Signed Electronically First Aid Risk Assessment Made Easy

Signed electronically first aid risk assessment

[Music] welcome to today's lecture guys so today we're looking at bonds in emergency different types of bonds different scenarios of burns different depths of born in different age groups of birds okay so gonna look at assessment and classification of bonds when I discuss their trends in cleaning and dressing of birds how to apply the medical legal aspects pertaining to the bird management regard to the emergency nurse applied above mentioned knowledge when analyzing a case scenario we're gonna discuss the fluid requirements the patient of the burn injury and illicit drugs used to manage burn injuries I was gonna detonate the nursing process in the merriment of a patient with burn injuries now the advances in burn treatment dub in plenty' fluid resuscitation inhalation injury wound care practice early debridement and excision increased nutritional support now there are plenty of risk factors for the burn patients so very young and very old our high risk of death burns in combination with an inhalation of injury always worsen a prognosis prevention is small clubs but wise and possible risk factors in provide solutions so what happens is that vendors apone there's an inflammatory response heat redness pain edema Alima amount of edema correlates with the depth and extent of injury and fluids administered rule of nines per hospital estimate Allen Raj Hart is more precise and this combo is bad fluid shift edema formation evaporative water loss from the bull hypovolemia loss of plasma is greatest in the first four to six hours after the burn injury let's have a look at the first aid in burns first goal is to stop the burning process stop drop and roll smother with a blanket or doused with water do not run disconnect the person from the source of electricity remove the clothing in jewelry take off the blanket used to small to defile coal burns or scales by immediate emotion of water for at least 20 minutes irrigation of chemical burns should be for one hour do not use ice for cooling avoid hypothermia and keep the person as warm as possible now how to get how do we get to where we are going how this burn management strategy assessment is by primary and secondary assessment or resuscitation focused assessment includes subjective data collection objective data collection psychological social and environmental factors occupational risk factors alterations and the ability to perceive environmental threats social risk factors environmental risk factors diagnostic procedures include lab studies imaging studies and some other studies catalyst of look at the system so primary assessment as in all IDI patient emergency patient's is airway C spine breathing circulation disability exposed is very important especially in burns [Music] the airway see if the air is open do you have singe facial or loss hair is there any suit in the back of the throat is the throat swollen or borne any trauma concerning c-spine injury immobilize early and remember easy Ellis jaw thrust in chin left or head tilt if appropriate breathing you have look at the chest rise and fall look at the diffraction and rate of breathing circumferential cyanosis look at breaths out okay listen to read sound then next is circulation shock and tissue perfusion color of the skin blistering depth of bonds of the degree of birds capillary refill the next disability or neurological loss of consciousness avpu alert verbal pain and unresponsive for pupils equal round reactive light combination Glasgow Coma Scale [Music] next is expose of environmental controls stop the burning process expose the patient keep the patient warm okay so secondary assessment in bird full set of vitals focus adjuncts in facilitate family presidency give comfort measures history in head-to-toe assessment inspect the posterior surfaces focus assessment cues chief complaint mechanism pain length of time exposed to the bird source time of occurrence body area and type environmental electrical lightning chemicals type of burns loss of consciousness other any related injuries Kattabomman resuscitation and scene whether it's given a lot efforts to relieve symptoms home remedies alternative therapies medications which can be prescribed or over-the-counter past medical history is very important current pre-existing disease or unless any surgical procedures smoking history substance or alcohol abuse suicidal behavior medications prescriptions over-the-counter or herbal medications if there are any allergies immunization status especially in kids then data collection includes the general appearance of the patient loss of continuous behavior vital signs order is very important get is very important hygiene level of distress or discomfort now the inspection whether the airway is patent or not burn tissues erythema of the area rather mortal blister dark on Latorre waxy a while addict rhythm on Lolita still attractions auscultation palpation peripheral or central pulses deformities sensory perceptions rounding the burn tips what is rule of nines whenever you estimate the degree of bone or the percentage of points you have to look at rule of nines okay so the rule of nine basically divides the body into different percentage and according to the body area in all's head and neck all the other arm see the trunk interior truck whole leg the other whole leg and grinning okay so where the neck is nine whole arm is nine the other whole arm is 9 OC a trunk is 18 and here truck is 18 whole leg is 18 whole leg is 18 and then last depth the perineum is 1 ok so that's that's how you do it so trunk and leg are 18 others are 9 and freedom is 1 that gives you a hundred percent so depending upon which area is in all you can calculate the percentage of bones okay so this is the diagram have a look [Music] can Cena adult head in Nikki's nine front is 18% of the trunk 18 percent of the back of the trunk he's 9 percent 9 percent on the front in the back so 18 for