Problem 2

Erwin budi/405130151
Learning Objective 1

Explain about trauma

Head Injuries
 Head Injuries
ö EPIDURAL HEMATOMA :
 Head Injuries
ö ACUTE SUBDURAL HEMATOMA :
 Head Injuries
ö INTRAVENTRICULAR HEMATOMA :
Spine and spinal cord trauma
Spine anda spinal cord trauma
Learning Objective 2

Explain about thermal injuries

 Thermal injuries
• All thermal injuries require the identification
and management of associated mechanical
injuries and the maintenance of hemodynamic
normality with volume resuscitation.
• Smoke inhalation
• Identification and management of associated
mechanical injuries
• Maintenance of hemodynamic normality with
volume resuscitation
 Stop the burning process

Remove all clothing

Rinse all involve body

surface area

Cover patient with

warm, clean, dry linens
 Size and Airway
depth

Burns to head
and face

Burn inside Massive Risk for upper aiway

the mouth edema obstruction Intubation

Inhalation
injury

Associated
trauma

Clinical indications of inhalation injury include:

•Face and/or neck burns
•Singeing of the eyebrows and nasal vibrissae
•Carbon deposits in the mouth and/or nose and
carbonaceous sputum
•Acute inflammatory changes in the oropharynx,
including erythema
•Hoarseness
•History of impaired mentation and/or
confinement in a burning environment
•Explosion with burns to head and torso
•Carboxyhemoglobin level greater than
10% in a patient who was involved in a fire
 Intravenous access
• Any patient with burns over more than 20% of the
body surface requires fluid resuscitation.
• If the extent of the burn precludes placement of the
catheter through unburned skin, the IV should be
placed through the burned skin into an accessible
vein.
• The upper extremities are preferable to the lower
extremities as a site for venous access
• Begin infusion with an isotonic crystalloid solution,
preferably lactated Ringer’s solution.
 History
• Associated injuries can be sustained while the
victim attempts to escape the fire, and injury
from explosions can result in internal injuries
or fractures
• Burns sustained within an enclosed space
suggest the potential for inhalation injury
• Preexisting illnesses, drug therapy, any
allergies and tetanus immunization
Rule of nines
Depth of burns
 Primary and secondary survey
• Primary: airway, breathing, cicrculation
• Secondary: physical examination,
documentation, complete blood count (CBC),
type and crossmatch/screen, an arterial blood
gas with HbCO, serum glucose, electrolytes,
and pregnancy test in all females of
childbearing age. A chest x-ray should be
obtained for those patients who are intubated
or have a suspected smoke inhalation injury
 PERIPHERAL CIRCULATION IN
CIRCUMFERENTIAL EXTREMITY BURNS
• Rule out compartment syndrome.
• Compartment syndrome results from an increase in the pressure
inside a compartment that interferes with perfusion to the
structures within that compartment.
• signs of a compartment syndrome: increased pain with passive
motion, tightness, numbness, and, eventually, decreased distal
pulses.
• If the pressure is >30 mm Hg, escharotomy is indicated. a pressure
of >30 mm Hg within the compartment may lead to muscle
necrosis.
• signs of a compartment syndrome: increased pain with passive
motion, tightness, numbness, and, eventually, decreased distal
pulses.
 Secondary survey
• Gastric tube insertion
• Narcotics analgesics and sedatives
• Wound care
• Antibiotics
• Tetanus
 Chemical injuries
• Alkali burns are generally more serious than acid burns,
because the alkalies penetrate more deeply.
• Rapid removal of the chemical and immediate attention to
wound care is essential.
• If dry powder is still present on the skin, brush it away before
irrigating with water. Otherwise, immediately flush away the
chemical with large amounts of water, for at least 20 to 30
minutes, using a shower or hose
• Alkali burns to the eye require continuous irrigation during the
first 8 hours after the burn.
• A small-caliber cannula can be fixed in the palpebral sulcus for
irrigation.
 Electrical burns
• The body can serve as a volume conductor of electrical
energy, and the heat generated results in thermal injury
to tissue.
• Airway and breathing, establishment of an intravenous
line in an uninvolved extremity, ECG monitoring, and
placement of an indwelling bladder catheter.
• Electricity may cause cardiac arrhythmias that may
require chest compressions.
• Fluid administration should be increased to ensure a
urinary output of 100 mL/hr in adults or 2 mL/ kg/hr in
children <30 kg
 Triage
• Triage involves the sorting of patients based
on their needs for treatment and the
resources available to provide that treatment.
• Multiple casualties
• Mass casualties