Burns and ER care
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| injury to the tissues are caused by what things; amount of damage is influenced by what | heat, chemical, electric current, radiation; temperature, duration ofconact, type of tissue injured
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| who is mist likely to die bc of burns | children <4 and adults >65
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| how much we damage the tissue depends on what | how long tissue exposed, the degree of injury and the type of tissue damaged
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| thermal burns: what are the sources of thermal burns; TX: what should we flush with; when should we seek medical help; | flame, contact, scald, flash; cool water- not ice; when brn is more then superficial
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| chemical burns: what are the sources of chemical tissue injury and destruction; what are frequent causes of injury; the injury can continue after exposure for how long | acids, alkalis, organic compounds; skin, eyes, resp, liver, kidney, 72 hrs
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| chemical burns: tx- what should be diluted; what should we flush with with closed skin; what should we flush with with open skin and eyes; what should be removed; who should be contacted and what should be reviewd | chemical; area with water; NS; contaminated clothing; poisin control, MSDS
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| ELectrical Burns: what is the source of these burns; what happens to proteins r/t heat; why do the proteins coagulate; the coagulation of proteins causes what; | direct or alternating current or lightening; they coagulate; b/c intracellular environment is baked; necrosis;
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| ELectrical Burns: there is direct damage to what; the damage to nerves and vessels cause what; severity depends on what; | nerves and vessels; tissue anoxia; voltage, tissue resistance,current pathways, contact surface area, time exposed
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| ELectrical Burns: tx- what do we need to assess first; we need to consider what other injury; why do we need to consider a C-spine injury; assess what; check for what 2 wounds; these ppl usually are edmitted where | ABCs; C-spine injury; b/c there usually is a fall involved; severity; entry and exit wounds; the burn center
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| what is the iceberg effect; | there is a hhuge amount of damage under the surface with certain burns that we cannot see
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| ELectrical Burns: what can occur within the first 24 hours; why is pt at risk for dysrhythmias and cardiac arrest; what lyte is circulating outside of the cells too much | dysrhythmias, cardiac arrest; b/c the environmental balance is disturbed between the intracellular and extracellular space; K+
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| ELectrical Burns: what abnormal ABG is person at risk for; why does pt have myoglobinurea; why is there acute renal failure | metabolic acidosis; this is bc of acute tubular necrosis and ARF; b/c the myoglobin is circulating in the body
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| radiation burns: what are the sources of radiation burns; is skin intact; is it painful; what other damage can pt suffer from; how can we prevent this; what is tx; | sun, tanning beds, Xrays, radiation exposure; yes; yes; internal damage; shielding, exposure , maintain distance from radiation source; topical tx
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| frostbite: what happens to peripheral BVs; what happens to the tissue; when tissue freezes does this increase or decrease blood flow; when there is decreased blood flow and vasoconstriction this causes venous _____ | they vasocontrict; it freezes; decrease blood flow; stasis
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| frostbite: tx- what should be removed; what type of water should pt frostbitten area be immersed in; what needs to be managed; why is pain an issue | constrictive clothing or jewelry; warm water 102-108 degrees; pain; lots of nerve damage
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| burn injury: inhalation-carbon monoxide poisoning: carbon monoxide takes the place of ___ on the hemoglobin; the displacement of oxygen equals what; this displacement is termed as what; what will skin look like; tx | 02; hypoxia, death; carboxyhemoglobinemia; cherry red; 100% O2
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| burn injury: inhalation w/ injury above the glottis- this is thermally produced from what; a mechanical obstruction can occur from mucousal burns where; s/s that this may have occured | hot air, steam, or smoke; in the oropharynx and larynx; facial, chest or neck burns, singed nasal hair, hoarse, painful swallowing, blackened sputum or if pt trapt in enclosed area
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| burn injury: inhalation w/ injury below the glottis- the amount of injuy is r/t the ___ of exposure; what serious thing can occur; pulmonary edema leads to what; when is the onset of pulmonary edema; | length; pulmonary edema; ARDS; late 12-24hours after
