Burns Flashcards
Burns result from?
The disruption of proteins in the cell membrane
A _____ burn causes damage by increasing the rate at which the molecules within an object move and collide with each other.
Thermal
To ____ is to alter the usual substance of something.
Denature
What three components does the amount of heat energy in thermal burns depend on?
Temperature
Concentration of heat enrage it possesses
Length of contact time with patients skin
In general, what tends to have a high heat content?
Liquids
What is the name of the theory which helps to explain the physical effects of high heat and a number of clinical effects?
Jacksons theory of thermal wounds
What is the zone of coagulation in jacksons theory of thermal wounds?
Most damaged area nearest heat source
What happens in the zone of coagulation?
Cell membranes are destroyed, blood coagulates, structural proteins denature
Where is the zone of stasis?
Adjacent to most damaged region
What occurs in the zone of stasis?
Inflammation
Blood flow decreases
Where is the zone of hyperemia?
Area farthest from heat source
What occurs in the zone of hyperemia?
Limited inflammation
Changes in blood flow
If the zone of coagulation penetrates the dermis, the resulting injury is termed?
Full-thickness or third-degree
Which zone in jacksons theory of thermal burns accounts for erythema associated with some burns?
Zone of hyperemia
What occurs in the zone of stasis stage of a burn?
Vasoconstriction and clotting take place to isolate damage
How does a patient experiencing the emergent stage of a burn present?
Tachycardia
Tachypnea
Mild hypertension
Mild anxiety
Burn injuries are the ______ leading cause of death in children under 12 years of age and the _____ overall cause of trauma death.
Second
Fourth
What is the second zone of a burn in Jacksons thermal wound theory?
Fluid shift phase
What occurs in the fluid shift stage?
A massive shift of fluid from the intravascular to the extravascular space
Which phase of the burn process can last up to 24 hours and peaks in 6-8 hours?
Fluid shift phase
The _____ phase occurs with thermal burns larger than 15-20% of body.
Fluid shift
Which phase follows the fluid shift phase?
Hypermetabolic
Which phase of the burn process may last for many days or weeks, depending on the burn severity?
Hypermetabolic
Which phase in the burn process is characterized by a large increase in the body’s demands for nutrients?
Hypermetabolic
In which phase of the burn process is scar tissue laid down and remodeled?
Resolution
_____ is the difference of electric potential between two points with different concentrations of electrons.
Voltage
_____ is the rate of flow of an electric charge.
Current
______ is the basic unit for measuring strength of an electric current.
Ampere
What is the property of a conductor that opposes the passage of an electric current?
Resistance
What is the basic unit for measuring the strength of electrical resistance?
Ohm
The relationship between current, resistance, and voltage is known as?
Ohms law
Heat is proportional to the _____ of the current flow.
Square
The highest heat occurs at the points of greatest resistance, often at ____.
The skin
Dry, calluses skin can have _________ resistance values.
Enormous
Mucous membranes have _____ resistance and allow even small currents to pass.
Low
How does high voltage or current impact a burn?
Burn increases
The smaller the area of contact, the ______the concentration of current flow and ______ injury.
Greater
Greater
What type of burns denature the biochemical makeup of cell membranes and destroy the cells?
Chemical
What is the most common causes of chemical burns?
Strong acids or bases
What occurs in coagulation necrosis?
An acid, while destroying tissue, forms an insoluble layer that limits further damage.
In chemical burns, ______ do not form a coagulum.
Alkalis
What is the name for the process in which an alkali dissolves and liquefies tissue?
Liquefaction necrosis
_____ is a general term applied to the transmission of electromagnetic or particle energy.
Radiation
What are protons?
They are positively charged particles that form the nucleus of hydrogen and that are present in the nuclei of all elements.
The atomic number indicates?
Number of protons
What are neurons?
Subatomic particles that are approximately equal in mass to a proton but lack an electrical charge
A _____ has an average life of less than _____ minutes.
Neuron
17
____ are minute particles with negative electrical charges that revolve around the nucleus of an atom.
Electrons
When emitted from radioactive substances, electrons are called ______.
