Top Banner

Click here to load reader

of 55

Schedule Burns Hypothermia Anaphylaxis. You will need Paper Pen Coin MCQ card.

Jan 17, 2018

Download

Documents

Sybil Nash

Burns Dr. Stella Yiu Emergency Physician, TOH
Welcome message from author
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript

Schedule Burns Hypothermia Anaphylaxis You will need Paper Pen Coin MCQ card Burns Dr. Stella Yiu Emergency Physician, TOH LMCC objectives Determine severity and extent Diagnose Complications Institute initial management of burn trauma 1. Severity & extent Skin layer Image credit: Simon Yiu Derived from work by Persian Poet Gal at en.wikipedia [GFDL (http://www.gnu.org/copyleft/fdl.html) or CC-BY-3.0 (http://creativecommons.org/licenses/by/3.0)], from Wikimedia Commons 1 st degree/Superficial Superficial PT/2 nd degree Image credit: Simon Yiu Derived from work by Persian Poet Gal at en.wikipedia [GFDL (http://www.gnu.org/copyleft/fdl.html) or CC-BY-3.0 (http://creativecommons.org/licenses/by/3.0)], from Wikimedia Commons Superficial PT/2 nd degree By Cjr80 (Own work) [CC-BY-SA-3.0 (http://creativecommons.org/licenses/by- sa/3.0)], via Wikimedia Commonshttp://creativecommons.org/licenses/by- sa/3.0 Deep PT/2 nd degree Image credit: Simon Yiu Derived from work by Persian Poet Gal at en.wikipedia [GFDL (http://www.gnu.org/copyleft/fdl.html) or CC-BY-3.0 (http://creativecommons.org/licenses/by/3.0)], from Wikimedia Commons Deep PT/2 nd degree Photo credit:The Victorian Adult Burns Service, Alfred Health, Melbourne, Australia Full thickness/3 rd degree Image credit: Simon Yiu Derived from work by Persian Poet Gal at en.wikipedia [GFDL (http://www.gnu.org/copyleft/fdl.html) or CC-BY-3.0 (http://creativecommons.org/licenses/by/3.0)], from Wikimedia Commons Photo credit:The Victorian Adult Burns Service, Alfred Health, Melbourne, Australia Full thickness/3 rd degree What body surface area? Scattered areas Image credit: Simon Yiu Knowing surface area -> who needs special burn unit care -> how much fluids to give Photo credit:The Victorian Adult Burns Service, Alfred Health, Melbourne, Australia MCQ 1: Calculate his area of burn: Anterior torso + Whole left arm A.18% B.27% C.31.5% D.36% E.45% 2. Diagnose Complications Burn: Cellular level ++ Inflammation Capillaries leak with fluids and proteins Edema and hypovolemia Fluids Airway Edema Chemicals Burn patients need ++ fluids ++ Fluids Parkland Formula (1 st 24 hrs) 4cc x %BSA (2-3deg) x Wt (kg) ++ Fluids 1 st half 8 hr from time 0 Time zero 8 hours ++ Fluids 1 st half 8 hr from time 0 Time zero Hospital arrival time 8 hours MCQ 2: 80kg, Ant + post torso, left arm. Presents 4 hr post. Rate of fluids/first hour? A.1800 cc/hr B.1500 cc/hr C.1000 cc/hr D.900 cc/hr E.700 cc/hr Fluids Airway Edema Chemicals Image credit: Patrick J. Lynch, medical illustrator; C. Carl Jaffe, MD, cardiologist.via Wikimedia commons Photo credit:The Victorian Adult Burns Service, Alfred Health, Melbourne, Australia Who is at risk for inhalation injury? Face burn Soot Voice Photo credit: Dr. Mark Silverberg Face burn: Singed brows Soot: Mouth, nose, sputum Voice: Hoarse, change Intubate early even if no airway compromise Fluids Airway Edema Chemicals Tight skin + Edema Compartment syndrome Escharotomy Photo credit: Drs. Mike Cadogan and Chris Nickson, lifeinthefastlane.com Fluids Airway Edema Chemicals Carbon Monoxide 200x Affinity to Hb Carbon Monoxide is chased Atmos air T1/2 = 4 hours Atmos 100% Oxygen = 1 hour Hyperbaric oxygen = < 20 minutes Cyanide chokes mitochondria Photo credit:The Victorian Adult Burns Service, Alfred Health, Melbourne, Australia 3. Patient now arrives, what to do? CDMQ: Write nursing orders (6) Iv Fluids Cardiac monitor (BP, HR, O2 sat) Pain control, Tetanus CBC, lytes, Cr, CO level, Lactate, Trop CXR Who needs special care Area Agent Vulnerable population Area: 10% second or third (deep partial or full) Area: Hands Perineum Face Circumferential Chemical burn Electricity Children Burn unit LMCC objectives Determine severity and extent Diagnose Complications Institute initial management of burn trauma