外科急诊创伤(英文)烧伤课件

BURNSLeaugeayWebreBS,CCEMT-P,NREMT-PBURNSLeaugeayWebre1ScenarioParamediciscalledtothesceneofastructurefire.FDhasremovedavictimfromthehouse.BSIScenesafe1patientA/CstandbyFD/PDonsceneNowwhat?ScenarioParamediciscalledto2GeneralImpression33yomaleptwrithinginpain.Screamsandbegsforpainmedicationhoweverpoorhistorian.S-blisteringtobackandchest,Rupperventralarealegexposedmuscle;eyebrowssingedA-PCN,codeineM-noneP-noneL-earliertodayE-wokeuponfireGeneralImpression33yomalep3A-B-C-Transportdecision?%BSAburned?Tx?A-4ObjectivesDescribethestructureandfunctionofskinDiscussthetypesofburns.Explainthedegreesofthermalburns.Discusscausesandtreatmentsofinhalationinjuries.Identifymethodsofapproximatingburninjuries.Describeandapplytreatmentmodalitiesfortheburnpatient.ObjectivesDescribethestructu5Burns,thermal.Escharotomytoreleasechestwallandallowforventilationofthepatient.Burns,thermal.Escharotomyto6SkinLargestorganofthebodySkinLargestorganofthebody7AnatomyEpidermisDermisSubcutaneoustissueAnatomyEpidermis8LayersEpidermisDermisSubcutaneosUnderlyingStructuresFasciaNervesTendonsLigamentsMusclesOrgansAnatomy&Physiology

oftheSkinLayersAnatomy&Physiology

of9FunctionProtectionRegulationPreventionSensoryFunctionProtection10EpidermisOuter,thinnerlayerConsistsofdeadkeratinizedcellsProtectsdehydrationtraumalightinfectionEpidermisOuter,thinnerlayer11DermisGellikematrixConsistsofcollagenandelastinContainsbloodvessels,lymphatics,sweatglands,hairfollicles,sensoryfibersDermisGellikematrix12SubcutaneousConnectivetissueAdiposetissuecushioninginsulationSubcutaneousConnectivetissue13CausesThermalElectricalChemicalRadiationCausesThermal14ThermalMajorityflamescaldcontactwithhotobjectsThermalMajority15ChildwithburnsfromascaldChildwithburnsfromascald16DeterminingSeverity1stdegree2nddegree3rddegree(4thdegree)DeterminingSeverity1stdegree17DepthofBurnSuperficialBurnPartialThicknessBurnFullThicknessBurnDepthofBurnSuperficialBurn18FirstDegreeSuperficialinvolveonlyepidermisLocalpainandrednessNoblisteringpresentHealspontaneously2-5dayswithoutscarringNotincludedwhencalculating%TBSAFirstDegreeSuperficialinvolv19BurnDepthSuperficialBurn:

1stDegreeBurnSigns&SymptomsReddenedskinPainatburnsiteInvolvesonlyepidermisBurnDepthSuperficialBurn:

1s20SecondDegreeInvolveepidermisanddermisPartialthicknesssuperficialpartialthicknessred,painful,blistereddeeppartialthicknesspale,mottledVerypainfulInfectionmayevolveinto3rddegreeSecondDegreeInvolveepidermis21BurnDepthPartial-ThicknessBurn:2ndDegreeBurnSigns&SymptomsIntensepainWhitetoredskinBlistersInvolvesepidermis&dermisBurnDepthPartial-ThicknessBu22外科急诊创伤(英文)烧伤课件23ThirdDegreeInvolveepidermis,dermis,subcutaneoustissueWhite,waxy,red,brown,leatheryDryandpainless(muscleandbone)ThirdDegreeInvolveepidermis,24BurnDepthFull-ThicknessBurn:3rdDegreeBurnSigns&SymptomsDry,leatheryskin(white,darkbrown,orcharred)Lossofsensation(littlepain)Alldermallayers/tissuemaybeinvolvedBurnDepthFull-ThicknessBurn:25外科急诊创伤(英文)烧伤课件26FourthDegreeIncludeinvolvementofmuscleandboneCharredinappearancePainlessFourthDegreeIncludeinvolveme27PathophysiologyLocalchanges->111FproduceinjuryPathophysiologyLocalchanges-28AreaofDamageZoneofcoagulationZoneofstasisZoneofhyperemiaAreaofDamageZoneofcoagulat29Jackson’sTheoryofThermalWoundsZoneofCoagulationAreainaburnnearesttheheatsourcethatsuffersthemostdamageasevidencedbyclottedbloodandthrombosedbloodvesselsZoneofStasisAreasurroundingzoneofcoagulationcharacterizedbydecreasedbloodflow.ZoneofHyperemiaPeripheralareaaroundburnthathasanincreasedbloodflow.Jackson’sTheoryofThermalWo30Jackson’sTheoryof