Beta particles
_____ is the process by which radiation causes damage.
Ionization
Which human cells are most sensitive to radiation injury?
Erythrocytes Leukocytes Platelet production Cells lining intestinal tract Reproductive cells
Which type of radiation is very weak and can be stopped by paper, clothing, or the epidermis?
Alpha
What type of radiation is more powerful than alpha and can travel 6-10 feet through air, through clothing, and first few millimeters of skin?
Beta
_____ radiation is the most powerful ionizing radiation. It has great penetrating power and protection requires thick concrete or lead shielding.
Gamma
_______ radiation has great penetrating power but is uncommon outside of nuclear reactors and bombs.
Neutron
What happens in “clean” radiation accidents?
Patient is exposed to radiation but not contaminated by radioactive particles, liquids, gases, or smoke.
What occurs in “dirty” radiation accidents?
Patient is contaminated by radioactive particles, liquids, gases, or smoke.
What is the most commonly used device to detect ionizing radiation?
Geiger counter
Cumulative radiation exposure is measured by a device called a _____.
Dosimeter
What is the basic unit of absorbed radiation dose?
Rad - radiation absorbed dose
A _____ is a unit of absorbed radiation dose equal to 100 rads.
Gray
The first signs of serious radiation exposure are?
Slight nausea and fatigue occurring 4-24 hours after exposure
What symptoms are seen in prolonged radiation exposure?
Anorexia, vomiting, diarrhea, and malaise
What are the factors affecting g exposure to radiation?
Time
Distance
Shielding
Doubling the distance away from a radiation source reduces the exposure by a factor of _____.
4
Carbon monoxide bonds to hemoglobin ______ times faster than oxygen.
200
Superheated steam is created under great pressure and can have a temperature well above _____.
212°
The ____ burn, also termed first degree burn, involves only the ____.
Superficial
Epidermis
A ________ burn, also termed a second-degree burn, produces ____.
Partial-thickness
Blisters
A ________ burn, or third degree burn, penetrates both the epidermis and dermis and extends into the subcutaneous layers or even deeper, into the muscles, bones, and enteral organs.
Full-thickness
What is the rule of palms?
Plantar surface is point of comparison in gauging the size of affected body area - patients Palm=1% BSA
You can estimate the total BSA affected by visualizing the ___ surface area and applying it to the burn area mentally.
Palmer
The rule of ___ is easier for ___ burns up to about 10% BSA, while the rule of ___ is more appropriate for ___ burns,
Palms - local - nines - larger
Detail the rule of nines - adult.
ADULT:
- Head & neck –> 9%
- Upper back / Anterior chest–> 9%
- Upper extremity (each) –> 9%
- Lower back / anterior abdomen –> 9%
- External genitalia –> 1%
- Anterior / Posterior lower extremity (each) –> 9%
Detail the rule of nines - child.
CHILD: -Head & neck --> 9% -Upper extremity (each) --> 9% -Posterior / anterior trunk --> 9% -Genitalia --> 1% Anterior / posterior lower extremity (each) --> 13.5%
Burns cause ___ complications, and the typical complications include ___, ___, ___, and ___.
Systemic complications
Include: hypothermia, hypovolemia, Escher formation, and infection
Detail the systemic complication hypothermia.
- Burn disrupts body’s ability to regulate its core temperature.
- Tissue destruction reduces/eliminates the skin’s ability to contain the fluid within.
- The burn process releases plasma and other fluids which seep into the wound. These evaporate and rapidly remove heat energy.
- The injured skin has increased blood flow. This enhances the heat loss.
- Burn injuries do not have the reflex vasoconstriction that normally protects against excessive heat loss.
- If the Burn is extensive, uncontrolled body heat loss induces rapid and severe hypothermia.
Detail systemic complication hypovolemia.
- The inability of damage blood vessels to contain plasma causes a shift of proteins, fluid, and electrolytes into the burn tissue.
- The loss of plasma protein reduces the bloods ability (via osmosis) to draw fluids from the on injured tissues. This compromise is the body’s natural response to fluid loss and may produce a profound hypovolemia.
