6-hour bundles are aimed at rapid restoration of tissue perfusion and prevention of organ dysfunction to reduce mortality in patients with severe sepsis or septic shock. Early goal-directed therapy and completion of bundles within time targets are emphasized.
With growing industrialization and mechanization of every household electrical injuries are becoming quite common. Electrical injuries are quite intricate with the damage caused. They cause not only external burns injury but a wide spectrum of visceral injuries which in many cases is difficult to diagnose and manage. Therefore, a sound understanding of the engineering aspects is pivotal in diagnosing and managing these cases. A brief review of the pathophysiology and management of electrical injuries is presented.
Hemorrhagic shock occurs due to heavy blood loss, which reduces tissue perfusion and oxygen delivery. It is defined as inadequate oxygen delivery to tissues due to reduced circulating blood volume and oxygen-carrying capacity. Common causes are trauma, gastrointestinal bleeding, and obstetrical bleeding. Signs and symptoms include low blood pressure, rapid heart rate, confusion, and loss of consciousness as organs are deprived of oxygen. Diagnostic evaluation includes physical examination, imaging studies, and laboratory tests. Management focuses on restoring circulating volume through fluid replacement, blood transfusion, and vasopressor medications to maintain adequate blood pressure and oxygen delivery to tissues in order to prevent multiple organ failure and death.
1) Hemoglobinopathies are inherited disorders affecting hemoglobin structure or production, ranging from asymptomatic to fatal. The most common types are sickle cell disease and thalassemias.
2) Thalassemias are caused by deficient production of globin chains, leading to imbalanced globin synthesis and red blood cell damage. Beta thalassemias result from low beta chain production while alpha thalassemias involve alpha chains.
3) Clinical features vary by specific disorder from mild anemia to transfusion-dependent anemia and organ damage. Management involves treatment of complications, transfusions, chelation therapy, and in severe cases, stem cell transplant.
The document discusses different types of burns including thermal, chemical, and electrical burns. It describes how burns are assessed based on depth and percentage of total body surface area affected. First, second, and third degree burns are defined based on the level of skin layers involved. Complications from burns can include fluid shifts causing hypovolemia, infection, and multi-organ dysfunction. Burn management involves wound assessment, fluid resuscitation to address fluid imbalances, and treatment depending on severity.
Electrical injuries can cause damage through direct tissue damage, thermal energy, and mechanical injury. They result in around 1000 deaths and 3000 burns center admissions per year in the US. The main mechanisms of injury are electrical energy altering cell membranes, massive tissue destruction from heat, and physical trauma. Management involves following ATLS protocols, monitoring for cardiac issues, treating potential myoglobinuria, aggressive wound care, and surgery as needed. Prevention focuses on electrical safety practices and seeking shelter during storms.
1) Direct current refers to a continuous flow of electricity in one direction. Therapeutic direct current is applied for over 1 second and can cause sensory stimulation, hyperemia, and electrotonus in tissues.
2) Direct current is transmitted through wet pads or sponges in contact with the skin. Over time, chemical changes and electrolysis may occur near the electrodes.
3) Direct current can be used to accelerate wound healing, reduce pain through sensory stimulation, and destroy unwanted tissues at high densities through coagulation and liquefaction near the electrodes. Precautions must be taken with neoplastic or infected tissues.
1. Burns are injuries caused by heat, cold, electricity, chemicals, friction or radiation that damage the skin and other tissues. Most burns are caused by hot liquids, solids or fire.
2. Burns are classified by depth and extent of injury. Depth is classified as partial thickness or full thickness burns. Extent looks at the total body surface area affected.
3. Management of burns involves addressing the patient's hypovolemic state, wound care, infection control and rehabilitation to address scarring and mobility issues. Complications can be both early like fluid shifts and infections or late with scarring and contractures.
An electric burn occurs when an electrical current passes through the body, potentially causing damage to the skin, tissues, and organs. It can result from accidental contact with exposed wiring or appliances, lightning strikes, or occupational accidents. Low voltage burns under 1000V may cause blistering while high voltage burns can cause deep tissue damage and compartment syndrome. Symptoms range from numbness to cardiac arrest. Diagnosis involves assessing the burn depth. Management includes cutting the power source, emergency care for severe symptoms, IV fluids to prevent renal failure from rhabdomyolysis, and possible surgical debridement or amputation.
This document provides an overview of burns, including:
- Definitions of burns as injuries caused by heat, chemicals, electricity or radiation.
