This is a lecture by Dr. JIm Holliman from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
compartment syndrome, causes, compartments of legs,compartments of forearm,compartments of hand,compartments of foot, compartments of arm,compartments of thigh,fasciotomy of leg,fasciotomy of forearm, fasciotomy of hand,fasciotomy of foot, fasciotomy of thigh, fasciotomy of arm
This presentation covers the principle and practice of Burns management in a pre-hospital care setting with the focus on Thermal burns. The session was presented in the EMCON2018 National conference, Paramedic session at Bangalore
compartment syndrome, causes, compartments of legs,compartments of forearm,compartments of hand,compartments of foot, compartments of arm,compartments of thigh,fasciotomy of leg,fasciotomy of forearm, fasciotomy of hand,fasciotomy of foot, fasciotomy of thigh, fasciotomy of arm
This presentation covers the principle and practice of Burns management in a pre-hospital care setting with the focus on Thermal burns. The session was presented in the EMCON2018 National conference, Paramedic session at Bangalore
THYROIDECTOMY- Operative Surgery
Dear viewers,
Greetings from “Surgical Educator”
Because of the popular demand by viewers of the YouTube channel “Surgical Educator”, I have decided to create and upload videos on common surgeries. I have already uploaded two videos on open and Laparoscopic Appendicectomy. In this video today, I have discussed Thyroidectomy Surgery. However, these videos are not real surgeries but the theoretical aspect of operative surgery like going through an atlas of operative surgery. Along with these videos, I recommend you to watch real operative surgery videos as well and I will give a link for each surgery in the end of the video as end-cards, which I think will be very useful. This will give a very good opportunity for the surgical trainees to mentally rehearse various surgical steps in a sequential manner prior to actual surgery. You can watch the video in the following links:
Surgicaleducator.blogspot.com
Youtube.com/c/surgicaleducator
Thank you for watching the videos.
Minimally invasive/accessed surgery comprises of robotic and non robotic surgery. Non robotic surgery includes laparoscopy, endoscopy, arthroscopy and etc.
This PPT is mainly for the III yr MBBS - Students for whom this topic is important. Moreover mainly day today clinical practice practising doctors will come across these types of cases.
**Download to see my lecture notes!!**
Learn about the pathophysiology, clinical signs and symptoms, diagnosis and managment of the hernias of the groin- femoral and inguinal. Surgical approach is mentioned and common complications.
Approah to a child / adult presenting with acute scrotum - testicular pain.
The acute scrotum – definition and causes with differential diagnosis
Management of the acute scrotum
Testicular torsion
Torsion of a testicular or epididymal appendage
Epididymitis or epididymo-orchitis
Idiopathic scrotal oedema
Fat necrosis of the scrotum
Case Discussion
GEMC: Introduction to Burns: Resident TrainingOpen.Michigan
This is a lecture by Dr. Robert Preston from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC: Burn Mass Casualty Incidents: Resident TrainingOpen.Michigan
This is a lecture by Dr. Jim Holliman from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
THYROIDECTOMY- Operative Surgery
Dear viewers,
Greetings from “Surgical Educator”
Because of the popular demand by viewers of the YouTube channel “Surgical Educator”, I have decided to create and upload videos on common surgeries. I have already uploaded two videos on open and Laparoscopic Appendicectomy. In this video today, I have discussed Thyroidectomy Surgery. However, these videos are not real surgeries but the theoretical aspect of operative surgery like going through an atlas of operative surgery. Along with these videos, I recommend you to watch real operative surgery videos as well and I will give a link for each surgery in the end of the video as end-cards, which I think will be very useful. This will give a very good opportunity for the surgical trainees to mentally rehearse various surgical steps in a sequential manner prior to actual surgery. You can watch the video in the following links:
Surgicaleducator.blogspot.com
Youtube.com/c/surgicaleducator
Thank you for watching the videos.
Minimally invasive/accessed surgery comprises of robotic and non robotic surgery. Non robotic surgery includes laparoscopy, endoscopy, arthroscopy and etc.
This PPT is mainly for the III yr MBBS - Students for whom this topic is important. Moreover mainly day today clinical practice practising doctors will come across these types of cases.
**Download to see my lecture notes!!**
Learn about the pathophysiology, clinical signs and symptoms, diagnosis and managment of the hernias of the groin- femoral and inguinal. Surgical approach is mentioned and common complications.
Approah to a child / adult presenting with acute scrotum - testicular pain.
