Burns and ER care
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| show | 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 | show 🗑
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| show | how long tissue exposed, the degree of injury and the type of tissue damaged
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| show | 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 | 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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| 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 | show 🗑
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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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| 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; | show 🗑
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| show | they vasocontrict; it freezes; decrease blood flow; stasis
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| show | constrictive clothing or jewelry; warm water 102-108 degrees; pain; lots of nerve damage
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| show | 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 | show 🗑
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| show | length; pulmonary edema; ARDS; late 12-24hours after
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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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| depth of burn: an epidermis burn effects what; a dermis burn effects what; def subq | show 🗑
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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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| show | 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 | show 🗑
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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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| extent: rule of 9s: when is pt transferred to the burn center; when is adult rule of 9s used; | show 🗑
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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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| show | 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 | show 🗑
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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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| 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; | show 🗑
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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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| what are the phases of burn management | show 🗑
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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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| cooling burn with in __ minute/s helps minimize what; | show 🗑
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| show | 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; | show 🗑
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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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| show | 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; | 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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| show | decreases it in this case; increases it
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| show | increases it; increases it; increases
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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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| phases of burn management: emergent phase- complications- there is a huge risk for pulmonary edema and resp distress r/t ___ | show 🗑
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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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| 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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| show | to reduce edema
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| show | direct thermal injury or edema; b/c of swelling in the lungs;
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| show | 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; | show 🗑
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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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| complications of the emergent phase- respiratory: what tests are done to see if there is CO poisoning; | show 🗑
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| show | ATN; decreased renal perfusion and hypovolemia; myoglobin and hemoglobin;
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| show | 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; | 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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| the emergent phase ends when ___ mobilization and ____ begin | show 🗑
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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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| healing: partial thickness- does it form eschar; what needs to be done to theeschar; | show 🗑
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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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| show | ROM and ADLs;
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| show | 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; | 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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| fat embolism syndrome: what causes are the least common but can occur post procedure; | show 🗑
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| show | lungs, brain, heart, kidneys, and skin;
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| show | 48 hours; oxygen exchange; hemorrhagic interstitial phneumonitis; ARDS;
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| show | 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 | show 🗑
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| show | blood, urine, sputum;<60 mm Hg; St changes; bc we have hypoxia; decreased;
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| show | long; infiltrates or multiple areas of consolidation - white out
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| show | careful immobilization of long bones; to prevent hypovolemic shock; resp acidosis;
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| show | 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; | show 🗑
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| show | 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; | 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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| primary survey: airway with spine stabilization- what injury is at risk for airway issues; s/s of airway obstruction | show 🗑
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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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| primary survey: breathing- ___ does not equal ventilation; breathing issues are r/t what injury; s/s of breathing issues; | show 🗑
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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; | show 🗑
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| primary survey: circulation- injuries that cause circulation issues; s/s of circulatory issues; | show 🗑
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| primary survey: circulation- when is CPR done; direct pressure should be given to what; | show 🗑
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| primary survey: Disability- pt LOC measures degree of what; what does AVPU stand for; | show 🗑
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| primary survey: disability- glascow coma scale has what 3 components; | show 🗑
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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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| show | 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; | show 🗑
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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; | show 🗑
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| show | through the skin; progressive papule to ulcer, lymph involved and edema;
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| show | contaminated, undercooked meat source; intestinal inflammation/ulceration, NVD, ascites, sepsis, hematesis;
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| what type of anthrax is most common | show 🗑
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| show | ABX, cipro;
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| show | 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 | show 🗑
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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; | show 🗑
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| show | 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 | 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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| show | 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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| show | 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 | show 🗑
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| show | perforation of visceral pleurae during insertion; admin O2, high fowlers, prep for chest tube insertion;
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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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