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| severity of burn: determined by what 4 things; what are the 3 different depths of burns; extent of burn is determined by what %; | depth,extent, and location of burn, and pt risk factors; epidermis, dermis, subq; % total body surface area burned TBSA
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| depth of burn: an epidermis burn effects what; a dermis burn effects what; def subq | superficial partial thickness; the deep partial thickness 1st degree and 2nd degree; this is full thickness
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| depth of burn: def superficial partial thickness burn; def deep partial thickness; def full thickness; | involves the epidermis; involves the dermis; involves fat, possibly muscle and bone
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| superficial partial thickness burns: what is the depth; what are the causes; what is the appearance; when could is possibly blister; is tactile sensation intact; what is pain; does it effect nerves; how long to heal | epeidermis; sunburn, steam, heat flash, open flame, hot food or liquid; erythema, mild edema, blanchable, no vesicles; after 24 hours; yes; mod to severe tenderness; yes; 3-7 days no scarring
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| deep partial thickness: depth; causes; appearance; what is pain; pt is hypersensitive to what; how long to heal; can pigment change afterwards | dermis; flames, contact, flash/scald, chemical, tar, electric current; fluid filled vesicles, skin mottled, blanchable, mild to mod edena; mod to severe; touch or air; 7-21 days; yes
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| full thickness burn: depth; causes; appearance; is it blanchable; pain; why no pain; healing time; is there scarring | subcutaneous-can involve muscle, tendons and bones; flame/scald, chemical, tar, electrical; dry, leathery, hard, waxy white, dark brown, or charred, strong burn odor, visible thrombosed vessels; no; absence of pain; b/c nerve endings destroyed; 21 days;
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| full thickness burn: is there scarring; why is grafting needs; | yes; skin reproducing cells in dermis are destroyed9
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| extent-% total BSA: rule of 9s: what is head %; arms; from of chest; back of body; groin; legs; | 9%; 18%; 9%; 1%; 18%; 18%
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| extent: rule of 9s: when is pt transferred to the burn center; when is adult rule of 9s used; | what % of burns is > 10%; when pt is >1 yo
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| burn location: what areas of the body burned are at risk for respiratory obstruction; what areas of body burned put pt at risk for self care and functional loss; | face, neck, chest; hands, feet, joints, eyes;
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| burn location: circulferential burns- when this type of burn happens on the extremities this causes circulatory compromise where; if this type happens in the chest what issues can pt have; why can this cause compartment syndrome; | distal to the injury; difficulty with chest expansion/respirations; when we have swelling indife the leg we cause pressure to the inner layers of muscle;
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| compartment syndrome: what separate groups of muscles in the arms and legs from each other; inside each layer of fascia is what; this confined space is aka; the compartment include what components; so fascia surrounds these structures like __ surrounds wi | the fascia; a confined space; a compartment; muscle, tissue, nerves and bv; insulation
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| compartment syndrome: does fascia expand; any swelling in the compartment leads to increased pressure on what; if this pressure is high enough what can be blocked; the block of blood flow can lead to permanent injury where; | no; muscle, bone, BVs and nerves; blood flow to the compartment; to the muscle and nerves;
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| compartment syndrome: if pressure is long enough what can happen; what is the hallmark s/s of this; other s.s; | the muscle may die and the limb may need to be amputated; severe pain that does not go away when you take a pain med or raise the affected area; decreased sensation, paleness of skin, severe pain that gets worse, weakness;
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| compartment syndrome: tx- what is needed; what type of surgery; how long are the wounds left open; what is done if cast is the cause; | surgery; long surgical cuts are made through the fascia to relieve the pressure; 48-72 hours; the dressing should be loosened/ cut to relieve pressure;
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| compartment syndrome: how is the outlook; when does permanent nerve injury and loss of muscle function occur; ____ hours of compression can cause permanent nerve injury | with prompt tx it is excellent; if the dx is delayed; 12-24 hrs
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| risk factors outcomes for burns: ages; what preexisting conditions; why is DM an issue; | older, youngers; CV, resp, renal disease, dm, MALNUTRITION; causes poor healing and gangrene;
