Burns :: essays research papers

Burns Epidemiology: US – 2M seek serious burns  70k require hospitalizations, 5k die Usually caused by careless and ignorance, nearly half are smoking or alcohol -related. Goal: well healed durable skin with normal function and near-normal appearance. Pathology Cutaneous burns – caused primarily by the application of heat to the skin resulting in coagulative necrosis of some or all of the epidermis and dermis. Depth of burn – depends on heat of the burn source, thickness of the skin, duration of contact, and the blood flow. Classifications: Shallow burns †¢Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  First Degree – involve only the epidermis; no blisters; painful and erythematous due to dermal vasodilation; erythema and pain subsides in 2-3 days; desquamation occurs in day 4 †¢Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Superficial Dermal Burns (Second Degree) - include the upper layer of the dermis; form blisters at the interface of the epidermis and dermis; when blisters are removed, wound is pink and wet, and currents of air passing over it cause pain; wound is hypersensitive and blanches with pressure; if without infection, spontaneous healing in 5% TBSA in any age group 5.  Ã‚  Ã‚  Ã‚  Ã‚  Electrical burns including lightning injury 6.  Ã‚  Ã‚  Ã‚  Ã‚  Chemical injury 7.  Ã‚  Ã‚  Ã‚  Ã‚  Inhalation injury 8.  Ã‚  Ã‚  Ã‚  Ã‚  Burns of any size in patients with pre-existing medical disorders that could complicate management, prolong recovery, or affect mortality 9.  Ã‚  Ã‚  Ã‚  Ã‚  Burns with concomitant mechanical trauma (e.g. fractures) where the burn injury poses the greatest risk of morbidity and mortality 10.  Ã‚  Ã‚  Ã‚  Ã‚  Burns in children if there are no qualified personnel or equipment for pediatric care at the initial hospital 11.  Ã‚  Ã‚  Ã‚  Ã‚  Burns in patients requiring special social, emotional, and/or long-term rehabilitative support, including cases of suspected child abuse, substance abuse, etc Emergency Care Airway – initial attention must be directed to this; if patient is rescued from a burning building or exposed to a smoky fire, place on 100% oxygen by tight-fitting mask; if patient unconscious, place ET tube attached to a source of 100% oxygen Once airway is secured, assess patient for other injuries and transport to the nearest hospital. Begin fluid administration of crystalloid solution at a rate of approximately 1L/h. Wrap patient in clean sheet, remove constricting clothing and jewelries. Cold application is used in smaller burns, particularly scalds. Ice should not be used. Assessment of Inhalational Injury - suspect for patients with a flame burn, esp in enclosed space. Hoarseness and expiratory wheezes are signs of potentially serious airway edema or smoke poisoning; inspect mouth for swelling, blisters, soot; copious mucus production and carbonaceous sputum are signs of smoke inhalation and other products of combustion; get ABGs and carboxyhemoglobin levels (if >1, smoke inhalation) Burns :: essays research papers Burns Epidemiology: US – 2M seek serious burns  70k require hospitalizations, 5k die Usually caused by careless and ignorance, nearly half are smoking or alcohol -related. Goal: well healed durable skin with normal function and near-normal appearance. Pathology Cutaneous burns – caused primarily by the application of heat to the skin resulting in coagulative necrosis of some or all of the epidermis and dermis. Depth of burn – depends on heat of the burn source, thickness of the skin, duration of contact, and the blood flow. Classifications: Shallow burns †¢Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  First Degree – involve only the epidermis; no blisters; painful and erythematous due to dermal vasodilation; erythema and pain subsides in 2-3 days; desquamation occurs in day 4 †¢Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Superficial Dermal Burns (Second Degree) - include the upper layer of the dermis; form blisters at the interface of the epidermis and dermis; when blisters are removed, wound is pink and wet, and currents of air passing over it cause pain; wound is hypersensitive and blanches with pressure; if without infection, spontaneous healing in 5% TBSA in any age group 5.  Ã‚  Ã‚  Ã‚  Ã‚  Electrical burns including lightning injury 6.  Ã‚  Ã‚  Ã‚  Ã‚  Chemical injury 7.  Ã‚  Ã‚  Ã‚  Ã‚  Inhalation injury 8.  Ã‚  Ã‚  Ã‚  Ã‚  Burns of any size in patients with pre-existing medical disorders that could complicate management, prolong recovery, or affect mortality 9.  Ã‚  Ã‚  Ã‚  Ã‚  Burns with concomitant mechanical trauma (e.g. fractures) where the burn injury poses the greatest risk of morbidity and mortality 10.  Ã‚  Ã‚  Ã‚  Ã‚  Burns in children if there are no qualified personnel or equipment for pediatric care at the initial hospital 11.  Ã‚  Ã‚  Ã‚  Ã‚  Burns in patients requiring special social, emotional, and/or long-term rehabilitative support, including cases of suspected child abuse, substance abuse, etc Emergency Care Airway – initial attention must be directed to this; if patient is rescued from a burning building or exposed to a smoky fire, place on 100% oxygen by tight-fitting mask; if patient unconscious, place ET tube attached to a source of 100% oxygen Once airway is secured, assess patient for other injuries and transport to the nearest hospital. Begin fluid administration of crystalloid solution at a rate of approximately 1L/h. Wrap patient in clean sheet, remove constricting clothing and jewelries. Cold application is used in smaller burns, particularly scalds. Ice should not be used. Assessment of Inhalational Injury - suspect for patients with a flame burn, esp in enclosed space. Hoarseness and expiratory wheezes are signs of potentially serious airway edema or smoke poisoning; inspect mouth for swelling, blisters, soot; copious mucus production and carbonaceous sputum are signs of smoke inhalation and other products of combustion; get ABGs and carboxyhemoglobin levels (if >1, smoke inhalation)

