Transcript BURN: Fluid Resuscitation Formula

ENPC
TIPS
SPINE
BRAIN
ENPC TIPS
P: PAIN
P: Pallor
P: Pulse
P: Paralysis
P: Paresthesia
Primary Survey
ABCDE
Secondary Survey
FGHI
Dope
D: Dislodgement
O: Obstruction
P: Pneumothorax
E: Equipment Failure
M: Mechanism Of Injury
I: Injuries Sustained
V: Vital Signs
T: Treatment
ENPC TIPS
P: PAIN
P: Pallor
P: Pulse
P: Paralysis
P: Paresthesia
2 x age + 8= wt/kg
M: Mechanism Of Injury
I: Injuries Sustained
V: Vital Signs
T: Treatment
Dope
D: Dislodgement
O: Obstruction
P: Pneumothorax
E: Equipment Failure
EPI
0.01mg/kg
1:10000
16+ age
4
ENPC TIPS
Neurovascular Assessment
The 5 P’s
P: Pallor
P: Pulse
P: Pain
P: Paresthesia
P: Paralysis
Neurological Assessment
AVPU
A:
V:
P:
U:
Awake & Alert
Verbal Stimuli only
Painful Stimuli only
Unresponsive
M: Mechanism of Injury
I: Injuries Sustained
V: Vital Signs
T: Treatment
DOPE
D: Dislodgement
O: Obstruction
P: Pneumothorax
E: Equipment Failure
Pediatric Assessment Triangle
Inspect
Auscultate
Palpate
Appearance
Work of breathing
Circulation
Emergent
Urgent
Nonurgent
½ first 8
½ second 16
2-4 cc/kg x % BSA over 24 hours
Triage History
C: Chief Complaint
I: Immunizations
A:
M:
P:
E:
D:
S:
Isolation
Allergies
Medications
Past Medical History
Parent’s Impression
Events
Diet
Diapers
Symptoms
Pediatric patients need
Maintenance fluids too
BURN: Fluid Resuscitation Formula
2-4 cc/kg x % BSA over 24 hours
½ in first 8 hours post burn
½ in next 16 hours
INITIAL ASSESSMENT
PRIMARY ASSESSMENT
A
B
C
D
E
AIRWAY
BREATHING
CIRCULATION
DISABILITY
EXPOSE
ENVIRONMENTAL CONTROL
SECONDARY ASSESSMENT
F
G
H
I
FULL SET OF VITAL SIGNS
FAMILY PRESENCE
FIVE INTERVENTIONS
GIVE COMFORT MEASURES
HEAD TO TOE ASSESSMENT
HISTORY (CIAMPEDS)
INSPECT POSTERIOR SURFACES
Epidural Hematoma
Subdural Hematoma
Subarachnoid Hemorrhage
Definition
*Disruption of the middle
meningeal artery
*Blood collects between the
skull and dura mater
*Venous bleeding
*Blood collects between the
dura mater and
arachnoid mater
*Arterial disruption
*Blood collects between arachnoid
mater and pia mater
Causes
* Blunt Trauma
* May be caused by violent
shaking
*Consider child maltreatment
or shaken baby
symdrome
*Frequently a result of child
maltreatment
Signs and Symptoms
* Initial loss of consciousness,
followed by transient
consciousness
* Ipsilateral pupil dilation
*Contralateral paresis or
paralysis
*Rapid Deterioration in level of
consciousness
*Signs of increased intracranial
pressure
* Stiff neck
*Headache
*Seizures
*Irritability
*Signs of increased intracranial
pressure
Traumatic Brain Injury
Primary injuries are those that occur at the time of impact and are a result of direct traumatic forces that injure brain tissue and kill brain cells. Primary
injuries occur in a fraction of a second and may be irreversible. Common types of primary injuries include:
Concussion
Contusion and
Laceration
Skull fracture
Scalp laceration
Epidural hematoma
Subdural hematoma
Subarachnoid hemorrhage
Diffuse axonal injury
600,000 yearly treated for head injuries
25,000 yearly die from head injuries
30,000 yearly are left with permanent disabilities
Leading cause of acquired disabilities in childhood
Age related Risks:
Infants:
Have large heads in relation to rest of body.
Are commonly result of falls over 4 months of age
Have involuntary reflexes, such as crawling may propel infants forward unexpectantly
Begin to roll from back to abdomen in second month which predisposes fall from heights
Motor vehicle crashes are the major source of severe TBI in infants; major cause is:
Unrestrained or improperly restrained child
Rear facing child seats from birth to 20 pounds or one year of age.
Toddler and Preschoolers:
Are involved in motor vehicle accidents as passengers and pedestrians.
Children who weigh more than 20 pounds and greater than one year should ride forward
Until they are 40 pounds or 4 years of age.
