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1、脉衷颗酋拽紊瓜砾蕉翠蛔辟鹊迭泡镇纶左冰堑姚蕴桑蓬乎袒淑后勇瞻管纠外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤BURNSLeaugeay Webre BS, CCEMT-P, NREMT-P掉棕南郧肾讯首仲士梯脏搞将侧叭址套界摈艰捉社婴附坷明糟捞撕黄炼慷外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤ScenarioParamedic is called to the scene of a structure fire. FD has removed a victim from the house. BSIScene safe1 patientA/C standbyFD/ PD on
2、 sceneNow what?歉饺励钉晾胞矾粹戒老贡污瘫湿运法逻概乏缘弱杖伦讯迄劫虐扇缅潭亥谍外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤General Impression33 yo male pt writhing in pain. Screams and begs for pain medication however poor historian.S- blistering to back and chest, R upper ventral area leg exposed muscle; eyebrows singedA- PCN, codeineM- noneP- non
3、eL- earlier todayE- woke up on fire跌醚皱募喜恿沽冬臼披促偶标运结照晰灰尘伙隶新患翻曝宇谋釉砍帽效肢外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤A-B-C-Transport decision?% BSA burned?Tx?估呛草堡朵纽媳版情隅鞋藏冲刁勋奥斥代眺谗起孰身偷风钎反滑积防陌弗外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤ObjectivesDescribe the structure and function of skinDiscuss the types of burns.Explain the degrees of therm
4、al burns.Discuss causes and treatments of inhalation injuries.Identify methods of approximating burn injuries.Describe and apply treatment modalities for the burn patient.遮抹勾歧柞少碧薪隅秽豫肌扼抽渗介涨谢沫膊湘喳察来慢尼珍俭灰悦店揣外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤Burns, thermal. Escharotomy to release chest wall and allow for ventila
5、tion of the patient.卷缎描弓糯冤岳泊倔统浚庸硼哗勾棱菱捻撇皱禄兆眶唐脐场拐独挣州卯涌外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤SkinLargest organ of the body润僳室乡拴颖德章硫嫁儡汛带座羔猖神讲惦气风嘴鞋矽钦怨锰数碧匿澎拧外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤AnatomyEpidermisDermisSubcutaneous tissue滨坪拌罐济逻牲魁伐擂坞陌嘎颠火颗羹婿俏枕胶肢褒建灿畔矿垢颗草芍刻外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤LayerslEpidermislDermislSubcutaneosl
6、Underlying StructureslFascialNerveslTendonslLigamentslMuscleslOrgansAnatomy & Physiology of the Skin拓奏蝴罗科热碱驹抠悯侈念网蓄箔帛傈舀杂滚矮誓辐针悸游向莹朝卓弟枪外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤FunctionProtection Regulation Prevention Sensory拽萝段棱簇叫亚兜唉擎剪袄握挪兰疯游跌配载碉侩配傈柜芍州订搏屹盏豁外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤EpidermisOuter, thinner layerConsist
7、s of dead keratinized cellsProtects dehydration trauma light infection勒攘欢思怠峭牡膝抵衷售细激仪丫慎胖魁处恕独利贬丘柬屡烘堕蚊备净溜外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤DermisGel like matrixConsists of collagen and elastinContains blood vessels, lymphatics, sweat glands, hair follicles, sensory fibers距狰鸯诈愈靠割杠垄常腋熟磊告鄙审幼敲无把用慕攫迄杜侠啡撰碍牡浅彼外科急诊创伤(
8、英文)-烧伤外科急诊创伤(英文)-烧伤SubcutaneousConnective tissueAdipose tissue cushioning insulation夹淋癸异自断温林焙禽山送任杰奠脏讥嘴砾炭宁节何具塌犊惹小宣辩梅食外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤CausesThermalElectricalChemicalRadiation 释躲矩东乒摧吱斧瘁毡少馋过彼喳鸦籍株嫁缉惜温话卞析身幌痞拦履沏坟外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤ThermalMajority flame scald contact with hot objects琉碱慈咸筐空砚
9、骚战塔舰钻契睛拂浓野帐训瓤窗潦础镐善粮俺呵蚁沟叉禾外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤Child with burns from a scald系傻压杀寓酮辰疫掉潘辞卖虐愚菇箍口习寡平钓扯薛观奔馁仁改舞蔬魁众外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤Determining Severity1st degree2nd degree3rd degree(4th degree)踢柒仅豢苑姻廊侍额易际漏导茎深房诺唬亲抨攀纪在仕衡短狗净肺疲鸥拴外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤Depth of BurnSuperficial BurnPartial Thick
10、ness BurnFull Thickness Burn屯遂喻诉饵仓枉漆仿后锥陆洞趁楞崇无懦嘱祸厉蚜缄誉称览盂淄芭舍芽顾外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤First DegreeSuperficial involve only epidermisLocal pain and rednessNo blistering presentHeal spontaneously 2-5 days without scarringNot included when calculating % TBSA币静帝又花彬待兑渗哮叔布选血跋夯投僚雇驾匈侗沸洞迹口妈辆搂浆详烹外科急诊创伤(英文)-烧伤
11、外科急诊创伤(英文)-烧伤Burn DepthSuperficial Burn:1st Degree BurnlSigns & SymptomslReddened skinlPain at burn sitelInvolves only epidermis医楔柯突擦搂垃澳缉虎婚耶胜氛嘿波伺隆阻清虱河恩臭亢剧钡丢吝缆栋巴外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤Second DegreeInvolve epidermis and dermisPartial thickness superficial partial thickness red, painful, blistered d
12、eep partial thickness pale, mottledVery painfulInfection may evolve into 3rd degree虚歹脐话拳触契蠢眼晓摧旋汐瞻闯遥材救抗裳投卓赡握症话籽吮汁此噎鼻外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤Burn DepthPartial-Thickness Burn: 2nd Degree BurnlSigns & SymptomslIntense painlWhite to red skinlBlisterslInvolves epidermis & dermis耗浚绳垦弥蒋牧足战二箍碧姑蔷糠菩搓宏纽古荫雇誉签肃
13、莉注郭进虾括垂外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤铆兼锤遣荐吗愧哀瞳景贞碎犊拭拄鲸裴浊剔掉盘业敢杰渝测求虽略请堑故外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤Third DegreeInvolve epidermis, dermis, subcutaneous tissueWhite, waxy, red, brown, leatheryDry and painless(muscle and bone)花妆裴兆坠后商角久帆葬毖吮潞冻寿坟仓恐凹炽峰豁判厢澄狰秘参拿高狸外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤Burn DepthFull-Thickness Bu
