316 lines
No EOL
16 KiB
HTML
316 lines
No EOL
16 KiB
HTML
<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN"
|
|
"http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd">
|
|
<html xmlns="http://www.w3.org/1999/xhtml">
|
|
<head>
|
|
<title>Pediatric Terrorism and Disaster Preparedness: Table 7.4</title>
|
|
<meta http-equiv="Content-Type" content="text/html; charset=iso-8859-1" />
|
|
|
|
<!-- "metadata" -->
|
|
<meta name="description" content="Comprehensive report and summary for pediatricians to consult in planning for and responding to natural disasters and bioterrorist events." />
|
|
<meta name="keywords" content="Agency for Health Care Policy and Research, Agency for Healthcare Research and Quality, AHRQ, AHCPR, bioterrorism, community resources, disaster preparedness, emergency, hospital, mass casualty event, public health, surge capacity, urgent care" />
|
|
|
|
<link href="/includes/archive.css" rel="stylesheet" type="text/css" />
|
|
<link href="/includes/ahrqstyleprint_arch.css" rel="stylesheet" type="text/css" media="print" />
|
|
<script>
|
|
(function(i,s,o,g,r,a,m){i['GoogleAnalyticsObject']=r;i[r]=i[r]||function(){
|
|
(i[r].q=i[r].q||[]).push(arguments)},i[r].l=1*new Date();a=s.createElement(o),
|
|
m=s.getElementsByTagName(o)[0];a.async=1;a.src=g;m.parentNode.insertBefore(a,m)
|
|
})(window,document,'script','//www.google-analytics.com/analytics.js','ga');
|
|
|
|
ga('create', 'UA-75759936-1', 'auto');
|
|
ga(' set', 'anonymizeIp', true);
|
|
|
|
ga('send', 'pageview');
|
|
|
|
</script></head><body><!-- Google Tag Manager -->
|
|
<noscript><iframe src="//www.googletagmanager.com/ns.html?id=GTM-W4DST4"
|
|
height="0" width="0" style="display:none;visibility:hidden"></iframe></noscript>
|
|
<script>(function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':
|
|
new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],
|
|
j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src=
|
|
'//www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);
|
|
})(window,document,'script','dataLayer','GTM-W4DST4');</script>
|
|
<!-- End Google Tag Manager -->
|
|
<noscript>
|
|
Your browser doesn't support JavaScript. Please upgrade to a modern browser or enable JavaScript in your existing browser.
|
|
</noscript>
|
|
|
|
<!-- Page Header v2.0 -->
|
|
<a name="top" id="top"></a>
|
|
<!--Begin Banner CodeS-->
|
|
<div id="ahrqbanner">
|
|
<div class="hhsportion">
|
|
<a href="#h1" class="skipnav">Skip Navigation</a>
|
|
<a href="http://www.hhs.gov" title="U.S. Department of Health and Human Services">
|
|
<img src="/images/hhs_banner.gif" alt="U.S. Department of Health and Human Services" />
|
|
</a>
|
|
<a href="http://www.hhs.gov" title="www.hhs.gov" class="hhsright">
|
|
<img src="/images/hhs_link.gif" alt="www.hhs.gov" />
|
|
</a>
|
|
</div>
|
|
|
|
<div class="ahrqportion">
|
|
<a href="/" title="Archive: Agency for Healthcare Research Quality">
|
|
<img src="/images/ahrq_banner.gif" alt="Agency for Healthcare Research Quality" />
|
|
</a><form name="searchForm" method="get" action="https://search.ahrq.gov/search" id="banner_searchform">
|
|
<label for="search" style="z-index:-1;position:relative;margin-right:-65px; font-size:0px;">Search</label>
|
|
<input name="q" type="text" value=" Search Archive" size="11" onfocus="this.value='';" class="gotext" label="Search archive" id="search" />
|
|
