Summary: Environmental Hazards

Read the summary and the most important questions on Environmental Hazards

• Burns, including electrical injury

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• Can Thermal injury mostly be seen as an isolated event?

  Thermal injury should not be viewed as an isolated event but rather has effects on multiple organ systems.

• What is relevant to assess in a burn patient after burn resucitation ant treatment?

  Burns resuscitation and treatment of associated life-threatening injuries such as pneumothorax, haemorrhage and severe head trauma should proceed concurrently. It

• Which burn victims are potentially at risk for upper airway or inhalation injury?

  All burn patients are potentially at risk, but those at particular risk include patients who were burned in an enclosed space, those who were asleep or under the influence of drugs or alcohol and those who have, for example, associated head injuries.

• How far can inhalation injury of hot gasses reach into the lungs?

  Inhalation of hot gases can produce burns as far as the terminal bronchi.

• What is the etiology of smoke injury?

  Smoke injury is a result of corrosive damage by chemical products produced by the fire.

• What are important aspects of the history of the patient and event and which signs and symptoms could make you aware of a potential inhalation or upper airway injury?

  see table

• Should all upper airway or smoke injury victims be intubated?

  A delay in securing the airway can lead to a difficult or impossible intubation at a later stage when massive facial and upper airway oedema can develop.

• Can suxamethonium (succinylcholine) be used safely for intubation of a burn or inhalation injury patient?

  Suxamethonium can be used safely to secure the airway only on initial presentation. Use of suxamethonium at a later stage can lead to life-threatening hyperkalaemia.

• What are key elements in circulatory resuscitation of burn victims

  - Two large bore canules (preferable in intact skin)
  - Start of 2 liters of normal saline untill the burn size is estimated and the fluid therapy can be tailored
  - In moderate and severe burns a central venous catheter should be placed preferable before onset of edema and transportation to a specialised centre

• What is the best fluid therapy in burn victims

  There is currently no evidence that either cristalloid or a combination cristalloid and colloid is the therapy of choice.