The acute scrotum – definition and causes with differential diagnosis
Management of the acute scrotum
Testicular torsion
Torsion of a testicular or epididymal appendage
Epididymitis or epididymo-orchitis
Idiopathic scrotal oedema
Fat necrosis of the scrotum
Case Discussion
GEMC: Introduction to Burns: Resident TrainingOpen.Michigan
This is a lecture by Dr. Robert Preston from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC: Burn Mass Casualty Incidents: Resident TrainingOpen.Michigan
This is a lecture by Dr. Jim Holliman from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC- Burns: Managements and Survivability- for ResidentsOpen.Michigan
This is a lecture by Carol Choe from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This is a lecture by Dr. Jeff Holmes from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This is a lecture by Dr. Jim Holliman from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC - Trauma Patient Care in the Emergency Department : Pitfalls to AvoidOpen.Michigan
This is a lecture from the Ghana Emergency Medicine Collaborative (GEMC). To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC - Acute Asthma in Adults - Resident TrainingOpen.Michigan
This is a lecture by Dr. Rockefeller Oteng from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC: Acute Asthma in Adults: Resident TrainingOpen.Michigan
This is a lecture by Dr. Rockefeller Oteng from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
Acute management in burns
Types of burns
Admission criteria in burns
Fluid management in burns
Early surgical management in burns
Facial burn
Chemical burn
Eye burn
Ear burn
Hand burn
Electrical burn
This is a lecture by Dr. Peter Moyer from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This is a lecture by Dr. Peter Moyer from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC: ENT Case Files: Resident Training Open.Michigan
This is a lecture by Dr. Matt Dawson and Dr. Zach Sturges from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC: Aspirated and Ingested Foreign Bodies: Resident TrainingOpen.Michigan
This is a lecture by Dr. Jim Holliman from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This is a lecture from the Ghana Emergency Medicine Collaborative (GEMC). To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This is a lecture by Jim Holliman, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC- Alterations in Body Temperature: The Adult Patient with a Fever- Reside...Open.Michigan
This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC- Rapid Sequence Intubation & Emergency Airway Support in the Pediatric E...Open.Michigan
This is a lecture by Michele Nypaver, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC- Disorders of the Pleura, Mediastinum, and Chest Wall- Resident TrainingOpen.Michigan
This is a lecture by Andrew Barnosky, DO from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC- Dental Emergencies and Common Dental Blocks- Resident TrainingOpen.Michigan
This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC- Arthritis and Arthrocentesis- Resident TrainingOpen.Michigan
This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC- Bursitis, Tendonitis, Fibromyalgia, and RSD- Resident TrainingOpen.Michigan
This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC- Right Upper Quadrant Ultrasound- Resident TrainingOpen.Michigan
This is a lecture by Jeff Holmes from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC: Nursing Process and Linkage between Theory and PracticeOpen.Michigan
This is a lecture by Jeremy Lapham from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
2014 gemc-nursing-lapham-general survey and patient care managementOpen.Michigan
This is a lecture by Dr. Jeremy Lapham from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This is a lecture by Dr. Jessica Holly from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC: The Role of Radiography in the Initial Evaluation of C-Spine TraumaOpen.Michigan
This is a lecture by Dr. Stephen Hartsell from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This is a lecture by Dr. Jim Holliman from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
Normal Labour/ Stages of Labour/ Mechanism of LabourWasim Ak
Normal labor is also termed spontaneous labor, defined as the natural physiological process through which the fetus, placenta, and membranes are expelled from the uterus through the birth canal at term (37 to 42 weeks
A review of the growth of the Israel Genealogy Research Association Database Collection for the last 12 months. Our collection is now passed the 3 million mark and still growing. See which archives have contributed the most. See the different types of records we have, and which years have had records added. You can also see what we have for the future.
Macroeconomics- Movie Location
This will be used as part of your Personal Professional Portfolio once graded.
Objective:
Prepare a presentation or a paper using research, basic comparative analysis, data organization and application of economic information. You will make an informed assessment of an economic climate outside of the United States to accomplish an entertainment industry objective.
This slide is special for master students (MIBS & MIFB) in UUM. Also useful for readers who are interested in the topic of contemporary Islamic banking.
Safalta Digital marketing institute in Noida, provide complete applications that encompass a huge range of virtual advertising and marketing additives, which includes search engine optimization, virtual communication advertising, pay-per-click on marketing, content material advertising, internet analytics, and greater. These university courses are designed for students who possess a comprehensive understanding of virtual marketing strategies and attributes.Safalta Digital Marketing Institute in Noida is a first choice for young individuals or students who are looking to start their careers in the field of digital advertising. The institute gives specialized courses designed and certification.
for beginners, providing thorough training in areas such as SEO, digital communication marketing, and PPC training in Noida. After finishing the program, students receive the certifications recognised by top different universitie, setting a strong foundation for a successful career in digital marketing.
