There is always the opportunity for someone in a very severe burn to slip into shock give us an idea of of how that’s looked at registered when you know that the patient is in trouble and then what you can do from there yeah so when I think that that happens ed is and we usually anticipate these things and as one of the things that we spoken on a rule of 9 or getting a history of what happened to the patient we anticipate the patients that we know are gonna be at risk sometimes we don’t get this but most of the time we have an idea of who the patients can it be at risk is gonna be the elderly person it’s gonna be the person who has some type of medical condition and depending on the degree of burn of the surface area the burn we can anticipate who’s the person who’s gonna be in shock so the way that we treat this is a standards in a standardized approach we try to rule out that there’s no other cause of shock because a Bernie medially shouldn’t cost you shock at least not immediately this is something that could occur a couple of days but it shouldn’t happen in the first initial hours I’m have anything you expect a patient probably to be more you know his blood pressure and everything to be high cuz of the you know pain and the injury so we first the first thing we will do is assess and make sure that the patient in a standardized protocol with any type of injury will go to the airway breathing and circulation which is standardized approach for someone in the ER and then once we we covered those things and rule out other injuries and we start looking for the management of the burn and the real the reality is shock and low pressure and a burn really relates to that loss off fluid the skin and that’s an important function of the skin it’s maintaining your fluid in your body and you can imagine your burn this is open you’re gonna drain you’re gonna lose yours you’re gonna lose fluid plus the inflammation that’s happening so we treat this by giving IV fluids so based on the degree the dimension of the wound the surface area we will calculate how much fluids the patient is gonna need so there’s gonna be a higher requirement so we already anticipate and have an idea of how much fluids that patient is gonna need before we get to shock hopefully we can avoid getting to shock