外科急诊创伤(英文)-烧伤148页PPT
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cushioning insulation
Causes
Thermal Electrical Chemical Radiation
Thermal
Majority flame scald contact with hot objects
Child with burns from a scald
Determining Severity
Zone of Stasis
Area surrounding zone of coagulation characterized by decreased blood flow.
Zone of Hyperemia
Peripheral area around burn that has an increased blood flow.
Zone of Stasis
Moderate degree of insult Decreased tissue perfusion Vascular damage/ leakage May progress to necrosis 24-48 hours
Zone of Hyperemia
Vasodilation Inflammation Viable tissue
Length 18-24 hours Begins after Emergent Phase
Reaches peak in 6-8 hours
Damaged cells initiate inflammatory response
Increased blood flow to cells Shift of fluid from intravascular to extravascular space
Renal
Decrease circulating plasma Increase hematocrit Decreased CO
decreased renal blood flow oliguria acute renal failure
Gastrointestinal
Decreased gastrointestinal blood flow Increased mucosal hemorrhage > 20% ileus
Cardiovascular
Loss of plasma volume Increased peripheral vascular resistance Decreased cardiac output
decreased blood volume decreased venous return increased blood viscosity decreased contractility
superficial partial thickness red, painful, blistered
deep partial thickness pale, mottled
Very painful Infection may evolve into 3rd degree
Burn Depth
Partial-Thickness Burn: 2nd Degree Burn
Fluid Shifts
Initial decrease blood flow to burned area Followed by increased arterial vasodilation Release of vasoactive substance resulting in increased capillary permeability and edema
Function
Protection Regulation Prevention Sensory
Epidermis
Outer, thinner layer Consists of dead keratinized cells Protects
dehydration trauma light infection
General Impression
33 yo male pt writhing in pain. Screams and begs for pain medication however poor historian. S- blistering to back and chest, R upper ventral area leg exposed muscle; eyebrows singed A- PCN, codeine M- none P- none L- earlier today E- woke up on fire
Burns, thermal. Escharotomy to release chest wall and allow for ventilation of the patient.
Skin
Largest organ of the body
Anatomy
Epidermis Dermis Subcutaneous tissue
Jackson’s Theory of Thermal Wounds
Zone of Hyperemia Zone of Stasis
Zone of Coagulation
Zone of Coagulation
Central area of burn Necrotic from time of exposure
Body’s Response to Burns
Emergent Phase (Stage 1)
Pain response Catecholamine release Tachycardia, Tachypnea, Mild Hypertension, Mild
Anxiety
Fluid Shift Phase (Stage 2)
Burn Depth
Full-Thickness Burn: 3rd Degree Burn
Signs & Symptoms
Dry, leathery skin (white, dark brown, or charred)
Loss of sensation (little pain)
Signs & Symptoms
Intense pain White to red skin Blisters Involves epidermis
& dermis
Third Degree
Involve epidermis, dermis, subcutaneous tissue White, waxy, red, brown, leathery Dry and painless (muscle and bone)
ABCTransport decision? % BSA burned? Tx?
Ob来自百度文库ectives
Describe the structure and function of skin Discuss the types of burns. Explain the degrees of thermal burns. Discuss causes and treatments of inhalation injuries. Identify methods of approximating burn injuries. Describe and apply treatment modalities for the burn patient.
Burn Depth
Superficial Burn: 1st Degree Burn
Signs & Symptoms
Reddened skin Pain at burn site Involves only
epidermis
Second Degree
Involve epidermis and dermis Partial thickness
nutrients as it repairs itself
Resolution Phase (Stage 4)
Area of Damage
Zone of coagulation Zone of stasis Zone of hyperemia
Jackson’s Theory of Thermal Wounds
Zone of Coagulation
Area in a burn nearest the heat source that suffers the most damage as evidenced by clotted blood and thrombosed blood vessels
BURNS
Leaugeay Webre BS, CCEMT-P, NREMT-P
Scenario
Paramedic is called to the scene of a structure fire. FD has removed a victim from the house. BSI Scene safe 1 patient A/C standby FD/ PD on scene Now what?
MASSIVE EDEMA “Leaky Capillaries
Systemic Changes
Massive release of inflammatory mediators Produce vasoconstriction/ dilation Increased capillary permeability Edema
Anatomy & Physiology of the Skin
Layers
Epidermis Dermis Subcutaneos Underlying
Structures
Fascia Nerves Tendons Ligaments Muscles Organs
Immune System
Depressed immune function > 20% directly proportional to burn size
sepsis
Body’s Response to Burns
Hypermetabolic Phase (Stage 3)
Last for days to weeks Large increase in the body’s need for
All dermal layers/tissue may be involved
Fourth Degree
Include involvement of muscle and bone Charred in appearance Painless
Pathophysiology
Local changes- > 111F produce injury
Dermis
Gel like matrix Consists of collagen and elastin Contains blood vessels, lymphatics, sweat glands, hair follicles, sensory fibers
Subcutaneous
Connective tissue Adipose tissue
1st degree 2nd degree 3rd degree (4th degree)
Depth of Burn
Superficial Burn Partial Thickness Burn Full Thickness Burn
First Degree
Superficial involve only epidermis Local pain and redness No blistering present Heal spontaneously 2-5 days without scarring Not included when calculating % TBSA
Causes
Thermal Electrical Chemical Radiation
Thermal
Majority flame scald contact with hot objects
Child with burns from a scald
Determining Severity
Zone of Stasis
Area surrounding zone of coagulation characterized by decreased blood flow.