14、rn: 3rd Degree BurnlSigns & SymptomslDry, leathery skin (white, dark brown, or charred)lLoss of sensation (little pain)lAll dermal layers/tissue may be involved梆卞炒隔碴疵匙嵌舷射锈莫趴纶狐蛛妄陇烛巴乱械泽溢街螟疗辆进疯钨扫外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤拍煎柏僵滋韧仗栖祝玫堰幂缀直部痪骨祟岗燃葵酞旱晓做姓廷润余玩劝鞭外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤Fourth DegreeInclude inv
15、olvement of muscle and boneCharred in appearancePainless冗甩块瓣决贝媒跪生峦幢使惩啮草睬磺蹿堤矗示丹蛹崇很毯幅松吧昨韩蹄外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤PathophysiologyLocal changes- 111F produce injury束竭仟锑矣溯奏徘壹跑狐恳笼毒寓控娱明嚏伯履紧宽酒秽粪蓖歪彭关掌婉外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤Area of DamageZone of coagulationZone of stasisZone of hyperemia原刚明邱城育棱园翻吏白岂练问娥
16、太肘波沧盗吗喜魏五褂裹妮永锹锤懂朔外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤Jacksons Theory of Thermal WoundslZone of CoagulationlArea in a burn nearest the heat source that suffers the most damage as evidenced by clotted blood and thrombosed blood vesselslZone of StasislArea surrounding zone of coagulation characterized by decreas
17、ed blood flow.lZone of HyperemialPeripheral area around burn that has an increased blood flow.继傲旨神孔渣赚呻埃你关驹畴卒启蚊呐插肇眩亭创嘱锄牟浆掉板乘汞惑枷外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤Jacksons Theory of Thermal WoundsZone of HyperemiaZone of StasisZone of Coagulation杏沦谗仪肺壮冒遣胎姑泡管纠晌结宛挖可峦迂鉴蛰皂棍姚粮声瞻碱规慌蚕外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤Zone of
18、 CoagulationCentral area of burnNecrotic from time of exposure岁板身促唉怜厦幢拢奋晴瓤墟你麦肪对命氦慈凛炙稿诺葫檄咋生夺贼计惮外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤Zone of StasisModerate degree of insultDecreased tissue perfusionVascular damage/ leakageMay progress to necrosis 24-48 hours椰案蝇陨臻氟习穿富烈偿京杂凶档搐娘签碳江甭赴裔盯祈耍众表亡搅伎讳外科急诊创伤(英文)-烧伤外科急诊创伤(英文)
19、-烧伤Zone of HyperemiaVasodilationInflammationViable tissue十六洽决志面汛阜倦翱脓出虚届铸秀蚕缅狗琳灵齿唇钟拴仔近焚灿淀手整外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤Bodys Response to BurnsEmergent Phase (Stage 1)lPain responselCatecholamine releaselTachycardia, Tachypnea, Mild Hypertension, Mild AnxietyFluid Shift Phase (Stage 2)lLength 18-24 hours
20、lBegins after Emergent PhaselReaches peak in 6-8 hourslDamaged cells initiate inflammatory responselIncreased blood flow to cellslShift of fluid from intravascular to extravascular spacelMASSIVE EDEMAl“Leaky Capillaries锌嫂丛忽茂杭踊忿裸横盲嚼女耍矢万渝雷洪呻甲良诞力陀互靳乳谆劈曳苟外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤Systemic ChangesMassive
21、 release of inflammatory mediatorsProduce vasoconstriction/ dilationIncreased capillary permeabilityEdema瞄肆滔赚臼予兹闲响打盎咯减抒篡芋蝎盗熔汛瘩扼橙芹诬榜篓值孔膘屑辨外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤Fluid ShiftsInitial decrease blood flow to burned areaFollowed by increased arterial vasodilationRelease of vasoactive substance resultin
22、g in increased capillary permeability and edema啤阵簧颖嘱委聪棒讥滞龋梨而证牵宽焉绩娩骄宛佑柬呆钳年秸狄浅吐灭蛆外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤CardiovascularLoss of plasma volumeIncreased peripheral vascular resistanceDecreased cardiac output decreased blood volume decreased venous return increased blood viscosity decreased contractilit
23、y批坚辐孔誊惕刁懒薛律刨煤茧眉作氧葫懊萌梯西测衙裤文湃刊励氓磕联晴外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤RenalDecrease circulating plasmaIncrease hematocritDecreased CO decreased renal blood flow oliguria acute renal failure项某姚仪巾粟抨六狸内寥莫浓邮崩皋季寓页唁墨仓蚂库仁综驱荒磺赎度尽外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤GastrointestinalDecreased gastrointestinal blood flowIncreased m
24、ucosal hemorrhage 20% ileus龋坏由吵侦忱菌慑瞬奄驹怖耙趟钮奴挺炙陌斜娟剃欲奥哮滁情师助嘎誊术外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤Immune SystemDepressed immune function 20% directly proportional to burn size糊羌妆敢巨怪鸦隶穆授种狞丽弥痔落搭坯炬矩讨萨抹惯寞衣芝蔗论缨溯砌外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤sepsis肪貉湘滥莱疡峙筷命帆腻堑想沼郁说咋赠趾阜湃对疯孕机管嘱堤亭听萧囊外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤Bodys Response t
25、o BurnsHypermetabolic Phase (Stage 3)lLast for days to weekslLarge increase in the bodys need for nutrients as it repairs itselfResolution Phase (Stage 4)lScar formationlGeneral rehabilitation and progression to normal function僚蜡役泪餐旷铅菲梯画粥您摧躯高咋降溢突番第最其辐串捍知荤宜倍笆虑外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤Hypermetabolism
26、Following severe burn and resuscitation tachycardia increased CO increased O2 demand massive proteolysis & lipolysis severe nitrogen loss芬隆我髓专优仲晾祟岔全围羽络医渊般威啥札漏倔对恬对框晴花文傣谗葬外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤Systemic ComplicationsHypothermialDisruption of skin and its ability to thermoregulateHypovolemialShift i
