4th quarter handout

4TH QUARTER NOTES

Health 4

Burns

Classifications According to DEPTH

• 1st degree redness, epidermis

• 2nd degree blisters, dermis

• 3rd degree charred, subcutaneous

Determine the depth!!

What are the causes?

Burn Severity

Remember the Rule of Nines

Adult Anatomic structure Surface area

Head 9%

Anterior Torso 18%

Posterior Torso 18%

Each Leg 18%

Each Arm 9%

Perineum 1%

Anatomic structure Surface area

Head 18%

Anterior Torso 18%

Posterior Torso 18%

Each Leg 14%

Each Arm 9%

Perineum 1%

Child

Determine extent of burned area!!

Burn Severity

Determine location of burned area!!

• Face

• Hands and Feet

• Genital Area

• Joint Area

Burn Severity

Look for complicating factors!!

• Below 5 years old (fluid loss)

• Above 55 years old (delayed healing)

• Diabetes (delayed healing)

• CVD (hypoperfusion)

BURN SEVERITY CLASSIFICATION

CRITICAL

• 3rd degree burn involving hands, feet, face, or genitals

• 3rd degree burns covering more than 10%

• 2nd degree burns covering more than 20%

• burns encompassing a body part

MODERATE

• 3rd degree burns covering 2%-10%

• 2nd degree burns covering 10%-20%

• 1st degree burns greater than 50%

FIRST AID

• Stop the burning process (HOW?)

• Remove clothing / jewelry

• Transport if critical / moderate

• Do not drain the blisters

• Take analgesic

• Cover with “burn sheet”

What about bites?

• infection (rabies)

• tetanus toxin

• venom

Epidemiology (Rabies)

• Incidence rate:

– 5–7/million

– Average cases: 326 annually (Phil.)

– Philippine is 4th worldwide

– San Lazaro Hospital:

• Pet dogs – 88% of cases

• Stray dogs – 10% of cases

• Cats – 2% of cases

Transmission • Incubation periods (Human):

– 1 days to 5 yrs. (average 8wks)

– Variations:

1. Severity of the bite

2. Site of bite in relation to nerve supply and

distance from CNS

3. Size of innoculum, protection offered by

clothing and other factors

4. Age and immune status of the host

Transmission

• Virus stays in:

1. CNS

2. Liver

3. Salivary gland

• Travels thru the nerve

• Incubation periods:

– 1 days to 5 yrs. (average 8wks)

Snake Bites? . . . Look for . . .

• Check the puncture marks

• Pain, redness, swelling at bite mark

• Breathing difficulty

• Blurred vision

• Numbness

What next?

• Keep the victim still and calm

• Decrease blood flow to bitten area

• Wash the wound and cover

• Transport the victim

• Keep the victim awake

• Apply a tourniquet when necessary

• Do not suck out the venom

Types of Venom

1.Neurotoxic

2.Hemotoxic

3.Necrotic

Antivenin are

highly specific!

Antivenin Therapy

• Antivenin dose depends on the severity of envenomation and administered over 2-4hrs.

Grade I = No antivenin

Grade II = 3-4 amp. in 500ml

Grade III = 5-15amp. in 500ml

• Pt re-evaluated every 2hrs and if necessary a repeat dose of antivenin should be evaluated and given.

Antivenin Therapy

• Children: antivenin be increased by 50% bec. of higher rate of venom to body mass.

• Pregnancy is not contraindicated

• Antivenin for coral snake bite should be initiated even if envenomation is only suspected for there are frequently no local manifestation

Insect Stings

Bees and wasp stings

contain chemicals

such as histamine and

other enzymes that

destroy collagen fibres

and tissue death!

Marine Stings

The most common form

of envenomation is

through stinging cells

called nematocysts.

The deadliest of such

animals are the box

jellyfish and the man-o-

war.

What to do with stings?

• redness

• pain

• swelling

• itching

• nausea

• allergic reaction

** worst case scenario is anaphylaxis

For Mild Allergic Reaction,

take anti-histamine and put

a cold pack on the skin.

Allergy is an exaggerated immune

response to a foreign substance which has

been introduced through the skin, GI tract,

or the respiratory tract.

Sometimes (around

5%) people would

exhibit severe

allergic reactions

which is called

anaphylaxis.

Anaphylactic Reaction

• Itching and burning

• Widespread urticaria

• Swelling of the lips and tongue

• Bronchospasm

• Hypotension

Anaphylaxis is a life threatening condition!!

First Aid for Anaphylaxis

Inject EPINEPHRINE immediately - it will

buy you 15-20 minutes then transport to

nearest hospital.

POISONS!!

ALL CHEMICALS CAN BE TOXIC TO HUMANS PROVIDED . . .

Types of poisoning

1.Food

2.Heavy metal / Chemical

3.Drug

Types of poisoning

1.Ingested

2.Inhaled

3.Injected

PGH Poison Center

524-1078

Epidemiology

WHO? Children less than 5 y.o.

WHERE? Over 90% happen at home

HOW? Ingestion

WHAT? Cleaning fluids, OTC

WHY?!?

Ingested Poison

• Food Poisoning

– Shellfish

– E. Coli

– Salmonella

– Botulism

– Heavy Metal

• Household Chemicals

• OTC Drug Overdose

• Alcohol

First Aid for Ingested Poison

• Get critical info

1. age / weight

2. type of poison

3. dose and time

• Assess ABCs

• Lie on left side

• Give activated charcoal if instructed

Inhaled Poisons

Carbon Monoxide

- tasteless, colorless, odorless

- binds to hemoglobin

Signs to look for . . .

- altered state of consciousness

- pink/rosy skin complexion

What is the appropriate first aid?

Injected Poisons

• Envenomation

- stings

- snake bites

• Drug Overdose

- narcotics

- stimulants

- hallucinogens

Transport to closest

medical facility!!

Check vital signs

frequently!

Absorbed Poisons

Look for . . .

- powder on the skin

- burns

- itching / irritation

- redness and rashes

What to do?

In June 2004, 25 Russian soldiers

became ill from thallium exposure

when they found a can of

mysterious white powder in a

rubbish dump on their base.

Oblivious to the danger of misusing

an unidentified white powder from

a military dump site, they added it

to tobacco, and used it as a

substitute for talcum powder on

their feet.