Perioperative assessment (pdf)
Added on 2021-04-24
12 Pages3321 Words78 Views
Healthcare and Research
|
|
|
Running head: CASE STUDYCASE STUDYName of the StudentName of the universityAuthor’s note
1CASE STUDYPerioperative assessmentZaynab is a kid and is vulnerable to slips, falls and burns. They have sensitiveskin and can be life threatening, depending upon the severity of the burn (de Jong etal.2014). It is evident form the case study that Zaynab was having second degree burnthat involves deep layers beneath the skin, dermis. These burns are painful as theyform blisters and the healing time can take more than three weeks. Pain occurs due tothe release of the inflammatory mediators like prostaglandins and bradykinin triggeringthe pain receptors present in the skin. (McBride and Holland 2015). Young children arephysically unstable and are mentally inquisitive, hence burn can bring physical as wellas emotional trauma in the patient. (Bittner et al. 2015). The health care professionals incharge of the paediatric units should be able to act promptly against any kind ofemergency situations. In order to do this, communication among the multidisciplinaryteam is very crucial in order to manage the perioperative care in a manner that is incompliance with treatment goals of the clinical setting (Krishnamoorthy et al. 2012).Zaynab is an emergency case; he will not be prepared for any kind of surgicalprocedures and hence will require an operating department practitioner (ODP). I orderto apply the anaesthesia it is essential to detect if Zaynab had any histories of allergies.Pain and trauma can bring about gastric emptying; hence it is necessary to address theconcerns of the child by assessing her facial expression or her voice. The preliminary assessment of a burn includes the Clearance of the airways,breathing, and stabilization of the circulation followed by homeostasis. One of the majorparts of the treatment is the pain management (Snell et al. 2013). Regardless of the
2CASE STUDYaetiology of the burn, there should be a check up of any signs of hypovolemis,decreased blood pressure and the output of urine (Bittner et al. 2015). Early excision of the dead tissues with permanent or temporary coverage of theopen areas reduces the chance of colonization of the wound and sepsis (Brown et al.2012). A deep second degree burn may require surgery for removing the burnt tissue. Ahealthy skin from another part of the body is generally used as a skin graft. After a skingraft the dressings has to be changed regularly ensuring no infection (Snell et al. 2013).Less serious second degree burn would simply require topical antibiotic creams. Theburnt site has to be regularly monitored for ensuring proper healing (Brown et al. 2012).A child with burns should be treated as a multiple trauma patient at first andassessment of the airway should be the first priority during the initial assessment(Krishnamoorthy et al. 2012). As Zaynab has had some injury over her chest hence, thepresence of any airways injury and airway obstruction should be identified. Airwayinjuries might go unnoticed in the beginning but airway oedema may be formed due toheavy fluid resuscitation (Bittner et al. 2015). Hence it is safer to provide intubation tothe patient early, as it might become difficult to intubate after the swelling of the airways.As per the Royal college of Anaesthesia, when there are limited resources, basic airwaymanoeuvres can be followed such as Zaynab's head and chin can be tilted, Jaw thrustcan be provided to clear the airways (Royal collage of Anesthesia, 2018)As per the Association of Anaesthetists of Great Britain and Ireland (AAGBI), theairway management should include the equipments involving airway managementincluded endotracheal tubes and face masks and before commencing any intervention it
3CASE STUDYis necessary to assess the anatomical variation in each child (AAGBI, 2013). Zaynabdid not suffer from excessive burns as face burns can be a warning sign for the upperairways injury, hence intubation may disrupt the clinical evolution. Intubation inpaediatric patients can be difficult due the variation in the anatomical structure of theairway (Krishnamoorthy et al. 2012). This is due to the fact as the epiglottis of some ofthe children might be large or floppy hence the intubation tool, miller blade can be usedin order to get a clear view of the epiglottis (Belanger et al. 2014). Oral intubation can beperformed by direct laryngoscopy (Haberal et al. 2010). In case of facial burns the tubecan be fixed by encircling the front maxillary incisors and the tracheal tube with heavybraided silk sutures or dental wires. Mask ventilation can be given to Zaynab, as shewas not having any facial or neck burns (Krishnamoorthy et al. 2012). Rapid sequence induction (RSI) can be given for reducing the risks of aspirationof the intestinal contents and regurgitation (Barnard et al.2012). Just before theplacement of an endotracheal tube, intravenous induction of the anaesthesia along withthe application of cricoid pressure, because the upper oesophagus is occluded by beingcompacted between the cervical vertebrae and the trachea preventing the passivereflux of the gastric content (Barnard et al.2012).Since Zaynab is over two years,endotrachaeal tube of size 4mm can be given. Fluid balance Severe fluid loss is one of the greatest problems faced in burn injuries. Heatinjury releases sets of inflammatory and vasoactive mediators that are responsible forthe systemic vasodilatation, local vasoconstriction and increased transcapillary
End of preview
Want to access all the pages? Upload your documents or become a member.
Related Documents
Wound Managementlg...
|14
|2491
|243
Acute Management of Burns in Childrenlg...
|13
|3941
|57
Burn Injuries | Research Reportlg...
|9
|2451
|17
Management of Burn Injuries: Perspectives of ODP, STP, and Anaestheticlg...
|9
|3913
|168
Compartment Syndrome and its Treatmentlg...
|5
|2418
|31