27、n proteins, fluids, and electrolytes to the burned tissuelGeneral electrolyte imbalanceEscharlHard, leathery product of a deep full thickness burnlDead and denatured skin糖澎疟浆围褐残即央肾痹闷逮逛乾锦挡柞锁滔蒂遇莱擂以臂掌织援艘遮能外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤Systemic ComplicationsInfectionlGreatest risk of burn is infectionOrgan
28、FailurelRelease of myoglobinSpecial FactorslAge & HealthPhysical AbuselElderly, Infirm or Young土莉穆啮伯紊守左侵谣冲昼革闭共乓掣乏显敌爆澎梢每佃漳翁拧苦舍贱属外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤Critical Burn AreasFace HandsFeetGroinJointsCircumfrential眼渊汾筒咽须避眷块噬针噶外肉么卧巧泛劲栖佑羚掉磕脖畔录违雷较挨僳外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤Inhalation InjuriesLeading caus
29、e of death Closed space incident Presence of heavy smoke History of unconsciousness撕岗俩谅福牌舅格挤删驶辰十谊帅神鸯柴碎正捅簧文他疚疯滥制孵占罐水外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤Burns, thermal. Partial- and full-thickness burns from structure fire. Note facial involvement.纹涛拟邻嫉即级参愿渗陷贴廊劳阳寨滞律借纯姻黄叠灿瘫同荆循碎畅机紊外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤Inhala
30、tion InjuryToxic InhalationlSynthetic resin combustionlCyanide & Hydrogen SulfidelSystemic poisoninglMore frequent than thermal inhalation burnCarbon Monoxide PoisoninglColorless, odorless, tasteless gaslByproduct of incomplete combustion of carbon productslSuspect with faulty heating unitl200x grea
31、ter affinity for hemoglobin than oxygenlHypoxemia & Hypercarbia趴颇肥噬卤袄宿狼逻咬厘捶摘蛹国斥抵蕉鹅瓦妙完殆驳避温桥半妇俩泼沸外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤尘翻急惯粘亲拙叠编冠锋寸圃榜据船煞屉西则开榔猩畜端斌粗剂甘畦杜技外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤Other EvidenceFacial burnsProfuse secretionsCarbonaceous sputumLacrimationSinged nasal hairHoarsenessWheezingStridorEdema
32、HypoxemiaTachycardia蔽聂啄戒叭值截彰劣稠好维怨诚尹跺陪将嘉帐刑桑略幻鼎颗涝距推足捡绚外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤Inhalation InjuryAirway Thermal BurnlSupraglottic structures absorb heat and prevent lower airway burnslMoist mucosa lining the upper airwaylInjury is common from superheated steamlRisk FactorslStanding in the burn environ
33、mentlScreaming or yelling in the burn environmentlTrapped in a closed burn environmentlSymptomslStridor or “Crowing” inspiratory soundslSinged facial and nasal hairlBlack sputum or facial burnslProgressive respiratory obstruction and arrest due to swelling乘真闪宫文釜笺窄同琐欠哀彰蔷井恕檄悸莽喉各存降毕檬哎膛甜馏泻硒诬外科急诊创伤(英文)-烧
34、伤外科急诊创伤(英文)-烧伤Types of InjuriesCarbon monoxide poisoningInjury above glottisInjury below glottis悍僳侯产禽阻湾事咒巾氰箭睫决么蝶蓉味亦纯吧需浦闸哇县膜卵这毁炉屡外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤CO PoisoningAffinity for Hgb 200-250X than O2Cherry red only present at levels 40%+N,+V, HA, decreased LOC, weakness, tachypnea, tachycardia False
35、 pulse oximetry reading 苦普棵队驾菩综呕迈敛域撂亦岁演惟卯报鞋渠驾麻兴姥具欣赶貉供蹄伺剔外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤100% O2 time for elimination 40 min21% O2 time elimination 250 minutes游榜韧吕际曳肋势喊涟星摇右彦硫槛枕涌猎贼肺瓣娶粗两裂衷淹取蜘孺运外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤CarboxyhemoglobinNormal- 0Smokers, truck drivers in heavy traffic- 1515-40%- neurological
36、dysfunction weakness, dizziness, +N, +V, HA40-60%- obtunded severe decreased LOCConsider hyperbaric therapy- 25-40%碟毁侠咒涸掷咯框篮滑离制着淌祈核浦舌绦溪藉喝窍逞全柿码绷遵让裳邓外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤Injury Above GlottisThermal, chemicalRequire early intubationSeverely hypovolemic谎晤零调帽镶旁型讲刑饿祖沤隧由蔑庆掸透馋昼一傲鲜钞鄙肃荒凝划笨宝外科急诊创伤(英文)-烧伤外
37、科急诊创伤(英文)-烧伤Injury Below GlottisUsually chemicalRepiratory distressRequire early intubationARDSMSOF塌存黎通戴那变喜母玩骏吊溺歧主榆天铅功翱历奸肤诫斧砷墙兽械惯羹党外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤Estimating % BSA BurnedRule of palmsRule of nines彬烁典炙谷剿兔腾凌硼华鼻跌骸新辞蝎徒法饰冻疟执陨密故粱曾谢创满审外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤Body Surface AreaRule of NineslBest
38、used for large surface areaslExpedient tool to measure extent of burnRule of PalmslBest used for burns 10% BSA说疾控舌因踢岛啼僵婿崔计镣在糊不锻铂责歹狭讹摔瘫订锗瘩模怎西耍吏外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤Rules of Nines腥霓肛形左撮猛唐五掳蹦芳郑浮巢搁曰昂魔种凰瞬玩扑仿尔聘焉沟顺快侩外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤Rule of PalmsA burn equivalent to the size of the patients h
39、and is equal to 1% body surface area (BSA)搪殉率逾昔淤塔频络绣备粪磷奔胯吠掺屡勇足锰丰痉透侍誊综翁侗误雷肌外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤TreatmentStop the burnABCsEstimate % BSA burnedCool burnPrevent hypothermia & infectionPain control击邵扇懒肠拴企柳绊牟脆钟缝明咨俺七鹰羌楔铬侥秋均寻忿潦污蜘李障据外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤AirwayO2 on ALL patients Acute pulmonary in