ThermalWoundsZoneofHyperemiaZoneofStasisZoneofCoagulationJackson’sTheoryof

ThermalW31ZoneofCoagulationCentralareaofburnNecroticfromtimeofexposureZoneofCoagulationCentralare32ZoneofStasisModeratedegreeofinsultDecreasedtissueperfusionVasculardamage/leakageMayprogresstonecrosis24-48hoursZoneofStasisModeratedegree33ZoneofHyperemiaVasodilationInflammationViabletissueZoneofHyperemiaVasodilation34Body’sResponsetoBurnsEmergentPhase(Stage1)PainresponseCatecholaminereleaseTachycardia,Tachypnea,MildHypertension,MildAnxietyFluidShiftPhase(Stage2)Length18-24hoursBeginsafterEmergentPhaseReachespeakin6-8hoursDamagedcellsinitiateinflammatoryresponseIncreasedbloodflowtocellsShiftoffluidfromintravasculartoextravascularspaceMASSIVEEDEMA“LeakyCapillariesBody’sResponsetoBurnsEmerge35SystemicChangesMassivereleaseofinflammatorymediatorsProducevasoconstriction/dilationIncreasedcapillarypermeabilityEdemaSystemicChangesMassivereleas36FluidShiftsInitialdecreasebloodflowtoburnedareaFollowedbyincreasedarterialvasodilationReleaseofvasoactivesubstanceresultinginincreasedcapillarypermeabilityandedemaFluidShiftsInitialdecreaseb37CardiovascularLossofplasmavolumeIncreasedperipheralvascularresistanceDecreasedcardiacoutputdecreasedbloodvolumedecreasedvenousreturnincreasedbloodviscositydecreasedcontractilityCardiovascularLossofplasmav38RenalDecreasecirculatingplasmaIncreasehematocritDecreasedCOdecreasedrenalbloodflowoliguriaacuterenalfailureRenalDecreasecirculatingplas39GastrointestinalDecreasedgastrointestinalbloodflowIncreasedmucosalhemorrhage>20%ileusGastrointestinalDecreasedgast40ImmuneSystemDepressedimmunefunction>20%directlyproportionaltoburnsizeImmuneSystemDepressedimmune41sepsissepsis42Body’sResponsetoBurnsHypermetabolicPhase(Stage3)LastfordaystoweeksLargeincreaseinthebody’sneedfornutrientsasitrepairsitselfResolutionPhase(Stage4)ScarformationGeneralrehabilitationandprogressiontonormalfunctionBody’sResponsetoBurnsHyperm43HypermetabolismFollowingsevereburnandresuscitationtachycardiaincreasedCOincreasedO2demandmassiveproteolysis&lipolysisseverenitrogenlossHypermetabolismFollowingsever44SystemicComplicationsHypothermiaDisruptionofskinanditsabilitytothermoregulateHypovolemiaShiftinproteins,fluids,andelectrolytestotheburnedtissueGeneralelectrolyteimbalanceEscharHard,leatheryproductofadeepfullthicknessburnDeadanddenaturedskinSystemicComplicationsHypother45SystemicComplicationsInfectionGreatestriskofburnisinfectionOrganFailureReleaseofmyoglobinSpecialFactorsAge&HealthPhysicalAbuseElderly,InfirmorYoungSystemicComplicationsInfectio46CriticalBurnAreasFaceHandsFeetGroinJointsCircumfrentialCriticalBurnAreasFace47InhalationInjuriesLeadingcauseofdeathClosedspaceincidentPresenceofheavysmokeHistoryofunconsciousnessInhalationInjuriesLeadingcau48Burns,thermal.Partial-andfull-thicknessburnsfromstructurefire.Notefacialinvolvement.Burns,thermal.Partial-andf49InhalationInjuryToxicInhalationSyntheticresincombustionCyanide&HydrogenSulfideSystemicpoisoningMorefrequentthanthermalinhalationburnCarbonMonoxidePoisoningColorless,odorless,tastelessgasByproductofincompletecombustionofcarbonproductsSuspectwithfaultyheatingunit200xgreateraffinityforhemoglobinthanoxygenHypoxemia&HypercarbiaInhalationInjuryToxicInhalat50外科急诊创伤(英文)烧伤课件51OtherEvidenceFacialburnsProfusesecretionsCarbonaceoussputumLacrimationSingednasalhairHoarsenessWheezingStridorEdemaHypoxemiaTachycardiaOtherEvidenceFacialburnsHoar52InhalationInjuryAirwayThermalBurnSupraglotticstructuresabsorbheatandpreventlowerairwayburnsMoistmucosaliningtheupperairwayInjuryiscommonfromsuperheatedsteamRiskFactorsStandingintheburnenvironmentScreamingoryellingintheburnenvironmentTrappedinaclosedburnenvironmentSymptomsStridoror“Crowing”inspiratorysoundsSingedfacialandnasalhairBlacksputumorfacialburnsProgressiverespiratoryobstructionandarrestduetoswellingInhalationInjuryAirwayTherma53TypesofInjuriesCarbonmonoxidepoisoningInjuryaboveglottisInjurybelowglottisTypesofInjuriesCarbonmonoxi54COPoisoningAffinityforHgb200-250X>thanO2Cherryredonlypresentatlevels>40%+N,+V,HA,decreasedLOC,weakness,tachypnea,tachycardiaFalsepulseoximetryreadingCOPoisoningAffinityforHgb255100%O2½timeforelimination40min21%O2½timeelimination250minutes100%O2½timeforelimination56CarboxyhemoglobinNormal-0Smokers,truckdriversinheavytraffic-1515-40%-neurologicaldysfunctionweakness,dizziness,+N,+V,HA40-60%-obtundedseveredecreasedLOCConsiderhyperbarictherapy-25-40%CarboxyhemoglobinNormal-057InjuryAboveGlottisThermal,chemicalRequireearlyintubationSeverelyhypovolemicInjuryAboveGlottisThermal,c58InjuryBelowGlottisUsuallychemicalRepiratorydistressRequireearlyintubationARDSMSOFInjuryBelowGlottisUsuallych59Estimating%BSABurnedRuleofpalmsRuleofninesEstimating%BSABurnedRuleof60BodySurfaceAreaRuleofNinesBestusedforlargesurfaceareasExpedienttooltomeasureextentofburnRuleofPalmsBestusedforburns<10%BSABodySurfaceAreaRuleofNines61RulesofNinesRulesofNines62RuleofPalmsAburnequivalenttothesizeofthepatient’shandisequalto1%bodysurfacearea(BSA)RuleofPalmsAburnequivalent63TreatmentStoptheburnABC’sEstimate%BSAburnedCoolburnPreventhypothermia&infectionPaincontrolTreatmentStoptheburn64AirwayO2onALLpatientsAcutepulmonaryinsufficiencyPulmonaryedema2-3daysBronchopneumonia5-7daysConsiderintubationSx/liklihoodofimpendingairwayobstructionAirwayO2onALLpatients65CirculationFluidreplacementcriticaltosurvivalTissuedestructionresultsinincreasedcapillarypermeabilityProfoundfluidlossfromtheintravascularspaceLargeamountsfluidlostfromlossofskinintegrityduetoevaporationCirculationFluidreplacementc66ParklandFormula4mlxwtkgx%BSAburned=24hrinfusion1sthalfoverfirst8hoursCalculatedfromtimeofinjury2nd/3rddegreeburnsonlyParklandFormula4mlxwtkgx67FluidResuscitationRestoreeffectiveplasmavolumeMaintainvitalorganfunctionHypovolemia/renalfailure-complicationsPulmonaryedemaAssessadequacybyUAoutputFluidResuscitationRestoreeff68CoolBurnWithin30minutesinhibitslactateproductionandacidosispromotescatecholaminefunctionandardiovascularhomeostasisinhibitsburnwoundhistaminereleaseblockshistaminemediatedincreasedvascualrpermeabilityCoolBurnWithin30minutes69Con’tminimizesedemaformationsuppressesthromboxanemediatorofvascularocclusionprogressivedermalischemiaCon’tminimizesedemaform70Hypothermia&InfectionCoverwithdrysterilesheetKeepwarmHypothermia&InfectionCoverw71PainControlMorphinesulfatedecreasesamountofproteinbindingrapidlyeliminatedsmall,frequentdosesmayuseupto50mg/hrFentanylVersedPainControlMorphinesulfate72SpecialConsiderationsCircumfrentialburnsmayrequirefasciotomyPediatricsmoresusceptibletocircumfrential<6monoshiveringmechanismnorepiconvertsbrownfatSpecialConsiderationsCircumfr73BurnCenter2nd/3rddegreeburns>10%<10or>502nd/3rddegreeburns20%TBSA2nd/3rddegreeburnstocriticalareas3rddegree>5%TBSASignificantelectrical/chemicalburnsInhalationinjuryCircumfrentialburnsPreexisitingconditionsmedicalorconcomitanttraumaBurnCenter2nd/3rddegreeburn74SceneSize-upFireDepartmentSCBAandprotectiveclothingInitialAssessmentABC’sMUSTbeintactConsiderETorRSIRapidevacuationofpatientifsceneisunstableAssessmentof