<input type="hidden" name="entqr" value="0" />
|
|
<input type="hidden" name="output" value="xml_no_dtd" />
|
|
<input type="hidden" name="proxystylesheet" value="ARCHIVE_Front_End" />
|
|
<input type="hidden" name="client" value="ARCHIVE_Front_End" />
|
|
<input type="hidden" name="site" value="ARCHIVE_AHRQ_GOV" />
|
|
<input src="/images/topbn_GoButton.gif" class="gobtn" name="Submit" onclick="javascript:document.searchForm.submit();" type="image" alt="Search" />
|
|
</form>
|
|
<a href="https://www.ahrq.gov/" class="ahrqright">www.ahrq.gov</a>
|
|
</div><div class="ahrqlinks"><a href="https://www.ahrq.gov/">AHRQ Home—Live Site</a> | <a href="/">Archive Home</a> | <a href="/sitemap.htm">Site Map</a> <!-- | <img src="/images/envelope1.jpg" alt="" width="21" height="14" /><a href="https://subscriptions.ahrq.gov/service/multi_subscribe.html?code=USAHRQ">E-mail Updates</a> --></div>
|
|
</div>
|
|
<div id="PrintBanner">
|
|
<img src="/images/printbanner_arch.jpg" alt="Archive print banner" />
|
|
</div>
|
|
<a name="h1"></a>
|
|
<!-- End banner code -->
|
|
<!-- End of Page header -->
|
|
|
|
<!-- Content Body -->
|
|
<div id="mainContent">
|
|
<table width="100%" border="0" cellspacing="0" cellpadding="0" >
|
|
<tr valign="top">
|
|
<td width="70%">
|
|
<!-- Center Content section -->
|
|
<table width="100%" border="0" cellpadding="0" cellspacing="0" style="margin-left:10px; margin-right:10px;margin-top:5px" summary="This table gives the layout format of the bread crumb area and the center content area.">
|
|
<!--DWLayoutTable-->
|
|
<tr>
|
|
<td class="crumb_link"><div id="crumbContent">
|
|
<p><strong>You Are Here:</strong> <span class="crumb_link"><a href="/" class="crumb_link">AHRQ Archive Home</a> > <a href="/prep/" class="crumb_link">Public Health Preparedness Archive</a> > <a href="." class="crumb_link">Pediatric Terrorism and Disaster Preparedness</a> > Table 7.4</span></p>
|
|
</div>
|
|
</td>
|
|
</tr>
|
|
<tr>
|
|
<td height="30px"><span class="title"><a name="h1" id="h1"></a>Pediatric Terrorism and Disaster Preparedness </span></td>
|
|
</tr>
|
|
<tr>
|
|
<td><div id="centerContent"><p><strong>Public Health Emergency Preparedness</strong></p> <div class="headnote">
|
|
|
|
<p>This resource was part of AHRQ's Public Health Emergency Preparedness program, which was discontinued on June 30, 2011, in a realignment of Federal efforts.</p>
|
|
<!-- <p>Now this resource is supported by the <a href="http://emergency.cdc.gov/">Centers for Disease Control and Prevention</a> (CDC).</p> -->
|
|
|
|
|
|
<p>This information is for reference purposes only. It was current when produced and may now be outdated. Archive material is no longer maintained, and some links may not work. Persons with disabilities having difficulty accessing this information should contact us at: <a href="https://info.ahrq.gov/">https://info.ahrq.gov</a>. Let us know the nature of the problem, the Web address of what you want, and your contact information. </p>
|
|
|
|
|
|
<p>Please go to <a href="https://www.ahrq.gov/">www.ahrq.gov</a> for current information.</p></div>
|
|
|
|
<h3>Table 7.4. Principles of Advanced Burn Life Support®</h3>
|
|
|
|
<table border="1" cellspacing="0" cellpadding="3" width="80%">
|
|
<tr valign="top">
|
|
<th scope="col">Principle</th>
|
|
<th scope="col">Description</th>
|
|
</tr>
|
|
<tr valign="top">
|
|
<td colspan="2" scope="row" align="center"><strong><em>Primary Survey</em></strong>