Model Attribute Check Company Auto PropertyCeline George
In Odoo, the multi-company feature allows you to manage multiple companies within a single Odoo database instance. Each company can have its own configurations while still sharing common resources such as products, customers, and suppliers.
June 3, 2024 Anti-Semitism Letter Sent to MIT President Kornbluth and MIT Cor...Levi Shapiro
Letter from the Congress of the United States regarding Anti-Semitism sent June 3rd to MIT President Sally Kornbluth, MIT Corp Chair, Mark Gorenberg
Dear Dr. Kornbluth and Mr. Gorenberg,
The US House of Representatives is deeply concerned by ongoing and pervasive acts of antisemitic
harassment and intimidation at the Massachusetts Institute of Technology (MIT). Failing to act decisively to ensure a safe learning environment for all students would be a grave dereliction of your responsibilities as President of MIT and Chair of the MIT Corporation.
This Congress will not stand idly by and allow an environment hostile to Jewish students to persist. The House believes that your institution is in violation of Title VI of the Civil Rights Act, and the inability or
unwillingness to rectify this violation through action requires accountability.
Postsecondary education is a unique opportunity for students to learn and have their ideas and beliefs challenged. However, universities receiving hundreds of millions of federal funds annually have denied
students that opportunity and have been hijacked to become venues for the promotion of terrorism, antisemitic harassment and intimidation, unlawful encampments, and in some cases, assaults and riots.
The House of Representatives will not countenance the use of federal funds to indoctrinate students into hateful, antisemitic, anti-American supporters of terrorism. Investigations into campus antisemitism by the Committee on Education and the Workforce and the Committee on Ways and Means have been expanded into a Congress-wide probe across all relevant jurisdictions to address this national crisis. The undersigned Committees will conduct oversight into the use of federal funds at MIT and its learning environment under authorities granted to each Committee.
• The Committee on Education and the Workforce has been investigating your institution since December 7, 2023. The Committee has broad jurisdiction over postsecondary education, including its compliance with Title VI of the Civil Rights Act, campus safety concerns over disruptions to the learning environment, and the awarding of federal student aid under the Higher Education Act.
• The Committee on Oversight and Accountability is investigating the sources of funding and other support flowing to groups espousing pro-Hamas propaganda and engaged in antisemitic harassment and intimidation of students. The Committee on Oversight and Accountability is the principal oversight committee of the US House of Representatives and has broad authority to investigate “any matter” at “any time” under House Rule X.
• The Committee on Ways and Means has been investigating several universities since November 15, 2023, when the Committee held a hearing entitled From Ivory Towers to Dark Corners: Investigating the Nexus Between Antisemitism, Tax-Exempt Universities, and Terror Financing. The Committee followed the hearing with letters to those institutions on January 10, 202
Operation “Blue Star” is the only event in the history of Independent India where the state went into war with its own people. Even after about 40 years it is not clear if it was culmination of states anger over people of the region, a political game of power or start of dictatorial chapter in the democratic setup.
The people of Punjab felt alienated from main stream due to denial of their just demands during a long democratic struggle since independence. As it happen all over the word, it led to militant struggle with great loss of lives of military, police and civilian personnel. Killing of Indira Gandhi and massacre of innocent Sikhs in Delhi and other India cities was also associated with this movement.
1. Project: Ghana Emergency Medicine Collaborative
Document Title: Burn Injuries
Author(s): Jim Holliman, M.D., F.A.E.C.P. (Uniformed Services University)
2012
License: Unless otherwise noted, this material is made available under
the terms of the Creative Commons Attribution Share Alike-3.0
License:
http://creativecommons.org/licenses/by-sa/3.0/
We have reviewed this material in accordance with U.S. Copyright Law and have tried to maximize your
ability to use, share, and adapt it. These lectures have been modified in the process of making a publicly
shareable version. The citation key on the following slide provides information about how you may share and
adapt this material.
Copyright holders of content included in this material should contact open.michigan@umich.edu with any
questions, corrections, or clarification regarding the use of content.
For more information about how to cite these materials visit http://open.umich.edu/privacy-and-terms-use.
Any medical information in this material is intended to inform and educate and is not a tool for selfdiagnosis or a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional.
Please speak to your physician if you have questions about your medical condition.
Viewer discretion is advised: Some medical content is graphic and may not be suitable for all viewers.
