Shock and Burn ppt For Doctors and NUrses 2024: Must Know Emergency

Shock and Burn Powerpoint PPT : Loksewa, NMCLE and MDMS entrance

Table of Contents(toc)

Introduction

Fire accidents are common type of injuries that happen in world daily basis. 

Shock is a clinical condition that results due to inadequate tissue perfusion.

A critical condition brought on by the sudden drop in blood flow through the body. 

May result from trauma, heatstroke, blood loss, an allergic reaction, severe infection, poisoning, severe burns or other causes. 

Occurs when the metabolic needs of cells are not met because of inadequate blood flow.

These two topics are very common in emergency managent and should be well taught to medical students, graduates and paramedics.

Signs and symptoms 

1. Cool, clammy skin
2. Pale or ashen skin
3. Bluish tinge to lips or fingernails (or gray in the case of dark complexions)
4. Rapid pulse
5. Rapid breathing
6. Nausea or vomiting
7. Enlarged pupils
8. Weakness or fatigue
9. Dizziness or fainting
10. Changes in mental status or behavior, such as anxiousness or agitation

    

    Burn with Fire

Types of Shock

1. Hypovolemic Shock
2. Cardiogenic Shock 
3. Neurogenic Shock
4. Anaphylatic Shock
5. Septic Shock  

Introduction to BURN 

Burns are tissue damage that results from heat, overexposure to the sun or other radiation, or chemical or electrical contact. 

Wound with destruction of tissue due to coagulation necrosis.

Causes of burn

1. Thermal burn/heat burn: dry heat
2. Scald: moist heat 
3. Electric burn: electricity 
4. Cold burn: frost bite 
5. Chemical burn: strong acid and alkali 
6. Radiation burn: X-rays, Gamma rays

Degree of Burn Classification and grading

1.  First degree - superficial thickness
2.  Second degree - Partial or intermediate thickenss
3. Third degree - Full thickness
4. Fourth degree

Management of burn

• Remove burning source immediately.
• Wrap the patient in a cloth and roll him in the floor.
• Immerse 10-15 minutes in water or cool down the burnt part in running water for 15 minutes
• Give liquids orally. Provide analgesics and antibiotics.
• Do not rupture blister.
• TT injection 
• First-degree burns: 
• Run cool water over the burn. Don’t apply ice. For sunburns, apply aloe vera gel. For thermal burns, apply antibiotic cream and cover lightly with gauze. You can also take over-the-counter pain medication.
• Second-degree burns: 
• Treatment for second- and first-degree burns is similar. 
• Stronger antibiotic - such as silver sulfadiazine, to kill bacteria
• Elevating the burned area can reduce pain and swelling.
• May need dressing to be applied
• Third-degree burns:
•  Third-degree burns can be life-threatening and often require skin grafts. Skin grafts replace damaged tissue with healthy skin from another of the uninjured part of the person’s body.

Wallace Rule of Nine

The Wallace Rule of Nines is a method used to estimate the total body surface area (TBSA) affected by burns. It divides the body into sections, each representing approximately 9% (or multiples thereof) of the total body surface area. The distribution is slightly different for adults and children due to differences in body proportions.

Wallace Rule of Nines for Adults:

• Head and Neck: 9%
• Each Arm: 9% (4.5% front, 4.5% back)
• Each Leg: 18% (9% front, 9% back)
• Anterior Torso (Chest and Abdomen): 18%
• Posterior Torso (Back and Buttocks): 18%
• Perineum/Genitalia: 1%

Wallace Rule of Nines for Children:

• Head and Neck: 18% (larger proportion due to the relatively larger head size in children)
• Each Arm: 9% (4.5% front, 4.5% back)
• Each Leg: 14% (7% front, 7% back; less than in adults because legs are relatively shorter)
• Anterior Torso (Chest and Abdomen): 18%
• Posterior Torso (Back and Buttocks): 18%
• Perineum/Genitalia: 1%

These percentages are used to help us quickly estimate the extent of burns and its severity, which is critical for determining the severity of the injury and guiding treatment decisions, such as fluid resuscitation and transfer to a specialized burn center.

Parkland Formula:

The Parkland formula, also known as the Baxter formula, is used to calculate the amount of fluid required for resuscitation in burn patients within the first 24 hours after injury. The formula is based on the patient's weight and the total body surface area (TBSA) burned.

Total fluid requirement: $4 \, \text{mL} \times \text{body weight (kg)} \times \text{\% TBSA burned}$

$4\text{mL}\times \text{body weight (kg)}\times \text{\% TBSA burned}$

Administration:

• First 8 hours: Administer half of the total fluid requirement.
• Next 16 hours: Administer the remaining half.

Example for an Adult:

If an adult weighs 70 kg and has 30% TBSA burns:

• Total fluid requirement: $4 \times 70 \times 30 = 8,400 \, \text{mL}$
• First 8 hours: $8,400 / 2 = 4,200 \, \text{mL}$
• Next 16 hours: $4,200 \, \text{mL}$

The Parkland formula provides an initial guideline for fluid resuscitation, but ongoing assessment and adjustments based on the patient's clinical response (urine output, vital signs, etc.) are critical for effective management.

OTHER CONCEPTs on bubrn management

1. Patient may require IV antibiotics for infection prevention/control
2. If oral intake not possible IV fluids till oral can be started
3. Topical antibiotics
4. Vaseline gauze
5. Scar prevention
6. Contracture prevention/compartment syndrome
7. Deformity prevention
8. Scar prevention
9. Alkali burn is more dangerous than acid burn- deep burn in alkali
10. Electrolyte imbalance, fluid status and vitals and end organ monitoring in severe burns
11. Rhabdomyolysis
12. CO poisoning

UPPER AIRWAY BURNS AND UGI BURNS

1. Speciality vare needed
2. To prevent long term disability and management of complications
3. Do not try to neutralize acid with base or vice versa
4. Warer is the best method to contro

SPECIAL POPULATION

• >10% BSA in <10 & >50 yrs
• >20% BSA
• Face, genitalia, major joints
• Electrical/Chemical burns
• Inhalational injury
• Co-morbid diseases/injuries
• Children with special needs

Shock and Burn PPT

Thank you for reading.