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Catastrophic Blast
FORTUNE DE AMOR
405140230
GROUP 8
BURN INJURY Clinical indications of inhalation
injury include:
Face and/or neck burns
establishing Singeing of the eyebrows and
airway control nasal vibrissae
Carbon deposits in the mouth
Immediate Lifesaving and/or nose and carbonaceous
Measures for Burn stopping the sputum
burning Acute inflammatory changes in
Injuries
process the oropharynx, including erythema
Hoarseness
History of impaired mentation
gaining and/or confinement in a burning
intravenous environment
access Explosion with burns to head and
torso
Carboxyhemoglobin level greater
than 10% in a patient who was
involved in a fire
BURN INJURY
The Rule of Nines
The adult body configuration is divided
into anatomic regions that represent 9%, or
multiples of 9%, of the total body surface
Body-surface area (BSA) differs
considerably for children. The infant’s or
young child’s head represents a larger
proportion of the surface area, and the
lower extremities represent a smaller
proportion than an adult’s.
The palmar surface (including the fingers)
of the patient’s hand represents
approximately 1% of the patient’s body
surface
BURN INJURY First-degree burns
Erythema, pain, and the absence of
blisters
They are not life-threatening and
generally do not require intravenous
fluid replacement because the
epidermis remains intact
Partial-thickness burns
Red or mottled appearance with
associated swelling and blister
formation
The surface can have a weeping, wet
appearance and is painfully
hypersensitive, even to air current
BURN INJURY
Full-thickness burns
Usually appear dark and leathery
The skin also may appear translucent or
waxy white
The surface is painless and generally dry;
it may be red, but does not blanch with
pressure
BURN INJURY
Electric burn
a source of electrical power contact with a body
Mechanism: The body can serve as a conductor of electrical energy heat generated
results in thermal injury to tissue different rates of heat loss from superficial and deep
tissues deepmuscle necrosis, spinal injuries, trombosis rhabdomyolysis
myoglobin release acute renal failure.
BURN INJURY
CRITERIA FOR TRANSFER
1. Partial-thickness and full-thickness burns on greater than 10% of the BSA in any patient
2. Partial-thickness and full-thickness burns involving the face, eyes, ears, hands, feet, genitalia, and
perineum, as well as those that involve skin overlying major joints
3. Full-thickness burns of any size in any age group
4. Significant electrical burns, including lightning injury (significant volumes of tissue beneath the surface
can be injured and result in acute renal failure and other complications)
5. Significant chemical burns
6. Inhalation injury
7. Burn injury in patients with preexisting illness that could complicate treatment, prolong recovery, or
affect mortality
8. Any patient with a burn injury who has concomitant trauma poses an increased risk of morbidity or
mortality, and may be treated initially in a trauma center until stable before being transferred to a burn
center
9. Children with burn injuries who are seen in hospitals without qualified personnel or equipment to
manage their care should be transferred to a burn center with these capabilities
10. Burn injury in patients who will require special social and emotional or long-term rehabilitative
support, including cases involving suspected child maltreatment and neglect
Significant cause mortality Chest injuries
Hypoxia, Hypercarbia, Acidosis
Initial assessments & treatments : Breathing :
Primary Survey Signs :
Resuscitation of Vital Functions ↑↑ RR
Change in breathing pattern
Detailed Secondary Survey Shallows respirations
Definitive care Cyanosis ( late sign )
Must be recognized :
Airway : Tension Pneumothorax
Open Pneumothorax
Look, Listen, Feel
Fail Chest
Identification Injury : Pulmonary Contusion
Upper Airway Obstruction Massive Hemothorax
Change in voice quality
Chest injuries: TENSION PNEUMOTHORAX
Signs :
Chest pain Management :
Air hunger Immediate decompression
Respiratory distress inserting a large-caliber needle
Tachycardia in the 2nd ICS in the
Hypotension midclavicular line of the
affected side
Tracheal deviation away from the side of
injury Repeated reassessment is
necessary
Unilateral absence of breath sounds
Definitive treatment : insertion
Elevated hemithorax without respiratory
of a chest tube
movement
Neck vein distention
Cyanosis (late manifestation)
Chest injuries: TENSION PNEUMOTHORAX
Needle decompression
Chest injuries: OPEN PNEUMOTHORAX
Management :
Large defects of the chest wall that
Closing the deffect
remain open results in an open
pneumothorax ( sucking chest wound ) Sterile oclusive dressing
Pathophysiology : Large, overlap the wound
If wound is 2/3 of the tracheal chest Taped securely on 3 side
wall defect with each respiratory effort Inspiration: prevented air entering
effective ventilation is impaired Expiration: air escape from pleural
Signs : Definitive treatment: surgical closure
Hypoxia, Hypercabia
Chest injuries: OPEN PNEUMOTHORAX
Dressing for
treatment
Chest injuries: Flail Chest & Pulmonary Contusion
Pathopysiology :
Multiple rib fractures ( 2/> ) Chest X-Ray multiple rib
Loss of continuity of chest wall fractures
Deffect on thoracic cage ABG hypoxia
Severe disruption of normal chest wall Initial treatment :
movement Ventilation
Can cause hypoxia Oxygen
Diagnose : Fluid Resuscitation
Moves air poorly Definitive treatment :
Thorax’s movement asymmetrically Oxygenation
Uncoordinated Fluids administer
Palpation : abnormal respiratory motion & Analgesia
crepitation
Chest injuries: Flail Chest & Pulmonary Contusion
Chest injuries
Circulation :
Quality, rate, and regularity of pulse
Hypovolemia : radial and dorsalis pedis pulse is absent
Skin color and temperature
Neck vein
Cardiac monitor and pulse oxymeter
Must be recognized :
Massive Hemothorax
Cardiac Tamponade
Chest injuries: MASSIVE HEMOTHORAX
Accumulation >1500 mL blood in
chest cavity
Diagnose :
Shock + absence of breath
sound/dullness to percution on 1
side of chest
Initial treatment :
simultaneous restoration of blood
volume and decompression of the
chest cavity
IV access, crystalloid infusion
Accumulation of blood & fluid
Chest tube, collect the blood compressing the lung
autotransfusion compromise respiratory effort
Chest injuries: CARDIAC TAMPONADE