Based on Nancy Carolines Emergency Care in the streets Chapter 20 Burns
Apply downward manual traction below the venipuncture site to stabilize the vein in position.
Apply the constricting band to a distal location
Use a through the needle IV catheter in order to gain better control over the rolling vein
Place a chemical heat pack over the vein for 10 minutes in order to decrease movement of the vein
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Once hot liquids come in contact with clothing, heat is rapidly dissipated
Scald burns often cover large surface areas because liquids spread quickly
Scald burns caused by grease or oil are typically limited to the epidermis
Scald burns are less commonly seen in pediatric patients that adult patients
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Immediately gain access to the patien
Apply gloves, a gown and facial protection
Determine if air medical transport is available
Carefully assess the scene for safety hazards
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Apply firm manual pressure to the hematoma to reduce internal bleeding
Place him in a sitting position and apply a chemical heat pack to his head
Apply an icepack to the hematoma and monitor his level of consciousness
Start an IV of normal saline and administer 2 mg of morphine for the pain
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Determining if the scene is safe to enter
Thoroughly decontaminating the patient
Quickly moving the patient to a safe area
Evaluating airway, breathing, and circulation
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Tetanus
Meningitis
A viral infection
A staph infection
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A massive infection that occurs when microorganisms breach burned skin
Renal failure secondary to excess myoglobin production from burned muscle
Fluid loss across damaged skin and volume shifts within the rest of the body
Acute dehydration, and it commonly manifests within 30 minutes after the burn
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Contact your medical director at once
Ask the physician to repeat the order
Refuse to administer the ordered dose
Confirm the correct dose in your field guide
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Steam burns
Flame burns
Scald burns
Arc burns
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Never rule out CO poisoning because of the absence of cherry red skin
The most common symptom of CO poisoning is chest pressure
CO results in systemic hypoxia by disintegrating red blood cells
Hyperbaric therapy is beneficial only if CO levels are above 40%
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Generally extended into the dermal layer
May appear hours or days after exposure
Are typically confined to the epidermis
Are immediately apparent after exposure
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Decreased melanin granules
Disturbances in fluid balance
Difficulty with thermoregulation
Susceptibility to bacterial invasion
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Toxic gases are often present, even after the fire is out
The lead paramedic determines where you should stage
Most fabric materials release cyanide when they burn
You may need to provide rehabilitation for fire fighters
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Anticholineric
Sympathomimetic
Sympatholytic
Parasympatholytic
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Have minimal penetrating energy
Easily pass through solid materials
Are able to travel much farther in air
Are not dangerous if they are ingested
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Gently manipulate the catheter and reassess the flow
Discontinue the IV and reestablish it in the other arm
Ensure that the constricting band has been removed
Use a pressure infuser device to improve the IV flow
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Partial thickness burns are usually extremely painful for the patient
They are difficult to distinguish from a superficial burn in the field
The majority of partial thickness burns are caused by an open flame
Is the central part of the burn and suffers the most damage
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Require the paramedic to incise the burn to decompress it
May cause significant restriction of respiratory excursion
Are generally not significant unless the skin is unyielding
Necessitate immediate intubation and ventilatory support
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Analgesia
High flow oxygen
Moist dressings
Sterile burn pads
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The inhalation of superheated gases
Exposure to carbon monoxide or cyanide
The inhalation of hot particulate steam
Direct flame exposure to the oropharynx
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Extravasation due to an inappropriate angle of IO catheter insertion
Inadvertent entry of a large vein, causing infiltration
Fracture of the bone with leakage of bone marrow into the soft tissue
Acute osteomyelitis 2nd to inappropriate cleansing of the site
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Protect his spine, insert a nasal airway, assist ventilations with a BVM and 100% O2. keep him warm and elevate his legs, transport at once, and establish vascular access en route to a trauma center
Perform immediate endotracheal intubation, apply a cervical collar, establish two large bore IV lines and give a fluid bolus at the scene, apply warm blankets, and transport expeditiously to a trauma center
Apply high flow oxygen via nonrebreathing mask, apply blankets, elevate his lower extremities 12 inches, insert bilateral intraosseous catheters, deliver a 500mL fluid bolus, and begin transport to a trauma center
Insert an oral airway, hyperventilate him with a BVM at 24 breaths/min, keep him warm and elevate his legs, transport at once, and establish at least one large bore IV line of normal saline while en route to a trauma center
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Experiences a direct hit while standing in a large open area
Is talking on a phone and a utility pole is truck by lighting
Is attempting to escape an oncoming thunderstorm by running
Receives a splash effect after lighting strikes a nearby object
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Apply supplemental oxygen and keep her warm
Elevate her extremity above the level of her heart
Apply a pressure dressing and start a large bore IV
Locate and apply digital pressure to the brachial artery
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Can be reversed if chemotherapy is administered within 24 hours
Occur over time and will not be apparent in the prehospital setting
Are a direct result of beta particles and are usually life threatening
Manifest with lethal cardiac dysrhythmias and sudden cardiac arrest
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Apply and inflate the PASG, start two large bore IV lines with an isotonic crystalloid, and transport.