- The pathophysiology of burns, including the zones of injury and systemic responses affecting the kidneys, gut and lungs.
- Classification of burns by depth, extent of body surface area burned, and mechanism.
- Common complications of burns like infection, pulmonary issues, and metabolic and fluid shifts.
- The goal of fluid resuscitation to maintain circulation and protocols like the Parkland formula for calculating fluid needs.
Shock is a life-threatening condition defined as inadequate tissue perfusion and cellular respiration. The document discusses the pathophysiology, classification, signs, and management of shock. Shock can be caused by hemorrhage, sepsis, anaphylaxis, or trauma. Early recognition and treatment is critical to prevent multiple organ failure and death. Fluid resuscitation is initially used but controlling any hemorrhage is paramount to recovery. Monitoring for signs of persistent or worsening shock is also important.
This document provides an overview of different types of burns, including definitions, causes, severity classifications, and treatment approaches. It discusses thermal burns from flame, scald, or hot gases; electrical burns; chemical burns; and radiation burns. It describes the degrees of burns from superficial to full thickness. Treatment depends on the depth and extent of the burn, with fluid resuscitation, wound care, skin grafting, or other approaches used. Inhalation injuries from smoke inhalation are also addressed.
Obstetrical Emergency in details this plan of clinical teaching. word filesonal patel
This document outlines an obstetrical emergency seminar on shock, vasa previa, and uterine inversion. It defines each condition and discusses causes, types, diagnosis, symptoms, and management. Shock is summarized as a condition resulting from circulatory system inability to provide tissues with oxygen and nutrients. Types of shock include hemorrhagic, neurogenic, endotoxic, and anaphylactic. Vasa previa is defined as babies' blood vessels crossing near the uterus' internal opening, putting them at risk of rupture during membrane rupture. Risk factors include velamentous cord insertion and IVF pregnancy. Uterine inversion occurs when the uterus turns inside out, and can be acute or chronic with causes including uterine atony
BURN details types and definition and allTanusriBarui2
Burns are injuries caused by heat, cold, electricity, chemicals, friction or radiation. They can range from superficial partial thickness burns to full thickness burns. The main causes of burns are thermal burns from hot liquids, solids or fire, as well as chemical and electrical burns. Burn injuries lead to local skin damage and systemic physiological changes due to fluid shifts, metabolic changes, and increased risk of infection. Treatment involves stopping the burning process, assessing the extent and depth of the burn, fluid resuscitation, wound care, infection control and rehabilitation.
This document provides an overview of sickle cell disease (SCD), including its definition, epidemiology, pathogenesis, clinical presentation, diagnosis, treatment, and counseling. SCD is caused by a genetic mutation resulting in abnormal hemoglobin called HbS. It most commonly presents as painful vasoclusive crises, acute chest syndrome, splenic sequestration, or aplastic crises. Treatment involves management of symptoms, antibiotics, hydroxyurea, blood transfusions, and counseling to enable informed family planning decisions.
Fluid resuscitation is critical for burn patients to prevent hypovolemic shock and maintain organ perfusion. The document outlines the steps for fluid resuscitation, which include securing IV access, estimating burn size using methods like the Rule of Nine, calculating resuscitation fluid needs using formulas like Parkland, monitoring urine output and other parameters, and adjusting fluid rates based on monitoring. The goal is to support circulation with enough fluid while avoiding complications of under or over-resuscitation.
I had made a comprehensive presentation that covers the types of burns,causes,method to calculate the percentage of burns,symptoms&signs and management of burns.Hope it will be very much useful for medical students and emergency care physicians.
This document discusses different types of burns including thermal, chemical, electrical, and cold burns. It describes the pathophysiology of burns and inhalation injuries. Burn depth is classified as superficial, partial thickness, or full thickness. Burn management involves fluid resuscitation, airway management, infection prevention, wound care including debridement and grafting, nutrition support, and rehabilitation. Complications can include hypovolemic shock, respiratory issues, infections, and scarring/contractures. The goals are to restore fluid and electrolyte balance, support healing, and help patients resume normal activities and lifestyle.
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Acs0522 procedures for benign and malignant biliary tract disease-2005medbookonline
This document discusses procedures for benign and malignant biliary tract diseases. It provides guidance on preoperative evaluation and management of biliary obstruction. Specific considerations are given to infection, renal dysfunction, impaired immunity, malnutrition, and coagulation issues. The document outlines operative planning details such as patient positioning, exposure techniques, and guidelines for biliary anastomoses including suture placement and techniques for difficult access situations.
