Effective Skin and Wound Management in Non-Complex Burns
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Recognizing When a Child's Injury Or Illness Is Caused by Abuse
U.S. Department of Justice Office of Justice Programs Office of Juvenile Justice and Delinquency Prevention Recognizing When a Child’s Injury or Illness Is Caused by Abuse PORTABLE GUIDE TO INVESTIGATING CHILD ABUSE U.S. Department of Justice Office of Justice Programs 810 Seventh Street NW. Washington, DC 20531 Eric H. Holder, Jr. Attorney General Karol V. Mason Assistant Attorney General Robert L. Listenbee Administrator Office of Juvenile Justice and Delinquency Prevention Office of Justice Programs Innovation • Partnerships • Safer Neighborhoods www.ojp.usdoj.gov Office of Juvenile Justice and Delinquency Prevention www.ojjdp.gov The Office of Juvenile Justice and Delinquency Prevention is a component of the Office of Justice Programs, which also includes the Bureau of Justice Assistance; the Bureau of Justice Statistics; the National Institute of Justice; the Office for Victims of Crime; and the Office of Sex Offender Sentencing, Monitoring, Apprehending, Registering, and Tracking. Recognizing When a Child’s Injury or Illness Is Caused by Abuse PORTABLE GUIDE TO INVESTIGATING CHILD ABUSE NCJ 243908 JULY 2014 Contents Could This Be Child Abuse? ..............................................................................................1 Caretaker Assessment ......................................................................................................2 Injury Assessment ............................................................................................................4 Ruling Out a Natural Phenomenon or Medical Conditions -
Neurological and Neurourological Complications of Electrical Injuries
REVIEW ARTICLE Neurologia i Neurochirurgia Polska Polish Journal of Neurology and Neurosurgery 2021, Volume 55, no. 1, pages: 12–23 DOI: 10.5603/PJNNS.a2020.0076 Copyright © 2021 Polish Neurological Society ISSN 0028–3843 Neurological and neurourological complications of electrical injuries Konstantina G. Yiannopoulou1, Georgios I. Papagiannis2, 3, Athanasios I. Triantafyllou2, 3, Panayiotis Koulouvaris3, Aikaterini I. Anastasiou4, Konstantinos Kontoangelos5, Ioannis P. Anastasiou6 1Neurological Department, Henry Dunant Hospital Centre, Athens, Greece 2Orthopaedic Research and Education Centre “P.N. Soukakos”, Biomechanics and Gait Analysis Laboratory “Sylvia Ioannou”, “Attikon” University Hospital, Athens, Greece 31st Department of Orthopaedic Surgery, Medical School, National and Kapodistrian University of Athens, Athens, Greece 4Medical School of Athens, National and Kapodistrian University of Athens, Athens, Greece 51st Department of Psychiatry, National and Kapodistrian University of Athens, Eginition Hospital, Athens, Greece 61st Urology Department, Laiko Hospital, National and Kapodistrian University of Athens, Athens, Greece ABSTRACT Electrical injury can affect any system and organ. Central nervous system (CNS) complications are especially well recognised, causing an increased risk of morbidity, while peripheral nervous system (PNS) complications, neurourological and cognitive and psychological abnormalities are less predictable after electrical injuries. PubMed was searched for English language clinical observational, retrospective, -
Emergency Medical Retrieval Service (EMRS)
Emergency Medical Retrieval Service (EMRS) www.emrs.scot.nhs.uk Standard Operating Procedure Public Distribution Title Burns Version 7 Related Documents British Burns Care Review Author A. Inglis, R. Price, A. Hart Reviewer C McKiernan Aims · To ensure appropriate treatment and triage of major burns patients Background · The team is involved in the retrieval and pre-hospital care of patients with burns. Assessment and early management of actual and potential airway and respiratory compromise is essential, as is adequate fluid resuscitation. · National Burns Care Review recommends that failure to admit complex burns cases into burns service site within 6 hours be “regarded as a critical incident and the reasons investigated” Application EMRS team members SAS Paramedics Burns Unit, GRI / ARI / St John’s, Livingston SOP-Burns 1 Patients appropriate for retrieval team activation · Adult burns cases where advanced medical intervention is appropriate to optimise safe transfer Advice to GP prior to team arrival · High volume irrigation of chemical burns, cold water immersion/ irrigation of thermal / electrical burns) + immediate dressings (Clingfilm) · Oxygen, opioid analgesia, crystalloid fluids (normal saline / Hartmann’s by Parkland formula). · Warming / hypothermia prevention Medical management on scene PRIMARY SURVEY A Airway burns (perioral/ nasal stigmata; altered voice; stridor) - early intubation B Smoke inhalation (circumstances; nasal / pharyngeal soot) CO poisoning (oximetry unreliable). Commence oxygen. C Early shock is due to other injury! Escharotomy considered only after transfer D Other injuries; cardiac / neurological / diabetic / drug event? E Extent of burn, ocular burn? Core temperature? Avoid hypothermia • Have a low threshold for endotracheal intubation if air transfer is indicated. • Use an Uncut ETT for intubation SOP-Burns 2 SECONDARY SURVEY Total Body Surface Area Assessment Wallace Rule of nines to assess BSA. -
Skin Injuries – Can We Determine Timing and Mechanism?