|
|
</td></tr>
|
|
<tr valign="top">
|
|
<td width="33%" scope="row">Airway</td>
|
|
<td width="67%">Rapid upper airway closure may occur following inhalation injury and require early intubation</td>
|
|
</tr>
|
|
<tr valign="top">
|
|
<td scope="row">Breathing</td>
|
|
<td>Circumferential full thickness burns of the trunk may impair ventilation and require escharotomy</td>
|
|
</tr>
|
|
<tr valign="top">
|
|
<td scope="row">Circulation</td>
|
|
<td>Circulation in a limb with full thickness burns may be impaired and require escharotomy</td>
|
|
</tr>
|
|
<tr valign="top">
|
|
<td scope="row">Disability</td>
|
|
<td>Consider carbon monoxide poisoning if the patient is not initially alert and oriented</td>
|
|
</tr>
|
|
<tr valign="top">
|
|
<td scope="row">Exposure and environment</td>
|
|
<td>Remove all jewelry to avoid constriction of digits</td>
|
|
</tr>
|
|
<tr valign="top">
|
|
<td colspan="2" scope="row" align="center"><strong><em>Adjuncts</em></strong></td>
|
|
</tr>
|
|
<tr valign="top">
|
|
<td scope="row">Foley catheter</td>
|
|
<td>Needed to titrate fluid replacement against urine output</td>
|
|
</tr>
|
|
<tr valign="top">
|
|
<td scope="row">Gastric tube</td>
|
|
<td>Needed to decompress stomach due to burn ileus</td>
|
|
</tr>
|
|
<tr valign="top">
|
|
<td colspan="2" scope="row" align="center"><strong><em>Resuscitation</em></strong></td>
|
|
</tr>
|
|
<tr valign="top">
|
|
<td scope="row">Stop the burning process<br /></td>
|
|
<td> </td>
|
|
</tr>
|
|
<tr valign="top">
|
|
<td scope="row">Fluid resuscitation</td>
|
|
<td> <em>Parkland formula</em>: 3-4 mL Ringer's lactate × body weight in kg × total body surface area (BSA) burned; administer half the amount during the first 8 hr after injury, half over the next 16 hr. <br /> <br />
|
|
<em>Modification for pediatric patients:</em> Add maintenance fluid to Parkland formula for children and infants; 100 mL/kg for first 10 kg + 50 mL/kg for next 10 kg + 20 mL/kg for each additional kg</td>
|
|
</tr>
|
|
<tr valign="top">
|
|
<td colspan="2" scope="row" align="center"><strong><em>Secondary Survey </em></strong></td>
|
|
</tr>
|
|
<tr valign="top">
|
|
<td scope="row" colspan="2"><em>History and physical</em></td>
|
|
</tr>
|
|
<tr valign="top">
|
|
<td scope="row">Obtain as much information as possible regarding the circumstances of injury<br /></td>
|
|
<td><p><strong><em>Flame</em></strong></p>
|
|
<blockquote><p>How did the burn occur?<br />
|
|
Did the burn occur outside or inside?<br />
|
|
Did the clothes catch on fire?<br />
|
|
How long did it take to extinguish the flames?<br />
|
|
How were the flames extinguished?<br />
|
|
Was gasoline or another fuel involved?<br />
|
|
Was there an explosion?<br />
|
|
Was there a house fire?<br />
|
|
Was the patient found in a smoke-filled room?<br />
|
|
How did the patient escape?<br />
|
|
If the patient jumped out a window, from what floor?<br />
|
|
Were others killed at the scene?<br />
|
|
Was there a motor vehicle crash?<br />
|
|
How badly was the car damaged?<br />
|
|
Was there a car fire?<br />
|
|
Are there other injuries?<br />
|
|
Are the purported circumstances of the injury consistent with the burn characteristics?</p>
|
|
</blockquote>
|
|
<p><strong><em>Scald</em></strong></p>
|
|
|
|
<blockquote><p>How did the burn occur?<br />
|
|
What was the temperature of the liquid?<br />