This document discusses the anatomy and surgical procedure of splenectomy. It describes:
- The spleen's highly variable arterial blood supply, which can take bundled or distributed patterns. This variability impacts the difficulty of surgery.
- The splenic artery typically branches off the celiac axis but can originate from other nearby arteries in rare cases.
- Additional branches of the splenic artery before it enters the spleen, including short gastric and pancreatic arteries.
- A history of splenectomy beginning in the 16th century and its increasing use through the 20th century for trauma and hematologic disorders.
- The development of laparoscopic splenectomy in the early 1990s and ongoing refinement of minim
Gastrostomy is commonly used as a temporary procedure to avoid discomfort from prolonged nasogastric suction after major abdominal surgery. It can also be used permanently when the esophagus is obstructed to nonresectable cancer. The Stamm gastrostomy is most common temporary procedure where a catheter is placed through the stomach wall and anchored to the skin. The Janeway gastrostomy is a permanent alternative where a flap of stomach is brought through the abdominal wall and attached to form a mucosal lined tube to prevent regurgitation. Postoperative care involves gradual advancement to oral intake as the stomach heals and functions return to normal.
This document describes the Billroth I gastric resection procedure, which involves removing part of the stomach and reattaching it to the duodenum. Key steps include transecting the stomach, attaching it to the duodenum using a circular stapler, and closing the gastrotomy site. The procedure aims to control peptic ulcers by combining hemigastrectomy with vagotomy while restoring normal gastrointestinal continuity. Postoperative care focuses on gradual advancement of oral intake and monitoring for complications.
This document describes the Billroth I procedure for gastroduodenostomy. It involves extensive mobilization of the stomach and duodenum to allow for an end-to-end anastomosis between the stomach and duodenum, restoring normal continuity of the gastrointestinal tract. The stomach is divided and sutured closed, then sutured to the duodenum in layers to create the gastroduodenal connection. Postoperative care focuses on gradual advancement of diet and monitoring for gastric retention to support healing and prevent complications.
Gastrostomy is commonly used as a temporary procedure to avoid discomfort from prolonged nasogastric suction after major abdominal surgery. It can also be used permanently when the esophagus is obstructed to nonresectable cancer. The Stamm gastrostomy is most common temporary procedure where a catheter is placed through the stomach wall and anchored to prevent leakage. The Janeway gastrostomy is a permanent alternative where a flap of stomach is brought through the abdominal wall and lined with mucosa to form a permanent opening, preventing regurgitation. Postoperative care involves gradual advancement to oral intake as the stomach and bowel recover function.
Gastrojejunostomy is a surgical procedure that connects the stomach directly to the jejunum. It is indicated for patients with duodenal ulcers complicated by pyloric obstruction or nonresectable stomach or pancreatic cancers causing obstruction. The procedure involves opening the stomach and jejunum, suturing them together to form a stoma, then closing in multiple layers. Postoperatively, gastric emptying is monitored and diet advanced gradually to ensure proper healing.
This document provides guidance on treating a perforated ulcer or subphrenic abscess. It describes:
1) Preparing patients preoperatively by administering IV fluids/antibiotics and gastric suction.
2) Closing perforations by suturing the ulcer and reinforcing it with omentum, or sealing it if too indurated.
3) Draining subphrenic abscesses extraperitoneally by making incisions below the costal margin or through the 12th rib bed and inserting drains into the abscess cavity.
A C S0103 Perioperative Considerations For Anesthesiamedbookonline
This document discusses perioperative considerations for anesthesia. It notes advancements in modern surgical care and alterations in anesthetic management to maximize patient benefit. A preoperative evaluation is important to assess medical history and current medications. Certain medications may need to be adjusted or discontinued before surgery, such as MAOIs, oral anticoagulants, and some herbal supplements, to reduce risks of adverse reactions or bleeding complications during the procedure. The risks and options for anesthesia should be discussed with the patient.
A C S0105 Postoperative Management Of The Hospitalized Patientmedbookonline
This document discusses postoperative management of surgical patients. It describes the different levels of postoperative care including same-day surgery, the surgical floor, telemetry ward, and intensive care unit. Factors determining a patient's disposition include their preoperative health, procedure performed, and postoperative clinical status. The document also discusses common postoperative orders related to tubes, drains, oxygen therapy, and wound care to guide nursing staff.
