The document discusses burn injuries and their management. It describes the causes and types of burns including thermal, chemical, electrical, and radiation burns. It covers burn wound assessment including classifying burns by depth and percentage of total body surface area affected. The phases of burn injuries are discussed including the emergent, acute, and rehabilitative phases. Key aspects of management are covered such as fluid resuscitation and shifts, infection prevention and signs, wound care including debridement and dressings, and skin grafting.
A burn is a type of injury to skin, or other tissues, caused by heat, cold, electricity, chemicals, friction, or radiation. Most burns are due to heat from hot liquids, solids, or fire. While rates are similar for males and females the underlying causes often differ.
A burn is a type of injury to skin, or other tissues, caused by heat, cold, electricity, chemicals, friction, or radiation. Most burns are due to heat from hot liquids, solids, or fire. While rates are similar for males and females the underlying causes often differ.
it consist definition, types of burn, its cause, scales to measure degree of burn, first aid management and supportive management along with rehabilitation therapy.
it consist definition, types of burn, its cause, scales to measure degree of burn, first aid management and supportive management along with rehabilitation therapy.
EWMA 2013 - Ep476 - Treatment of Split Thickness Skin Graft Donor Sites with ...EWMA
Moti Harats MD, Tanya Motiei R.N, M.A, Oren Weissman MD, Josef Haik MD MPH
Department of Plastic and Reconstructive Surgery and The Burn Unit, Sheba Medical Center
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DARIER’S DISEASE, Keratosis folliculiris, rare genetic disorder that is manifested predominantly by skin changes, due to ATP2A2 mutation, The histology is characteristic, known as focal acantholytic dyskeratosis associated with varying degrees of papillomatosis
This lecture introduces pharmacists to burn care. Although there are advances in burn treatments most of the information provided in this presentation remain the standard of care for the patient.
medical surgical nursing , nursing management of burn patients, it includes definition, classification of burn injury, clinical manifestaion, assessment of burn injury , management of patient with burn, care given to the patient.
The presentation is about the definition and type of burns classification and total body surface area involved. Fluid therapy in adults and children. Various formulae of calculating fluid requirement.
Protocols for burn centre management and critical care. Most elaborated description of burn management. Latest guidelines and Protocols, relevant investigation and management.
Brief description about what are burns, structure of skin, how we can classify burns based upon mechanism and differential diagnosis ,pathophysiology of burn, rule of 9, general and systemic response to burns, complications, fluid resuscitation, parkland formula, monitoring of resuscitation
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
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1. BURN INJURIES & ITS
MANAGEMENT
Dr Ibraheem Bashayreh, RN, PhD
4/1/2011
1
2. BURNS
Wounds caused by exposure to:
1. excessive heat
2. Chemicals
3. fire/steam
4. radiation
5. electricity
4/1/2011 2
3. BURNS
Results in 10-20 thousand deaths annually
Survival best at ages 15-45
Children, elderly, and diabetics
Survival best burns cover less than 20% of TBA
4/1/2011 3
4. TYPES OF BURNS
Thermal
exposure to flame or a hot object
Chemical
exposure to acid, alkali or organic substances
Electrical
result from the conversion of electrical energy into heat.
Extent of injury depends on the type of current, the
pathway of flow, local tissue resistance, and duration of
contact
Radiation
result from radiant energy being transferred to the body
resulting in production of cellular toxins
4/1/2011 4
7. BURN WOUND ASSESSMENT
Classified according to depth of injury and
extent of body surface area involved
Burn wounds differentiated depending on
the level of dermis and subcutaneous
tissue involved
1. superficial (first-degree)
2. deep (second-degree)
3. full thickness (third and fourth
degree)
4/1/2011 7
9. SUPERFICIAL BURNS
(FIRST DEGREE)
Epidermal tissue only affected
Erythema, blanching on pressure, mild swelling
no vesicles or blister initially
Not serious unless large areas involved
i.e. sunburn
4/1/2011 9
13. DEEP (SECOND DEGREE)
*Involves the epidermis and deep layer of the
dermis
Fluid-filled vesicles –red, shiny, wet, severe pain
Hospitalization required if over 25% of body
surface involved
i.e. tar burn, flame
4/1/2011 13
17. FULL THICKNESS
(THIRD/FOURTH DEGREE)
Destruction of all skin layers
Requires immediate hospitalization
Dry, waxy white, leathery, or hard skin, no pain
Exposure to flames, electricity or chemicals can
cause 3rd
degree burns
4/1/2011 17
20. CALCULATION OF BURNED BODY
SURFACE AREA
Calculation of Burned
Body Surface Area
4/1/2011 20
21. TOTAL BODY SURFACE AREA
(TBSA)
Superficial burns are not involved in the
calculation
Lund and Browder Chart is the most accurate
because it adjusts for age
Rule of nines divides the body – adequate for
initial assessment for adult burns
4/1/2011 21
22. LUND BROWDER CHART USED FOR
DETERMINING BSA
4/1/2011 22Evans, 18.1, 2007)
23. RULES OF NINES
Head & Neck = 9%
Each upper extremity (Arms) = 9%
Each lower extremity (Legs) = 18%
Anterior trunk= 18%
Posterior trunk = 18%
Genitalia (perineum) = 1%
4/1/2011 23
25. VASCULAR CHANGES
RESULTING FROM BURN
INJURIES
Circulatory disruption occurs at the burn
site immediately after a burn injury
Blood flow decreases or cease due to
occluded blood vessels
Damaged macrophages within the tissues
release chemicals that cause constriction
of vessel
Blood vessel thrombosis may occur
causing necrosis
Macrophage: A type of white blood that ingests (takes in) foreign
material. Macrophages are key players in the immune response to foreign
invaders such as infectious microorganisms.
