# data[].attributes.body
Burn Mechanism

Heat — The depth of the thermal injury is related to contact temperature, duration of contact with the external heat source, and the thickness of the skin.

Electrical discharge —The magnitude of the injury depends on the pathway of the current, the resistance to the current flow through the tissues, and the strength and duration of the current flow.

Friction — Injury from friction can occur due to a combination of mechanical disruption of tissues and heat generated by friction.

Chemicals — A wide range of caustic reactions, including alteration of pH, disruption of cellular membranes, and direct toxic effects on metabolic processes, causes injury. In addition to the duration of exposure, the nature of the agent will determine injury severity. Contact with acid causes coagulation necrosis of the tissue, while alkaline burns generate liquefaction necrosis.

Radiation — Radiofrequency energy or ionizing radiation can cause damage to skin and tissues. The most common type of radiation burn is sunburn.

Classification by dept

Superficial — Superficial or epidermal burns involve only the epidermal layer of skin. They do not blister but are painful, dry, red, and blanch with pressure.

Over the next two to three days the pain and erythema subside, and by approximately day 4, the injured epithelium peels away from the newly healed epidermis. Such injuries are generally healed in six days without scarring. This process is commonly seen with sunburns.

Partial-thickness — Partial-thickness burns involve the epidermis and portions of the dermis. They are characterized as either superficial or deep.

●Superficial partial thickness – These burns characteristically form blisters within 24 hours between the epidermis and dermis. They are painful, red, weep, and blanch with pressure. Burns that initially appear to be only epidermal in depth may be determined to be partial thickness 12 to 24 hours later. These burns generally heal in 7 to 21 days; scarring is unusual, although pigment changes may occur. A layer of fibrinous exudates and necrotic debris may accumulate on the surface, which may predispose the burn wound to heavy bacterial colonization and delayed healing. These burns typically heal without functional impairment or hypertrophic scarring.

●Deep partial thickness – These burns extend into the deeper dermis and are characteristically different from superficial partial-thickness burns. Deep burns damage hair follicles and glandular tissue. They are painful to pressure only, almost always blister (easily unroofed), are wet or waxy dry, and have variable mottled colorization from patchy cheesy white to red. rBlanching with pressure may be sluggish. If infection is prevented and wounds are allowed to heal spontaneously without grafting, they will heal in two to nine weeks. These burns invariably cause hypertrophic scarring. If they involve a joint, joint dysfunction is expected even with aggressive physical therapy. A deep partial-thickness burn that fails to heal in two weeks is functionally and cosmetically equivalent to a full-thickness burn. Differentiation from full-thickness burns is often difficult.

Full-thickness — These burns extend through and destroy all layers of the dermis and often injure the underlying subcutaneous tissue. Burn eschar, the dead and denatured dermis, is usually intact. The eschar can compromise the viability of a limb or torso if circumferential.

Full-thickness burns are usually anesthetic or hypo-aesthetic. Skin appearance can vary from waxy white to leathery gray to charred and black. The skin is dry and inelastic and does not blanch with pressure (picture 4). Hairs can easily be pulled from hair follicles. Vesicles and blisters do not develop.

Pale full-thickness burns may simulate normal skin except that the skin does not blanch with pressure. Features that differentiate partial-thickness from full-thickness burns may take some time to develop.

The eschar eventually separates from the underlying tissue and reveals an unhealed bed of granulation tissue. Without surgery, these wounds heal by wound contracture with epithelialization around the wound edges. Scarring is severe with contractures; complete spontaneous healing is not possible.

Extension to deep tissues — Fourth-degree burns are deep and potentially life-threatening injuries that extend through the skin into underlying soft tissue and can involve muscle and/or bone.

# data[].attributes.attachment_link.readable_text
The mechanisms that result in burns and their classification will be reviewed here. The clinical assessment and management of burns in adults and children are discussed elsewhere. (See "Treatment of minor thermal burns" and "Treatment of superficial burns requiring hospital admission" and "Overview of the management of the severely burned patient" and "Treatment of deep burns".)

BURN MECHANISMS

Friction - Injury from friction can occur due to a combination of mechanical disruption of tissues as well as heat generated by friction.

Radiation burns can be seen in individuals who work in the nuclear industry. Radiation burns are often associated with cancer due to the ability of ionizing radiation to interact with and damage DNA. The clinical results of ionizing radiation depend on the dose, time of exposure, and type of particle that determines the depth of exposure. Depending on the photon energy, radiation can cause very deep internal burns.

CLASSIFICATION BY DEPTH - Cutaneous burns are classified according to the depth of tissue injury. The depth of the burn largely determines the healing potential and the need for surgical grafting.

General considerations - The traditional classification of burns as first, second, third, or fourth degree was replaced by a system reflecting the need for surgical intervention. Current designations of burn depth are superficial, superficial partial-thickness, deep partial-thickness, and full-thickness ( table 1 and figure 1) [ 3]. The term fourth degree is still used to describe the most severe burns, burns that extend beyond the skin into the subcutaneous soft tissue and can involve underlying vessels, nerves, muscle, bone, and/or joints.

Burn wounds are not usually uniform in depth, and many have a mixture of deep and superficial components. A precise assessment of the depth of the burn wound may be difficult initially as burn wounds are dynamic and can progress as well as convert to deeper wounds, and as such may require several days for a final determination [ 3,4]. Thin skin, particularly on the volar surfaces of the forearms, medial thighs, perineum, and ears, sustains deeper burn injuries than suggested by initial appearance [ 4]. It is best to assume there are no shallow burns in these areas [ 5]. Children under the age of 5 and adults over the age of 55 are also more susceptible to deeper burns because of thinner skin [ 4-6].

Appropriate burn wound care may necessitate multiple treatment modalities for different parts of a burn wound depending on the burn depth of each injured part.

The American Burn Association (ABA) has published an educational resource that reviewed the classification and management of the burn wound. The classification system below is largely in agreement [ 1].

Partial-thickness - Partial-thickness burns involve the epidermis and portions of the dermis. They are characterized as either superficial or deep.

●Superficial partial thickness - These burns characteristically form blisters within 24 hours between the epidermis and dermis. They are painful, red, and weeping and blanch with pressure ( picture 2). Burns that initially appear to be only epidermal in depth may be determined to be partial thickness 12 to 24 hours later. These burns generally heal in 7 to 21 days; scarring is unusual, although pigment changes may occur. A layer of fibrinous exudates and necrotic debris may accumulate on the surface, which may predispose the burn wound to heavy bacterial colonization and delayed healing. These burns typically heal without functional impairment or hypertrophic scarring.

●Deep partial thickness - These burns extend into the deeper dermis and are characteristically different from superficial partial-thickness burns. Deep burns damage hair follicles and glandular tissue. They are painful to pressure only, almost always blister (easily unroofed), are wet or waxy dry, and have variable mottled colorization from patchy cheesy white to red ( picture 3). They do not blanch with pressure. If infection is prevented and wounds are allowed to heal spontaneously without grafting, they will heal in two to nine weeks. These burns invariably cause hypertrophic scarring. If they involve a joint, joint dysfunction is expected even with aggressive physical therapy. A deep partial-thickness burn that fails to heal in two weeks is functionally and cosmetically equivalent to a full-thickness burn. Differentiation from full-thickness burns is often difficult.

Full-thickness - These burns extend through and destroy all layers of the dermis and often injure the underlying subcutaneous tissue. Burn eschar, the dead and denatured dermis, is usually intact. The eschar can compromise the viability of a limb or torso if circumferential.