the arm 18 for the leg similarly and 1% for the Pyrenean in the child it's a little bit different if 80% had the head and neck line each for the arms 18 for the front and 18 for the back of the trunk 13.5 percent of the legs each of them in premium is one person so that's the major difference okay the second most important thing in burns patient is the assessment of depth or the degree of birds okay what the rule of man gives you is a percentage of birds that assessment of birds the superficial burns our first degrees so superficial partial thickness our second degree deep partial thickness our second degree and full thickness our third degree first degree burns only the epidermis is involved it's red and tender mild discomfort some good over-the-counter topical creams are used like aloe vera or little cane first degree foot look like this okay so the only involved the epidermis okay then you have superficial partial thickness burn on a superficial second degree burn epidermis and part of the dermis is in all da the blistered red and blanch with pressure often seen with scowling injuries sensitive to light touch or pinprick treated on an outpatient basis the heel usually in one to three weeks this is an example of a second-degree burn now I can see it's just not a redness or an erythema but there are multiple blisters all over okay so there's a second-degree burns now deep second-degree or deep partial thickness or of an epidermis in most of the doubles is alone okay there be a white or for vascular vascularized I mean not blister they are less sensitive to light touch than the superficial form extensive time to heal three to four weeks they often require oxygen of the wool in skin grafting the deep partial remember white is deeper than pink okay so if it is white it's bad if it's pink it's a little bit better all the know but is good but if you compare the degree of birds white is bad the full thickness or third-degree Birds epidermis dermis and into subcutaneous tissue dry leathery and insensate typically no blistering commonly seen when close a qualifier as a skin indirectly exposed to the flame extensive healing time and need for skin grafting [Music] you can see this is an example of third-degree burns [Music] okay so what are 40 degrees 40 degree have full thickness which extend the muscle on the bottom there that man the coalition high-voltage electric injury or severe thermal burns hospital admission maybe Surgical amputation of the affected extremity may be required so that's an example of electric burns fourth degree which are going down to the bone and the muscle you can see all of the muscle is exposed okay so this is an example of fourth-degree burns [Music] assessment is psychological social and environmental occupational firefighters and electricians alterations and perception is poor decision-making decreased sensation in the affected area social risks you look for child abuse assault or depression and by mental cooking in closed area of contacting the flame okay so what needs to be done diagnostic procedures labs complete blood count your knees carbon monoxide type and cross-match regulations during pregnancy blood gases serum urine toxicology imaging include chest x-rays c-spine CT and fast abdominal ultrasound scan others include ECG or peritoneal lavage strategy is differential diagnosis and collaborative problems have to be made analyzed and then implement a plan evaluation and ongoing monitoring is very very important documentation or intervention and patient response age related consideration in the children and the genetic population so diagnosed and from risk for ineffective airway clearance impaired gas exchange ineffective breathing pattern the deficient fluid volume hypothermia infection ineffective tissue perfusion acute pain impaired skin integrity was rightly related to fear [Music] determine the priorities in care that's very important fluid management wound management pain management tipnis okay so this is very very important as a London router chart it gives you the area so divide the areas as a B and Z is half of head B's a half of one tie and you see is half of one leg okay so age zero to adult so the chart voices headed make torso upper arm in low arm hands of our leg and lower leg feet in genitals okay so that's again an assessment of both treatment so relative percent is the body area affected by growth London brow a chart [Music] so fluid management remember that a formula is only an estimate and investments need to be made based on patient status fluid resuscitation and protocol establish and maintain adequate circulation more than 20% burns require initial fluid resuscitation use at least one boh intravenous catheter begin ringers lactate estimate initial rate according to the estimated percent of total body skin surface blood estimate the body way for milliliter per kilogram percentage one surface born in 24 hours and giving half of the estimate in one to eight hours then you maintain blood pressure more than 90 systolic urine output right 5 to 1 when one milliliter per kilogram per hour pulse less than 130 temperature more than 37 modify the protocol in the presence of messy boats or international injury shock and in elderly patients fluid requirements are greater - plane bones shock include colloid and out has pain or albumin in the patient from the beginning [Music] transfer to bond center if a major bone is present or a moderate bone depending on local resources hey control the pain with narcotic analgesics provide a dry seat to protect nerve endings from air tetanus is a simulation up-to-date okay then you again evaluate airway breathing circulation perfusion pain temperature skin integrity documentation document document document everything all of your interventions and patient response person burn pain vitals response to pain meds own description dressings applied AIDS related considerations at with pediatric in the genetic age group turbulent inhalational birds assessment analysis planning and