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| what are the phases of burn management | rehospital care, emergent phase, acute phase, rehabilitation phase
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| phases of burn management: prehospital care- what are priorities; small thermal burns <10% TBSA should be covered with what; | remove person from the source of the burn, stop the burning process, protect rescuers from injury; a damp towel;
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| cooling burn with in __ minute/s helps minimize what; | 1 min, the depth of the injury
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| phases of burn management: prehospital care- what burns do we need to focus on ABCs; what to check for airway; what to check for breathing; what to check for circulation; | larger burns of electrical burns; patency, soot, singed nasal hair, dark membranes; adequacy of ventilation; pulses/ elevate burned limb
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| phases of burn management: prehospital care- when cooling area what should we not use; what should we do with clothing; what should be done with chemical burns; | ice; remove if able; remove solids, clothing and flush;
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| phases of burn management: prehospital care- carbon dioxide intoxication is treated with what; with what burn do we want to immobilize spine; | 100% O2; electrical burns- b/c they may have fallen;
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| phases of burn management: emergent phase- life threatening effects of burn can occur how long after burn; what are the 2 primary concerns; when does this phase end | 72 hours after burn; onset hypovolemic shock and edema formation; when fluid moves back to vasculature and diuresis begins again;
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| phases of burn management: emergent phase- what is the greatest threat to pt; | hypovolemic shock
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| phases of burn management: emergent phase- hypovolemic shock- where does fluid shift out of; where does fluid shift into; what blood components move into the interstitial space; does capillary permeability increase or decrease; | he blood vessels; the tissues; Na+,water, albumin; increases;
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| phases of burn management: emergent phase- hypovolemic shock- does colloidal osmotic pressure increase or decrease; why does colloidal osmotic pressure decrease; the decrease of colloidal osmotic pressure increases or decreases the fluid shift | decrease; b/c protein is lost; increases it
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| phases of burn management: emergent phase- hypovolemic shock- since the blood becomes "thicker" is it more or less viscous?; does Hct increase or decrease; the increase in viscosity increases or decrease PVR | more; increase it is more concentrated; increases vascular resistance
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| phases of burn management: emergent phase- hypovolemic shock- will pt have lots or little edema; is there fluid in the intravascular and intracellular space; is there an increase or decrease of insensible loss; | lots; no; increase;
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| phases of burn management: emergent phase- hypovolemic shock- what causes the increase in insensible loss; what lyses; what electrolytes move out of the cell; | from burns and resp system; the circulatory RBCs; Na+ and K+
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| phases of burn management: emergent phase- hypovolemic shock- RBC hemolysis is RT what; | circulating free radical wih burn injury, damage from burn itself thrombosis of capillaries in burned tissue;
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| phases of burn management: emergent phase- electrolyte shift- Na+ shifts where; how long does Na stay in the interstitial spaces; why does k+ shift; | the interstitial spaces; until edema formation ceases; due to release with injured tissue and RBCs
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| phases of burn management: emergent phase- hypovolemic shock- inadequate tissue perfusion is caused by what 2 things; inadequate tissue perfusion is aka | fluid shifting out of vascular space an loss of blood volume; shock
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| phases of burn management: emergent phase- hypovolemic shock- a burn increases or decreases vascular permeability; increased vascular permeability causes what 2 things | increases it; edema and decreased intravascular volume;
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| phases of burn management: emergent phase- hypovolemic shock- edema increases or decreases blood volume; decreased blood volume increases or decreases peripheral vascular resistance | decreases it in this case; increases it
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| phases of burn management: emergent phase- hypovolemic shock- decreased intravascular volume increases or decreases Hct; increases Hct increases or decreases viscosity; increased blood viscosity increases or decreases PVR; | increases it; increases it; increases