Skin injuries – can we determine timing and mechanism? Jo Tully VFPMS Seminar 2016 What skin injuries do we need to consider? • Bruising • Commonest accidental and inflicted skin injury • Basic principles that can be applied when formulating opinion • Abrasions • Lacerations }we need to be able to tell the difference • Incisions • Stabs/chops • Bite marks – animal v human / inflicted v ‘accidental’ v self-inflicted Our role…. We are often/usually/always asked…………….. • “What type of injury is it?” • “When did this injury occur?” • “How did this injury occur?” • “Was this injury inflicted or accidental?” • IS THIS CHILD ABUSE? • To be able to answer these questions (if we can) we need knowledge of • Anatomy/physiology/healing - injury interpretation • Forces • Mechanisms in relation to development, plausibility • Current evidence Bruising – can we really tell which bruises are caused by abuse? Definitions – bruising • BLUNT FORCE TRAUMA • Bruise =bleeding beneath intact skin due to BFT • Contusion = bruise in deeper tissues • Haematoma - extravasated blood filling a cavity (or potential space). Usually associated with swelling • Petechiae =Pinpoint sized (0.1-2mm) hemorrhages into the skin due to acute rise in venous pressure • medical causes • direct forces • indirect forces Medical Direct Indirect causes mechanical mechanical forces forces Factors affecting development and appearance of a bruise • Properties of impacting object or surface • Force of impact • Duration of impact • Site - properties of body region impacted (blood supply, -
Wound Classification
Wound Classification Presented by Dr. Karen Zulkowski, D.N.S., RN Montana State University Welcome! Thank you for joining this webinar about how to assess and measure a wound. 2 A Little About Myself… • Associate professor at Montana State University • Executive editor of the Journal of the World Council of Enterstomal Therapists (JWCET) and WCET International Ostomy Guidelines (2014) • Editorial board member of Ostomy Wound Management and Advances in Skin and Wound Care • Legal consultant • Former NPUAP board member 3 Today We Will Talk About • How to assess a wound • How to measure a wound Please make a note of your questions. Your Quality Improvement (QI) Specialists will follow up with you after this webinar to address them. 4 Assessing and Measuring Wounds • You completed a skin assessment and found a wound. • Now you need to determine what type of wound you found. • If it is a pressure ulcer, you need to determine the stage. 5 Assessing and Measuring Wounds This is important because— • Each type of wound has a different etiology. • Treatment may be very different. However— • Not all wounds are clear cut. • The cause may be multifactoral. 6 Types of Wounds • Vascular (arterial, venous, and mixed) • Neuropathic (diabetic) • Moisture-associated dermatitis • Skin tear • Pressure ulcer 7 Mixed Etiologies Many wounds have mixed etiologies. • There may be both venous and arterial insufficiency. • There may be diabetes and pressure characteristics. 8 Moisture-Associated Skin Damage • Also called perineal dermatitis, diaper rash, incontinence-associated dermatitis (often confused with pressure ulcers) • An inflammation of the skin in the perineal area, on and between the buttocks, into the skin folds, and down the inner thighs • Scaling of the skin with papule and vesicle formation: – These may open, with “weeping” of the skin, which exacerbates skin damage. -
Gunshot Wounds
Gunshot Wounds Michael Sirkin, MD Chief, Orthopaedic Trauma Service Assistant Professor, New Jersey Medical School North Jersey Orthopaedic Institute Created March 2004; Reviewed March 2006, August 2010 Ballistics • Most bullets made of lead alloy – High specific gravity • Maximal mass • Less effect of air resistance • Bullet tips – Pointed – Round – Flat – Hollow Ballistics • Low velocity bullets – Made of low melting point lead alloys – If fired from high velocity they melt, 2° to friction • Deform • Change missile ballistics • High velocity bullets – Coated or jacketed with a harder metal – High temperature coating – Less deformity when fired Velocity • Energy = ½ mv2 • Energy increases by the square of the velocity and linearly with the mass • Velocity of missile is the most important factor determining amount of energy and subsequent tissue damage Kinetic Energy of High and Low Velocity Firearms Kinetic Energy of Shotgun Shells Wounding power • Low velocity, less severe – Less than 1000 ft/sec – Less than 230 grams • High velocity, very destructive – Greater than 2000 ft/sec – Weight less than 150 grams • Shotguns, very destructive at close range – About 1200 ft/sec – Weight up to 870 grams Factors that cause tissue damage • Crush and laceration • Secondary missiles • Cavitation • Shock wave Crush and Laceration • Principle mechanism in low velocity gunshot wounds • Material in path is crushed or lacerated • The kinetic energy is dissipated • Increased tissue damage with yaw or tumble – Increased profile – Increased rate of kinetic -
The Use of Hydrofera Blue™ on a Chemical Burn By