1
2. Attribution Key
for more information see: http://open.umich.edu/wiki/AttributionPolicy
Use + Share + Adapt
{ Content the copyright holder, author, or law permits you to use, share and adapt. }
Public Domain – Government: Works that are produced by the U.S. Government. (17 USC § 105)
Public Domain – Expired: Works that are no longer protected due to an expired copyright term.
Public Domain – Self Dedicated: Works that a copyright holder has dedicated to the public domain.
Creative Commons – Zero Waiver
Creative Commons – Attribution License
Creative Commons – Attribution Share Alike License
Creative Commons – Attribution Noncommercial License
Creative Commons – Attribution Noncommercial Share Alike License
GNU – Free Documentation License
Make Your Own Assessment
{ Content Open.Michigan believes can be used, shared, and adapted because it is ineligible for copyright. }
Public Domain – Ineligible: Works that are ineligible for copyright protection in the U.S. (17 USC § 102(b)) *laws in
your jurisdiction may differ
{ Content Open.Michigan has used under a Fair Use determination. }
Fair Use: Use of works that is determined to be Fair consistent with the U.S. Copyright Act. (17 USC § 107) *laws in your
jurisdiction may differ
Our determination DOES NOT mean that all uses of this 3rd-party content are Fair Uses and we DO NOT guarantee that
your use of the content is Fair.
2
To use this content you should do your own independent analysis to determine whether or not your use will be Fair.
3. Burn Injuries
Jim Holliman, M.D., F.A.C.E.P.
Program Manager, Afghanistan Health Care Sector
Reconstruction Project
Center for Disaster and Humanitarian Assistance Medicine
Professor of Military and Emergency Medicine
Uniformed Services University
Bethesda, Maryland, U.S.A.
4. Burns
Lecture Outline
•
•
•
•
•
•
•
•
Scene considerations & ABC aspects
Smoke inhalation injury
Carbon monoxide poisoning
Estimating extent & depth of the burn
Fluid resuscitation
Severity categorization
Outpatient burn care
Followup & prevention
5. Burns : Incidence
•
•
•
•
2,000,000 per year in U.S.
Over 100,000 hospitalizations per year
? 8,000 to 10,000 deaths annually
Lesser incidence in Europe due to
better enforcement of fire codes & less
arson
6. Burns : Etiology
• Stupidity is the major factor
• Therefore, at least 75 % are preventable
• Usual type distribution :
•
•
•
•
•
Flame : 75 %
Scald : 15 %
Chemical : 5 %
Electrical : 3 to 5 %
Radiation : < 1 %
11. Physiologic Functions of Skin
Disrupted By Burns
•
•
•
•
•
Barrier to microorganisms
Temperature regulation
Fluid retention
Sensory
Cosmesis
12. Burns : Suspect Associated Injuries
•
•
•
•
Explosion
Falls
Motor vehicle crash with fire
High voltage electrical
Note : Treat the associated injuries first : Do
not focus on just the burn !
13. Suspect Associated Injuries
• The burn patient initially should be
treated as a trauma patient (not a
dermatology patient)
• A major burn causes multi-organ
dysfunction and is not just a skin
injury ; these patients can be the most
sick & complex you may ever care for
14. Burns : History
•
•
•
•
•
•
•
Type of burn (flame, chemical, electrical, flash)
Substances involved
Associated trauma
If in closed space
Time of injury
Duration of contact with smoke
"AMPLE"
• Allergies
• Medications
• Prior illnesses
• Last meal (time)
• Events preceding the injury
15. Burns : Primary Scene Care
• Most important : Do not become a victim yourself !