Full-thickness burns are usually anesthetic or hypo-aesthetic. Skin appearance can vary from waxy white to leathery gray to charred and black. The skin is dry and inelastic and does not blanch with pressure ( picture 4). Hairs can easily be pulled from hair follicles. Vesicles and blisters do not develop.

Pale full-thickness burns may simulate normal skin except that the skin does not blanch with pressure. Features that differentiate partial-thickness from full-thickness burns may take some time to develop.

The eschar eventually separates from the underlying tissue and reveals an unhealed bed of granulation tissue. Without surgery, these wounds heal by wound contracture with epithelialization around the wound edges. Scarring is severe with contractures; complete spontaneous healing is not possible.

Extension to deep tissues - Fourth-degree burns are deep and potentially life-threatening injuries that extend through the skin into underlying soft tissue and can involve muscle and/or bone.

EXTENT OF BURN INJURY - A thorough and accurate estimation of burn size is essential to guide therapy and to determine when to transfer a patient to a burn center. Using one of the methods described below, the extent of burns is estimated and expressed as the total percentage of body surface area (ie, TBSA). Superficial (first-degree) burns are not included in percentage TBSA burn assessment.

The locations of partial-thickness and full-thickness burned areas are recorded on a burn diagram ( figure 2). Burns with an appearance compatible with either deep partial-thickness or full-thickness are presumed to be full-thickness until accurate differentiation is possible.

Superficial (first-degree) burns are not included in percentage TBSA burn assessment.

●Lund-Browder - The Lund-Browder chart ( figure 2) is the most accurate method for estimating TBSA for both adults and children. Children have proportionally larger heads and smaller lower extremities, so the percentage TBSA is more accurately estimated using the Lund-Browder chart ( table 2 and figure 2).

●Rule of Nines - For adult assessment, the most expeditious method to estimate TBSA in adults is the "Rule of Nines" [ 9,10]:

*The head represents 9 percent TBSA

*Each arm represents 9 percent TBSA

*Each leg represents 18 percent TBSA

*The anterior and posterior trunk each represent 18 percent TBSA

●Palm method - Small or patchy burns can be approximated by using the surface area of the patient's palm. The palm of the patient's hand, excluding the fingers, is approximately 0.5 percent of total body surface area, and the entire palmar surface including fingers is 1 percent in children and adults [ 11-13].

Accuracy of percentage TBSA estimates - In several observational reports comparing the estimation of burn size at the referring hospital with the estimation at the receiving burn center, the size of larger burns was underestimated. This resulted in under-resuscitation at the referring hospital [ 14-16]. Early transfer to a burn center should be arranged when injuries meet the criteria for major burns ( table 3). (See "Emergency care of moderate and severe thermal burns in adults", section on 'Initial assessment and treatment'.)

The percentage TBSA burned may be underestimated in women with large breasts who have burns of the anterior trunk. A table based on the cup size of a brassiere is intended to complement the Lund-Browder chart for burn estimation in adults. In a review of 60 volunteers to determine the difference in percentage TBSA of the anterior trunk between males and females, large-breasted women (cup size D and greater) were found to have a significantly greater amount of percentage TBSA on the anterior chest compared with men (16 versus 11 percent) [ 17]. This additional percentage TBSA is concentrated on the pectoral region and represents 10 percent of TBSA as compared with 5 percent for men and 7 percent for women with smaller breasts. There was an equal distribution of anterior and posterior trunk TBSA in men but a 1.6:1 ratio in large-breasted women. For every increase in cup size, the TBSA of a woman's anterior trunk increases by a factor of 0.1, relative to the posterior trunk ( figure 3).

In addition, a study in patients with obesity suggested that both the Rule of Nines and Lund-Browder diagrams underestimate the extent of burns involving the torso and overestimate the percentage of burns involving the extremities in the patients with obesity [ 18]. In this study, the patient's primary shape (android versus gynecoid) was important for determining the percentage TBSA in comparison to body mass index (BMI) and sex.

A variety of methods that aim to improve burn depth assessment are in development or in early clinical use. Experimentally, optical methods can predict burn depth with over 90 percent accuracy. Additional studies will help provide a better understanding as to which technologies will be of greatest clinical use. Examples of such technologies include the following [ 21-33]:

●Laser Doppler analysis assays the velocity of blood cells in the superficial dermis. This is reported as an index and correlated with blood perfusion.

● Indocyanine green is a dye that can be injected intravenously and can be imaged by the application of ultraviolet light showing both an arterial and venous phase. Cameras are available in most large hospitals, and these systems are commonly used to monitor skin perfusion in skin flaps.

●Thermography also provides an index of perfusion based on the temperature of the tissue. This provides two-dimensional images of perfusion in large areas.

●A number of dermoscopy techniques have also been reported to correlate nicely with burn depth.

●Hyperspectral imaging uses multiple light frequencies to image deoxy and oxyhemoglobin in tissues and has been shown in animal models to accurately correlate with burn depth.

Additional tools that have been evaluated include a single-sided planar magnetic resonance (MR) imaging probe, a unilateral MR imaging sensor equipped with a 2D gradient coil system, novel uses of lasers (eg, optimal coherence tomography), spatial frequency domain imaging alone and in combination with laser speckle imaging, and videomicroscopy.

●Head and neck - (See "Principles of burn reconstruction: Face, scalp, and neck".)

●Extremities - (See "Principles of burn reconstruction: Extremities and regional nodal basins" and "Primary operative management of hand burns".)

●Trunk - (See "Principles of burn management: The breast" and "Principles of burn reconstruction: Perineum and genitalia".)

●Respiratory tract - Superheated gases can cause burns to the respiratory system. More commonly, injury occurs from smoke exerting its effects through local chemical irritation. In addition, chemicals such as carbon monoxide or cyanide can lead to systemic toxicity. Direct thermal injury from hot smoke usually burns only the pharynx while steam can also burn the airway below the glottis. (See "Inhalation injury from heat, smoke, or chemical irritants".)

Moderate burn injury - Moderate burns would be those that require admission to a hospital but not to a burn center. These include superficial burns or deeper burns of limited extent. (See "Emergency care of moderate and severe thermal burns in adults" and "Treatment of superficial burns requiring hospital admission".)

Severe burn injury - Severe burn injury can be defined as burns that should be referred to, and treated at, a designated burn center ( table 3). (See "Emergency care of moderate and severe thermal burns in adults" and "Overview of the management of the severely burned patient" and "Treatment of deep burns".)

● Burn definition - A burn is defined as a traumatic injury to the skin or other organic tissue primarily caused by heat or exposure to electrical discharge, friction, chemicals, and radiation. (See 'Introduction' above and 'Burn mechanisms' above.)

● Classification by burn depth - Cutaneous burns are classified according to the depth of tissue injury ( table 1 and figure 1). The depth of the burn largely determines the healing potential and the need for surgical grafting. (See 'Classification by depth' above.)

*Superficial or epidermal burns involve only the epidermal layer of skin.

*Partial-thickness burns involve the epidermis and portions of the dermis.

*Full-thickness burns extend through and destroy all layers of the dermis.

*Deeper (fourth-degree) burns extend through the skin into underlying soft tissues such as fascia, muscle, and/or bone.