|
|
What was the liquid?<br />
|
|
How much liquid was involved?<br />
|
|
What was the temperature setting of the water heater?<br />
|
|
Was the patient wearing clothes?<br />
|
|
How quickly were the patient's clothes removed?<br />
|
|
Was the burned area cooled?<br />
|
|
Who was with the patient when the burn took place?<br />
|
|
How quickly was care sought?<br />
|
|
Where did the burn occur?<br />
|
|
Are the purported circumstances of the injury consistent with the burn characteristics?</p>
|
|
</blockquote>
|
|
|
|
<p> <strong><em>Chemical</em></strong></p>
|
|
<blockquote><p> What was the agent?<br />
|
|
How did the exposure occur?<br />
|
|
What was the duration of contact?<br />
|
|
What decontamination occurred?<br />
|
|
Was there an explosion?</p>
|
|
</blockquote>
|
|
|
|
<p> <strong><em>Electrical</em></strong></p>
|
|
<blockquote>
|
|
<p> What kind of electricity was involved?<br />
|
|
What was the duration of contact?<br />
|
|
Did the patient fall?<br />
|
|
What was the estimated voltage?<br />
|
|
Was there loss of consciousness?<br />
|
|
Was cardiopulmonary resuscitation administered at the scene?</p>
|
|
</blockquote></td>
|
|
</tr>
|
|
<tr valign="top">
|
|
<td scope="row">Determine the severity of the burn</td>
|
|
<td><p><strong><em>Extent of burn</em></strong></p>
|
|
<blockquote><p>Rule of nines for adolescents<br />
|
|
Lund-Browder chart for children and infants (<a href="pedtab6_5.htm">Table 6.5</a>)</p>
|
|
</blockquote>
|
|
<p><strong><em>Depth of burn</em></strong></p></td>
|
|
</tr>
|
|
<tr valign="top">
|
|
<td colspan="2" scope="row" align="center"><strong><em>Adjuncts</em></strong></td>
|
|
</tr>
|
|
<tr valign="top">
|
|
<td scope="row">Imaging and laboratory studies </td>
|
|
<td>Carboxyhemoglobin</td>
|
|
</tr>
|
|
<tr valign="top">
|
|
<td colspan="2" scope="row" align="center"><strong><em>Reevaluation</em></strong></td>
|
|
</tr>
|
|
<tr valign="top">
|
|
<td scope="row" colspan="2">Continued assessment of ventilatory effort<br />
|
|
Continued assessment of extremity perfusion<br />
|
|
Pain management<br />
|
|
Psychosocial assessment</td>
|
|
</tr>
|
|
<tr valign="top">
|
|
<td colspan="2" scope="row" align="center"><strong><em>Burn Wound Care </em></strong></td>
|
|
</tr>
|
|
<tr valign="top">
|
|
<td scope="row">Thermal burns</td>
|
|
<td>Cover the area with a clean, dry sheet<br />
|
|
Ice applications are appropriate only in small burns</td>
|
|
</tr>
|
|
<tr valign="top">
|
|
<td scope="row">Chemical burns</td>
|
|
<td>Flush the chemical agent from the body surface with copious amounts of water<br />
|
|
Powdered chemicals should be brushed from the skin prior to flushing the involved area<br />
|
|
Remove all contaminated clothing<br />
|
|
Chemical eye injuries require continuous irrigation until otherwise instructed by an expert</td>
|
|
</tr>
|
|
<tr valign="top">
|
|
<td scope="row">Electrical burns</td>
|
|
<td>Continuous cardiac monitoring may be necessary during the first 24 hr after injury<br />
|
|
Maintain urine output at twice normal target volumes if myoglobinuria</td>
|
|
</tr>
|
|
<tr valign="top">
|
|
<td colspan="2" scope="row" align="center"><strong><em>Burn Center Referral </em></strong></td>
|
|
</tr>
|
|
<tr valign="top">
|
|
<td scope="row" colspan="2">Partial thickness burns >10% total BSA<br />
|
|
Burns that involve face, hands, feet, genitalia, perineum, or major joints<br />