• Turn off gas / pump / electric power, etc. if possible
• Remove patient from heat source (push with dry
nonconductive material if in contact with electricity)
• Immediately move patient from vicinity if danger of
explosion
• Keep low to avoid smoke ; use protective breathing
apparatus if available
• Put fire out ; extinguish burning clothing (H2O or CO2
extinguisher)
16. Burns : Secondary Scene Care
• Position airway ; start O2 and / or CPR if
needed
• Get off all potentially affected clothing
• Soak clothing or burn area if heat transfer still
possible ; continue to copiously irrigate if
chemical burn
• Ventilate area if smoke present
• Arrange transport
• Immobilize neck & back, etc., if needed
17. Burns : Physical Exam
• ABC's same as for any other trauma
patient
• Burn wound extent
• Burn wound depth
• Do not debride or dress burns until exam
complete
• Get patient's weight
18. Burns : Airway Management
• If early respiratory distress despite O2 :
consider endotracheal intubation quickly
• 100 % O2 for everybody initially
• Place nasal airway early for deep facial burn
(will hold open nose against edema swelling)
• Airway evaluation steps same as for other
trauma patients (remember C-spine
precautions and immobilization)
19. Burns : Smoke Inhalation Injury
• 80 % of fire deaths
• Main problems :
• Carbon monoxide poisoning
• Chemical tracheobronchitis (true smoke
inhalation injury)
• Asphyxia (air O2 content may go to only 5 % in a
flash fire ; one cannot maintain consciousness at
O2 content of only 5 %)
20. Smoke Inhalation Injury
• A chemical tracheobronchitis
• Not due to direct heat transfer (except for live
steam and impacting hot particles)
• Incidence : 15 to 33 % of serious burns
• Survival > 90 % if no associated burn
• Doubles the mortality that would be calculated
based on burn size area
• Is a major contributor to mortality in the elderly
22. Smoke Inhalation Injury :
Pathophysiology
•
•
•
•
•
•
•
•
Mucosal edema
Mucus and ash plugs
Loss of surfactant
Bronchospasm
Pulmonary capillary leakage
Mucosal cilia paralysis
May progress to mucosal slough
Predisposes to bacterial pneumonia
23. Smoke Inhalation Injury
• Suspect from history if :
•
•
•
•
Burns from explosions
Burns indoors or in "closed space"
Clothing fires
Unconscious after the burn
27. Smoke Inhalation Injury :
Other Studies
• ABG's : often normal, but may show resp. alkalosis
• If hypoxemia or hypercapnia, consider early intubation
• CXR : often normal
• May show fluffy infiltrates at 24 hrs.
• PFT's : (not necessary to obtain on most cases)
decreased FRC, decreased compliance, increased
shunt
• Sputum exam : sloughed cells and carbon deposits
• Bronchoscopy : very accurate but invasive
• Xenon 133 ventilation scan : if radionuclide retention >
90 seconds : indicates abnormal ; very accurate
29. Smoke Inhalation Injury :
Criteria for Extubation
• When eyelid edema resolved (usually
at 2 to 4 days postburn)
• No profuse bronchial secretions
• No respiratory failure by ABG's
30. Smoke Inhalation Injury :
Treatment
• Moist O2
• Pulmonary toilet (incentive spirometry, suction, chest
physical therapy & postural drainage)
• Intubation : oral or nasal, if upper airway edema or
respiratory failure
• Mechanical ventilation ; may need PEEP if severe
respiratory failure
• Bronchodilators : useful only for wheezing if present
• Antibiotics : not useful prophylactically
• Steroids or tracheostomy : NO ! (increase mortality)
31. Burns : Carbon Monoxide Poisoning
• Probably commonest cause of death from fires
• Interferes with O2 delivery by binding reversibly
to hemoglobin and by leftward shifting of O2
dissociation curve
• Also restricts cellular respiration by binding to
cytochromes
• Should measure directly the carboxyhemoglobin
level on all flame burn patients (venous is just as
accurate or useful as arterial)
32. Carboxyhemoglobin Level : Half-life
• Room air : 4 hours
• 100 % O2 : 40 minutes
• 2 atmospheres pressure hyperbaric
O2 : 25 minutes
Should always “back-calculate” the carboxyhemoglobin
level to what the level was at the time of injury in
determining treatment (each 40 minute period the
patient has been on oxygen counts as one half life)
33. Carbon Monoxide Poisoning
• If patient requires resuscitative care for burns or
other injuries, DO NOT send to non-walk-in
hyperbaric chamber
• Large walk-in chamber required so resuscitation
can continue during hyperbaric treatment
• Efficacy of hyperbaric Rx has never actually been
proven in a randomized trial against face mask
O2 given for an extended period
34. Carboxyhemoglobin Levels
and Usual Symptoms
•
•
•
•
•
< 10 %
: Usually asymptomatic (same as
smoker's)
10 to 20 % : Headache, nausea, irritability,
dyspnea
20 to 40 % : Arrhythmias, CNS depression,
vomiting
40 to 50 % : Seizures, coma, cardiovascular
collapse
> 60 %
: Often fatal (but certainly can have
neurologically intact survival)
35. Treatment of Elevated
Carboxyhemoglobin Levels
< 10 %
: 100 % O2 for one hour or until symptoms
(cough, headache, etc.) resolve
10 to 20 % : 100 % O2 until symptoms resolve
(usually 2 hours)
20 to 40 % : 100 % O2 ; recheck levels ; consider
hyperbaric O2
> 40 %
: 100 % O2 ; most should probably get
hyperbaric O2* (?)