Postoperative pain is a complex experience involving sensory, emotional, and mental components. Effective pain management is important for patient comfort and recovery. Guidelines for postoperative pain treatment have been developed for specific procedures. Multimodal analgesic regimens targeting multiple pathways are recommended over reliance on opioids alone to prevent tolerance and hyperalgesia. Nonpharmacological complementary therapies can be combined with drug treatments to enhance pain control.
The document discusses the approach to a patient experiencing ongoing bleeding. It outlines the following key steps:
1. First consider the possibility of a technical cause like an unligated vessel and examine for injuries.
2. If no technical cause is found, check the patient's temperature and perform laboratory tests. Hypothermia can cause coagulopathy.
3. Evaluate test results along with the patient's history for clues to underlying causes like platelet dysfunction, coagulation factor deficiencies, or inherited bleeding disorders. Treat the specific condition while continuing evaluation.
A C S0812 Brain Failure And Brain Deathmedbookonline
This document discusses brain failure and brain death. It defines different levels of impaired consciousness from cloudy consciousness to coma. It describes how brain failure results from cardiac arrest and the challenges of restarting the brain after lack of oxygen. It outlines the criteria for diagnosing brain death, including absence of brain stem reflexes and apnea testing. It also discusses the evolution of determining death as technology has allowed life support to prolong vital signs indefinitely.
This document summarizes key points about surgical treatment of early rectal cancer and care of elderly surgical patients. It discusses that radical resection for early rectal cancer achieves excellent local control but has risks, while local excision may be preferable but has a higher local recurrence rate. Adjuvant therapy after local excision may help address this. It also notes that the elderly population is growing and physiologic changes with aging, like cardiac function decline, must be considered in surgical planning and risk assessment for elderly patients. Functional status is more important than age alone.
This document provides information on parotidectomy surgery and the Fundamentals of Laparoscopic Surgery (FLS) program.
It describes the technique for parotidectomy surgery, including identifying and dissecting around the facial nerve. It notes that most parotid tumors are benign and complications are usually temporary facial nerve paralysis.
It then discusses the development of the FLS program to standardize laparoscopic surgery training. The program includes cognitive training and manual skills assessment. Many residency programs and hospitals now require surgeons to complete the FLS. A large grant will help make the program more accessible to residency programs.
This document summarizes an article about volunteer surgeons providing care to wounded soldiers in Iraq and Afghanistan. It discusses the senior visiting surgeon program established by the American College of Surgeons that allows surgeons to volunteer their time. The volunteer rotation described involved caring for patients at Landstuhl Regional Medical Center in Germany as part of the complex medical evacuation process bringing wounded soldiers from war zones to the United States for further treatment and recovery.
1. The document discusses various sources of data for benchmarking surgical outcomes, including public reporting programs, public use administrative databases, and clinical registries. It notes limitations of using administrative data including problems with accuracy, completeness, and clinical precision of coding.
2. Clinical registries like the National Surgical Quality Improvement Program (NSQIP) and the Society of Thoracic Surgeons database are described as better sources of benchmarking data as they provide risk-adjusted outcomes while protecting individual hospital and surgeon confidentiality.
3. Limitations of all surgical benchmarking sources include small sample sizes, lack of generalizability between databases, and lack of external auditing to ensure accuracy and completeness of submitted data.
This document discusses organ procurement from cadaveric donors. It describes the coordination between donor and recipient activities, including matching organs to recipients based on factors like blood type, medical urgency, and waiting time. The evaluation of donor organs is outlined for different organs. Careful donor management aims to optimize organs while respecting donor dignity.
Hand-assisted laparoscopic surgery (HALS) is a hybrid technique that provides many of the advantages of traditional open surgery and laparoscopic colectomy. HALS employs a special access device that allows the surgeon to place a hand in the abdomen to assist with retraction, dissection, and visualization while maintaining pneumoperitoneum and laparoscopic instrumentation through trocars. Studies have shown HALS results in shorter operative times and lower conversion rates to open surgery compared to traditional laparoscopic colectomy while preserving similar short-term clinical outcomes. HALS may help expand the use of minimally invasive approaches for complex colectomies by providing an easier transition from open surgery than traditional laparoscopic techniques.
The document summarizes the evolution of trauma surgery training and practice in the United States. It discusses how trauma surgery originated in large city hospitals but has since expanded to regional trauma centers. It also notes changes in surgical training away from generalist models towards increased specialization. Trauma surgery is increasingly encompassing broader emergency general surgery duties due to workforce shortages, while training programs emphasize specialized rather than broad skills.