[Richo]

Hello to you all again

I have been working on a case study for emergency nursing (uni elective) which involves a burns patient being brought into a rural hospital setting with burns to all areas of her body. I have to discuss the preparation for her arrival and treatment once in the hospital and have a question regarding this. Primary Survey (ABCDE) (ABCDEF) (I have seen a few differing ABC's which is also confusing me), does it occur again once the patient arrives, even if the patient is stabilized by the ambulance/paramedics? I am finding that all the text books I read having differing theories on this.

Cheers
Tracy

[gwenith]

Tracy - give us some examples and I will see if I can explain.

[Richo]

Hi Gwenith

Ok, an example is in Sheehy's Emergency Nursing Principals and Practice (this is the prescribed textbook for the unit) which goes through and explains Airway, Breathing, Circulation, Infection, Pain Management and Wound Care, then on this website that our lecturer gave us (http://www.swsahs.nsw.gov.au/livtrau...ok/primary.asp) it says Airway, Breathing, Circulation, Disability and Exposure, then in another book I have (CARPA Standard Treatment Manual) says DRABC which I'm guessing is for immediate treatment rather than E.D. treatment. I'm just finding it a little difficult to describe the primary treatment when there are so many different terms and theories, I know once I have actually worked and gain some experience the "basis" for this type of scenario will be in my head but for now, the slightest bits of difference confuses me , so for now what I have been doing is trying to pinpoint what airway problems a burns patient may have and the treatment for that etc. Thanks for your help once again!

Tracy

Originally Posted by gwenith

Tracy - give us some examples and I will see if I can explain.

[gwenith]

Now I know where you are coming from the explanation is easy and is focus oriented.

OKAY - DRABC as you surmised is for the scene of the accident. It is the bog standard mnemonic used to teach lay people about resuscitation. It does have a place here though because some burns may be caused by substances hazardous to ANYONE coming in contact with the agent or even with the fumes

http://www.emedicine.com/EMERG/topic228.htm

A case in point may be the acid burn where the acid is still on the skin of the patient and the patient needs to be throughly washed down first. Usually this is done at the scene but you may not be so lucky. Hydrofluoric acid is one hazard that springs to mind

http://www.whs.qld.gov.au/alerts/02i04.pdf

http://www.uic.edu/com/er/toxikon/toxweek.htm

http://www.akhdem.co.nz/Guidelines/h...acid_burns.htm

The last site also has some "ABC's in it.

ABCDE is the bog standard assessment criteria taught for all Emergency Nursing courses and is more specific to trauma cases. Sheehy will have ABCDE in other chapters I know I have Sheehy here at home it is a good book. You would use it in the case of a trauma + burn i.e. car fire following MVA Pt who while on fire ran and fell (not an uncommon scenario)

The last one is a very specific one for primary uncomplicated burns. In fact they have with the inclusion of infection and pain management included more of a secondary survey.

I would break my answer up into primary survey - DRABC (especially as you have no information on the mechanism of the burn) and leave the (Disability, Exposure, Pain management, Infection etc) as a secondary survey.

Hope this helps.

[Richo]

Yes it does help heaps, thanks for that. In the case of the patient smelling of fuel, would it be the same? to wash the patient down to stop the chemical (from what I have read this would be a chemical burn aswell as flame as she was found alight) from burning her? Therefore I see how DRABC is relevant here if this is the case. I will go look at those sites u listed now to see what else I can find. Thanks again Gwenith.

Cheers
Tracy

Originally Posted by gwenith

Now I know where you are coming from the explanation is easy and is focus oriented.

OKAY - DRABC as you surmised is for the scene of the accident. It is the bog standard mnemonic used to teach lay people about resuscitation. It does have a place here though because some burns may be caused by substances hazardous to ANYONE coming in contact with the agent or even with the fumes

http://www.emedicine.com/EMERG/topic228.htm

A case in point may be the acid burn where the acid is still on the skin of the patient and the patient needs to be throughly washed down first. Usually this is done at the scene but you may not be so lucky. Hydrofluoric acid is one hazard that springs to mind

http://www.whs.qld.gov.au/alerts/02i04.pdf

http://www.uic.edu/com/er/toxikon/toxweek.htm

http://www.akhdem.co.nz/Guidelines/h...acid_burns.htm

The last site also has some "ABC's in it.

ABCDE is the bog standard assessment criteria taught for all Emergency Nursing courses and is more specific to trauma cases. Sheehy will have ABCDE in other chapters I know I have Sheehy here at home it is a good book. You would use it in the case of a trauma + burn i.e. car fire following MVA Pt who while on fire ran and fell (not an uncommon scenario)

The last one is a very specific one for primary uncomplicated burns. In fact they have with the inclusion of infection and pain management included more of a secondary survey.

I would break my answer up into primary survey - DRABC (especially as you have no information on the mechanism of the burn) and leave the (Disability, Exposure, Pain management, Infection etc) as a secondary survey.

Hope this helps.

[gwenith]

If it is only fuel you can leave the DR bit until later as it only really refers to clear and present danger - yes get rid of the fuel but after the ABC's. Specify that you would use warm water to wash the patient with because heat loss is of prime importance.

[Richo]

Ok, thanks Gwenith, this is a really interesting assignment, I cant wait until I get the chance to do my prac in E.D. so some of this theory comes together for me. You sound like u have a broad range of experience, do you still practice nursing? and if so what area do u work in?

Tracy

[gwenith]

ICU/CCU mate - though I might be going to a rural hospital soon - I get sick of ICU after a while and just HAVE to take a break,