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Coverage
Preventive and Safety Measures Assessment and Classification Management During:
Emergent (Prioritization) 1st Phase (Fluids, Electrolytes & ABG) 2nd Phase (Fluids, Electrolytes & ABG) 3rd Phase (Rehabilitation)
Fire Hazards
MAJORITY OF BURN CASES ARE DUE TO
Due to
NEGLIGENCE!
Childs curiosity
R ESCUE remove
client
A LARM activate
fire alarm, report
C ONFINE close
doors and windows
E XTINGUISH fire
Things to do..
Drop to the floor Cover face with wet cloth Look for the fire exit DONT PANIC!
POSSIBLE INJURIES!
Most fatal!
Consider CO poisoning
ASSESSMENT
A B C D E
IRWAY
REATHING
IRCULATION
ISABILITIES
XPOSE
Types of Burns
Chemical acid or alkali Electrical most fatal Mechanical friction or abrasion Radiation sunlight Thermal dry flames, moist and heat
Radiation
Thermal
Mechanical
Chemical
Electrical
Epidermis Only
1st degree superficial thickness painful, no blisters, pink and red, NSG
4th Degree
4th degree full thickness, black painless bones and visceral organs are affected FTSG
Burn Category
Minor Burn Injury
15-30% , 1st and 2nd degree 10%, 3rd degree
What is your Priority? 1. Airway 2. Hypovolemia 3. Hypothermia 4. Continuing burn injury 5. Pain 6. Compartment Syndrome
Emergency Room
ABCDE assessment Airway and fluid resuscitation (priority) Strict I and O monitoring (foley catheter) Prevent hypothermia (heat loss) Give TIG/TAT (passive) and TT (active) Prophylactic antibiotic Silvadene Silver Nitrate (may lead to Acidosis)
Fluid Replacement
LRS
Choose?
A. Isotonic B. Hypotonic C. Hypertonic
Parkland Formula
(TBSA x 4ml x BWkg) 1st 8H give 2nd 8H give 3rd 8H give
Case: Burnt Area: Head/neck, chest, and left lower extremity ___? BW: 60 kg Formula: TBSA x 4ml x BWkg 36% x 4ml x 60kg
Computation
= 36% x 4ml x 60kg = 36 x 4 x 60 = 8640 ml/24h 1st 8h = 4320 ml () 2nd 8h = 2160 ml () 3rd 8h = 2160 ml () Note: (Parkland) Use LRS fluid Given in the 1st 24h only Start the infusion at the time of injury
st 1
Phase
Hypovolemia tissue perfusion Hyponatremia Hyperkalemia Circumferential edema Rhabdomyolysis Myoglobinuria Oliguria
nd 2
Phase
Renal Failure
st 1
and
nd 2
Phase
First Phase
Hypovolemia tissue perfusion Hyponatremia Hyperkalemia Circumferential edema Rhabdomyolysis Myoglobinuria Oliguria
Second Phase
Hypervolemia Hypokalemia Hyponatremia Infection Diuresis
Debridement
1. Wet to dry dressing 2. Occlusive dressing 3. Chemical dressing 4. Sharps
Skin Grafting
Donor site
Recipient site
Unsuccessful Management!
Escharotomy
RECAP
Emergent Phase 1st Phase or Fluid Accumulation 2nd Phase or Fluid Remobilization 3rd Phase or Rehabilitation
It can be prevented!
Thank you!
Noel Go partial thickness burn(anu itsura), mgmt: burning pt(anu gagawin), electricution(anu gagawin?), pt(sa wheelchair): "ano gagawin ko pag ako nasunog?"
Neyz Intalan wat if burning pt?? u cover wid blanket? or tell him to stop first then roll saka blanket?
Marvin Tablisma burning pt (roll at blanket) partial thickness (mas mababaw ung burn mas masakit) yan po sagot ko hehehe ewan ko lng kung tama
Mgjerika Olumor Deep partial thickness po yung given... Ang pagpipilian kung Charred, blanch, with blister, at namumula yung isang option ata...
The nurse see a reddened area on the client's skin but no lesions. The nurse's best action is to: A. Put gauze on the reddened area to prevent any further injury.
A nurse is preparing to care for for a burn client scheduled for an escharotomy procedure being performed for a third-degree circumferential arm burn, the nurse understands that the anticipated therapeutic outcome of the escharotomy is: A. brisk bleeding from the site B. formation of granulation tissue C. decreasing edema formation D. return of distal pulses ***********************************
C old C hemicals
H eat E lectricity F riction or Radiation
Its a form of heat converted to an energy
CO2 48 upacidosis+3
HCO3 30 upalkalosis +4 Ph is 7.40 ..normal Check! Compensated!!! NEXTTT
If its compensated check the difference The one with higher difference will be the primary problem Fully if ph is at 7.40
Uncompensated
Ph is always abnormal CO2 and HCO3 will have the same arrows Example!
Co2 33 downalkalosis
Interpret this
pH 7.40 normal CO2 49 upacidosis + 4 HCO3 31 upalkalosis + 5 Same arrows? Compensation Is it compensated or uncompensated? What is the primary problem? The one with higher difference
This fluids will allow movement of water from IC to IV? A. hypotonic IV B. isotonic C. hypertonic
IC
ratio
Hypertonic has high solutes thereby creating an osmosis ORAYT!
FVD
Osmolality of plasma is? A. High B. low
electrolytes
Effects of giving D5W and insulin adminstration? A. K excretion via feces-KAYEXALATE B. K moves out from the cell-INCORRECT C. creates PISO-Na HCO3 po D. K moves inside the cell-CORRECT