If pregnant or any neuro symptoms, should get
hyperbaric treatment regardless of level* (?)
*There is debate about these indications ; some
say just use prolonged facemask O2
36. Carbon Monoxide Poisoning :
Complications
•
•
•
•
•
•
•
Cerebral edema
Cerebral infarcts
Acute MI
Persistent learning deficit
Personality changes
Memory impairment
Death from progressive
encephalopathy
37. Burns : Burn Wound Extent
• Expressed as percent of total body
surface area (% TBSA)
• Rough guidelines :
• Area of patient's hand = 1 % TBSA
• Rule of 9's
38. Burn Wound Extent : Rule of Nines
•
•
•
•
•
•
Head : 9 % adult (18 % in babies)
Arm : 9 % each
Anterior trunk : 18 %
Posterior trunk : 18 %
Leg : 18 % each (14 % each in babies)
Genitalia : 1 % (greater if the patient is from
Texas or is a surgeon ; at least they say so)
39. US Department of Health and Human Services, Wikimedia Commons
Lund and Browder chart for estimation of burn wound extent
40. Burn Wound Depth
• Initial depth determination often unreliable (especially in
children)
• May need 2 weeks observation to accurately determine depth
of injury
• First degree : Only outer epidermis damaged
• Second degree Shallow partial thickness : only epidermis
damaged
• Second degree Deep partial thickness : damage extends into
dermis but can heal by regrowth from cells of sweat glands
and hair follicles
• Third degree : All of dermis destroyed ; requires grafting
unless < 2.5 cm in diameter
41. Burn Wound Depth
• First degree : like sunburn
• Red, painful, no blisters
• Do not count when determining burn
surface area to calculate fluids
• Heals in 3 to 7 days without scarring
• Only cases which need admission
would be babies with associated
dehydration or heat illness
• Rx with any soothing cream, NSAID's
• Steroids shown not to be helpful
42. Burn Wound Depth
• Second degree (or partial thickness)
•
•
•
•
•
•
Usually red but can be white
Usually painful
Usually blisters
Heals in 7 to 28 days
May scar
May need skin grafting (because of its
tendency to cause deforming or
hypertrophic scarring)
45. Burn Wound Depth
• Third degree (full thickness)
•
•
•
•
•
•
Usually white (may be red)
Leathery
Insensate
Usually no blisters
Thrombosed subcutaneous vessels
Will heal from edges if < 2.5 to 3 cm in
diameter (otherwise needs skin
grafting)
47. Source Undetermined
Deep third degree burns of face (note need for nasal trumpet to
hold nasal passage open & inability to close eyelids
necessitating ophthalmic ointment protection of the cornea)
48. Burn Shock
• "Burn shock" due to loss of capillary seal
throughout body with > 25 % TBSA burn
• Local loss of capillary seal occurs in vicinity
of smaller burns
• "Burn shock" lasts 18 to 48 hours, then
spontaneously resolves
• Etiology of "burn shock" uncertain but
probably due to vasoactive mediators
49. Burns : IV Placement
• Peripheral lines OK ; seldom need
central line
• OK to place IV through burned tissue
• Femoral lines OK
• Arterial line may facilitate monitoring
• Should change all IV catheters every
48 to 72 hours (to prevent line
infections)
50. Burns : Fluid Resuscitation
• Aim of early fluid resuscitation is to maintain
intravascular volume despite the body-wide
loss of capillary seal
• Isotonic crystalloid best (colloid just leaks
into lung in first 24 hours)
• Sodium at 0.5 meq / Kg / % TBSA burn is key
factor
• Different resuscitation formulas used ; most
provide the above similar amount of Na+
51. Parkland Formula
• 4 cc Lactated Ringers times # of kg body
weight times # of % TBSA burn
• Give one-half in first 8 hrs. (from time of
burn)
• Then give one-half over the next 16 hrs.