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| emergent phase- CV complications- what can happen to ht rhythm; what other potential complications; what is sludging phenomenon; | dysrhythmias; hypovolemic shck ,impaired circulation to extremities; r/t increased blood viscosity and damage to microcirculation;
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| phases of burn management: emergent phase- complications- there is a huge risk for pulmonary edema and resp distress r/t ___ | fluid therapy
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| phases of burn management: emergent phase- CV prevention and TX: what kind of IVs should be given; why should these lines be placed early in care; | peripheral large bore Central lines and art lines; bc pt will become edematous making it difficult for IV access
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| estimate fluid requirements for burn patients:what type of fluid; formula for 1st 24 hours ___ ml x ___ kg x % ___; what amount of the 1st 24 hours of fluid need to be given in the 1st 8 hours; what amount of the 24 fluid need to be given in the last 16hr | lactated ringers; 4 ml x pt wt in kg x %TBSA of burn in 1st 4 hours; 1/2 of the fluid in first 8 hours; 1/2 in remaining 16 hrs
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| estimate fluid requirements for burn patients: is lactated ringers crystalloid or colloid; is albumin crystalloid or colloid; when is albumin given; | crystalloid; colloid; when capillaries are permeable WNL from 12-24 hours;
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| estimate fluid requirements for burn patients: urine output goal is ___ ml/ kg/ hr; why do we want more urine output with electrical burns; | 0.5-1 ml/kg/hr; there is circulating myoglobin and we need to flush it through the kidneys;
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| estimate fluid requirements for burn patients: what is goal of MAP; what is goal SBP; what is goal or HR; | >65; >90; <130;
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| estimate fluid requirements for burn patients:what type of fluid; formula for 1st 24 hours ___ ml x ___ kg x % ___; what amount of the 1st 24 hours of fluid need to be given in the 1st 8 hours; what amount of the 24 fluid need to be given in the last 16hr | lactated ringers; 4 ml x pt wt in kg x %TBSA of burn in 1st 4 hours; 1/2 of the fluid in first 8 hours; 1/2 in remaining 16 hrs
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| estimate fluid requirements for burn patients: is lactated ringers crystalloid or colloid; is albumin crystalloid or colloid; when is albumin given; | crystalloid; colloid; when capillaries are permeable WNL from 12-24 hours;
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| estimate fluid requirements for burn patients: urine output goal is ___ ml/ kg/ hr; why do we want more urine output with electrical burns; | 0.5-1 ml/kg/hr; there is circulating myoglobin and we need to flush it through the kidneys;
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| estimate fluid requirements for burn patients: what is goal of MAP; what is goal SBP; what is goal or HR; | >65; >90; <130;
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| estimate fluid requirements for burn patients: why are burns elevated | to reduce edema
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| complications of the emergent phase- respiratory: upper airway injury- what is the r/t; why does this lead to mechanical obstruction; | direct thermal injury or edema; b/c of swelling in the lungs;
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| complications of the emergent phase- respiratory: lower airway injury- why is there alveolar damage; this airway damage can create ___ edema; interstitial edema prevents what | r/t inhalation of toxic fumes/smoke; interstitial edema; diffusion of O2
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| complications of the emergent phase- respiratory: why is there PNA; what can cause pulmonary edema; | r/t debilitation, flora and immobility; if there is excessive fluid replacement;
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| complications of the emergent phase- respiratory: what do we need to consider r/t burn location and exposure; intubation should be done early or late; why is O2 at 100% if pt is not intubated; how is chest compression relieved; | how does this effect the airway; early; b/c this decreases risk of CO poisoning; with escharotomies;
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| complications of the emergent phase- respiratory: what tests are done to see if there is CO poisoning; | CXR, ABG, bronchoscopy
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| complications of the emergent phase- urinary- Acute tubular necrosis: aka; what is renal ischemia r/t; what is released from damaged tissues and clogs the renal tubules; | ATN; decreased renal perfusion and hypovolemia; myoglobin and hemoglobin;
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| complications of the emergent phase- urinary: what is best fluid output goal again; what labs should be monitored; | 0.5-1 ml/ kg/ hr; BUN,creat, lyte, urine and myoglobin, CK, urine specific gravity;