● Extent of burn injury - A thorough estimation of burn size is essential to guide therapy. The extent of the burn injury is expressed as a percentage of the patient's total body surface area (TBSA). Superficial (first-degree) burns are not included in percentage TBSA burn assessment. This estimation can be facilitated using a Lund-Browder chart, the Rule of Nines, or the palm method. The most accurate method of assessment of TBSA burn in children and adults is the Lund-Browder chart. The extent of large TBSA burns is often underestimated, and factors such as sex, body shape, and obesity can affect the assessment. (See 'Extent of burn injury' above.)

● Anatomic location - The anatomic location of a burn often directs treatment. Burns on the face, hands, feet, and genitalia as well as large burns in other areas of the body are often referred to burn centers for specialized expertise. (See 'Anatomic location of burn injury' above.)

● Overall burn severity - A combination of the burn mechanism, burn depth, extent, and anatomic location helps determine the overall severity of the burn injury (minor, moderate, severe), which provides general guidance for the preferred disposition and care of these patients. (See 'Overall severity of burn injury' above.)

# data[].attributes.attachment_link.title
Assessment and classification of burn injury - UpToDate

# data[].attributes.attachment_link.description
The mechanisms that result in burns and their classification will be reviewed here. The clinical assessment and management of burns in adults and children are discussed elsewhere. (See "Treatment of minor thermal burns" and "Treatment of superficial burns requiring hospital admission" and "Overview of the management of the severely burned patient" and "Treatment of deep burns".)

# data[].attributes.body
https://onlinelibrary-wiley-com.ezproxy.canberra.edu.au/doi/epdf/10.1111/jonm.12085

https://www-sciencedirect-com.ezproxy.canberra.edu.au/science/article/pii/S0020748918301895?via%3Dihub

# data[].attributes.body
It was the first week of semester 2, so I had nothing planned for the week. However, I was keen to know about the INC 6 module, including the assignment summary, workshop, and simulation details. I was looking forward to a good orientation about the INC 6 placement, new grad portfolio development, and module outline.

# data[].attributes.body
Module 1 week was all about orientating the INC 6 students to the new learning environment. The new learning cycle includes a one-hour simulation, an hour clinical workshop, and an hour tutorial session. During the week, we got to familiarise ourselves with the three different settings.

Simulation class

Discussed the clinical viva, division of groups and

Clinical Workshop

Tutorial class

Ice-breaking

Introductory quiz for next week

# data[].attributes.body
Need to do pre-work for module 2.

# data[].attributes.body
DKA

What?

Diabetic ketoacidosis (DKA) is characterized by uncontrolled hyperglycemia, metabolic acidosis, and increased body ketone concentration.

It is a life-threatening complication of diabetes and is usually seen in patients with type-1 diabetes mellitus.

Causes and treatment

Diabetic ketoacidosis usually happens after:

An illness. An infection or other illness can cause the body to make higher levels of certain hormones, such as adrenaline or cortisol.

A problem with insulin therapy. Missed insulin treatments can leave too little insulin in the body. Not enough insulin therapy or an insulin pump that doesn't work right also can leave too little insulin in the body.

Other things that can lead to diabetic ketoacidosis include:

Physical or emotional trauma

Heart attack or stroke

Pancreatitis

Pregnancy

Alcohol or drug misuse, particularly cocaine

Certain medicines,

Symptoms might include:

Being very thirsty

Urinating often

Feeling a need to throw up and throwing up

Having stomach pain

Being weak or tired

Being short of breath

Having fruity-scented breath

Being confused

More certain signs of diabetic ketoacidosis — which can show up in home blood and urine test kits — include:

High blood sugar level

High ketone levels in urine

Treatment

Fluids. Fluids replace those lost through too much urinating.

Electrolyte replacement. Electrolytes are minerals in the blood, such as sodium, potassium and chloride, that carry an electric charge.

Insulin therapy. Insulin reverses diabetic ketoacidosis.

# data[].attributes.body
Simulation

Case study- 17-year-old female with Diabetic symptoms.

Anxious and needs mother to make medical decisions. Based on the assessment, the patient has low blood glucose. Require insulin infusion and IV Infusion.

Clinical workshop

ISBAR

Drug Calculation

Administration of Insulin therapy and

Intravenous fluid resuscitation

# data[].attributes.body
Completed the Introductory Quiz.

DKA can present symptoms such as hyperglycemia, ketosis, acidosis, dehydration, and electrolyte imbalance which can be investigated by assessments such as biochemistry, ABG, ECG, Urine analysis, and BGL.

# data[].attributes.body
I realized from the introductory quiz, that I need to keep revising the human anatomy and primary assessment.

By the end of the module, I was glad to understand the different symptoms of DKA and the different assessments required to screen DKA.

I also need to revise the IV infusion drug calculation for kids.

# data[].attributes.body
-Complete placement ANSAT assessment for the student.

-Continue reading about common complications in cancer treatment.

# data[].attributes.body
Increased patient load to two.

Continued to read about hematological care plans, education and blood report reading.

Met CLN and did a learning cycle about two medications, the pathophysiology behind and the nursing standard.

Completed the ANSAT assessment and end of clinical placement.

# data[].attributes.body
Need to work towards increasing patient load to three and time management.

Draft a time management schedule for each patient to keep track of task and prioritize the task.

Continue working towards taking leadership and working independently.

# data[].attributes.body
-Read on different types of assessment to evaluate the mental health status of adolescent patients.

-Early recognition of the deteriorating patient including implementation of guidelines for escalation of care.

-Naloxone

Understanding about Naloxone. is an opioid antagonist medication used to block or reverse the effects of opioid drugs, particularly within the setting of drug overdoses which are rapidly becoming a leading cause of death worldwide.

# data[].attributes.attachment_link.readable_text
Summary

Naloxone is an opioid receptor antagonist used to rapidly reverse an opioid overdose. Also included in some drug formulations as an abuse deterrent to prevent injection.

Brand Names

Kloxxado, Narcan, Suboxone, Targin, Targiniq, Zimhi, Zubsolv

Generic Name

Naloxone

DrugBank Accession Number

DB01183

Background

Naloxone is an opioid antagonist medication used to block or reverse the effects of opioid drugs, particularly within the setting of drug overdoses which are rapidly becoming a leading cause of death worldwide.3 More specifically, naloxone has a high affinity for μ-opioid receptors, where it acts as an inverse agonist, causing the rapid removal of any other drugs bound to these receptors.3 When taken in large quantities, opioid medications such as morphine, hydromorphone, methadone, heroin, or fentanyl are capable of causing life-threatening symptoms such as respiratory depression, reduced heart rate, slurred speech, drowsiness, and constricted pupils.3,13 If untreated, this can progress to vomiting, absent pulse and breathing, loss of consciousness, and even death.13 Naloxone is indicated for the rapid reversal of these symptoms of central nervous system depression in opioid overdose.2 It's important to note that naloxone only works on opioid receptors within the body, and is therefore not capable of reversing the effects of non-opioid medications such as stimulants like methamphetamine or cocaine, or benzodiazepines like lorazepam or diazepam.

Also known as the brand name product Narcan, naloxone is currently available by intramuscular (IM) or subcutaneous (SubQ) injection, nasal spray, or intravenous (IV) infusion.14,16 Naloxone IM injections are commonly available in the form of "kits", which is ideal for making overdose treatment accessible and readily available for administration by minimally trained individuals within the community.15 Kits commonly include the supplies necessary to treat an overdose in a non-medical setting such as alcohol swabs, syringes, a rescue breathing mask, and instructions for use. Frequently also carried by medical and emergency personnel and at events known to be associated with heavy drug use like music festivals, naloxone kits are considered a key component of harm reduction strategies. There are over-the-counter nasal sprays available.