• Example : 50 % TBSA burn in a 70 kg. man : 4
times 70 times 50 equals 14,000 cc ; give
7000 cc over first 8 hours, or about 1 liter per
hour
52. Parkland Formula for Children
• Add 4 cc / Kg / % burn to maintenance
fluid requirement :
• 100 cc / Kg for < 10 Kg
• 1000 cc + 50 cc / Kg for 10 to 20 Kg
• 1500 cc + 20 cc / Kg for 20 to 30 Kg
53. Shriner's Formula
(More Accurate for Children)
• 2000 ml / M2 TBSA maintenance plus
5000 ml / M2 BSA burned per 24 hours
• Requires access to a body surface
area nomogram
54. Burns : Monitoring Fluid
Resuscitation
• Urine output is key criterion
• 30 cc / hr in adults
• 1 cc / Kg / hr in children
• 2 cc / Kg / hr for electrical burns
•
•
•
•
Mental status & sensorium
Pulse & BP : less useful
Skin perfusion in non-burned areas
Use the formula only as a guide ;
adjust up or down as needed
55. Importance of Monitoring
Fluid Resuscitation Volumes
• If patient requires much higher then
expected (calculated) fluid volumes
for resuscitation:
• Search for additional undiagnosed
injury
• Check serum electrolytes or hematocrit
• Consider use of bicarb (extra Na+)
• Consider hypertonic resuscitation
• Consider transfusion with packed cells
• Consider plasmapheresis (can be lifesaving)
56. Escharotomy
• Circumferencial full thickness burns of limb may
cause ischemia of distal limb
• Anterolateral full thickness burn of thorax may
cause restrictive ventilation defect
• Dx by distal paresthesias, pain, pallor
• Decreased pulse by Doppler or palpation is very
late sign
• Most accurate dx by direct measurement of
compartment pressure (> 30 mm Hg is abnormal)
57. Escharotomy
• Measure pressure in distal compartments with
needle and manometer or wick catheter
• If pressure < 30 mm Hg then repeat
measurement in 2 hours
• If pressure > 30 mm Hg, perform escharotomy
• Need for thoracic escharotomy dictated by
clinical (ventilatory effort) status, not pressure
measurements
58. Escharotomy Technique
• Incise through burned tissue till deeper tissue
gapes
• No anesthesia needed
• May delay procedure only up to 4 hours after
onset of restricted circulation
• Have ointment and bandaging material ready
• Incise along medial and lateral limb
• Incise along anterior axillary line and
transverse subcostal for thoracic
60. Burns : Admission Criteria Based
on Categorization
• Severe : Transfer to burn center
• Moderate : Admit to local hospital
• Minor : Treat as outpatient
61. Minor Burns
•
•
•
•
Second degree < 15 % in adults
Second degree < 10 % in children
Third degree < 2 %
No involvement of face, hands, feet,
genitalia (technically difficult areas to
graft)
• No smoke inhalation
• No complicating factors
• No possible child abuse
62. Moderate Burns
• Second degree of 15 to 25 % TBSA in adults
• Second degree of 10 to 20 % TBSA in children
• Third degree of 2 to 10 % (not involving hands, feet,
face, genitalia)
• Circumferencial limb burns
• Household current (110 or 220 volt) electrical injuries
• Smoke inhalation with minor (< 2 % TBSA) burns
• Possible child abuse
• Patient not intelligent enough to care for burns as
outpatient
63. Severe Burns
•
•
•
•
•
Second degree > 25 % in adults
Second degree > 25 % in children
Third degree > 10 %
High voltage electrical burns
Deep second or third degree burns of face, hands,
feet, genitalia
• Smoke inhalation with > 2 % burn
• Burns with major trunk, head or orthopedic injury
• Burns in poor risk patients (elderly, diabetic, COPD,
obese, etc.)
64. Burns : Additional Interventions
•
•
•
•
NPO until evaluation complete
NG tube (burns > 25 % TBSA cause an ileus)
Foley
IV narcotics (morphine) : low dose
• No IM narcotics !