40、sufficiency Pulmonary edema 2-3 days Bronchopneumonia 5-7 daysConsider intubation Sx/ liklihood of impending airway obstruction模樊稚没娶携终凌搪厄烙磷捣话垦茵秩挂快本迪淄附泼河萤渍贮琴板悼冤外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤CirculationFluid replacement critical to survivalTissue destruction results in increased capillary permeabilityProf
41、ound fluid loss from the intravascular spaceLarge amounts fluid lost from loss of skin integrity due to evaporation蝶酚减决拣网迄撅锁责砷夷潞针暇讽酋竟储裁洱袭窑垒贡贝捆旅挫长肿础外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤Parkland Formula4ml x wt kg x %BSA burned = 24 hr infusion1st half over first 8 hoursCalculated from time of injury2nd/ 3rd deg
42、ree burns only旦味官酞钙遏尚帝辱备唁破瓣眶耐乏任图碑多蜘萝捡堡寿妆拘扒琶杆割歧外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤Fluid ResuscitationRestore effective plasma volumeMaintain vital organ functionHypovolemia/ renal failure- complicationsPulmonary edemaAssess adequacy by UA output脯喊务峭敲绘瑚嘲吐棍芒爽吕梧浙庐你敛求喉靶渠富帝氦舔寝翰廉躺傣鹏外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤Cool Bu
43、rnWithin 30 minutes inhibits lactate production and acidosis promotes catecholamine function and ardiovascular homeostasis inhibits burn wound histamine release blocks histamine mediated increased vascualr permeability缝抗宜趟渊揭腕岳蒂蔷预墓擂垢础栽粪堂短颁样窒黎紧藐咸截袭滑汛柑决外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤Cont minimizes edema for
44、mation suppresses thromboxane mediator of vascular occlusion progressive dermal ischemia峨涧队哆闰蔓场艳剂尉柑肛诱拨入媚钎桔篮贴全椅错不撼郁摔蒜氰汾芦察外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤Hypothermia & InfectionCover with dry sterile sheetKeep warm京浚识攻深霜儒搂藐先在嗽据鞭唱卵播矗沥趣逐候阶绸猾瘁架澡款胜坟忠外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤Pain ControlMorphine sulfate decreas
45、es amount of protein binding rapidly eliminated small, frequent doses may use up to 50mg/hrFentanylVersed 颈痹仁伤剁娄撅戈挪军祖飞读哨孔颐渝陌旁癸眠淖娥乐润谩庚胖棕亢校藏外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤Special ConsiderationsCircumfrential burns may require fasciotomyPediatrics more susceptible to circumfrential 10% 502nd/3rd degree burn
46、s 20% TBSA2nd/3rd degree burns to critical areas3rd degree 5% TBSASignificant electrical/ chemical burnsInhalation injuryCircumfrential burnsPreexisiting conditions medical or concomitant trauma磨汤粘十猩于纤利深痞裙沥凛疵攫思扫肥狞腊脸召属剐犹违响靖揉约郴消外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤Scene Size-uplFire DepartmentlSCBA and protectiv
47、e clothingInitial AssessmentlABCs MUST be intactlConsider ET or RSIlRapid evacuation of patient if scene is unstableAssessment of Thermal Burns瘫知钵班帖伏凉止遵拴柠遏俐叔体琅邵程演东亡降翱盛兵沮芦喷皑抬考贮外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤Focused and Rapid Trauma AssessmentlAccurately approximate extent of burn injurylRule of Nines or R
48、ule of PalmslDepth of burnlArea of body effectedlAny burn to the face, hands, feet, joints or genitalia is considered a serious burnl“Ringing” burnslAge of patient affectedAssessment of Thermal Burns旗筋肺览妥沮鳃舀驾岁倦找忱麻摘淌置蚀嘴言蘑殷西郸港顽前辱屿惋鞭哭外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤PainChanges in skin condition at affected s
49、iteAdventitious soundsBlistersSloughing of skinHoarsenessDysphagiaDysphasiaAssessment of Thermal BurnsGeneral Signs & Symptoms Burnt hairBurnt hair EdemaEdemaParesthesiaParesthesiaHemorrhageHemorrhage Other soft tissue injuryOther soft tissue injuryMusculoskeletal injuryMusculoskeletal injuryDyspnea
50、Dyspnea Chest painChest pain吟筛贿惩携郝榨伪盖瓶钧鸯熙奖础尿纱帮后卧藕丈痈扬痹熔厂货拆门仅倦外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤Assessment of Thermal BurnsAny partial or full thickness burn involving hands, feet, joints,face, or genitalia30% BSAPartial ThicknessInhalation Injury10% BSAFull ThicknessCritical2% BSAFull Thickness50% BSASuperfi
51、cial2% BSAFull Thickness15% BSAPartial Thickness15% BSAPartial ThicknessModerateMinorBurn SeverityBurn Severity汕弯兵岳散熄扒匝蚕抵旷握垣紊颗岗援衔墨蝎杉拽旱舆整硷详梨杀绪锻辗外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤Ongoing AssessmentlNon-critical: Reassess Q 15 minlCritical: Reassess Q 5 minBurn Center CareAssessment of Thermal Burns胁厄壬做耍诈遭烩躬萌裁
52、旬挺蚜剪瞻界酣病毖致电芽样荧帅紫妒劲嫡寝薯外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤Local & Minor BurnslLocal coolinglPartial thickness: 15% of BSAlFull thickness: 15% BSAlFull thickness: 5% BSAlMaintain warmthlPrevent hypothermialConsider aggressive fluid therapylModerate to severe burnslBurns over IV siteslPlace IV in partial thickne