Case Study: The Use of Hydrofera Blue™ on a Chemical Burn by Cyhalothrin Jeanne Alvarez, FNP, CWS Independent Medical Associates, Bangor, ME History of Present Illness/Injury: This 70 year old white male was spraying a product containing cyhalothrin (Hot Shot Home Insect Control) overhead to kill spiders. Some of the product dripped and came in contact with his skin in five locations on his upper right arm and hand. He states he washed his arm and hand with copious amounts of soap and water right after the contact of the product on his skin. He presented to the office for evaluation four days after the incidence complaining of burning pain, paresthesia and blistering at the sites. A colleague initially saw this patient and contacted poison control who provided information regarding the procedure for decontamination and monitoring. Prolonged exposure can cause symptoms similar to frostbite. Paresthesia related to dermal exposure is reported but there was no available guidance for treatment options for the blistered areas and/or treatment options for the paresthesia given. Washing the contact area with soap and water was indicated by the guidelines. Past Medical History: This patient has a significant history of hypertension. Medications/Allergies: This patient takes Norvasc 10mg daily. He has used Tylenol 1000mg every 4-6 hours as needed for pain without significant improvement in his pain level. He has no known allergies. Treatments: Day 4 (after exposure): The patient presented for evaluation after a dermal chemical exposure complaining of burning pain, blisters and paresthesia. He had washed the area after exposure with soap and water and had applied a triple antibiotic ointment. -
CRITICAL CARE NURSING. Objectives After Reading Through This Unit, You Should Be Able To; •Describe the Concepts in the Management of Critically Ill Patient
CRITICAL CARE NURSING. Objectives After reading through this unit, you should be able to; •Describe the concepts in the management of critically ill patient. •Explain different types of critical care facilities. •Discuss admission procedure of critically ill patient. •Identify the physical, psychological and social needs of a critically ill patient. •Describe the special investigations carried out in critically ill patients. •Demonstrate competency in the management of critically ill patients. Def; •Nursing that we should give to a patient whose health is in danger or in crisis so as to save their life or prevent complications. •purpose •To maintain accurate continuous observations of the patients’ vital functions and treat or support a failing or failed biological system. it focuses on the whole body system so as to maintain health. Types of critically ill patients •Severe injuries to the head or chest. •Effect of the disease /condition on circulation ,breathing and electrolyte balance. •Unconscious patients . •Burns of second degree greater than 25% •Acute poisoning. •Respiratory failure. •Cardiovascular failure •Multiple and severe injuries of the head,chest,spine or abdominal viscera. •Acute or chronic renal failure. •Ruptured ectopic pregnancy. •Critical care facilities Acute room Termed as an acute room because of its location,equipm ents used .and the condition of the patients who are nursed there . The following equipments are found in this unit; Sunction equipment . •Oxygen administration equipments fully assembled i.e. oxygen cylinder,adminstration mask or nasal catheters, oxygen key and gauge. •Intravenous administration set. •Adequate stocks of linen. •Other requirements to include observation equipment. There should always be a nurse in acute room in the ratio of 1:2. -
Accident, First Aid and Medical Conditions Policy
Accident, First Aid and Medical Conditions Policy Many children and staff will at some time become unwell at school, have a condition that requires medication or have an accident that requires First Aid. Our school is an inclusive community that supports the pupils to be healthy, stay safe and be prepared for moving onto their next school. This policy outlines the procedure concerning : 1. Reporting of Injuries, Diseases and Dangerous Occurrences 2. First Aid Procedures 3. The Administration of Medicines 4. Supporting pupils with medical conditions 1. Reporting of Injuries, Diseases and Dangerous Occurrences The Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 1995 (RIDDOR) require that employers report all fatal and specified major injuries, any injuries that result in the inability of an employee to work more than 3 days, or any injury which results in a person being admitted to hospital for more than 24 hours. The regulations relate to any employee or other person within the school or engaged upon an activity arranged by the school. Under the requirements of the Regulations, where someone dies or suffers a specified major injury or condition, or there is a dangerous occurrence, as defined in the Regulations, the school has to notify the Health and Safety Executive (HSE) immediately by the quickest practicable means. In practice, compliance with either of these provisions will normally mean a telephone call to the Incident Contact Centre (ICC) on 0845-300-9923 during normal office hours. The ICC operator will complete a report form over the phone and a copy will be sent to the school. -