ThermalBurnsSceneSize-upAssessmentof

Th75FocusedandRapidTraumaAssessmentAccuratelyapproximateextentofburninjuryRuleofNinesorRuleofPalmsDepthofburnAreaofbodyeffectedAnyburntotheface,hands,feet,jointsorgenitaliaisconsideredaseriousburn“Ringing”burnsAgeofpatientaffectedAssessmentof

ThermalBurnsFocusedandRapidTraumaAsses76PainChangesinskinconditionataffectedsiteAdventitioussoundsBlistersSloughingofskinHoarsenessDysphagiaDysphasiaAssessmentofThermalBurns

GeneralSigns&SymptomsBurnthairEdemaParesthesiaHemorrhageOthersofttissueinjuryMusculoskeletalinjuryDyspneaChestpainPainAssessmentofThermalBurn77AssessmentofThermalBurnsAnypartialorfullthicknessburninvolvinghands,feet,joints,face,orgenitalia>30%BSAPartialThicknessInhalationInjury>10%BSAFullThicknessCritical>2%BSAFullThickness>50%BSASuperficial<2%BSAFullThickness<15%BSAPartialThickness<50%BSASuperficial>15%BSAPartialThicknessModerateMinorBurnSeverityAssessmentofThermalBurnsAny78OngoingAssessmentNon-critical:ReassessQ15minCritical:ReassessQ5minBurnCenterCareAssessmentof

ThermalBurnsOngoingAssessmentAssessmento79Local&MinorBurnsLocalcoolingPartialthickness:<15%ofBSAFullthickness:<2%BSARemoveclothingCoolorColdwaterimmersionConsideranalgesicsManagementof

ThermalBurnsLocal&MinorBurnsManagement80ModeratetoSevereBurnsDrysteriledressingsPartialthickness:>15%BSAFullthickness:>5%BSAMaintainwarmthPreventhypothermiaConsideraggressivefluidtherapyModeratetosevereburnsBurnsoverIVsitesPlaceIVinpartialthicknessburnsite.Managementof

ThermalBurnsModeratetoSevereBurnsManage81ParklandBurnFormula4mLxPtwtinkgx%BSA=AmtoffluidPtshouldreceive½ofthisamountinfirst8hrs.Remainderin16hrsConsider1hourdose0.5mlxPtwtinkgx%BSA=AmtoffluidManagementof

ThermalBurnsParklandBurnFormulaManagemen82ModeratetoSevereBurnsCautionforfluidoverloadFrequentauscultationofbreathsoundsConsideranalgesicforpainMorphineNubainPreventinfectionManagementof

ThermalBurnsModeratetoSevereBurnsManage83InhalationInjuryProvidehigh-flowO2byNRBConsiderintubationifswellingConsiderhyperbaricoxygentherapyCyanideExposureSodiumNitrite,AmylNitrite,SodiumThiosulfateFormsmethemoglobinbindstocyanideNon-toxicsubstancesecretedinurineInhale1ampuleofAmylNitrite300mgSodiumNitriteover2-4minutes12.5gmofSodiumThiosulfateManagementof