|
|
Full-thickness burns<br />
|
|
Chemical burns<br />
|
|
Electrical burns, including lightning injury<br />
|
|
Inhalation injury<br />
|
|
Burn injury in patients with significant comorbidities; concomitant trauma; or who require special social, emotional, or rehabilitative intervention<br />
|
|
Burned children in hospitals without qualified personnel or equipment for care of children</td>
|
|
</tr>
|
|
</table>
|
|
|
|
<p class="size2"><strong>Note:</strong> The principles of Advanced Burn Life Support are identical to the principles of Advanced Trauma Life Support® (<a href="pedtab7_3.htm">Table 7.3</a>), with additional caveats pertinent to Advanced Burn Life Support.</p>
|
|
|
|
<p class="size2"><strong>Source:</strong> Courtesy American Burn Association. Used with permission.</p>
|
|
|
|
<p class="size2"><a href="pedchap7b.htm#Tab7.4">Return to Document</a> </p>
|
|
<p> </p>
|
|
<div class="footnote">
|
|
<p> The information on this page is archived and provided for reference purposes only.</p></div>
|
|
<p> </p>
|
|
|
|
</div>
|
|
</td>
|
|
</tr>
|
|
</table>
|
|
<!-- End of Center Content section -->
|
|
</td>
|
|
</tr>
|
|
</table>
|
|
</div>
|
|
<!-- End of Content Body -->
|
|
<!-- Footer graphic 1.2-->
|
|
<table cellspacing="0" cellpadding="0" border="0" width="100%">
|
|
<tr>
|
|
<td width="125" background="/images/bottom_ahrq_bkg.jpg"><img src="/images/bottom_ahrq_1.jpg" width="125" alt="AHRQ" /></td>
|
|
<td width="100%" background="/images/bottom_ahrq_bkg.jpg" ><img src="/images/bottom_ahrq_bkg.jpg" width="10" height="34" alt="" /></td>
|
|
|
|
<td width="310" background="/images/bottom_ahrq_bkg.jpg"><img src="/images/bottom_ahrq_2.gif" alt="Advancing Excellence in Health Care" width="310" height="34" /></td>
|
|
</tr>
|
|
</table>
|
|
<!-- Footer links section -->
|
|
<div id="banner_Footer2"><p> <a href="https://www.ahrq.gov/">AHRQ Home</a> | <a href="https://info.ahrq.gov" class="footer_navlink">Questions?</a> | <a href="https://www.ahrq.gov/contact/index.html" class="footer_navlink">Contact AHRQ</a> | <a href="https://www.ahrq.gov/sitemap.html" class="footer_navlink">Site Map</a> | <a href="https://www.ahrq.gov/policy/electronic/accessibility/index.html" class="footer_navlink">Accessibility</a> | <a href="https://www.ahrq.gov/policy/electronic/privacy/index.html" class="footer_navlink">Privacy
|
|
Policy</a> | <a href="https://www.ahrq.gov/policy/foia/index.html" class="footer_navlink">Freedom of Information Act</a> | <a href="https://www.ahrq.gov/policy/electronic/disclaimers/index.html" class="footer_navlink">Disclaimers</a> | <a href="http://www.hhs.gov/open/recordsandreports/plainwritingact/index.html" class="footer_navlink">Plain Writing Act</a> <br />
|
|
|
|
<a href="http://www.hhs.gov" class="footer_navlink">U.S. Department of Health & Human Services</a> | <a href="http://www.whitehouse.gov" class="footer_navlink">The White House</a> | <a href="http://www.usa.gov" class="footer_navlink">USA.gov: The U.S. Government's Official Web Portal</a></p>
|
|
</div>
|
|
<div id="banner_Footeraddress"><p>Agency for Healthcare Research and Quality <img src="/images/bottom_dot.gif" alt="" /> 5600 Fishers Lane Rockville, MD 20857 <img src="/images/bottom_dot.gif" alt="" /> Telephone: (301) 427-1364</p></div>
|
|
|
|
<!-- End of Footer links section -->
|
|
</body>
|
|
</html> |