学员英文PTC Slides_For PTC China_June 2010 Edition初级创伤的救治.ppt

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * Burns Objectives To understand the structured approach to the burnt patient To recognize and treat the consequences of severe burns 192 BurnsApproach Stop the burning ABCDE Determine area of burn Good IV access Early fluid replacement Prevent hypothermia 193 BurnsMortality Early death Late death airway obstruction respiratory failure shock renal failure sepsis multiple organ failure 194 BurnsAirway Consider early intubation ↑ Hoarseness Difficulty swallowing secretions ↑ Respiratory distress Transfer required 195 BurnsBreathing Suspect inhalational injury Fire in enclosed space Burns around mouth, face, nasal hair Respiratory distress Hoarseness, cough, stridor Ash in sputum 196 BurnsCirculation Treat shock Calculate ongoing fluids on size of burn Oral rehydration possible in smaller burns Maintain urinary output 0.5-1.0 ml/kg/hr 197 Burn Area Assessment Head and neck 9% Upper limb 9% Front of trunk 18% Back of trunk 18% Lower limb 18% Perineum 1% 198 BurnsCirculation - Fluid Resuscitation 2-4 ml crystalloid/kg/% burn in first 24 hours 1/2 of fluid in first 8 hours 1/2 of fluid over next 16 hours Remember maintenance fluids Calculations are only a guide 199 BurnsExposure Cover patient to prevent hypothermia 200 BurnsAssessment of depth Superficial: pain, erythema, no blisters Partial thickness: painful, weeping, blisters, mottled Full thickness: painless, white/dark and leathery Depth less important than size in early resuscitation 201 BurnsOther issues Analgesia Nasogastric drainage Tetanus prophylaxis Consider escharotomy Beware of other injuries Beware electrical burns 202 ? Burns 203 Burns Summary ABCDE Beware co-existing injuries Consider early intubation Fluids Beware hypothermia 204 * * * * * * * * * * * * * * * * * * * Limb TraumaAssessment ABC Look - colour, deformity, wounds