ThermalBurnsInhalationInjuryManagementof84外科急诊创伤(英文)烧伤课件85ScenarioScenario86LightningInjuriesOneofthetopthreecausesofenvironmentaldeath(flood,tempextremes)NotACorDCbutaunidirectional,massive,currentimpulsewithseveralreturnstrokesbacktothecloudTremendouslylargecurrentimpulsivelyflowsforanincrediblyshorttimeLightningInjuriesOneofthet87DifferenceBetweenLightningandElectricityDurationofexposuretocurrentNotenoughtimeforskinburnsInternalburnsandrenalfailureusuallyinconsequentialCardiacarrestRespiratoryarrestVascularspasmNeurologicaldamageDifferenceBetweenLightninga88ImmediateVentricularasystoleOftenspontaneouslyresumeProlongedrespiratoryarrestResultsinsecondarycardiacarrestIschemiaduetovascularspasmsMI,spinalarterysyndromesImmediateVentricularasystole89LongTermSurvivors10-20x>fatalitiesNeuropsychologicalandneurocognitivechangesChronicpainsyndromesChestpainSympatheticnervesystemdysfunctionSleepdisorders,HA,cardiaceffectsLongTermSurvivors10-20x>fa90DemographicsSunday,Saturday,WednesdayNoon-6pm,6-12pmMaybeinoroutdoorsMales,<16yoor26-35yoDemographicsSunday,Saturday,91BluntInjuriesMuscularcontractionsInstantaneousexpansionandcontractionofsurroundingairBluntInjuriesMuscularcontrac92CardiorespiratoryArrestOnlyknowndirectcauseofdeath“Cosmicdefibrillation”MomentaryasystoleSpontaneousrecoveryProlongedrespiratoryarrestHypoxiaSecondarycardiacarrestCardiorespiratoryArrestOnlyk93NeurologicMaypresentonlymildlydisorientatedMaystillsustaindisablingneurocognitivedeficitssimilartobluntheadinjuryMaynotbeimmediatelyapparentNeurologicMaypresentonlymil94PainPainNumbnessAbnormalsensationsChronicpainsyndromesmaydevelopduetosympatheticNSinjuryPainPain95SympatheticNSInjuryMaycausevascularspasmTemporaryparalysisMottlingTransienthypertensionLateproblemswith+tilttestsVertigo/dizzinessPainsyndromesSympatheticNSInjuryMaycause96BraininjurymayoccurDeepburnsrareSuperficialburnsmorecommonPunctate,fernlike,linearSecondarytometalinpockets/clothingEardrumrupturecommonDirectcurrententryConcussive/explosiveforceBasilarskullfxBraininjurymayoccur97TreatmentResuscitationSpinalimmobilizationNSAIDSPreventlongtermnuerologicaldamageTreatchronicpainsyndromesIbuprofen,ketoprofen,naproxenTreatmentResuscitation98PreventionAwarenessofweatherforecastEvacuationMaytravel>10milesfromthunderstorm,clouds/rainmaynotbepresentShelter-schoolbuses,metaltopvehiclesAvoidtrees,smallshelters,bleachers,fences,towers,anycurrenttransmittingstructures,pools/water,highareasAvoidusetelephones,electronicequipment,anycontactwithconductivesurfacesinside(plumbing,doingdishes),EMS/firedispatchradioPreventionAwarenessofweather99Arcingelectricalburns,throughshoearoundrubbersole.High-voltage(7600V)alternatingcurrentArcingelectricalburns,throu100ElectricalAgerelatedinjurypeaksinfancy-4years20-25yearoldmales-primarilyworkrelatedElectricalAgerelatedinjuryp101FactorsAffectingSeverityVoltageandamperageResistanceofbodytissueTypeandpathofcurrentDurationandintensityofcontactFactorsAffectingSeverityVolt102ElectricalBurnsTerminologyVoltageDifferenceofelectricalpotentialbetweentwopointsDifferentconcentrationsofelectronsAmperesStrengthofelectricalcurrentResistance(Ohms)OppositiontoelectricalflowElectricalBurnsTerminology103ElectricalBurnsOhm’sLawV:VoltageR:ResistanceI:CurrentBasedonelectronflowthruTungstenEmitmorelightthemorecurrentpassedthruElectricalBurnsOhm’sLaw104ElectricalBurnsJoule’sLawP:PowerSkinisresistanttoelectricalflowGreaterthecurrentthegreatertheflowthruthebodyandgreaterthereleaseofheatElectricalBurnsJoule’sLaw105ElectricalBurnsGreatestheatoccursatthepointsofresistanceEntranceandExitwoundsDryskin=GreaterresistanceWetSkin=LessresistanceLongerthecontact,thegreaterthepotentialofinjuryIncreaseddamageinsidebodySmallerthepointofcontact,themoreconcentratedtheenergy,thegreatertheinjuryElectricalBurnsGreatestheat106ElectricalBurnsElectricalCurrentFlowTissueofLessResistanceBloodvesselsNerveTissueofGreaterResistanceMuscleBoneResultsinSeriousvascularandnervousinjuryImmobilizationofmusclesFlashburnsElectricalBurnsElectricalCur107VoltageHigh>1000voltsLow<1000voltsMosthouseholdcurrent-110-220voltsProduceslowvoltageinjuryconsistentwiththermalinjuryHighvoltageproducesthermalinjuryatentryandexitaswellasdeeptissueinjuryalongpathAmperageisbetterindicatorofinjuryVoltageHigh>1000volts108ResistanceCurrententersthebodyFollowsthepathofleastresistanceExitsatgroundWhencurrentmeetsresistanceheatgeneratedburninjuryoccurs>resistance>injuryResistanceCurrententerstheb109ComplicationsCardiacarrythmiasRespiratorymuscleparalysisThrombosisRenalfailureFracturesComplicationsCardiacarrythmia110DC-directcurrentdiscreteexitAC-alternatingcurrentmoreexplosiveDC-directcurrentdiscreteex111CurrentPassageMortalityHandtohand-60%Handtofoot-20%Foottofoot-5%CurrentPassageMortalityHand112SpecialConsiderationsRespiratoryCardiacConcomitanttraumaRenalfailureRequire>fluidresuscitationSpecialConsiderationsRespirat113ElectricalInjuriesSafetyTurnoffpowerEnergizedlinesactaswhipsEstablishasafetyzoneLightningStrikesHighvoltage,highcurrent,highenergyLastsfractionofasecondNodangerofelectricalshocktoEMSAssessment&ManagementofElectricalandLightningInjuriesElectricalInjuriesAssessment114AssesspatientEntrance&ExitwoundsRemoveclothing,jewelry,andleatheritemsTreatanyvisibleinjuriesThermalburnsECGmonitoringBradycardia,Tachycardia,VForAsystoleACLSProtocolsTreatcardiac&respiratoryarrestAggressiveairway,ventilation,andcirculatorymanagement.ConsiderFluidbolusforseriousburns20ml/kgConsiderSodiumBicarbonate:1mEq/kgConsiderMannitol:10gAssessment&ManagementofElectricalInjuriesAssesspatientAssessment&Man115Contactelectricalburns,120-Valternatingcurrentnominal.TherightkneewastheenergizedsideContactelectricalburns,120-116ChemicalStrongacidscoagulationnecrosisStrongbasesliqueficationnecrosisWillcontinueburninguntilneutralizedordilutedChemicalStrongacids117DegreeofDamage/ToxicityChemicalnatureAmountConcentrationMechanismDurationDegreeofDamage/ToxicityChemi118ChemicalBurnsChemicaldestroystissueAcidsFormathick,insolublemasswheretheycontacttissue.CoagulationnecrosisLimitsburndamageAlkalisDestroycellmembranethroughliquefactionnecrosisDeepertissuepenetrationanddeeperburnsChemicalBurnsChemicaldestroy119OralcausticchemicalburnsOralcausticchemicalburns120StrongAcidsandAlkalisStrongacidsandalkalismaycauseburnstothemouth,pharynx,esophagus,andsometimestheupperrespiratoryandGItractsIngestionsofcausticandcorrosivesubstancesgenerallyproduceimmediatedamagetothemucousmembraneandtheintestinaltractAcidsgenerallycompletetheirdamagewithin1to2minutesafterexposureAlkalis,particularlysolidalkalis,maycontinuetocauseliquefactionoftissueanddamageforminutestohoursStrongAcidsandAlkalisStrong121AlkaliburntoeyeAlkaliburntoeye122SignsandSymptomsFacialburnsPaininthelips,tongue,throat,orgumsDrooling,troubleswallowingHoarseness,stridor,shortnessofbreathShocksecondarytobleedingorvomitingSignsandSymptomsFacialburns123ManagementEstablishanairway,considerintubation,orifnecessary,cricothyrotomyContactpoisoncontrolGastriclavageorcharcoaloftencontraindicatedIVwithNSorLRRapidtransportManagementEstablishanairway,124HydrocarbonsAgroupofsaturatedandunsaturatedcompoundsderivedprimarilyfromcrudeoil,coal,orplantsubstancesFoundinmanyhouseholdproductsandinpetroleumdistillatesHydrocarbonsAgroupofsaturat125HydrocarbonsViscosityisthemostimportantphysicalcharacteristicinpotentialtoxicityThelowertheviscosity,thehighertheriskofaspirationandassociatedcomplicationsClinicalfeaturesofhydrocarboningestionvarywidely,dependingonthetypeofagentinvolvedMaybeimmediateordelayedinonsetHydrocarbonsViscosityisthem126SignsandSymptomsBurnsduetolocalcontactWheezing,dyspnea,hypoxia,andpneumonitisduetoaspirationorinhalationHeadache,dizziness,slurredspeech,ataxia(irregularordifficult-to-controlmovements),anddulledreflexesFootandwristdropwithnumbnessandtinglingCardiacdysrhythmiasSignsandSymptomsBurnsdueto127ManagementMostarenotlife-threateningOccasionallygastriclavagemaybeofbenefitInseriouslysymptomaticpatients,protecttheairwayandestablishanIVifNSorLRContactpoisoncontrolTransportManagementMostarenotlife-th128ChemicalBurnsScenesize-upHazardousmaterialsteamEstablishhot,warmandcoldzonesPreventpersonnelexposurefromchemicalSpecificChemicalsPhenolDryLimeSodiumRiotControlAgentsAssessment&ManagementofChemicalBurnsChemicalBurnsAssessment&Man129SpecificChemicalsPhenolIndustrialcleanerAlcoholdissolvesPhenolIrrigatewithcopiousamountsofwaterDryLimeStrongcorrosivethatreactswithwaterBrushoffdrysubstanceIrrigatewithcopiousamountsofcoolwaterPreventsreactionwithpatienttissuesAssessment&ManagementofChemicalBurnsSpecificChemicalsAssessment&130SodiumUnstablemetalReactsvigorouslywithwaterReleasesExtremeheatHydrogengasIgnitionDecontaminate:BrushoffdrychemicalCoverthewoundwithoilsubstanceAssessment&ManagementofChemicalBurnsSodiumAssessment&Management131RiotControlAgentsAgentsCS,CN(Mace),Oleoresin,Capsicum(OC,pepperspray)Irritationoftheeyes,mucousmembranes,andrespiratorytract.NopermanentdamageGeneralSigns&SymptomsCoughing,gagging,andvomitingEyepain,tearing,temporaryblindnessManagementIrrigateeyeswithnormalsalineAssessment&ManagementofChemicalBurnsRiotControlAgentsAssessment132H2H2133RadiationDecontaminationisparamountTreatedlikeanyotherburnRadiationDecontaminationispa134RadiationInjuryRadiationTransmissionofenergyNuclearEnergyUltravioletlightVisibleLightHeatSoundX-RaysRadioactiveSubstanceEmitsionizingradiationRadionuclideorRadioisotopeRadiationInjuryRadiation135外科急诊创伤(英文)烧伤课件136RadiationInjury

BasicPhysicsProtons PositivechargedparticlesNeutronsEqualinmasstoprotonsNoelectricalchargeElectronsMinuteelectricallychargedparticlesWhenemittedfromradioactivesubstancesaretermedBetaParticles(continued)RadiationInjury

BasicPhysics137RadiationInjury

BasicPhysicsIsotopesAtomswithunstablenuclearcompositionIonizingRadiationHalf-lifeTimerequiredforhalfthenucleitoloseactivitythroughdecayRadiationInjury

BasicPhysics138RadiationInjury

RadioactiveSubstancesAlphaParticlesSlowmovingLow-energyStoppedbyclothingandpaperPenetrateafewcelllayersonskinMinorexternalhazardHARMFULifingestedBetaParticlesSmallerthanAlphaHigherenergythanalphaStoppedbyaluminumorsimil