Burns and ER care
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| injury to the tissues are caused by what things; amount of damage is influenced by what | show 🗑
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| show | children <4 and adults >65
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| show | 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; | show 🗑
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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 | show 🗑
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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 | show 🗑
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| show | direct or alternating current or lightening; they coagulate; b/c intracellular environment is baked; necrosis;
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| show | nerves and vessels; tissue anoxia; voltage, tissue resistance,current pathways, contact surface area, time exposed
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| show | ABCs; C-spine injury; b/c there usually is a fall involved; severity; entry and exit wounds; the burn center
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| show | there is a hhuge amount of damage under the surface with certain burns that we cannot see
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| show | dysrhythmias, cardiac arrest; b/c the environmental balance is disturbed between the intracellular and extracellular space; K+
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| show | metabolic acidosis; this is bc of acute tubular necrosis and ARF; b/c the myoglobin is circulating in the body
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| show | 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 _____ | show 🗑
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| show | 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 | show 🗑
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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 | show 🗑
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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; | show 🗑
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| show | depth,extent, and location of burn, and pt risk factors; epidermis, dermis, subq; % total body surface area burned TBSA
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| show | superficial partial thickness; the deep partial thickness 1st degree and 2nd degree; this is full thickness
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| show | involves the epidermis; involves the dermis; involves fat, possibly muscle and bone
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| show | 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 | show 🗑
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| show | 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; | show 🗑
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| show | 9%; 18%; 9%; 1%; 18%; 18%
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| show | 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; | show 🗑
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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; | show 🗑
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| show | 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; | show 🗑
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| show | 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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| show | 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 | show 🗑
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| risk factors outcomes for burns: ages; what preexisting conditions; why is DM an issue; | show 🗑
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| show | 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; | show 🗑
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| show | 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; | show 🗑
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| show | ice; remove if able; remove solids, clothing and flush;
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| show | 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 | show 🗑
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| phases of burn management: emergent phase- what is the greatest threat to pt; | show 🗑
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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; | show 🗑
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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 | show 🗑
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| show | more; increase it is more concentrated; increases vascular resistance
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| show | 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; | show 🗑
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| phases of burn management: emergent phase- hypovolemic shock- RBC hemolysis is RT what; | show 🗑
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| show | the interstitial spaces; until edema formation ceases; due to release with injured tissue and RBCs
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| show | fluid shifting out of vascular space an loss of blood volume; shock
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| show | 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 | show 🗑
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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; | show 🗑
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| show | dysrhythmias; hypovolemic shck ,impaired circulation to extremities; r/t increased blood viscosity and damage to microcirculation;
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| show | 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; | show 🗑
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| show | 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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| show | 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; | show 🗑
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| estimate fluid requirements for burn patients: what is goal of MAP; what is goal SBP; what is goal or HR; | show 🗑
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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 | show 🗑
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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; | show 🗑
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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; | show 🗑
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| show | >65; >90; <130;
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| show | 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; | show 🗑
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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 | show 🗑
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| show | 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; | show 🗑
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| show | 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; | show 🗑
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| complications of the emergent phase- urinary: what is best fluid output goal again; what labs should be monitored; | show 🗑
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| emergent phase: pain control- what route should they be given; why should they never be given Subq or IM; | show 🗑
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| show | 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; | show 🗑
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| show | 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; | show 🗑
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| show | 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; | show 🗑
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| when we know the emergent phase has ended: what is urine specific gravity; does pt start to diuresis | show 🗑
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| show | 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; | show 🗑
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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; | show 🗑
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| acute phase: WBCs phagocyte and what happens to wound; what sloughs; what lays collagen; after collogen is laid what begins; | show 🗑
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| show | when there is full thickness loss
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| show | 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; | show 🗑
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| show | electrolytes; according to clinical response;
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| show | cadaver skin; own skin;
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| acute phase: what is PT/OT responsibilities; | show 🗑
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| rehab phase: when does it begin; when does this occur after injury; | show 🗑
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| rehab phase: what are the goals in this phase; what are complications in this phase; | show 🗑
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| fat embolism syndrome: what is distributed into organs and tissues following traumatic skeletal injury; this is similar to what; | show 🗑
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| show | fx deaths; long bone fx; ribs, tibia, pelvic;
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| show | 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; | show 🗑
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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; | show 🗑
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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; | show 🗑
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| show | 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; | show 🗑
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| 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; | show 🗑
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| fat embolism syndrome: what do we want to do resp wise; pt can develop what resp things | show 🗑
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| show | 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 | show 🗑
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| primary assessment: what is the assessment progression; | show 🗑
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| show | airway obstruction; saliva, bloody secretions, vomitus, trauma; larynx, face, fx, dentures, tongue, edema secondary to burns;
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| show | 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 | show 🗑
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| show | 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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| show | increased; when resp is inadequate; underlying cause
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| show | internal/external bleeding, MI, shock, hypothermia; altered mental status, delayed cap refill, dim pulses, pallor, cyanosis;
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| show | 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; | show 🗑
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| show | eyes open, best verbal response, best motor response;
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| show | clothing; heat; warm blankets, warmers, warmed IV fluids
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| show | the primary survey; VS, comfort measures, history now, inspect posterior surfaces,
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| def emergency; def mass casualty incident (MCI); | show 🗑
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| disaster triage: how is it done; how is the number of victims extimated; | show 🗑
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| show | 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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| show | 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; | show 🗑
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| show | cutaneous
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| anthrax: what is tx; what is ABX drug of choice; | show 🗑
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| smallpox: how long does it incubate; how is it transmitted; is it very contagious; s/s; what is the tx; | show 🗑
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| show | 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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| show | 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 | show 🗑
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| hemorrhagic fever: what is the cause; how is it transmitted; s/s; what is tx | show 🗑
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| show | 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; | show 🗑
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| central venous catheter (CVC): where is it placed; where d;oes tip rest; what are the advantages of them; disadvantages | show 🗑
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| CVC: what can cause a cath occlusion; what to do if there is a cath occlusion; | show 🗑
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| CVC: what to do if there is a local cath associated infection; what about a systemic infection | show 🗑
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| CVC: how does a pneumothorax occur; what to do if there is a pneumothorax | show 🗑
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| show | 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 | show 🗑
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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 | show 🗑
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jmkettel
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