When injected intramuscularly (IM), naloxone acts within three to five minutes. Administration of naloxone is associated with very few side effects. Notably, if injected into a person not currently using opioid medications, there would be no noticeable effects at all. However, for individuals using opioid medications or experiencing an overdose, IM injection of naloxone rapidly reverses opioid effects and can cause the injected individual to immediately experience withdrawal symptoms.2 Common symptoms of opioid withdrawal include nausea, vomiting, sweating, runny nose, aches, and diarrhea.2 Although certainly physically uncomfortable, opioid withdrawal symptoms are not life-threatening; administration of naloxone is, therefore, appropriate for any person appearing to have any symptoms of an opioid overdose. Due to its short duration of action, persons injected with naloxone should be monitored for responsiveness and potentially injected a second time or taken to the hospital.2

Naloxone is also available within the combination product Suboxone with the opioid medication buprenorphine.11,12 Suboxone is used for the maintenance treatment of opioid dependence and addiction.11,12 When taken orally, naloxone has no pharmacological effect and does not reduce the effectiveness of the opioid effect of buprenorphine.11,12 The primary purpose of including naloxone within Suboxone is to act as a deterrent to injection, as injected naloxone would rapidly reverse the effects of buprenorphine.11,12

Naloxone was granted FDA approval on 13 April 1971.10

Type

Small Molecule

Groups

Approved, Vet approved

Structure

Weight

Average: 327.3743
Monoisotopic: 327.147058165

Chemical Formula

C₁₉H₂₁NO₄

Synonyms

(−)-naloxone

1-N-Allyl-14-hydroxynordihydromorphinone

17-allyl-3,14-dihydroxy-4,5α-epoxymorphinan-6-one

Nalossone

Naloxona

Naloxone

Naloxonum

External IDs

Indication

Naloxone nasal sprays are indicated for the reversal of an opioid overdose or suspected opioid overdose: it is intended for immediate administration as emergency therapy in settings where opioids may be present. Intramuscular, intravenous, and subcutaneous injections are indicated for complete or partial reversal of opioid depression, diagnosis of known or suspected opioid overdose, and as an adjunct therapy in the treatment of septic shock.

Sublingual tablets and films are formulated with buprenorphine for the treatment of opioid dependence. Naloxone is also formulated with pentazocine as an oral tablet for severe pain.

Intramuscular or subcutaneous naloxone autoinjectors are used for the emergency treatment of people 12 years of age and older where the use of high-potency opioids such as fentanyl analogues as a chemical weapon, is suspected.

Naloxone has been used off-label for the treatment of neuraxial opioid-induced pruritus.

Build, train, & validate predictive machine-learning models with structured datasets.

Associated Conditions

Associated Therapies

Contraindications & Blackbox Warnings

Avoid life-threatening adverse drug events & improve clinical decision support.

Pharmacodynamics

Naloxone is an opioid receptor antagonist indicated in the reversal of opioid overdoses. Naloxone has a shorter duration of action than opioids and multiple doses may be required. The therapeutic window of naloxone is wide, as it has no effect if a patient has not taken opioids. Patients treated with naloxone may experience opioid withdrawal and a person administering naloxone should be aware that reversal of opioid overdoses may not resolve all the symptoms a patient is experiencing if other drugs are involved.

Mechanism of action

Naloxone is a competitive inhibitor of the µ-opioid receptor. Naloxone antagonizes the action of opioids, reversing their effects. If a patient has not taken opioids, naloxone does not have a significant effect on patients.

Absorption

An intranasal dose of naloxone is 42-47% bioavailable. An 8 mg dose of nasal naloxone reaches a C max of 12.3-12.8 ng/mL, with a T max of 0.25 hours, and an AUC of 16.7-19.0 h*ng/mL. A 0.4 mg intramuscular dose reaches a C max of 0.876-0.910 ng/mL, with a T max of 0.25 hours, and an AUC of 1.94-1.95 h*ng/mL. A 2 mg intravenous dose reaches a C max of 26.2 ng/mL with an AUC of 12.8 h*ng/mL.

Volume of distribution

The volume of distribution of naloxone is 200 L. Naloxone distributes into tissues rapidly. It can also cross the placenta and blood-brain barrier.

Protein binding

Naloxone is approximately 45% bound to albumin, but there is significant binding to other proteins.

Naloxone primarily undergoes glucuronidation to form naloxone-3-glucuronide. Naloxone is also N-dealkylated to noroxymorphone or undergoes 6-keto reduction to naloxol.
Hover over products below to view reaction partners

Route of elimination

After oral or intravenous administration, naloxone is 25-40% eliminated in the urine within 6 hours, 50% in 24 hours, and 60-70% in 72 hours. The metabolites naloxone-3-glucuronide, noroxymorphone, and naloxol are all detected in the urine.

Half-life

The mean half life of naloxone hydrochloride is 1.8-2.7 hours intranasally, 1.4 hours intramuscularly, and 1.2 hours intravenously. In neonates, the mean half life is 3.1 ± 0.5 hours.

Clearance

The clearance of naloxone is 2500 L/day.

Adverse Effects

Improve decision support & research outcomes with our structured adverse effects data.

Toxicity

If a patient has not taken opioids, naloxone does not have a significant effect on patients.

The oral LD ₅₀ in mice and rats is >1 g/kg. The intraperitoneal LD ₅₀ is 80 mg/kg in mice and 239 mg/kg in rats. The subcutaneous LD ₅₀ is 286 mg/kg in mice and 500 mg/kg in rats.

Pathways

Pharmacogenomic Effects/ADRs

Not Available

Drug Interactions

This information should not be interpreted without the help of a healthcare provider. If you believe you are experiencing an interaction, contact a healthcare provider immediately. The absence of an interaction does not necessarily mean no interactions exist.

Drug

Interaction

Easily compare up to 40 drugs with our drug interaction checker.

Get severity rating, description, and management advice.
Learn more

Food Interactions

Take separate from meals. When formulated as a buccal film or sublingual form, avoid eating or drinking until the film has completely dissolved.

ATC Codes

A06AH04 - Naloxone N02AA53 - Hydromorphone and naloxone V03AB15 - Naloxone N02AA55 - Oxycodone and naloxone N02AX51 - Tilidine and naloxone

Drug Categories

Chemical TaxonomyProvided by Classyfire

Description

This compound belongs to the class of organic compounds known as phenanthrenes and derivatives. These are polycyclic compounds containing a phenanthrene moiety, which is a tricyclic aromatic compound with three non-linearly fused benzene.