• Tetanus toxoid +/- tetanus immune globulin
(TIG) prn
• Parenteral or oral antibiotics : usually not
needed
65. Inpatient Burn Care
• Resuscitation phase : First 24 to 48 hours postburn
• Post Resuscitation phase : day 2 to 5 postburn
• Determine capillary seal time ( when IV fluid can be decreased to
calculated maintenance rate and patient remains stable)
• Give plasma and change IV to D5W
• Extubate
• Discontinue NG ; Start PO feeding & supplemental tube feedings
• Start physical therapy
• Surgical phase : excision and skin grafting procedures
• Rehabilitation phase : after all skin grafts take
• Secondary surgeries, attempts to decrease hypertrophic scarring,
scar revision & cosmetic surgeries, rehabilitation
66. Major Burns :
Additional Considerations
• Elevated body temperature
• Usually persists until all burns closed
by skin grafts
• Not a reliable sign of infection
• Elevated metabolic rate
• All patients require 2 to 4 times more
calories & protein for nutritional
support
• This extra nutritional support can be
the key factor in surviving the burn
67. Burns : Wound Care
• Blisters : "to debride or not to
debride, that is the question "
• Probably should debride :
•
•
•
•
Large blisters
Ones already broken
If already infected
If unsure of depth of underlying burn
• Do not debride thick palmar or plantar
blisters
68. Blister Debridement
• Advantages :
•
•
•
•
Eliminates dead tissue
Less risk of infection
Allows better assessment of burn depth
May permit better limb mobility
• Disadvantages :
• More painful
• ? delays wound healing
69. Blister Debridement : Method
• Have ointment & bandaging material ready
• Perform as quickly as possible ; limit exposure
time to air
• Wipe tissue loose with dry 4 x 4 inch gauze
• Do not usually need to use scissors or knife
• Only debride what comes off easily ; should not
stir up bleeding
• Be sure to "test wipe" all sooty areas to make
sure they do not represent second degree burns
71. Burns : Topical Agents
• Silver sulfadiazine (Silvadene) : painless, soothing on
application, bacteriostatic, allergic sensitivity rare ;
probably agent of choice
• Sulfamylon : penetrates eschar best, stings on
application, cases metabolic acidosis by inhibition of
carbonic anhydrase; probably best for pinnae burns
• Povidone iodine (Betadine) : painful on application,
may sensitize to iodine, can cause iodine toxicity in
large amounts
• Gentamicin ointment : can be absorbed and cause
renal failure if used in large amounts
72. Management of Tar Burns
• Immediately cool the tar with cold
water to prevent further heat transfer
• Don't attempt to force peel off
• Use Orange-Sol, Neosporin ointment,
other petrolatum-based ointment, or
mineral oil to dissolve the tar
• Treat underlying burns same as other
flame burns once the tar is removed
74. Outpatient Burn Care
• Carefully instruct patient and family in dressing
change procedure
• Change the ointment and dressing at least once
a day (Preferably twice a day)
• See patient for recheck in 24 hours (after one
dressing change at home) if you think he is not
intelligent enough to do the burn care correctly
• See patient for recheck in 2 to 3 days if he
seems reliable
75. Outpatient Burn Care :
Patient Instructions
• Remove bandage and dressing
• Wash off the old Silvadene ointment with warm
soapy water (may soak area first)
• Peel off any loose or broken blisters & pat area dry
• Reapply new Silvadene ointment 1/16" to 1/8" (3 to
6 mm) thick
• Reapply new bandage
• May take pain medicine 30 minutes before
changing the ointment and bandage
76. Outpatient Burn Care :
What to Look for at Recheck Visits
• If patient is performing burn care satisfactorily
• If burn is developing signs of infection
• Erythema and tenderness outside the original
burned area
• Thick drainage from the burn is usually just
proteinaceous exudate and not a sign of infection
• If patient is maintaining satisfactory range of motion of
the affected area
• If healing is progressing ; if not, the burn may be full
thickness and referral for skin grafting may be needed
77. Outpatient Burn Care :
Advice to Patient After the Burn Heals
• Keep the area moist with cold cream
• Use Benadryl (diphenhydramine) for pruritis
• Keep the area out of the sun for 6 months (to
prevent unpredictable lightening or
darkening of the affected skin)
• Encourage extra active Range of Motion
(ROM) exercises
• Assess for hypertrophic scarring (usually at
6 weeks)
79. Outpatient Burn Care :
Hypertrophic Scarring Treatment
• Intensive physical therapy & active
ROM exercises
• Measure for Jobst garment ; wear the
garment all the time for 1 year
• Early scar surgical revision only if
major functional limitation
• Usually best to postpone surgical
scar excision or revision until one
year (time of full maturity for scar)
80. Major Burns :
Delayed Complications
• Infection
•
•
•
•
•
• Burn wound sepsis
• Pulmonary infection
• Line infections
• Fungal infections
Pulmonary emboli or DVT
Multiple organ failure
Anemia
Hypothermia
Graft failure or non-take
82. Burns : Prevention
• Don't be stupid !
• Turn water heaters down to 120 to 130 degrees F (50
to 55 degrees C)
• Don't use open frying pan if young children present
• Dress children with flame-retardant clothing
• Use smoke detectors & sprinkler systems
• Educate children about fires & matches
• Stay low in a burning building to avoid smoke
inhalation
• Familiarize yourself with building exits when on trips
or in new buildings
83. Burns
Lecture Summary
• Treat major burns by same principles as for
other major trauma
• Identify smoke inhalation early
• Monitor fluid resuscitation
• Categorize severity to decide on disposition
• Anticipate complications
• If Rx as outpatient, verify close followup thru
healing & hypertrophic scarring phases
• Assist in prevention efforts