implementation interventions evaluation and ongoing monitoring chemical burns assessment analysis planning evaluation electrical and lightning birds assessment analysis adding evaluation so what are the age-related concerns in the periodic burn patient could be growth a development related like a leading cause of death small of a way lady obstruction by aneema high rate of total body surface area the body mass increases heat exchange when the environment lack of subcutaneous tissue and thin skin lead to increased heat loss and calorie expenditure then dependent on caregivers fire direction maltreatment may be possible healing responses are more rapid then the poles are should be curious about the environment maltreatment inflicted burns both hands on both legs brands a contact burned cigarette and emotion burns hypothermia may render an injured child refractory to treatment geriatric burn patient could be again age-related there this loss subcutaneous tissue and thinning of the dermis they have decreased touch receptors pain receptors and slowing of reflexes decreased skin growth delays wood healing quite windy production the crease area clears decreased cough and laryngeal reflexes stiffening of elastin and connective tissue supporting the lungs decrease a lunar surface area ciliary action increased chest wall stiffness with declining trend in chest muscles both our altered mental status dementia are dependent on caregivers slowing the reflexes and decreased sensation chronic illnesses decrees reserved would stand a multi-system stress of a birth injury so let's have a look at double bonds now okay so UV light or conducted flame flash steam or scalding can cause thermal burns most common type of burn flash burns caused the most damage to the upper airway injuries tend to be limited to the superb glottic airways heat produces edema and can lead to the obstruction of the airway thermal bond smoke inhalation can lead to the absorption of carbon monoxide carbon monoxide has a higher affinity to attach to red blood cells than oxygen it leads to impaired delivery and utilization of oxygen it eventually results in systemic tissue hypoxia in death pulse oxygen monitor cannot differentiate between oxygen and carbon monoxide this further delays treatment of carbon monoxide poisoning thermal burns a suit contains elemental carbon and can absorb toxins from burning materials that are toxic to the bronchial mucosa and alveoli because of the pH and ability to form free radicals these compounds can cause airway inflammation and multiple complications right let's have a look at chemical burns it's Android cleaners I'll clear rust removers with pool cleaners organic compounds like phenols and petroleum cleaners so this is an example of chemical bird [Music] denature the protein within the tissues or desiccation of cells [Music] Alti products cause more tissue damage devlin acids dry substances should be wiped off first wet substances should be irrigated with copious amounts of water all fluids used to flush should be collected and contained not placed into the general draining system decontaminate the patient flush with warm water neatly two laterally protect yourself healthy birds go deep chemical boats the depth can be deceiving Abdulla tissue begins to slough off days later because of this chemical birth should always be considered deep partial thickness or full thickness so it's a horrible so this is an example of a table we can see the tar on the arm pretty clearly just an example of a tower now is the paint out of proportion to the skin involvement consider hydrofluoric burns hydrofluoric acid both are unique in several ways hydrofluoric acid is not a strongest in organic acids is used mainly for industrial purposes example glass etching metal plating electronic manufacturing hydrofluoric acid also may be found in home Earth's ribbons dilute solutions deeply penetrate before disassociating is causing delayed injury and symptoms burned through the fingers and nail bed and leave the overlock nails intact and pain may be severe with little surface abnormality washed majority of cases in all only small areas of exposure usually of the digits a unique feature of hydrofluoric exposure is a ability to cause significant systemic toxicity due to fluoride poisoning treatment of hydrofluoric burns immerse the burn area for two hours in point two percent ice Aquos tetra cane benzalkonium chloride or iced Equus Mendel corneum chloride Zephyr n PI the towel soaked with different and change every two to four minutes ice packs to relieve pain gain serum chemistry's hypercalcemia and hyperkalemia Institute cardiac monitoring hydrofluoric acid exposure can prolong QT interval peaked t-waves ventricular dysrhythmias treatment is calcium gluconate supply 2.5% calcium gluconate gel to the bone to the burn area subcutaneous infiltration point 5 milliliter of 10% calcium gluconate a two centimeter board extending point 5 centimeter beyond the margin of the wall tissue they leave 10 to 15 mils of 10% calcium gluconate in 5000 units heparin then dilute in 40 mils dextrose 5% in water electrical burns okay so these are very important as well so electrical birds can be alternating current household current more likely to induce fibrillation or a direct current as in a car battery part of least resistance electric current will find the easiest way to travel through the body nose tissue muscles in blood vessels are easier to travel through the bone then the bone of the farm Nova system is particularly sensitive damage is seen in the brain spinal cord & my linh producing cells this is an example of electrical bones have a look at this picture [Music] all right what happened when lightning strikes they can cause bullets as well okay [Music] the patient was playing in the kitchen around the stove the patient is a four year old male who was born on the right leg arm and right side of the chest and abdomen is bull while running around the kitchen and boiling water fed on to him [Music] [Music]