Help Individuals with Spinal Cord Injury, Traumatic Brain Injury, And
Help Individuals with Spinal Cord Injury, Traumatic Brain Injury, and Burn Injury Stay Healthy during the COVID-19 Pandemic Model Systems Knowledge Translation Center (MSKTC) Xinsheng “Cindy” Cai, PhD MSKTC Project Director American Institutes for Research Disclosures • The contents of this presentation were developed under a grant from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR grant number 90DP0082). NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The contents of this presentation do not necessarily represent the policy of NIDILRR, ACL, HHS, and you should not assume endorsement by the Federal Government. 2 Learning Objectives • Use the free research-based resources developed by the Model Systems Knowledge Translation Center (MSKTC) to help individuals living with spinal cord injury (SCI), traumatic brain injury (TBI), and burn injury to stay healthy during the COVID-19 pandemic • Understand how the MSKTC has worked with Model System researchers to apply a knowledge translation (KT) framework to make these resources useful to the end-users • Understand principles in effectively communicating health information to support individuals with SCI, TBI, and burn injuries 3 Session Overview • Model Systems Knowledge Translation Center (MSKTC) background • Example MSKTC resources to help individuals with spinal cord injury (SCI), traumatic brain injury (TBI) and burn to stay healthy during the COVID-19 pandemic • KT strategies -
Complex Airway After Electric Burns in the Neck - a Challenge for the Anesthesiologist Nitika Goel*1, Indumohini Sen2, Kiran Jhangra3 and Mukesh Kumar4
ISSN: 2474-9206 Case Report Journal of Anesthesia & Pain Medicine Complex Airway after Electric Burns in the Neck - A Challenge for the Anesthesiologist Nitika Goel*1, Indumohini Sen2, Kiran Jhangra3 and Mukesh Kumar4 1 3Assistant Professor Anesthesia, PGIMER, Chandigarh, India. *Corresponding author Nitika Goel MD, Assistant Professor Anesthesia, PGIMER, Chandigarh, 2Professor Anesthesia PGIMER, Chandigarh, India. India, Tel: +91 8826622159; E-mail: [email protected]. 4Senior Resident Anesthesia PGIMER, Chandigarh, India. Submitted: 30 July 2017; Accepted: 08 Aug 2017; Published: 22 Sep 2017 Abstract High voltage electric burns can cause massive damage to the body tissues. Direct contact with the live electric wires may result in the severe damage of the underlying subdermal tissues. However the superficial presentation is often misleading as most of the damage occurs under the skin. Very less literature has been found regarding the presentation of high voltage burns in head and neck region. We present a patient who sustained high voltage burns in the neck region resulting in massive damage of the underlying tissues. Keywords: Electric Burns, Burns Neck, Tracheal Injury. was referred to our institute for further management. The patient came to our hospital 5 days after his injury. Here the patient was Introduction planned for debridement and flap coverage on the burnt area. With widespread use of electricity, electric burn injuries are getting Preoperative evaluation revealed normal routine investigations. more common nowadays. Direct contact with the live electric wires Patient was communicative with no abnormality in speech. A may result in the severe damage of the underlying sub dermal tissues huge dressing was present around the neck. -
Supermicar Data Entry Instructions, 2006 365 Pp. Pdf Icon[PDF
SUPERMICAR TABLE OF CONTENTS Chapter I - Introduction to SuperMICAR ........................................... 1 A. History and Background ............................................. 1 Chapter II – The Death Certificate .................................................... 3 Exercise 1 – Reading Death Certificate ........................... 7 Chapter III Basic Data Entry Instructions ....................................... 12 A. Creating a SuperMICAR File ....................................... 14 B. Entering and Saving Certificate Data........................... 18 C. Adding Certificates using SuperMICAR....................... 19 1. Opening a file ....................................................... 19 2. Certificate ............................................................. 19 3. Sex ....................................................................... 20 4. Date of Death ....................................................... 20 5. Age: Number of Units ........................................... 20 6. Age: Unit............................................................... 20 7. Part I, Cause of Death .......................................... 21 8. Duration ................................................................ 22 9. Part II, Cause of Death ......................................... 22 10. Was Autopsy Performed....................................... 23 11. Were Autopsy Findings Available ......................... 23 12. Tobacco................................................................ 24 13. Pregnancy ...........................................................