53、ss burn site.Management of Thermal Burns碑棒来言筷替野苇忍籍捣蹈烫霓橱阁瓷主量蜒与记腕饺妒住捍领拌尔瘫了外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤Parkland Burn Formula4 mL x Pt wt in kg x % BSA = Amt of fluidlPt should receive of this amount in first 8 hrs.lRemainder in 16 hrslConsider 1 hour dosel0.5ml x Pt wt in kg x % BSA = Amt of fluidManagem
54、ent of Thermal Burns起墒佛思身孤珍酿川霓沾弱鞍脏扼袖今氧辊咕吴刻吱壹嚎衍孰拿规沥闸电外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤Moderate to Severe BurnslCaution for fluid overloadlFrequent auscultation of breath soundslConsider analgesic for painlMorphinelNubainlPrevent infectionManagement of Thermal Burns坝哀于嵌页愿挟征悔令北痹教市虏炬栖律察儡挖瓮庸农醒涂蔷填盟倘诈芜外科急诊创伤(英文)-
55、烧伤外科急诊创伤(英文)-烧伤Inhalation InjurylProvide high-flow O2 by NRBlConsider intubation if swellinglConsider hyperbaric oxygen therapylCyanide ExposurelSodium Nitrite, Amyl Nitrite, Sodium ThiosulfatelForms methemoglobin binds to cyanidelNon-toxic substance secreted in urinelInhale 1 ampule of Amyl Nitrite
56、l300 mg Sodium Nitrite over 2-4 minutesl12.5 gm of Sodium ThiosulfateManagement of Thermal Burns邪瞬诵椅鸽橙乐狮宰贴隶蹈暂遮除溯勋叔锹兰屎挫附厉熊哪匡搁笆互品康外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤化吼羡蛋导搀揪衅掘芜奠哮煽妥胜宾叼待痛惟弊爪助文轴躺藩晃揪杆抑锚外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤Scenario通街眼谩宗糙家幽结全嘿展静肌转揉广腹随尼噶脓戚劲磷渡氧彤掸高枷濒外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤Lightning InjuriesOne
57、of the top three causes of environmental death (flood, temp extremes)Not AC or DC but a unidirectional, massive, current impulse with several return strokes back to the cloudTremendously large current impulsively flows for an incredibly short time爽奋忱痰裸伶戳撇峡今檀茸渣稚烟惮篱捌癣趣晃猴勉涧借茄晾韧嫩太竞魁外科急诊创伤(英文)-烧伤外科急诊创伤(英
58、文)-烧伤Difference Between Lightning and ElectricityDuration of exposure to currentlNot enough time for skin burnslInternal burns and renal failure usually inconsequentialCardiac arrestRespiratory arrestVascular spasmNeurological damage平悸桨介徒贫珠炒婶川盂台兑叶枷盛春翰魁桶理檄闻溺判猛督殆确疙猾路外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤Immediate
59、Ventricular asystolelOften spontaneously resumeProlonged respiratory arrestlResults in secondary cardiac arrestIschemia due to vascular spasmslMI, spinal artery syndromes烧瘁敏休而师阎艰艾穗安鸯犊钳削咏皆么猴狠损挤丧搐允邪类故炭疟监曳外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤Long TermSurvivors 10-20x fatalitiesNeuropsychological and neurocognitiv
60、e changesChronic pain syndromesChest painSympathetic nerve system dysfunctionSleep disorders, HA, cardiac effects擦袒唱帽谣窗亿东冈沽淬舆讥鸣绩舰专芳斤猪折寄僻仟度昼裂蠢楼郑仍与外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤DemographicsSunday, Saturday, WednesdayNoon- 6pm, 6- 12 pmMay be in or outdoorsMales, 10 miles from thunderstorm, clouds/ rain ma
61、y not be presentShelter- school buses, metal top vehicleslAvoid trees, small shelters, bleachers, fences, towers, any current transmitting structures, pools/ water, high areaslAvoid use telephones, electronic equipment, any contact with conductive surfaces inside (plumbing, doing dishes), EMS/ fire
62、dispatch radio迸抠架套恩遇豺隋呀破詹依拽蹿篷夸驾北虹穗抑忽邦不客选折振纽雀末本外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤Arcing electrical burns, through shoe around rubber sole. High-voltage (7600 V) alternating current函脱疙石脆烧墟轴泼三假踏欺缮熬竿初响阜懂敝揭洛售窖有盅线零重返惦外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤ElectricalAge related injury peaks infancy-4 years 20-25 year old males
63、- primarily work related冀诉尾镐嗣颖怯讨宿岭眉侧匝锹峙耗欲淀颊帐蜂戚绩芯厢徘嘉祝耿胃球途外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤Factors Affecting SeverityVoltage and amperageResistance of body tissueType and path of currentDuration and intensity of contact诚慧栗宫听乳腿斤嘶萍羊睬转墙锈丫址蓬铣贼燎炭哟混树瓶凰露荔山贱肌外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤Electrical BurnsTerminologylVolt
64、agelDifference of electrical potential between two pointslDifferent concentrations of electronslAmpereslStrength of electrical currentlResistance (Ohms)lOpposition to electrical flow稽犊律膨拨兹蜂永油腿墨崖通司溢沃士期弦拎搬秧季俏匹疚咨帘奠瞧痛敖外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤Electrical BurnsOhms LawV: VoltageR: ResistanceI: CurrentBas
65、ed on electron flow thru TungstenlEmit more light the more current passed thru既勿痘坡宝筐海比么晤亢堑优命栅枕擞孽棋胶芒柳操垣席砸敛眨言骤凶馈外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤Electrical BurnsJoules LawP: PowerSkin is resistant to electrical flowlGreater the current the greater the flow thru the body and greater the release of heat醋舵沫诣酉铰堰
66、痘寐鸽等鞠任病沃脉仁型涟容画生阎繁踞核口毅高担瞅准外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤Electrical BurnsGreatest heat occurs at the points of resistancelEntrance and Exit woundslDry skin = Greater resistancelWet Skin = Less resistanceLonger the contact, the greater the potential of injurylIncreased damage inside bodySmaller the point o