The most serious head injuries often result from pedestrian-accidents, young thrown onto
The hood, windshield or top of vehicle.
School-Age Children:
Ages 6 to 12 years
Are at risk as pedestrians and passengers
Operated moving vehicles such as bikes, skateboards, rollerblades.
Injuries are decreased substantially by the use of helmets.
Mechanism of Injury
Relates to the force of impact or inertial forces that result in injury to the scalp, skull or brain tissue.
The extent of injury is based on the force and location of impact, rate of energy transfer and surface area.
8 Stages of Development per Erickson
Stage 1:
Infancy: Birth - 1 year old
Trust vs. Mistrust
During this stage an infant develops a sense of trust. They build on this level to see how their needs are met. If they
are met consistently they develop trust, if not consistently met, they develop a sense of mistrust.
The Toddler Period: 1 – 3 years old
Autonomy vs. Shame and Doubt
If trust has been developed, then the infant will be confident enough to accomplish new skills. They learn from
behavior limit setting. They learn to control their impulses. They try to be independent. It is important to promote independence so their autonomy
will develop. Toddlers learn by doing.
Stage 2:
The Preschool Period: 3 – 6 years old Initiative vs. Guilt
Preschoolers master developmental tasks and learn new skills. They develop the ability to make decisions. They
desire to do for themselves without the help of adults. They learn thru accomplishments. If they do not make accomplishments, then they will be
reluctant to act and will develop feelings of guilt
Stage 3:
The School-Ager: 6 – 12 years old
Industry vs. Inferiority
This is the age of workers and producers. The need achievement. They learn rules and how to compete and
cooperate with others. They need praise and mastery development
Stage 4:
Stage 5:
Adolescence: 12 – 18 years old
Identity vs. Role Confusion
The search for personal identity is in place. A sense of role confusion and identity crisis emerge during this time.
Young Adulthood: 18 – 40 years old Intimacy vs. Isolation
Young adults prepare to share meaningful relationships and friendships. During young adulthood interpersonal
development occur and self identity flourish.
Stage 6:
Stage 7:
Middle Adulthood: 40 – 65 years old Old Generativity vs. Stagnation
Productivity vs. Stagnation are the important components of this development tasks.
Stage 8:
Older Adult: 65 years +
Ego Integrity vs. Despair
A sense of purpose is vtally important during these years.
AIRWAY
VOCALIZATION
TONGUE OBSTRUCTION
LOOSE TEETH OR FOREIGN OBJECTS
VOMITUS, BLEEDING, SECRETIONS
EDEMA, DROOLING, DYSPHAGIA
PREFERRED POSTURE
ABNORMAL AIRWAY SOUNDS
INTERVENTIONS
INITIATE MANUAL CERVICAL SPINE IMMOBILIZATION OR MAINTAIN
SPINE IMMOBILIZATION FOR THE TRAUMA PATIENT
ALLOW PATIENT TO MAINTAIN POSITION OF COMFORT
OPEN AND CLEAR THE AIRWAY
JAW THRUST
HEAD TILT CHIN LIFT
POSSIBLE PADDING UNDER SHOULDER
SUCTION IMMEDIATELY FOR VOMITUS OR OTHERSECRETIONS
AIRWAY ADJUNCTS
PREPARE FOR ENDOTRACHEAL INTUBATION
BREATHING
LEVEL OF CONSCIOUSNESS
SPONTANEOUS BREATHING
RATE AND DEPTH OF RESPIRATION
CHEST RISE AND FALL
PRESENCE OF BILATERAL BREATH SOUNDS
WORK OF BREATHING
NASAL FLARING, RETRACTIONS, HEAD BOBBING,
ASSESSORY MUSCLE USE
JUGULAR VEIN DISTENTION
TRACHAEL POSITION
PARADOXICAL RESPIRATIONS
SOFT TISSUE, BONY CHEST WALL INTEGRITY
INTERVENTIONS
POSITION PATIENT
DELIVER SUPPLEMENTAL OXYGEN
ASSIST VENTILATIONS
ASSESS EFFECTIVENESS OF VENTILATION
LIST INDICATIONS FOR INTUBATION
CIRCULATION
CENTRAL AND PERIPHERAL PULSE RATE AND QUALITY
SKIN COLOR AND TEMPERATURE
CAPILLARY REFIL
UNCONTROLLED EXTERNAL HEMORRHAGE
INTERVENTIONS
CONTROL UNCONTROLLED EXTERNAL BLEEDING
OBTAIN VASCULAR ACCESS
INITIATE INTRAOSSEOUS IF NECESSARY
FLUID BOLUS OF 20CC/KG AND REPEAT IF NECESSARY
CARDIAC COMPRESSIONS
DRUG THERAPY
DEFIBRILLATION OR SYNCHRONIZED CARDIOVERSION