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| emergent phase: pain control- what route should they be given; why should they never be given Subq or IM; | IV; b/c of the circulatory changes they will no get benefit of the med;
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| emergent phase: wound management- what type of procedure; what vaccine should be given; what type of ABX; | sterile; tetanus; topical and systemic;
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| emergent phase: what are PT and OTs responsibilities; there is a big risk for ___ bc of the hypermetabolic state; | positioning to prevent contracture and splinting; paralytic ileus
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| emergent phase: pain control- what route should they be given; why should they never be given Subq or IM; | IV; b/c of the circulatory changes they will no get benefit of the med;
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| emergent phase: wound management- what type of procedure; what vaccine should be given; what type of ABX; | sterile; tetanus; topical and systemic;
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| emergent phase: what are PT and OTs responsibilities; there is a big risk for ___ bc of the hypermetabolic state; | positioning to prevent contracture and splinting; paralytic ileus
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| when we know the emergent phase has ended: what happens to the capillary membrane; what ceases; interstitial fluid returns to where; | the permeability returns to normal; fluid loss and edema formation; the vascular space;
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| when we know the emergent phase has ended: what is urine specific gravity; does pt start to diuresis | low; yes
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| the emergent phase ends when ___ mobilization and ____ begin | fluid and diuresis
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| acute phase: when does this begin; when does it conclude; how long can it take; what is the main focus; | with mobilization of ECF and diuresis; when covered with grafts and healed; weeks or many months; wound healing and care
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| acute phase: pt begins to ___ the situation; does edema increase or decrease; does urine output increase or decrease; fluid moves back to where; are bowel sounds active or not; | grieve; decreases; increases; circulation; actve;
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| acute phase: WBCs phagocyte and what happens to wound; what sloughs; what lays collagen; after collogen is laid what begins; | it begins to heal; necrotic dead tissue; fibroblasts; glanulation;
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| acute phase: when is a graft needed; | when there is full thickness loss
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| healing: partial thickness- does it form eschar; what needs to be done to theeschar; | yes; it needsto be removed before the area can bere epithelialization;
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| healing: what thickness needs surgical debridement; what is impairative to prevent; | full thickness; infection
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| acute phase: what labs should be monitored; how or IV fluids given; | electrolytes; according to clinical response;
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| acute phase: wound care- what is a homograft; what is an autograft; | cadaver skin; own skin;
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| acute phase: what is PT/OT responsibilities; | ROM and ADLs;
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| rehab phase: when does it begin; when does this occur after injury; | when burn wounds have healed and pt is able to resume a level of self care; 3 wks - 8 months after injury;
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| rehab phase: what are the goals in this phase; what are complications in this phase; | restore function, recovery from function and cosmetic surgery; skin and joint contractures, scarring;
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| fat embolism syndrome: what is distributed into organs and tissues following traumatic skeletal injury; this is similar to what; | fat globules; a blood clot but with fat;
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| fat embolism syndrome: this is associated with what associated deaths; what fx cause this the most; other fx that can cause this; | fx deaths; long bone fx; ribs, tibia, pelvic;
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| fat embolism syndrome: what causes are the least common but can occur post procedure; | joint displacement, spinal fusion, liposuction, crush injury, bone marrow transplants;
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| fat embolism syndrome: what areas in the body can it effect; | lungs, brain, heart, kidneys, and skin;
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| fat embolism syndrome: s/s- with in how many hours does it occur after surgery; s/s are because of poor ___ exchange; what can happen in the lungs; this hemorrhagic interstitial phneumonitis causes what; | 48 hours; oxygen exchange; hemorrhagic interstitial phneumonitis; ARDS;