Give oxygen via non rebreathing mask, start a large bore IV of lactated ringers or normal saline, and transport
Administer high flow oxygen, transport immediately, and attempt other bleeding control methods en route
Perform endotracheal intubation, administer crystalloid fluids until his carotid pulse strengthens, and transport at once
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Hypothermia
Burn shock
Inhalation injury
Cyanide toxicity
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Due to the risk of causing hemodynamic compromise,analgesia should be avoided in the field
One half of the usual dose of narcotic analgesics should be given in order to avoid drug toxicity
Benzodiazepines are preferred over narcotics because they are less likely to cause hypotension
Burns increase the metabolic rate, which may necessitate higher than normal doses of analgesia
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The type of liquid used to irrigate the burn
Whether the burn should be flushed
Whether toxicity is local or systemic
The antidote required to reverse the effects
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This increases the risk of intubating the right mainstream bronchus
Facial edema may cause tube dislodgement 2-3 days after the burn
Drugs given via the ET tube will not adequately disperse in the lungs
It may result in excessive volumes of air being delivered to the patient
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5.5
6.2
6.5
6.8
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Apply high flow oxygen, attempt transcutaneous pacing to increase his heart rate, apply spinal motion restriction precautions, establish vascular access and administer a crystalloid bolus of 10-20 mL/kg, begin transport, and infuse dopamine at 2 mcg/kg/min en route
Consider immediate intubation to protect his airway, apply spinal motion restriction precautions, apply warm blankets, begin transport, establish IV or IO access en route, and administer up to 4 liters of normal saline or lactated Ringer's solution to increase his BP and improve perfusion
Assist ventilations as needed, apply spinal motion restriction precatutions, keep him warm, begin transport, establish vascular access en route, administer crystalloid boluses in 200 mL increments, consider atropine for his bradycardia, and infuse dopamine if his blood pressure is refractory to fluid boluses.
Provide ventilatory assistance with a BVM device, establish immediate vascular access and infuse normal saline wide open, apply spinal motion restrictions, administer 1 mg of atropine to increase his heart rate above 60 beats/min, begin transport, and perform transcutaneous pacing en route if he remains bradycardic
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Cardiogenic,dopamine
Neurogenic,a beta blocker
Hypovolemic, saline boluses
Distributive, an antidysrhythmic
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Fireworks,air
Oven cleaner, water
Drain cleaner, air
Battery acid, water
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Typically only experiences burns to the epidermal layer because calcium oxide is a weak chemical
Often does not experience a burn unless he or she is exposed to the cement for longer than 2 hours
May not notice a skin burn for hours because cement penetrates through clothing and reacts with sweat
Experiences immediate pain and inflammation to the area because of the calcium oxide in the cement
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Five minutes of CPR generally restores a pulse
Perform a compression to ventilate ratio of 15:2
His or her heart may resume beating spontaneously
The ECG usually shows an organized cardiac rythm
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May undergo necrosis within 24-48 hours after the burn
Surrounds the central part of the burn and is often inflamed
Is the area least affected by the burn and will likely recover
Is the central part of the burn and suffers the most damage
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An air embolus
An allergic reaction
Circulatory overload
A pyrogenic reaction
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The body's ability to effectively dissipate significant heat energy and the patient's general state of health
The presence of any underlying medical problems, the duration of exposure, and the temperature of the heat source.
The duration of exposure, the physical size of the patient, and the presence of concomitant traumatic injuries.
The temperature of the heat source of the heat source, amount of heat energy possessed by the object or substance and the duration of exposure
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Is caused by excess serum potassium levels
Occurs when damaged muscle produces myoglobin
Can be prevented with boluses of lactated ringers
Is the result of electricity passing through the kidneys
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Infection
Hypovolemia
Hypothermia
Myoglobinemia
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Obtain an accurate calculation of how severe the patient's burns are
Determine whether the patient should be transported via helicopter
Ascertain how much IV fluid the patient should receive during transport
Help the paramedic determine the most appropriate destination hospital
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18
27
36
45
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Most commonly experience blast type injuries
Often have areas of burns that resemble a fine red rash
Typically experience intractable ventricular fibrillation
Experience full thickness burns that require debridement
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The patient may require another dose of the same drug
The dose was too low for the patient's clinical condition
The IV tubing was occluded proximal to the injection
You diluted the bolus by following it with a 20 mL saline flush
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Calcium chloride
Sodium bicarbonate
Magnesium sulfate
Viscous lidocaine gel
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Chlorine
Ammonium
Sulfur mustard
Hydrogen peroxide
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The red zone of coagulation necrosis
Simply caused by local inflammation
A charred area of full thickness burn
Characterized by cold, gray, dry tissue
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