Problem Solving and Decision Making Essay

Much of what managers and supervisors do is solve problems and make decisions. New managers and supervisors, in particular, often make solve problems and decisions by reacting to them. They are â€Å"under the gun†, stressed and very short for time. Consequently, when they encounter a new problem or decision they must make, they react with a decision that seemed to work before. It’s easy with this approach to get stuck in a circle of solving the same problem over and over again. Therefore, as a new manager or supervisor, get used to an organized approach to problem solving and decision making. Not all problems can be solved and decisions made by the following, rather rational approach. However, the following basic guidelines will get you started. Don’t be intimidated by the length of the list of guidelines. After you’ve practiced them a few times, they’ll become second nature to you — enough that you can deepen and enrich them to suit your own needs and nature. (Note that it might be more your nature to view a â€Å"problem† as an â€Å"opportunity†. Therefore, you might substitute â€Å"problem† for â€Å"opportunity† in the following guidelines.) 1. Define the problem This is often where people struggle. They react to what they think the problem is. Instead, seek to understand more about why you think there’s a problem. Defining the problem: (with input from yourself and others) Ask yourself and others, the following questions: a. What can you see that causes you to think there’s a problem? b. Where is it happening? c. How is it happening? d. When is it happening? e. With whom is it happening? (HINT: Don’t jump to â€Å"Who is causing the problem?† When we’re stressed, blaming is often one of our first reactions. To be an effective manager, you need to address issues more than people.) f. Why is it happening? g. Write down a five-sentence description of the problem in terms of â€Å"The following should be happening, but isn’t †¦Ã¢â‚¬  or â€Å"The following is happening and should be: †¦Ã¢â‚¬  As much as possible, be specific in your description, including what is happening, where, how, with whom and why. (It may be helpful at this point to use a variety of research methods. Also see . Defining complex problems: a. If the problem still seems overwhelming, break it down by repeating steps a-f until you have descriptions of several related problems. Verifying your understanding of the problems: a. It helps a great deal to verify your problem analysis for conferring with a peer or someone else. Prioritize the problems: a. If you discover that you are looking at several related problems, then prioritize which ones you should address first. b. Note the difference between â€Å"important† and â€Å"urgent† problems. Often, what we consider to be important problems to consider are really just urgent problems. Important problems deserve more attention. For example, if you’re continually answering â€Å"urgent† phone calls, then you’ve probably got a more â€Å"important† problem and that’s to design a system that screens and prioritizes your phone calls. Understand your role in the problem: a. Your role in the problem can greatly influence how you perceive the role of others. For example, if you’re very stressed out, it’ll probably look like others are, too, or, you may resort too quickly to blaming and reprimanding others. Or, you are feel very guilty about your role in the problem, you may ignore the accountabilities of others. 2. Look at potential causes for the problem a. It’s amazing how much you don’t know about what you don’t know. Therefore, in this phase, it’s critical to get input from other people who notice the problem and who are effected by it. b. It’s often useful to collect input from other individuals one at a time (at least at first). Otherwise, people tend to be inhibited about offering their impressions of the real causes of problems. c. Write down what your opinions and what you’ve heard from others. d. Regarding what you think might be performance problems associated with an employee, it’s often useful to seek advice from a peer or your supervisor in order to verify your impression of the problem. e. Write down a description of the cause of the problem and in terms of what is happening, where, when, how, with whom and why. 3. Identify alternatives for approaches to resolve the problem a. At this point, it’s useful to keep others involved (unless you’re facing a personal and/or employee performance problem). Brainstorm for solutions to the problem. Very simply put, brainstorming is collecting as many ideas as possible, then screening them to find the best idea. It’s critical when collecting the ideas to not pass any judgment on the ideas — just write them down as you hear them. (A wonderful set of skills used to identify the underlying cause of issues is Systems Thinking.) 4. Select an approach to resolve the problem When selecting the best approach, consider: a. Which approach is the most likely to solve the problem for the long term? b. Which approach is the most realistic to accomplish for now? Do you have the resources? Are they affordable? Do you have enough time to implement the approach? c. What is the extent of risk associated with each alternative? (The nature of this step, in particular, in the problem solving process is why problem solving and decision making are highly integrated.) 5. Plan the implementation of the best alternative (this is your action plan) a. Carefully consider â€Å"What will the situation look like when the problem is solved?† b. What steps should be taken to implement the best alternative to solving the problem? What systems or processes should be changed in your organization, for example, a new policy or procedure? Don’t resort to solutions where someone is â€Å"just going to try harder†. c. How will you know if the steps are being followed or not? (these are your indicators of the success of your plan) d. What resources will you need in terms of people, money and facilities? e. How much time will you need to implement the solution? Write a schedule that includes the start and stop times, and when you expect to see certain indicators of success. f. Who will primarily be responsible for ensuring implementation of the plan? g. Write down the answers to the above questions and consider this as your action plan. h. Communicate the plan to those who will involved in implementing it and, at least, to your immediate supervisor. (An important aspect of this step in the problem-solving process is continually observation and feedback.) 6. Monitor implementation of the plan Monitor the indicators of success: a. Are you seeing what you would expect from the indicators? b. Will the plan be done according to schedule?   c. If the plan is not being followed as expected, then consider: Was the plan realistic? Are there sufficient resources to accomplish the plan on schedule? Should more priority be placed on various aspects of the plan? Should the plan be changed? 7. Verify if the problem has been resolved or not One of the best ways to verify if a problem has been solved or not is to resume normal operations in the organization. Still, you should consider: a. What changes should be made to avoid this type of problem in the future? Consider changes to policies and procedures, training, etc. b. Lastly, consider â€Å"What did you learn from this problem solving?† Consider new knowledge, understanding and/or skills. c. Consider writing a brief memo that highlights the success of the problem solving effort, and what you learned as a result. Share it with your supervisor, peers and subordinates. Decision making is a key role for any manager or leader. Surprisingly many people struggle when it comes to taking decisions. This might be due to: o Fear of failure o Lack of a structured approach o Procrastinating o Lack of clarity Whatever the barriers, there are 6 steps that you can follow when taking any decision. 1. Problem Definition Before you can start to take any decisions, you need to be absolutely clear the problem you are trying to reach a decision on. One simple technique is just to write out in a sentence what the problem is that you need to take a decision on. 2. Assess the implications All decisions have implications. If it is a decision at work, it has implications for you, your peers, your team and your superiors. Depending on the decision (e.g. a promotion at work) it may even have implications for your family, especially if it involves relocation. 3. Explore different perspectives Perspectives are simply different lenses through which you look at the problem. By exploring different perspectives you start to get a feel for those that you are most attracted to. 4. Get clear on your ideal outcome When you are faced with a big decision, it is easy to get lost in the detail and circumstances. An alternative is to get clear on your ideal outcome and use this ideal outcome to inform your choices. Imagine you aspire to be a CFO of a Top 100 company. By having clarity on your outcome, you can make choices on promotions and experience linked to this ideal outcome. 5. Weigh up pros and cons Another way of looking at a decision is to consider the advantages and disadvantages of each of the options open to you. Simply listing the advantages and disadvantages of each option is a powerful way of moving forward on decisions. 6. Decide and act Once you have gone through the previous 5 steps, commit to a choice or course of action and start to make it happen. To avoid procrastination, give yourself permission to be okay with any failings that might arise. At the end of the day there is no magic formula for decision making. Following some simple steps and acting can however move you into the realm of effective decision maker.