Kingdom

Organic compounds

Super Class

Benzenoids

Class

Phenanthrenes and derivatives

Sub Class

Not Available

Direct Parent

Phenanthrenes and derivatives

Alternative Parents

Substituents

Molecular Framework

Aromatic heteropolycyclic compounds

External Descriptors

morphinane alkaloid, organic heteropentacyclic compound (CHEBI:7459)

Affected organisms

UNII

36B82AMQ7N

CAS number

465-65-6

InChI Key

UZHSEJADLWPNLE-GRGSLBFTSA-N

InChI

InChI=1S/C19H21NO4/c1-2-8-20-9-7-18-15-11-3-4-12(21)16(15)24-17(18)13(22)5-6-19(18,23)14(20)10-11/h2-4,14,17,21,23H,1,5-10H2/t14-,17+,18+,19-/m1/s1

IUPAC Name

(1S,5R,13R,17S)-10,17-dihydroxy-4-(prop-2-en-1-yl)-12-oxa-4-azapentacyclo[9.6.1.0^{1,13}.0^{5,17}.0^{7,18}]octadeca-7(18),8,10-trien-14-one

SMILES

OC1=CC=C2C[C@H]3N(CC=C)CC[C@@]45[C@@H](OC1=C24)C(=O)CC[C@@]35O

Synthesis Reference

Bianca Brogmann, Silke Muhlau, Christof Spitzley, "Pharmaceutical preparation containing oxycodone and naloxone." U.S. Patent US20050245556, issued November 03, 2005.
US20050245556

General References

1. Weinstein SH, Pfeffer M, Schor JM, Indindoli L, Mintz M: Metabolites of naloxone in human urine. J Pharm Sci. 1971 Oct;60(10):1567-8. doi: 10.1002/jps.2600601030. [Article]

2. Jordan MR, Morrisonponce D: Naloxone . [Article]

3. Rzasa Lynn R, Galinkin JL: Naloxone dosage for opioid reversal: current evidence and clinical implications. Ther Adv Drug Saf. 2018 Jan;9(1):63-88. doi: 10.1177/2042098617744161. Epub 2017 Dec 13. [Article]

4. Papathanasiou T, Springborg AD, Kongstad KT, Staerk D, Moller K, Taylor BK, Lund TM, Werner MU: High-dose naloxone, an experimental tool uncovering latent sensitisation: pharmacokinetics in humans. Br J Anaesth. 2019 Aug;123(2):e204-e214. doi: 10.1016/j.bja.2018.12.007. Epub 2019 Jan 18. [Article]

5. Kumar K, Singh SI: Neuraxial opioid-induced pruritus: An update. J Anaesthesiol Clin Pharmacol. 2013 Jul;29(3):303-7. doi: 10.4103/0970-9185.117045. [Article]

6. FDA Approved Drug Products: Kloxxado (Naloxone) Nasal Spray [Link]

7. Caymen Chemical: Naloxone MSDS [Link]

8. International Pharmacopoeia: Naloxone Hydrochloride [Link]

9. FDA Approved Drug Products: Narcan (Naloxone) Injection (Discontinued) [Link]

10. FDA Approved Drug Products: Suboxone (Buprenorphine, Naloxone) Sublingual, Buccal Film [Link]

11. FDA Approved Drug Products: Zubsolv (Buprenorphine, Naloxone) Sublingual Tablet [Link]

12. British Columbia CDC: Administration of Naloxone [Link]

13. FDA Approved Drug Products: Narcan (Naloxone) Nasal Spray [Link]

14. DailyMed: Lifems (Naloxone Hydrochloride) Kit [Link]

15. Dailymed: Naloxone Hydrochloride Subcutaneous, Intramuscular, Intravenous Injection [Link]

16. DailyMed: Naloxone and Pentazocine Oral Tablet [Link]

17. FDA Approved Drug Products: Naloxone Hydrochloride Injection Auto-Injector (referred throughout as NALOXONE AUTO-INJECTOR) for intramuscular or subcutaneous use [Link]

18. Kaléo News: FDA Approves Kaléo's Naloxone Auto-Injector 10 mg for the Treatment of Known or Potential Exposure to Ultra-Potent Weaponized Opioids [Link]

19. FDA Approved Drug Products: Naloxone Hydrochloride Nasal Spray [Link]

20. FDA Approved Drug Products: NARCAN® (naloxone hydrochloride) Nasal Spray [Link]

External Links

MSDS

Clinical Trials

Manufacturers

Packagers

Amphastar Pharmaceuticals

A-S Medication Solutions LLC

Bristol-Myers Squibb Co.

Bryant Ranch Prepack

Cardinal Health

Dispensing Solutions

Diversified Healthcare Services Inc.

Endo Pharmaceuticals Inc.

General Injectables and Vaccines Inc.

Hospira Inc.

Lake Erie Medical and Surgical Supply

Letco Medical Inc.

Mallinckrodt Inc.

Mckesson Corp.

Nucare Pharmaceuticals Inc.

Physicians Total Care Inc.

Reckitt Benckiser Inc.

Southwood Pharmaceuticals

Stat Rx Usa

Dosage Forms

Prices

DrugBank does not sell nor buy drugs. Pricing information is supplied for informational purposes only.

Patents

State

Solid

Experimental Properties

Predicted Properties

Predicted ADMET Features

ADMET data is predicted using admetSAR, a free tool for evaluating chemical ADMET properties. ( 23092397)

# data[].attributes.attachment_link.description
Naloxone is an opioid receptor antagonist used to rapidly reverse an opioid overdose. Also included in some drug formulations as an abuse deterrent to prevent injection.

# data[].attributes.body
As an observer, the following goals are important while caring for unconscious patients, who have low RR, Suspicious drug overdose, and diabetic background.

Do A-G assessment- prioritize the first concern

Refer to clinical notes if available

Critically analyse why intervention is required

# data[].attributes.body
ISBAR- Learn to hand over the most key details during the handover.

Administration of Naloxone for drug overdose-

why- as an opioid antagonist.

can be administered via different routes (nasal spray, IV injections, infusion, and sub cut).

# data[].attributes.body
Had to complete the following as the pre-word before starting the placement in the Hematology ward;

Read on cancer and blood disorder cancer.

# data[].attributes.headline
Assessment 2- Professional Portfolio Part A

# data[].attributes.subject
Assessment 2- Professional Portfolio Part A

# data[].attributes.body
The first week of placement was all about getting oriented to the ward and learning about the policies and procedures.

Started the placement with one patient load.

Met CLN and did the following;

-Discussed on the nursing standards from 1-7.

-Did ISBAR for one patient

# data[].attributes.body
Need to increase the patient load to two.

Continue learning about pathophysiology and anatomy.

Continue learning about policy and procedures.

# data[].attributes.body
Discussion about implicit bias and some of the examples of implicit bias in the health sector, such as;

White privileges.

# data[].attributes.body
Research -reading about nursing care plan about mental health

# data[].attributes.body
Take home learning from the pre-learning, simulation, clinical and seminar.

Diabetic ketoacidosis (DKA) occurs when there is a severe insulin deficiency, leading to hyperglycemia, ketosis, and metabolic acidosis.

The following assessment are required to be carried out for DKA.

A-G assessment, which includes of Vital Signs: To assess hemodynamic status. Tachycardia, hypotension, and Kussmaul respirations (deep, labored breathing) may indicate the severity of DKA.

Neurological assessment: Perform regular neurological assessments (e.g., Glasgow Coma Scale to detect signs of altered mental status or cerebral edema, a rare but serious complication of DKA.

Blood Glucose Monitoring: Continuously monitor blood glucose levels (typically every hour or more frequently in severe cases) to track the effectiveness of insulin therapy and avoid rapid changes in glucose levels, which can lead to complications.

Urine Ketones and Blood Gases analysis: Check for ketonuria or ketonemia, and monitor blood gases (e.g., arterial blood gas [ABG] analysis) to assess the degree of metabolic acidosis. A low pH, low bicarbonate, and elevated anion gap indicate acidosis.

Electrolytes and Renal Function: Monitor serum electrolytes (particularly potassium, sodium, and chloride), as DKA can lead to electrolyte imbalances. Hypokalemia can occur as insulin therapy begins. Renal function (BUN, creatinine) should also be evaluated.