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| fat embolism syndrome: s/s in lungs- where is there pain; what is HR; what is RR rate; what will skin look like; what will PaO2 be; | in the lungs; tachycardic; tachypnea; cyanotic; low;
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| fat embolism syndrome: what are the changes in mental status; why is there petechiae around the neck, anterior chest wall, axilla, buccal membranesl | memory loss, restlessness, HA, confusion, increased temp, impending doom; this is rt intravascular thrombosis secondary to hypoxia
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| fat embolism syndrome: DX- where will fat cells be found; what will PaO2 be; what will EKG changes be; why is there ST segment changes; are platelets and Hct increased or decreased; | blood, urine, sputum;<60 mm Hg; St changes; bc we have hypoxia; decreased;
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| fat embolism syndrome: what is PT time long or short; what will chest xrays show; | long; infiltrates or multiple areas of consolidation - white out
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| fat embolism syndrome: how is this prevented; why do we give fluids if symptomatic; what blood gas issues are there; | careful immobilization of long bones; to prevent hypovolemic shock; resp acidosis;
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| fat embolism syndrome: what do we want to do resp wise; pt can develop what resp things | o2 and intubate; pulmonary edema and ARDS
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| Triage: what is the French meaning of the word; what pt are treated first critical or non critical; | to sort; critical;
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| fat embolism syndrome:5 level system emergency severity index (ESI): def ES1; def ES2; def ES3; Def ES4; def ES5 | unstable, seen immediately; unstable see in a few minutes; stable seen <1 hour; stable could be delayed; stable delayed
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| primary assessment: what is the assessment progression; | airway, breathing, circulation, disability, exposure/environmental control;
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| primary survey: airway with spine stabilization- ___ obstruction is cause of most immediate trauma deaths; what is airway obstruction r/t; what trauma to body causes concern for airway obstruction; | airway obstruction; saliva, bloody secretions, vomitus, trauma; larynx, face, fx, dentures, tongue, edema secondary to burns;
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| primary survey: airway with spine stabilization- what injury is at risk for airway issues; s/s of airway obstruction | seizures, anaphylaxis, near-drowning, FBO, cardiac arrest; dyspnea, unable to speak, FB in airway, trauma, SOB
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| primary survey: airway with spine stabilization TX: how should we open airway; what needs to be removed; what needs to be inserted; if unable to intubate what needs to be done | head tilt chin lift or jaw thrust if neck injury suspected; foreign body; an airway; trach
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| primary survey: breathing- ___ does not equal ventilation; breathing issues are r/t what injury; s/s of breathing issues; | airflow; rib fx; pneumothorax, penetrating injury, PE, allergy, asthma attack; dypnea, paradoxic chest wall movement, decreased breath sounds, wound, cyanosis, tachycardia, hypotension;
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| primary survey: breathing- all critically injured/ill pts have increased or decreased O2 demands; when is bagmask ventilation used; what should be treted; | increased; when resp is inadequate; underlying cause
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| primary survey: circulation- injuries that cause circulation issues; s/s of circulatory issues; | internal/external bleeding, MI, shock, hypothermia; altered mental status, delayed cap refill, dim pulses, pallor, cyanosis;
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| primary survey: circulation- when is CPR done; direct pressure should be given to what; | when there is no pulse; the bleeding;
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| primary survey: Disability- pt LOC measures degree of what; what does AVPU stand for; | disability and mental function; Alert, responsive to voice, responsive to pain, unresponse;
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| primary survey: disability- glascow coma scale has what 3 components; | eyes open, best verbal response, best motor response;
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| primary survey: exposure/environmental- what needs to be removed for complete assessment of trauma pts; what do we want to prevent loss of; tx for hypothermia; | clothing; heat; warm blankets, warmers, warmed IV fluids
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| secondary survey: this survey is done after what survey; what is done in this survey | the primary survey; VS, comfort measures, history now, inspect posterior surfaces,
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| def emergency; def mass casualty incident (MCI); | estraordinary event that requires rapid and skilled response community can manage; natural or manmade event that overwhelms the community response;