Sonny s Blues A Story Based On A Boy - 1279 Words

Sonny’s Blues is a story based on a boy by the name of Sonny, and his brother who is the narrator of the story. In the story Sonny was addicted to heroin, sent to prison, and he and his brother didn’t have much of a relationship. On the other hand, Sonny’s older brother had his life together. He was well educated as he was a mathematics teacher with a family that he had to support. The short story has a lot of connections and relations to some of the biblical stories. One being the prodigal’s son, and the other story being Cain and Abel. Sonny’s Blues was also based on the sufferings of the African American Community, as Sonny and his brother lived in Harlem, New York. Some examples of their sufferings would be their childhood†¦show more content†¦The celebration consisted of a fatted calf being requested to be killed. This celebration leaves the older son upset, because he has worked very hard for all the years the younger son has been awa y living in sin. One would say this message leaves knowledge to the meaning of one can be found in their lost days. In the article The Biblical Foundation Of James Baldwin s Sonny s Blues written by James Tackach, Tackach writes about the biblical relations to the Prodigal’s son. Tackach says that the Prodigal’s Son and Sonny’s Blues are â€Å"sin and redemption† stories. (Tackach 113) The younger sons â€Å"return to their families and are praised and saved†, while the older sons lose grace, which results to the older brother in Sonny’s Blues actually losing Grace. (Tackach) The other connection that was made to the bible was the story of Cain and Abel, found in the book of Genesis. Cain and Abel were the sons of Adam and Eve. Cain was the eldest, and he was jealous of Abel. The jealousy came into play as they gathered their fruits and soil to provide for the Lord. The Lord was pleased with the amount of offering Abel had, but not so much with the amount of offering Cain had. Cain was later angry, which lead him to take Abel in the field to kill him. One may say Sonny and his brother’s relationship was killing them both on the inside, by them not speaking to each other. This accusation may be the reason Sonny’s brother had to contact Sonny for