Management of DKA

Immediate Fluid Resuscitation

Fluid Replacement: Initiate fluid resuscitation immediately to restore circulating volume and correct dehydration.

Ongoing Monitoring: Monitor fluid status by FB Chart to assess urine output, skin turgor, mucous membranes, blood pressure, and heart rate. Patients are often severely dehydrated in DKA, so fluid balance is crucial.

Insulin Therapy: IV Insulin Administration: Begin continuous intravenous insulin infusion to reduce blood glucose levels and suppress ketogenesis.

Electrolyte Monitoring and Replacement: Potassium: Close monitoring of potassium levels is crucial, as insulin therapy and rehydration can cause a rapid shift of potassium into cells, leading to hypokalemia.

Acidosis Management: Bicarbonate Therapy: Bicarbonate therapy is generally not indicated for mild to moderate DKA but may be considered in severe acidosis (pH < 6.9) to prevent cardiovascular collapse. If used, it must be administered carefully with close monitoring of blood gases.

Patient Education and Discharge Planning: Education on DKA Prevention:

# data[].attributes.body
Learn to provide the critical rationale behind every action. For example: if I am changing the position of the patient, then I need to justify why I am changing the position. In the case of Avery, we have to change the position to the front to evaluate the tache and to look for any obstruction. Likewise, I need to learn to critically analyze the situation and provide the rationale for action.

# data[].attributes.body
Understanding about the policy and guidelines in Canberra about the mental health support network.

# data[].attributes.attachment_link.description
The Mental Health Act 2015 is the law that says in what circumstances you can be assessed, treated, cared for and supported, if you have a mental illness or mental disorder.

# data[].attributes.attachment_link.title
How can I de-escalate a situation when someone is angry or agitated?

# data[].attributes.attachment_link.description
It is not your job to stop the person being angry, but these steps may help to make the person feel calmer. It is only then that you can look at how to deal with the situation and their concerns.

# data[].attributes.attachment_link.description
"In trauma-informed services, trauma survivors are seen as unique individuals who have experienced extremely abnormal situations and have managed as best they could". (Dr Cathy Kezelman)

# data[].attributes.attachment_link.readable_text
See also

Burns - Post Acute Care and Dressings

Key Points

1. Burn injuries should be managed as a Trauma case requiring primary and secondary survey

2. Accurate Total Body Surface Area (TBSA) estimation is essential for fluid resuscitation decision making. TBSA does not include epidermal burns

3. Ensure adequate analgesia to facilitate assessment and patient comfort

4. Appropriately consented photographs of the burn are very helpful for assessment and monitoring

Background

Specific features in children with burns

Children have thinner skin than adults, predisposing them to a deeper burn for any given temperature

Assessment of burn depth is difficult, especially early post injury

Young children are at risk of hypothermia, especially during initial cooling of the burn

Burns are described as epidermal, dermal (superficial/mid/deep) and full thickness

Assessment

History of burn

Time of injury

Mechanism of injury, including circumstance for specific pattern of burn

Scald: estimated temperature and nature of the liquid

Contact: estimated temperature and nature of the surface

Friction

Flame / explosion: product that burned/exploded, location (enclosed vs. open space); duration of exposure, inhalation injury

Electrical: voltage, type of current (AC or DC), duration of contact

Chemical: type of product

Cold: direct contact with cold surface or exposure (frostbite)

Radiant: sunburn

First aid

Time started (was it within 3 hours and maintained)

Agents used

If clothes and jewellery were removed

Decontamination method (for chemical exposure)

Consider co-existing non-burn injuries

Consider non-accidental injury or vulnerable child

Tetanus status

Examination and initial management

Like all traumas paediatric burn assessments require a primary and secondary survey with the initial aim of identifying and managing immediate life threats: do not get distracted by the burn injury.

Airway

Signs of airway burn/inhalation injury: stridor, hoarseness, black sputum, respiratory distress, singed nasal hairs or facial swelling

Sign of oropharyngeal burn: soot in mouth, intraoral oedema and erythema

Significant neck burn

If above present, consider early intubation

If suspicion of airway burns or carbon monoxide intoxication apply high flow oxygen

Protect the cervical spine with immobilisation if there is associated trauma

Breathing

Full thickness and/or circumferential chest burns may require escharotomy to permit chest expansion

Circulation

If early shock is present, consider causes other than the burn

IV fluid resuscitation as required

IV or IO access (preferably 2 points of access)

For circumferential burns check peripheral perfusion and need for escharotomy

Disability

If altered conscious state, consider airway support

Assess neurovascular status if limb involved

Exposure - burn assessment and initial management

Assessment of burn depth

Burns are dynamic wounds, it is difficult to accurately estimate the true depth and extent of the wound in the first 48-72 hours

Do NOT include area with epidermal burn (erythema only)

Assessment of TBSA

Expose whole body - remove clothing and log roll to visualise posterior surfaces

Use Lund & Browder Chart

The palmar surface of the child's hand (including fingers) represents approximately 1% TBSA and can be used to approximate TBSA

First aid

Remove jewellery and clothing in contact with burn source

Cool affected area as soon as possible (within 3 hours from time of burn) for 20 minutes with cool running water

If unavailable, other options include: frequently changed cold water compresses, immersion in a basin, irrigation via an open giving set

Never apply ice and avoid use of hydrogel burn products

Cover burn with plastic cling film lengthways along the burn (do not wrap circumferentially)

Do not apply plastic cling film to face (use paraffin ointment)

Do not apply plastic cling film to a chemical burn

Discuss chemical burn decontamination with Poisons Information (Tel: 131126)

Appropriately consented photos of burns prior to dressings are useful for ongoing management

Prevent hypothermia

Remove wet clothes/dressings after initial cooling

Try to keep child otherwise warm

Cover the wound and the child after assessment

When possible, warm intravenous fluids and the room

Fluid management in burns ≥10% TBSA

The Modified Parkland Formula provides a guide to resuscitation fluids to compensate for excess fluid losses in the first 24 hours after burn

Calculate requirements from time of the burn, not time of presentation

Calculate resuscitation fluid requirements using Modified Parkland Formula (see below)

Hartmann's Solution is the fluid of choice - if unavailable, use 0.9% sodium chloride

Insert urinary catheter for strict fluid balance

Keep nil by mouth and consider nasogastric tube - gastric ileus is a potential complication

Prescribe intravenous maintenance fluids (seeIntravenous fluids) until tolerating adequate oral/enteral intake

Patients with delayed fluid resuscitation, electrical conduction injury and inhalation injury have higher fluid requirements. Discuss with specialist team

Analgesia

Especially during cooling, dressing and mobilisation. See Acute Pain Management

Appropriate initial choices include intranasal fentanyl or IV morphine

Initial investigations

Burn wound management

General burn management

Limit debridement to wiping away clearly loose/blistered skin

De-roof blisters with moist gauze or forceps and scissors if >5mm or crossing joints. See blister management

Clean burn wound and surrounding surface with saline or water

Reassess burn, take photos with appropriate consent

Apply appropriate occlusive non-adherent dressing. If these products are not available, refer to local Burns service for alternative options

If there is anticipated delay or time until definitive care, consider use of multiple layer BactigrasTM

Facial and perineal burns

Epidermal or superficial dermal

Apply white soft paraffin twice daily after cleaning face
Chloramphenicol ointment to eye and ear burns
Perineal burns are at risk of contamination - after bowel action, area should be cleaned with soapy solution; consider catheterisation