4/1/2011 25
26. FLUID SHIFT
Occurs after initial vasoconstriction, then
dilation
Blood vessels dilate and leak fluid into
the interstitial space
Known as third spacing or capillary leak
syndrome
Causes decreased blood volume and blood
pressure
Occurs within the first 12 hours after the
burn and can continue to up to 36 hours
4/1/2011 26
27. FLUID IMBALANCES
Occur as a result of fluid shift and cell
damage
Hypovolemia
Metabolic acidosis
Hyperkalemia
Hyponatremia
Hemoconcentration (elevated blood
osmolarity, hematocrit/hemoglobin) due to
dehydration
4/1/2011 27
28. FLUID REMOBILIZATION
Occurs after 24 hours
Capillary leak stops
See diuretic stage where edema fluid
shifts from the interstitial spaces into the
vascular space
Blood volume increases leading to
increased renal blood flow and diuresis
Body weight returns to normal
See Hypokalemia
4/1/2011 28
29. CURLING’S ULCER
Acute ulcerative gastro duodenal disease
Occur within 24 hours after burn
Due to reduced GI blood flow and mucosal
damage
Treat clients with H2 blockers, mucoprotectants,
and early enteral nutrition
Watch for sudden drop in hemoglobin
4/1/2011 29
31. EMERGENT PHASE
*Immediate problem is fluid loss, edema,
reduced blood flow (fluid and electrolyte
shifts)
Goals:
1. secure airway
2. support circulation by fluid
replacement
3. keep the client comfortable with
analgesics
4. prevent infection through wound care
5. maintain body temperature
6. provide emotional support
4/1/2011 31
32. EMERGENT PHASE
Knowledge of circumstances surrounding the
burn injury
Obtain client’s pre-burn weight (dry weight) to
calculate fluid rates
Calculations based on weight obtained after fluid
replacement is started are not accurate because
of water-induced weight gain
Height is important in determining body surface
area (BSA) which is used to calculate nutritional
needs
Know client’s health history because the
physiologic stress seen with a burn can make a
latent disease process develop symptoms
4/1/2011 32
33. CLINICAL MANIFESTATIONS IN THE
EMERGENT PHASE
Clients with major burn injuries and with inhalation injury
are at risk for respiratory problems
Inhalation injuries are present in 20% to 50% of the clients
admitted to burn centers
Assess the respiratory system by inspecting the mouth, nose,
and pharynx
Burns of the lips, face, ears, neck, eyelids, eyebrows, and
eyelashes are strong indicators that an inhalation injury may
be present
Change in respiratory pattern may indicate a pulmonary
injury.
The client may: become progressively hoarse, develop a brassy
cough, drool or have difficulty swallowing, produce expiratory
sounds that include audible wheezes, crowing, and stridor
Upper airway edema and inhalation injury are most common
in the trachea and mainstem bronchi
Auscultate these areas for wheezes
If wheezes disappear, this indicates impending airway
obstruction and demands immediate intubation4/1/2011 33
34. CLINICAL MANIFESTATIONS
Cardiovascular will begin immediately
which can include shock (Shock is a
common cause of death in the emergent
phase in clients with serious injuries)
Obtain a baseline EKG
Monitor for edema, measure central and
peripheral pulses, blood pressure,
capillary refill and pulse oximetry
4/1/2011 34
35. CLINICAL MANIFESTATIONS
Changes in renal function are related to
decreased renal blood flow
Urine is usually highly concentrated and
has a high specific gravity
Urine output is decreased during the first
24 hours of the emergent phase
Fluid resuscitation is provided at the rate
needed to maintain adult urine output at
30 to 50- mL/hr.