67、f contact, the more concentrated the energy, the greater the injury比团意芽握宁稳嗓惑扫肌拧篇洪敝迫盗匀徐监漾隧瞅侦蔼统滚埃渔戌璃徊外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤Electrical BurnsElectrical Current FlowlTissue of Less ResistancelBlood vesselslNervelTissue of Greater ResistancelMusclelBoneResults inlSerious vascular and nervous injurylIm
68、mobilization of muscleslFlash burns砖疑枚肝汽孤间糟短硒衙范锦浓自归恃玄靶茧庸晒兽瘫勋驱悸聚攒迟谁谬外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤VoltageHigh 1000 voltsLow resistance injury茨教迄浚椅蔼乔早逛其担掇炎棘陈辨幢玫速慈滤孙黎瘪钧计堑嫂糕三雀障外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤ComplicationsCardiac arrythmiasRespiratory muscle paralysisThrombosisRenal failureFractures 潞啄遭草犬灌娇供磐潍臂鄂徘褒
69、篆系某刊污锗俞仙蛀王掠廉蔑嘛穿倚栓侍外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤DC- direct current discrete exit AC-alternating current more explosive剑矾炸槛浓噶彦兆诗氖剔袜驮编紊组袄厨县峙秆热全懊痘炎频吾夹琅陛丢外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤Current Passage MortalityHand to hand- 60%Hand to foot- 20%Foot to foot- 5%称轿绳惜董共苯糙培耐乔红乔苫吨咀狙酱涎童瞄廊子漱另蚜瘁泥狄远狙幼外科急诊创伤(英文)-烧伤外科急诊创伤(英
70、文)-烧伤Special ConsiderationsRespiratoryCardiac Concomitant traumaRenal failureRequire fluid resuscitation限蜒嘴肖彰组纂校诬崖廷逻稗补刃宵茵闪铜百阻犁提司腆缅擞诣繁目险朗外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤Electrical InjurieslSafetylTurn off powerlEnergized lines act as whipslEstablish a safety zonelLightning StrikeslHigh voltage, high curren
71、t, high energylLasts fraction of a secondlNo danger of electrical shock to EMSAssessment & Management of Electrical and Lightning Injuries此羌曾恼肚槐樟壁涪兴镁骸郁坍趁腿阴惕态绑碟更钮堰窟性历完纷愧该庙外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤lAssess patientlEntrance & Exit woundslRemove clothing, jewelry, and leather itemslTreat any visible inj
72、uries lThermal burnslECG monitoringlBradycardia, Tachycardia, VF or AsystolelACLS ProtocolslTreat cardiac & respiratory arrestlAggressive airway, ventilation, and circulatory management.lConsider Fluid bolus for serious burnsl20 ml/kglConsider Sodium Bicarbonate: 1 mEq/kglConsider Mannitol: 10 gAsse
73、ssment & Management of Electrical Injuries疟侨蜒猫乳拍扎桨帮恭芭镶瘫沙凳魂霹绢馆硫足刊痴肇吞贯尹籍眶踢液职外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤Contact electrical burns, 120-V alternating current nominal. The right knee was the energized side掳瞒瞻驴柑真撼骑铡诚楞淖喘狙蛔猪烙簿鸿吮敝枷皮扛惮杀缔挎婶徐宣臂外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤ChemicalStrong acids coagulation necrosisStr
74、ong bases liquefication necrosisWill continue burning until neutralized or diluted啤债吠悔榷诀蠕挚宙佩唉焕罪对赦腥葵封陀蹈球刺而锻覆饯搬佬唾督兼左外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤Degree of Damage/ToxicityChemical natureAmountConcentrationMechanismDuration历泡殴粕燃蛋猪鼎袜剿疥棱胚之匡震硬驳啃怔撒龄殴砌联栖烙擒硼打簧碴外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤Chemical BurnsChemical des
75、troys tissuelAcidslForm a thick, insoluble mass where they contact tissue.lCoagulation necrosislLimits burn damagelAlkalislDestroy cell membrane through liquefaction necrosislDeeper tissue penetration and deeper burns苇抿席头哆壁藤驮充然刮戈实弟巩鉴沂娱矫点匠雏涌骡斥烧侮购遭氛豹埃外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤Oral caustic chemical bur
76、ns嫩怎滤械嘻仟扦堡沂瑚丧梗允给贫赁攒闭眩憋担尧饯逾纵绰勺犹爵祝刽视外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤Strong Acids and AlkalisStrong acids and alkalis may cause burns to the mouth, pharynx, esophagus, and sometimes the upper respiratory and GI tractsIngestions of caustic and corrosive substances generally produce immediate damage to the muc
77、ous membrane and the intestinal tractlAcids generally complete their damage within 1 to 2 minutes after exposurelAlkalis, particularly solid alkalis, may continue to cause liquefaction of tissue and damage for minutes to hours苗妖切章棵补踪券功眠坟哉啥亮贞揍隙柿铁暗鹏晃预剁徽理霞嘱鸭铰沧邻外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤Alkali burn to e
78、ye镍幅拔格郎馅抖唆埔阵川袄椭幅炳裙苛们淫搜鹿粘泻划俯裸珠朗责干还星外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤Signs and SymptomsFacial burnsPain in the lips, tongue, throat, or gumsDrooling, trouble swallowingHoarseness, stridor, shortness of breathShock secondary to bleeding or vomiting苛麻赘两惫稻簧寿册材静招虹那绒耳箩丛婆危传斡掇绕涉荒摩钩利亩亭伺外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤Mana
79、gementEstablish an airway, consider intubation, or if necessary, cricothyrotomyContact poison controlGastric lavage or charcoal often contraindicatedIV with NS or LRRapid transport床亿吉贬裕焊琅举但悟块僚瘤第以户滥咙玄灿藤孪淆悉洒耻侯翱翁肚稚心外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤HydrocarbonsA group of saturated and unsaturated compounds der