Mid or deep dermal

Consider silver-impregnated dressing (discuss with Burns service)

Other body regions

May not require dressing
Consider covering with protective, low-adherent dressing (eg Mepitel TM, Melolin TM, Bactrigras TM) for comfort

Mid or deep dermal

Dressing product used depends on the expected duration required before removal or wound review

Consider consultation with local paediatric team when

Suspected non-accidental injury, self-inflicted burns or assault

Multiple co-morbidities

Concern regarding ability to care for burns at home

Consider transfer when

Child requiring care beyond the comfort level of the hospital
Following burns:

>10% TBSA

All full thickness

Special areas: face, ears, eyes, neck, hands, feet, genitalia, perineum or a major joint, even if <10%

Circumferential

Chemical

Electrical

Associated with trauma and/or spinal cord injury

All inhalation/airway

Children <12 months

For emergency advice and paediatric or neonatal ICU transfers, see Retrieval Services

Special considerations

Circumferential deep burn (deep dermal or full thickness)

Neurovascular compromise
Elevate part of limb distal to burn
Monitor colour, capillary refill time, temperature
Escharotomy may be required

Nurse head up to reduce swelling and oedema

Ocular burns (See Acute eye injuries in children)

Signs include blepharospasm, tearing, conjunctivitis
All facial burns should have assessment with fluorescein 2% eye drops to assess for corneal damage
Treat with copious irrigation using 0.9% sodium chloride with topical anaesthetic in eye (unaffected eye upwards)

Up to 1 hour with acidic contamination or until pain stops

Up to 2 hours with alkaline contamination or until pain stops

Topical chloramphenicol to prevent secondary infection
Urgent paediatric ophthalmology review

Suspicion of associated Carbon monoxide (CO) poisoning, Cyanide poisoning

Liaise early with Paediatric Burn Unit, Intensive Care and Poisons Information (Tel: 131126)

Liaise early with Paediatric Burn Service and Intensive Care
Inspect for entrance/exit wounds
Consider spinal precautions
Risk of dysrhythmias - consider 24 hours ECG monitoring
Monitor for elevated CK, urine haemoglobin and haemochromogen

Chemical burns

Personal protective equipment for first aid givers should be worn (gloves, mask, gown, eye protection)

Remove contaminated clothing

Brush powdered agent off skin

Areas in contact with chemical should be irrigated with cool water

Irrigate to floor with appropriate drainage so contaminated water does not cause further injury

Tetanus prone wounds

Parent information

Burns - medical treatment
Burns - prevention and first aid
Burns - rehabilitation

Additional notes

See individual State Burns and Trauma clinical information and mobile phone applications

Last updated June 2020

# data[].attributes.attachment_link.description
Burns - Post Acute Care and Dressings Burn injuries should be managed as a Trauma case requiring primary and secondary survey Accurate Total Body Surface Area (TBSA) estimation is essential for fluid resuscitation decision making.

# data[].attributes.attachment_link.readable_text
See also

Acute pain management

Acute pain management (RCH only)

Indications for use

Initial analgesia for children aged 1 year and older, in moderate to severe pain, with

Fractures and dislocations

Burns

Major lacerations

Painful procedures under nitrous oxide

Contraindications

Known fentanyl hypersensitivity

Altered conscious state - Sedation Score >2

Bilateral occluded nasal passage

Epistaxis

Prescribing Restrictions

Requires approval by Consultant/Fellow

Dose

Use 100 mcg/2 mL strength fentanyl solution for intravenous use

First dose - 1.5 mcg/kg dose

A second dose may be administered 10 minutes after the first to provide adequate analgesia - 0.75 - 1.5 mcg/kg

After 2nd dose, if further analgesia is required, review and consider alternative or additional analgesia

Dosage schedule

Note: Volumes have been rounded to the nearest 0.05 mL

Administration

Draw up appropriate dose for weight (see table below) plus 0.1 mL extra to the first dose (to account for the dead space in the device)

Attach Mucosal Atomiser Device (MAD300) on to the end of the syringe

With the child sitting at approximately 45 degrees or with head to one side, insert the device loosely into the nostril and press the plunger quickly

Dose should be divided between nostrils

Note: Do NOT draw up 0.1 mL extra for second dose when re-using the delivery device (MAD)

Patient monitoring

All patients require documented baseline pain score (Faces or Visual Analogue as age appropriate) and baseline sedation score.

Patient's receiving intranasal fentanyl will be monitored like a patient receiving IV or IM opioids such as morphine (RCH Children's Pain Management Service Guidelines):

Baseline set of observations prior to drug administration.

The patient should be awake or easily roused to voice prior to each dose.

Heart rate, respiratory rate, oxygen saturation, pain score & sedation score every 5 minutes after administration. If sedated or abnormal vital signs, inform treating physician and continue observations and sedation scores until return to baseline.

After the last dose has been given, two further sets of observations at 5 minute intervals should be completed.

The effectiveness of the analgesia should be recorded in the patient's medical record and/or on the general observation chart.

Side effects

Side effects are uncommon, but may include:

Respiratory depression

Hypotension

Nausea and vomiting

Pruritis

Chest wall rigidity (only reported in large intravenous doses)

Treatment of overdose includes:

Airway support and oxygen

Assist ventilation

Consider Naloxone bolus 0.1 mg/kg IM or IV, maximum 2 mg

# data[].attributes.attachment_link.description
Acute pain management Acute pain management (RCH only) Initial analgesia for children aged 1 year and older, in moderate to severe pain, with Fractures and dislocations Burns Major lacerations Painful procedures under nitrous oxide Known fentanyl hypersensitivity Altered conscious state - Sedation Score >2 Bilateral occluded nasal passage Epistaxis Requires

# data[].attributes.body
Participating in the burn simulation case.

# data[].attributes.body
Practicing the administration of intranasal fentanyl and practicing the modified parkland formula to administer IV Fluid resuscitation for patients with burns.

# data[].attributes.body
Learning about the burn wound assessment, and management.

# data[].attributes.body
Take home message from burn lesson;

Management of burn wound

-Cool the burn for 20 minutes under cool running water (to prevent burns in surrounding tissues).

-Avoid hypothermia

# data[].attributes.body
Reading about workplace injury

# data[].attributes.body
Discussion on the escalation when the patient is agitated.

Similarly, we discussed trauma-informed care and the team involved in trauma-informed care.

# data[].attributes.body
Discussed the different functions or responsibilities of the multi-disciplinary team.

# data[].attributes.body
Take home message

Fundamental principles of Trauma-Informed Care include:

1. Safety: Ensuring the patient feels physically and emotionally safe.

2. Trustworthiness and Transparency: Building trust through transparency in actions and decision-making processes.

3. Collaboration and Mutuality: Emphasizing partnership between providers and patients, leveling power differences.

4. Empowerment, Voice, and Choice: Promoting Pt strength and autonomy by involving them in their care decisions.

5. Cultural, Historical, and Gender Issues: Recognizing and addressing the cultural and societal contexts that impact Pt's experience of trauma.

Trauma-informed care involves being sensitive to the possibility that a patient has a history of trauma and avoiding practices that could unintentionally trigger traumatic responses.

# data[].attributes.body
https://www-sciencedirect-com.ezproxy.canberra.edu.au/science/article/pii/S1472029919300888?via%3Dihub

https://www-sciencedirect-com.ezproxy.canberra.edu.au/science/article/pii/S1751722217300902?via%3Dihub

# data[].attributes.body
Case study

Sam Green,

who has fallen and biba to ED

Chest wall fractures and head injury,

bruising,

deteriorating,

vitals are unstable.