Measure BUN, creat and NA levels
4/1/2011 35
36. CLINICAL MANIFESTATIONS
Sympathetic stimulation during the
emergent phase causes reduced GI
motility and paralytic ileus
Auscultate the abdomen to assess bowel
sounds which may be reduced
Monitor for n/v and abdominal distention
Clients with burns of 25% TBSA or who
are intubated generally require a NG tube
inserted to prevent aspiration and
removal of gastric secretions
4/1/2011 36
37. SKIN ASSESSMENT
Assess the skin to determine the size and
depth of burn injury
The size of the injury is first estimated in
comparison to the total body surface area
(TBSA). For example, a burn that
involves 40% of the TBSA is a 40% burn
Use the rule of nines for clients whose
weights are in normal proportion to their
heights
4/1/2011 37
38. IV FLUID THERAPY
Infusion of IV fluids is needed to maintain sufficient
blood volume for normal CO
Clients with burns involving 15% to 20% of the TBSA
require IV fluid
Purpose is to prevent shock by maintaining adequate
circulating blood fluid volume
Severe burn requires large fluid loads in a short time
to maintain blood flow to vital organs
Fluid replacement formulas are calculated from the
time of injury and not from the time of arrival at the
hospital
Diuretics should not be given to increase urine output.
Change the amount and rate of fluid administration.
Diuretics do not increase CO; they actually decrease
circulating volume and CO by pulling fluid from the
circulating blood volume to enhance diuresis
4/1/2011 38
39. COMMON FLUIDS
Protenate or 5% albumin in isotonic saline (1/2
given in first 8 hr; ½ given in next 16 hr)
LR (Lactate Ringer) without dextrose (1/2 given
in first 8 hr; ½ given in next 16 hr)
Crystalloid (hypertonic saline) adjust to maintain
urine output at 30 mL/hr
Crystalloid only (lactated ringers)
4/1/2011 39
40. NURSING DIAGNOSIS IN THE
EMERGENT PHASE
Decreased CO
Deficient fluid volume r/t active fluid volume loss
Ineffective Tissue perfusion
Ineffective breathing pattern
4/1/2011 40
41. ACUTE PHASE OF BURN INJURY
• Lasts until wound closure is complete
• Care is directed toward continued assessment and
maintenance of the cardiovascular and respiratory
system
• Pneumonia is a concern which can result in respiratory
failure requiring mechanical ventilation
• Infection (Topical antibiotics – Silvadene)
• Tetanus toxoid
• Weight daily without dressings or splints and compare
to pre-burn weight
• A 2% loss of body weight indicates a mild deficit
• A 10% or greater weight loss requires modification of
calorie intake
• Monitor for signs of infection
4/1/2011 41
42. LOCAL AND SYSTEMIC SIGNS
OF INFECTION- GRAM
NEGATIVE BACTERIA
Pseudomonas, Proteus
May led to septic shock
Conversion of a partial-thickness injury to a full-thickness
injury
Ulceration of health skin at the burn site
Erythematous, nodular lesions in uninvolved skin
Excessive burn wound drainage
Odor
Sloughing of grafts
Altered level of consciousness
Changes in vital signs
Oliguria
GI dysfunction such as diarrhea, vomiting
Metabolic acidosis
4/1/2011 42
43. LAB VALUES
Na – hyponatremia or Hypernatremia
K – Hyperkalemia or Hypokalemia
WBC – 10,000-20,000
4/1/2011 43
44. NURSING DIAGOSIS IN THE
ACUTE PHASE
Impaired skin integrity
Risk for infection
Imbalanced nutrition
Impaired physical mobility
Disturbed body image
4/1/2011 44
45. PLANNING AND
IMPLEMENTATION
Nonsurgical management: removal of exudates
and necrotic tissue, cleaning the area,
stimulating granulation and revascularization
and applying dressings. Debridement may be
needed
4/1/2011 45
46. DRESSING THE BURN WOUND
After burn wounds are cleaned and debrided,
topical antibiotics are reapplied to prevent
infection
Standard wound dressings are multiple layers of
gauze applied over the topical agents on the burn
wound
4/1/2011 46
47. REHABILITATIVE PHASE OF
BURN INJURY
Started at the time of admission
Technically begins with wound closure
and ends when the client returns to the
highest possible level of functioning
Provide psychosocial support
Assess home environment, financial
resources, medical equipment, prosthetic
rehab
Health teaching should include symptoms
of infection, drugs regimens, f/u
appointments, comfort measures to reduce
pruritus
4/1/2011 47
48. DIET
Initially NPO
Begin oral fluids after bowel sounds return
Do not give ice chips or free water lead to
electrolyte imbalance
High protein, high calorie
4/1/2011 48
49. GOALS
Prevent complications (contractures)
Vital signs hourly
Assess respiratory function
Tetanus booster
Anti-infective
Analgesics
No aspirin
Strict surgical asepsis
Turn q2h to prevent contractures
Emotional support
4/1/2011 49
50. DEBRIDEMENT
Done with forceps and curved scissor or through
hydrotherapy (application of water for treatment)
Only loose eschar removed
Blisters are left alone to serve as a protector –
controversial
4/1/2011 50
51. SKIN GRAFTS
Done during the acute phase
Used for full-thickness and deep partial-
thickness wounds
4/1/2011 51
52. POST CARE OF SKIN GRAFTS
Maintain dressing
Use aseptic technique
Graft should look pink if it has taken after 5 days
Skeletal traction may be used to prevent
contractures
Elastic bandages may be applied for 6 mo to 1
year to prevent hypertrophic scarring
4/1/2011 52