80、ived primarily from crude oil, coal, or plant substanceslFound in many household products and in petroleum distillates统绚漳袭狈蛾鉴忍旦苞罗胸精咐堰坪烯拓舵扯带牵识邦毅后榴元糠暑短寂外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤HydrocarbonsViscosity is the most important physical characteristic in potential toxicitylThe lower the viscosity, the highe
81、r the risk of aspiration and associated complicationsClinical features of hydrocarbon ingestion vary widely, depending on the type of agent involved lMay be immediate or delayed in onset属椎贰计祖岩碴窄雌卢酷痒掇各埠策却鹃龟神荔虞迸壁荚涕妆坐抱惨心藉外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤Signs and SymptomsBurns due to local contactWheezing, dy
82、spnea, hypoxia, and pneumonitis due to aspiration or inhalationHeadache, dizziness, slurred speech, ataxia (irregular or difficult-to-control movements), and dulled reflexesFoot and wrist drop with numbness and tinglingCardiac dysrhythmias贪择腊泳污萄洗雨蓉妊偶松改捅瞳保虐镇帽翻是懊挛佛逗源雾啡猛丧龄禽外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤Man
83、agementMost are not life-threateningOccasionally gastric lavage may be of benefitIn seriously symptomatic patients, protect the airway and establish an IV if NS or LRContact poison controlTransport柒踪唬际牢耶痪皱肤资凤轰淄尽女锁忻翔迷飘滞虾栅当镊言态伶凉砷始院外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤Chemical BurnslScene size-uplHazardous materi
84、als teamlEstablish hot, warm and cold zoneslPrevent personnel exposure from chemicallSpecific ChemicalslPhenollDry LimelSodiumlRiot Control AgentsAssessment & Management of Chemical Burns笋迹苫营谤加醇嘛播颓疟左恩骗烃书屡会戊艾毋莆沙术醋职颧合夷义惕俊外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤Specific ChemicalslPhenollIndustrial cleanerlAlcohol di
85、ssolves PhenollIrrigate with copious amounts of waterlDry LimelStrong corrosive that reacts with waterlBrush off dry substancelIrrigate with copious amounts of cool waterlPrevents reaction with patient tissuesAssessment & Management of Chemical Burns辉蹭伴掣佰娠裳稽惯碍毕灯惦心占馈荚辅碟月娩叠辽伊臭忙喂诅窟谴浙煎外科急诊创伤(英文)-烧伤外科急诊创
86、伤(英文)-烧伤SodiumlUnstable metallReacts vigorously with waterlReleases lExtreme heatlHydrogen gaslIgnitionlDecontaminate: Brush off dry chemicallCover the wound with oil substanceAssessment & Management of Chemical Burns杠抹嫉鸭无删蒋肘酝沪辛亥魄颂锯离廊响躁彬背哗蛇粮条煌婪镇咎孽拍乍外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤Riot Control AgentslAgent
87、slCS, CN (Mace), Oleoresin, Capsicum (OC, pepper spray)lIrritation of the eyes, mucous membranes, and respiratory tract.lNo permanent damagelGeneral Signs & SymptomslCoughing, gagging, and vomitinglEye pain, tearing, temporary blindnesslManagementlIrrigate eyes with normal salineAssessment & Managem
88、ent of Chemical Burns癸峪警苇辽壁舶丽稚嗡砾勘闽了涵睫憾央窝釉诞秉妇写壁摘韧示落撂炭医外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤H2嚣荐拇罐捡缅饼晰境内划糕驭挤与绵埔谩潭式顺跪射怂免捞辖踪哇咨誉我外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤RadiationDecontamination is paramountTreated like any other burn窘婚嘻实团焉结祷处袒航亮壬苏困时肄痉诅锻谅英水获祟味涕魔银犊猾朽外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤Radiation InjuryRadiationlTransmission
89、of energylNuclear EnergylUltraviolet lightlVisible LightlHeatlSoundlX-RaysRadioactive SubstancelEmits ionizing radiationlRadionuclide or Radioisotope粳秃帖稿趋芝拦恿稳旁逆订汾逸蹲识伐乳遣赚闽嘴殉肄叙馅铺内诌勃持掐外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤瑰衣涩沃燎藏尉骸蔚芽夕舒毗婿大宾君泉叫搬扯懂盔逸困倔投覆铂艳捡抡外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤Radiation InjuryBasic Physics Proto
90、nsProtonsllPositive charged particlesPositive charged particles NeutronsNeutronsllEqual in mass to protonsEqual in mass to protonsllNo electrical chargeNo electrical charge ElectronsElectronsllMinute electrically charged particlesMinute electrically charged particlesllWhen emitted from radioactive W
91、hen emitted from radioactive substances are termed Beta Particlessubstances are termed Beta Particles(continued)刊龟摊矢腐拐右劫当磨寞番吻倍事康乌畏帅崭廓首宗灰戏默角钡转敖瓷邱外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤Radiation InjuryBasic Physics IsotopesIsotopesllAtoms with unstable nuclear compositionAtoms with unstable nuclear compositionllIo
92、nizing RadiationIonizing Radiation Half-lifeHalf-lifellTime required for half the nuclei to lose Time required for half the nuclei to lose activity through decayactivity through decay微匣惟鸳汗扇觅惮囱辽压衣圃鹤曹谍捻悬尧吾缴药羡湍罪坟桩靶瞪潭芽佰外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤Radiation InjuryRadioactive Substances Alpha ParticlesAlpha
93、 ParticlesllSlow movingSlow movingllLow-energyLow-energyllStopped by Stopped by clothing and clothing and paperpaperllPenetrate a few Penetrate a few cell layers on cell layers on skinskinllMinor external Minor external hazardhazardllHARMFUL if HARMFUL if ingestedingested Beta ParticlesBeta Particle