# data[].attributes.body
Same case study

1. Practice Primary survey (A-G)

2. Secondary Survey (head to toe, neuro, abdominal, and pain assessment)

3. Chili Challenge

# data[].attributes.body
Case study 2.

Workplace injury

-intervention and assessments

# data[].attributes.body
When dealing with workplace injuries in a nursing context, prioritizing care involves several critical steps to ensure the safety and well-being of the injured individual.

Primary Survey (A-G):

Pain Assessment:

Immobilization:

Control Bleeding:

Wound Care:

Fracture Management:

Referral for Specialist Care:

Support for Stress or Trauma:

# data[].attributes.body
Good communication skills are the key to settling, resolving, and de-escalating a situation.

Staying calm; anger may be a sign that the person is in distress, experiencing fear or frustration.

Listen to what the issue is and the person's concerns.

Offer reflective comments to show that you have heard what their concerns are.

Wait until the person has released their frustration and explained their feelings.

Look and maintain appropriate eye contact to connect with the person.

Incline your head slightly to show you are listening and give you a non-threatening posture.

Nod to confirm that you are listening and have understood.

Express empathy to show you have understood.

# data[].attributes.body
Nursing Care Plan for Burn

Assessment for Burn injury.

Burn Depth: Superficial, partial-thickness, or full-thickness burns.

Burn Area: Use the Rule of Nines or Lund and Browder Chart to estimate the percentage of the body affected by burns.

Vital Signs: Monitor for signs of shock (e.g., tachycardia, hypotension) in severe burns.

Fluid Balance: Assess for signs of dehydration or fluid overload.

Pain Assessment: Use pain scales to evaluate pain intensity regularly.

Psychosocial: Assess the patient’s emotional response, including anxiety, depression, or post-traumatic stress.

Nursing care plan

Impaired Skin Integrity

Perform daily wound care using aseptic technique.

Proper wound care prevents infection and promotes healing

Use appropriate dressings (e.g., hydrocolloid, alginate) based on the wound stage.

Dressings help manage exudate and protect the wound from contamination.

Acute Pain

Administer analgesics

Pain control improves patient comfort and facilitates participation in care.

Risk for Infection

Maintain a clean, sterile environment during wound care and dressing changes.

Infection control practices reduce the risk of wound contamination.

Deficient Fluid Volume

Administer IV fluids based on the patient's fluid loss (using formulas

Fluid resuscitation replaces lost fluids, preventing hypovolemia and shock.

Monitor urine output hourly (target > 0.5 mL/kg/hr for adults).

Urine output is a crucial indicator of adequate fluid resuscitation.

Monitor electrolytes and replace them as needed (e.g., potassium, sodium).

Burns can cause electrolyte imbalances, which must be corrected to maintain physiological stability.

Impaired Physical Mobility

Encourage passive and active range-of-motion exercises when possible.

Maintaining mobility prevents contractures and muscle atrophy.

Collaborate with physical and occupational therapists for rehabilitation planning.

Early rehabilitation promotes mobility and prevents long-term disability.

Impaired Gas Exchange (if applicable for severe burns)

Assess for signs of inhalation injury (e.g., soot around the mouth, singed nasal hair, hoarseness).

Maintain adequate oxygenation and ventilation.

Disturbed Body Image

Provide emotional support and encourage verbalization of feelings regarding changes in appearance.

Support emotional adjustment to body changes.

Anxiety

Provide clear explanations about procedures and expected outcomes

Reduce anxiety and promote coping mechanisms.

# data[].attributes.body
Early recognition of a deteriorating patient is crucial in preventing serious complications, reducing mortality, and improving patient outcomes.

Nurses are pivotal in identifying subtle changes in patient conditions and initiating timely interventions. Check the policy and guidelines of the concerned agency or facility about the escalation of care for deteriorating patients.

Some key points to note while noting deteriorating patients.

Early recognition of changes in vitals during A-G assessments or any other assessments (e.g., altered vital signs, confusion, reduced urine output) allows for prompt interventions before the patient’s condition worsens, e.g., changes in the Modified Early Warning Score (MEWS).

Timely Interventions: Initiating interventions such as administering oxygen, fluids, medications, or escalating care to a higher level can reverse or stabilize the patient’s condition.

Escalation of care to senior nurses, physicians, or specialized teams (e.g., rapid response teams or critical care outreach teams) to provide immediate assessment and treatment of deteriorating patients, reducing the time to definitive care.

Timely Communication: Nurses are at the bedside and are often the first to notice subtle signs of deterioration. Early communication of concerns to the healthcare team is vital in ensuring prompt escalation. Clear, concise, and assertive communication using frameworks like ISBAR- to hand over the key and priority issue instead of all the details about the patient.

The clinical rationale is essential for any intervention and for prioritizing nursing care plans as and when they observe changes that may not align with normal parameters but are significant for that patient (e.g., a deviation from baseline trends).

Frequent Reassessments: Continuous reassessment after interventions is crucial in determining whether the patient is improving or if further escalation is required.

Providing information and seeking consent from the patient is key. Nurses are patient advocates, and if a patient’s condition is deteriorating, they must ensure that appropriate care is provided, even if this means escalating the situation to higher levels of authority or medical staff.

Collaborative Decision-Making: While providing care, any clinical decision has to be consented to by the patient, and all care plans with rationale have to be informed to the patient to provide patient safety and autonomy.

# data[].attributes.body
The class was divided into 3 teams, and each team had to work on the prioritisation of care depending on the case scenario and provide a rationale for choosing the patient.

# data[].attributes.body
The class was divided into two groups, and each had to nominate a team leader and auditor. The remaining team members were allocated to patients, and roles were changed with ISBAR. The clinical situation involved a team leading the ward, experiencing infection outbreaks and deteriorating patients.

Practiced

Identifying prioritisation of care for the patients based on A-G assessment.

Infection precaution and safety control

ISBAR

NG tube insertion

Escalation of care

# data[].attributes.body
Practice and review of clinical viva rubric and markings.

Case Study:

Lucas- 10 yr old type 1 diabetic

ed

symptoms: increasing fatigue,frequent urination, excessive thirst, more irritability, feeling nauseated.

fruit smell, breathing rapidly. BGL-15mmol/L missed a dose or two in school.

Assessment at ED

Kussmal respirations

Pain 6/10

Tachycardia, mildly hypotensive, cap refill 4 secs,

Finger BGL 22 mmol/L,

Urine dipstick is positive for ketones

# data[].attributes.body
Prioritisation of the nursing care plan can be identified by using assessments such as A-G assessment, life-threatening, high-risk risk and critical patent.

While providing care plan, it is essential to refer for NFR of patients or the agency's policy about escalating the care plan.

It is essential to refer to the Agency's policy and guidelines regarding infection outbreaks while providing care plans, such as the Agency's policy about gastro outbreaks in aged care.

Clinical viva rubric review

Critical thinking is needed to determine a nursing care plan ( providing a rationale for why it is required and why not, pathophysiological understanding of signs and symptoms, and associating with evidence).

-Complex medication management

How, why, what, safety orders, and side effects.

-Prioritisation of care

Able to identify the prioritisation of care based on AG assessment.

Provide rationale.

# data[].attributes.headline
Assignment 2- Professional portfolio (Part B)

# data[].attributes.subject
Assignment 2- Professional portfolio (Part B)