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Schedule

Schedule. Burns Hypothermia Anaphylaxis. You will need. P aper 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.

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Schedule

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  1. Schedule • Burns • Hypothermia • Anaphylaxis

  2. You will need • Paper • Pen • Coin • MCQ card

  3. Burns Dr. Stella Yiu Emergency Physician, TOH

  4. LMCC objectives Determine severity and extent Diagnose Complications Institute initial management of burn trauma

  5. 1. Severity & extent

  6. 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

  7. 1st degree/Superficial

  8. Superficial PT/2nd 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

  9. Superficial PT/2nd degree By Cjr80 (Own work) [CC-BY-SA-3.0 (http://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons

  10. Deep PT/2nd 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

  11. Deep PT/2nd degree Photo credit: www.vicburns.org.au The Victorian Adult Burns Service, Alfred Health, Melbourne, Australia

  12. Full thickness/3rddegree 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

  13. Full thickness/3rddegree Photo credit: www.vicburns.org.au The Victorian Adult Burns Service, Alfred Health, Melbourne, Australia

  14. What body surface area?

  15. Scattered areas Image credit: Simon Yiu

  16. Knowing surface area -> who needs special burn unit care -> how much fluids to give

  17. MCQ 1: Calculate his area of burn: Anterior torso + Whole left arm 18% 27% 31.5% 36% 45% Photo credit: www.vicburns.org.au The Victorian Adult Burns Service, Alfred Health, Melbourne, Australia

  18. 2. Diagnose Complications

  19. Burn: Cellular level ++ Inflammation Capillaries leak with fluids and proteins Edema and hypovolemia

  20. Fluids Airway Edema Chemicals

  21. Burn patients need ++ fluids

  22. ++ Fluids Parkland Formula (1st 24 hrs) 4cc x %BSA (2-3deg) x Wt (kg)

  23. ++ Fluids 1sthalf 8 hr from time 0 8 hours Time zero

  24. ++ Fluids 1sthalf 8 hr from time 0 8 hours Time zero Hospital arrival time

  25. MCQ 2: 80kg, Ant + post torso, left arm. Presents 4 hr post. Rate of fluids/first hour? • 1800 cc/hr • 1500 cc/hr • 1000 cc/hr • 900 cc/hr • 700 cc/hr

  26. Fluids Airway Edema Chemicals

  27. Image credit: Patrick J. Lynch, medical illustrator; C. Carl Jaffe, MD, cardiologist. http://creativecommons.org/licenses/by/2.5/, via Wikimedia commons

  28. Photo credit: www.vicburns.org.au The Victorian Adult Burns Service, Alfred Health, Melbourne, Australia

  29. Who is at risk for inhalation injury? • Face burn • Soot • Voice

  30. Photo credit: Dr. Mark Silverberg

  31. Face burn: Singed brows • Soot: Mouth, nose, sputum • Voice: Hoarse, change Intubate early even if no airway compromise

  32. Fluids Airway Edema Chemicals

  33. Tight skin + Edema  Compartment syndrome

  34. Escharotomy Photo credit: Drs. Mike Cadogan and Chris Nickson, lifeinthefastlane.com

  35. Fluids Airway Edema Chemicals

  36. Carbon Monoxide 200x Affinity to Hb

  37. Carbon Monoxide is chased Atmos air T1/2 = 4 hours Atmos 100% Oxygen = 1 hour Hyperbaric oxygen = < 20 minutes

  38. Cyanide chokes mitochondria

  39. 3. Patient now arrives, what to do? Photo credit: www.vicburns.org.au The Victorian Adult Burns Service, Alfred Health, Melbourne, Australia

  40. CDMQ: Write nursing orders (6)

  41. Iv Fluids • Cardiac monitor (BP, HR, O2 sat) • Pain control, Tetanus • CBC, lytes, Cr, CO level, Lactate, Trop • CXR

  42. Who needs special care

  43. Area Agent Vulnerable population

  44. Area: 10% second or third (deep partial or full)

  45. Area: Hands Perineum Face

  46. Circumferential

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