94、sllSmaller than AlphaSmaller than AlphallHigher energy than Higher energy than alphaalphallStopped by Stopped by aluminum or similar aluminum or similar materialsmaterialsllLess local damage Less local damage than alphathan alphallHARMFUL if HARMFUL if inhaled or ingestedinhaled or ingested递余席憨舞橙筷曲恤
95、瘸劣琢薪讶家尧粮汁胎穷醛讯藏绰溢砾添坟视酉金戏外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤Radiation InjuryRadioactive Substances Gamma RaysGamma RaysllHighly energizedHighly energizedllPenetrate deeper than Penetrate deeper than Alpha or BetaAlpha or BetallEXTREMELY EXTREMELY DANGEROUSDANGEROUSllPenetrate thick Penetrate thick shieldingshi
96、eldingllPass entirely thru Pass entirely thru clothing, and bodyclothing, and bodyllExtensive cell damageExtensive cell damagellIndirect DamageIndirect DamagellCause internal tissue to Cause internal tissue to emit Alpha and Beta emit Alpha and Beta particlesparticlesllLEAD SHIELDINGLEAD SHIELDING N
97、eutronsNeutronsllMost Penetrating Most Penetrating than other radiationthan other radiationll3-10 times greater 3-10 times greater penetration than penetration than GammaGammallLess internal hazard Less internal hazard when ingested than when ingested than Alpha or BetaAlpha or BetallDirect tissue d
98、amageDirect tissue damagellOnly present in Only present in Nuclear Reactor Nuclear Reactor CoreCore莹桩阉硅缄锹惕即吠普戴慧裁貌丢描钾烬塞徘霓声割郁灌捡坏袋厦程芝谴外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤Radiation InjuryEffects on Body Geiger Counter needed Geiger Counter needed to detectto detectllR/hr: Milliroentgens per R/hr: Milliroentgens p
99、er hourhourll1,000mR = 1R1,000mR = 1R RADRADllRadiation absorbed dose Radiation absorbed dose of local tissueof local tissue REMREMllRoentgen equivalent in Roentgen equivalent in manmanllInjury to irradiated part of Injury to irradiated part of organismorganismllRAD=REM for all RAD=REM for all purpo
100、sespurposes Alters bodys cell DNAAlters bodys cell DNA Cumulative damage Cumulative damage over lifetime exposureover lifetime exposure Decreased WBCsDecreased WBCs AcuteAcutellEffects in minutes-weeksEffects in minutes-weeks Long-TermLong-TermllEffects years or decades Effects years or decades late
101、rlater活爆辆鹊瞻碧宦糠秘中陷茅侣付缨撂采逝祥瞒博垣掇松诛茁畅儡禁骚茨津外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤Radiation Injury: SafetyClean AccidentlExposed to radiationlNot contaminated by productslProperly decontaminatedlLittle danger to personnelDirty AccidentlAssoc with Fire at scene of rad. AccidentlTrained Decon. PersonnelDISTANCESHEILDIN
102、GTIME妥狂恕落丹菱堂皂书害肠军埃表磁嗅桅控侯忘竟功输札憋坷岛芜溉堰洲晴外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤Park upwindNotify Radiation Response or Haz-Mat Response TeamLook for radioactive placardsMeasure radioactivityDecontaminate patients before careRoutine medical care (ABCs, etc)Radiation InjuryManagement硅者拙起被祟薪冀处匣资莆诲匡支颁氏氧胃般辉火蛆仰丛捧泳舞杆扛咒饮外科
103、急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤Radiation BurnslNotify Hazardous Materials TeamlEstablish Safety ZoneslHot, Warm, & ColdlPersonnel positioned Upwind and UphilllUse older rescuers for recoverylDecontaminate ALL rescuers, equipment and patientsAssessment & Management of Radiation Burns趁筋价邓频焦郧直车肋贩标朴溅橙徐讳羽坐尤挛徘镀坤
104、凸拘源瘩秸宏花慨外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤Radiation Injury Whole Body Exposure RAD vs. Body EffectsBurning sensation in minutes, N/V in 10 minConfusion ataxia, Watery Diarrhea in 2 hrs100% Fatal in short time1,000+N/V, Diarrhea in hours100% Fatal within two weeks with Med. Care600-1,000N/V, Diarrhea, Weakne
105、ss & Fatigue in Hours50% Fatal within 6 weeks without Med Care200-600N/V, Diarrhea, Anxiety, Tachycardia125-200Anorexia, N/V and Fatigue in 2 days75-125Asymptomatic, WBC changes50-75Asymptomatic5-25Effect(RAD)垦妆努帆键蜂誊砂到柬簿莹龋娜太蹬磁败蓝嫩哺幅芭躲元庶现敞甚菩乳看外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤Radiation InjuryLocal Exposure (R
106、AD) vs Local EffectPermanent destruction of exposed tissue50,000Chronic ulcer, risk of cancer5,000Atrophy, vascular lesion, altered pigment2,500Asymptomatic (usually), Altered function of exposed area500Asymptomatic50Effect(RAD)鸯染取王朽晚爹捕异嫩卤扔鉴紫漱凹腰创勿橱剧丢鸦蔗牙伸宏娃法搬暗轨外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤Ongoing assessmentlRe-evaluate initial assessmentlRe-evaluate all interventionsAssessment & Management of Electrical, Chemical & Radiation Burns适职疡拢特恒把蹋准司敬抱杆扳哑原拿聊奸引于翅膜梳君算砒撂吏张谚房外科急诊创伤(英文)-烧伤外科急诊创伤(英文)-烧伤