Zone of Hyperemia
Peripheral area around burn that has an increased blood flow.
Zone of Stasis
Moderate degree of insult Decreased tissue perfusion Vascular damage/ leakage May progress to necrosis 24-48 hours
Zone of Hyperemia
Vasodilation Inflammation Viable tissue
Length 18-24 hours Begins after Emergent Phase
Reaches peak in 6-8 hours
Damaged cells initiate inflammatory response
Increased blood flow to cells Shift of fluid from intravascular to extravascular space
Renal
Decrease circulating plasma Increase hematocrit Decreased CO
decreased renal blood flow oliguria acute renal failure
Gastrointestinal
Decreased gastrointestinal blood flow Increased mucosal hemorrhage > 20% ileus
Cardiovascular
Loss of plasma volume Increased peripheral vascular resistance Decreased cardiac output
decreased blood volume decreased venous return increased blood viscosity decreased contractility
superficial partial thickness red, painful, blistered
deep partial thickness pale, mottled
Very painful Infection may evolve into 3rd degree
Burn Depth
Partial-Thickness Burn: 2nd Degree Burn
Fluid Shifts
Initial decrease blood flow to burned area Followed by increased arterial vasodilation Release of vasoactive substance resulting in increased capillary permeability and edema
Function
Protection Regulation Prevention Sensory
Epidermis
Outer, thinner layer Consists of dead keratinized cells Protects
dehydration trauma light infection
General Impression
33 yo male pt writhing in pain. Screams and begs for pain medication however poor historian. S- blistering to back and chest, R upper ventral area leg exposed muscle; eyebrows singed A- PCN, codeine M- none P- none L- earlier today E- woke up on fire
Burns, thermal. Escharotomy to release chest wall and allow for ventilation of the patient.
Skin
Largest organ of the body
Anatomy
Epidermis Dermis Subcutaneous tissue
Jackson’s Theory of Thermal Wounds
Zone of Hyperemia Zone of Stasis
Zone of Coagulation
Zone of Coagulation
Central area of burn Necrotic from time of exposure
Body’s Response to Burns
Emergent Phase (Stage 1)
Pain response Catecholamine release Tachycardia, Tachypnea, Mild Hypertension, Mild
Anxiety
Fluid Shift Phase (Stage 2)
Burn Depth
Full-Thickness Burn: 3rd Degree Burn
Signs & Symptoms
Dry, leathery skin (white, dark brown, or charred)
Loss of sensation (little pain)
Signs & Symptoms
Intense pain White to red skin Blisters Involves epidermis
& dermis
Third Degree
Involve epidermis, dermis, subcutaneous tissue White, waxy, red, brown, leathery Dry and painless (muscle and bone)
ABCTransport decision? % BSA burned? Tx?
Ob来自百度文库ectives
Describe the structure and function of skin Discuss the types of burns. Explain the degrees of thermal burns. Discuss causes and treatments of inhalation injuries. Identify methods of approximating burn injuries. Describe and apply treatment modalities for the burn patient.
Burn Depth
Superficial Burn: 1st Degree Burn
Signs & Symptoms
Reddened skin Pain at burn site Involves only
epidermis
Second Degree
Involve epidermis and dermis Partial thickness
nutrients as it repairs itself
Resolution Phase (Stage 4)
Area of Damage
Zone of coagulation Zone of stasis Zone of hyperemia
Jackson’s Theory of Thermal Wounds
Zone of Coagulation
Area in a burn nearest the heat source that suffers the most damage as evidenced by clotted blood and thrombosed blood vessels
BURNS
Leaugeay Webre BS, CCEMT-P, NREMT-P
Scenario
Paramedic is called to the scene of a structure fire. FD has removed a victim from the house. BSI Scene safe 1 patient A/C standby FD/ PD on scene Now what?
MASSIVE EDEMA “Leaky Capillaries
Systemic Changes
Massive release of inflammatory mediators Produce vasoconstriction/ dilation Increased capillary permeability Edema
Anatomy & Physiology of the Skin
Layers
Epidermis Dermis Subcutaneos Underlying
Structures
Fascia Nerves Tendons Ligaments Muscles Organs
Immune System
Depressed immune function > 20% directly proportional to burn size
sepsis
Body’s Response to Burns
Hypermetabolic Phase (Stage 3)
Last for days to weeks Large increase in the body’s need for
All dermal layers/tissue may be involved
Fourth Degree
Include involvement of muscle and bone Charred in appearance Painless
Pathophysiology
Local changes- > 111F produce injury
Dermis
Gel like matrix Consists of collagen and elastin Contains blood vessels, lymphatics, sweat glands, hair follicles, sensory fibers
Subcutaneous
Connective tissue Adipose tissue
1st degree 2nd degree 3rd degree (4th degree)
Depth of Burn
Superficial Burn Partial Thickness Burn Full Thickness Burn
First Degree
Superficial involve only epidermis Local pain and redness No blistering present Heal spontaneously 2-5 days without scarring Not included when calculating % TBSA