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| disaster triage: how is it done; how is the number of victims extimated; | there is a color system to treat and stabilize victims, they are doubled then the number that arrive
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| biologic terrorism agents: anthrax- how long is incubation; how does it spread; where do spores multiply; what does it damage in body; s/s of it; | 1 day-6 wks; it is inhaled; in the alveoli; hemorrhage and destruction of lung tissue; chest pain, SOB, diaphoresis, fever, cough,
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| anthrax: in the cutaneous form how does it enter body; s/s of cutaneous; | through the skin; progressive papule to ulcer, lymph involved and edema;
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| anthrax: GI- how does someone get the GI; s/s; | contaminated, undercooked meat source; intestinal inflammation/ulceration, NVD, ascites, sepsis, hematesis;
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| what type of anthrax is most common | cutaneous
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| anthrax: what is tx; what is ABX drug of choice; | ABX, cipro;
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| smallpox: how long does it incubate; how is it transmitted; is it very contagious; s/s; what is the tx; | 7-17 days; droplet or contact; yes; fever, HA, myalgia, pustules; there is no cure, vaccinations ended in 1980;
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| botulism: def; how long does it incubate; how fast can person die; how is it transmitted; is it transmitted person to person; s/s; what is the Tx; is there a vaccine; prevention | lethal bacterial neurotoxin, spore forming anaerobe; 12-36 hours; w/I 24 hours; air or food; no; abd cramping, skeletal muscle paralysis, NVD, antitoxin, supportive care; no; boil
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| plague: what is the most common; what is the cause; what is incubation; how is it transmitted; s/s; what is the tx; | bubonic; bacterial; 2-4 days; person to person aerosol; hemoptysis, caough, fever, resp failure, lymph swollen; immediate antibiotic;
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| tularemia: what is the cause; how long is it incubated; how is it transmitted; s/s; tx | bacterial infection; 3-10 d; aerosol, intradermal, rabbits, ticks, contaminated food/air/water; fever, pna, pleural effusion, lymph swollen, sore throat; antibiotics
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| hemorrhagic fever: what is the cause; how is it transmitted; s/s; what is tx | viral- ebola, yellow fever; rodents, mosquitoes, person-to-person per body fluids, aerosolized; conjunctivitis, HA, hemorrghage in tissues and organs, organ failure; no cure, supportive care only, strict isolation
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| chemical agents: they are classified by what; what are they; | the organ or the effect; nerve gas, blood, pulmonary, vessicants, treatment protocols vary and relate to specific agents;
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| nuclear/radiologic agents: ex; degree of illness is r/t what; | dirty bombs scatter mix of explosive and radioactive material; the degree of exposure
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| central venous catheter (CVC): where is it placed; where d;oes tip rest; what are the advantages of them; disadvantages | in a large vessel, subclavian, jugular, femeral; in the distal end of the superior vena cava; access for blood samples, decreased risk of extravasation injury, immediate access to the central venous system, long term cath use; infection, invasive
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| CVC: what can cause a cath occlusion; what to do if there is a cath occlusion; | clamped, kinked, thrombosed, up against wall; check line, instruct pt to change position, raise arms, cough, meds;
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| CVC: what to do if there is a local cath associated infection; what about a systemic infection | cultures and compress; blood culture, abx and remove
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| CVC: how does a pneumothorax occur; what to do if there is a pneumothorax | perforation of visceral pleurae during insertion; admin O2, high fowlers, prep for chest tube insertion;
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| CVC: cath migration- s/s of this; what should we do; | sluggish, edema of chest or neck with infusion, gurgling in ear, dysrhythmias; check placement, remove and reinsert;
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| CVC: embolism- why does this happen; s/s of this; tx | entry of air, thrombus, catheter breakage; chest pain, resp distress, hypoxia, cyanosis, hypotension,tachycardis; O2, clamp cath, turn on left with head down, call Dr
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| CVC: cath care- what should we assess on the site; when changing the dressing we maintain a strict what; when removingwhat is done; when removing what should we check | redness, edema, warmth, tenderness, pain and fuction; sterile technique; valsalva maneuver; the tip
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