- —Although it is a severe complication, it takes hours to develop. Aggressive fluid resuscitation can effectively counteract this aspect of the burn process.
- Electrolyte imbalance happens with the massive shift of fluid to the interstitial space and the body’s ability to regulate sodium, potassium, and other electrolyte become overwhelmed.
- —Large thermal and electrical burns can lead to massive tissue destruction with a resultant release of breakdown products into the bloodstream. For example: potassium – and it’s over supply (aka hyperkalemia) can lead to life-threatening cardiac dysrhythmias.
- —ECG monitoring and fluid resuscitation can help prevent hyperkalemic complications.
Detail systemic complication - eschar.
- Eschar: hard, leathery product of a deep full-thickness burn; it consists of dead and denatured skin.
- Skin denaturing further complicates full-thickness thermal burns.
- Skin constricts over the wound site which increases pressure of any edema beneath and restricting flow of blood.
- —If extremity burn is circumferential, the constriction may be severe enough to occlude all blood flow int the distal extremity.
- —EXAMPLE: thorasic burn
Detail systemic complication - infection.
- Most persistent killer of burn victims but effects often don’t appear for several days following acute injury.
- Pathogens invade the wound and pose a hazard to life when they grow to massive numbers (this is what can take days or weeks)
- Use standard precautions, sterile dressings, clean equipment, and avoid gross contamination of the burn.
Pulse oximetry is a useful tool in evaluating respiratory and cardiovascular effectiveness in burn patients; however, what are the shortcomings?
Carbon monoxide replaces oxygen in red blood cells and colors it much the same as oxygen; leads the oximeter to display high saturation readings when the blood actually has greatly reduced oxygen-carrying cappacity
What is the advantage of performing intubation of burn patients in the field?
Edema is progressive and rapidly reduces airway lumen; waiting until patient is extremely dyspneic or goes into respiratory arrest risks the airway being so edematous that intubation is difficult
If intubating a burn victim, consider using ___ cautiously (if at all) because it may worsen the ___ sometimes associated with severe burns.
Succinylcholine
Hyperkalemia
Carefully assess ___ ___ if there are any ___ burns of the chest because the developing ___ may restrict chest excursion.
Tidal volume
Circumferential
Eschar
Characteristics of various depths of burns - superficial (first degree)
Cause: sun or minor flame
Skin color: red
Skin: dry with no blister
Sensation: painful
Healing: 3-6 days
Characteristics of various depths of burns - partial thickness (second degree)
Cause: hot liquids, flame
Skin color: mottled red
Skin: blisters with weeping
Sensation: painful
Healing: 2-4 weeks
Characteristics of various depths of burns - full thickness (third degree)
Cause: chemicals, electricity, hot metals, flame
Skin color: pearling white and/or charred, translucent, and parchment-like
Skin: dry with thrombosed blood vessels
Sensation: anesthetic
Healing: may require skin grafting
Burn severity - minor
Superficial: BSA
Burn severity - moderate
Superficial: BSA > 50%
Partial thickness: BSA
Burn severity - critical
Partial thickness: BSA > 30%
Full thickness: BSA > 10%
Inhalation Injury
Any partial- or full-thickness burns involving hands, feet, joints, face, or genitalia
Once determine ___, ___, and other factors that contribute to burn severity, categorize the patient as having ___, ___, or ___ burns.
Depth
Extent
Minor; moderate; critical
Conduct reassessments every ___ minutes for ___ burns and every ___ minutes for ___ or ___ burns
15 ; minor
5 ; moderate or critical
Local/minor burns: Use local ___ to treat minor soft-tissue burns involving only a ___ proportion of the BSA at partial thickness.
cooling ; small
Local/minor burns: ___ water immersion of minor, ___ burns maybe effective if accomplished in the first few ___ after a burn.
Cool ; localized ; minutes
Local/minor burns: Use cooling for partial-thickness burns that invole less than ___% of the BSA or very small full-thickness burns (less than ___% BSA).
15% ; 2%
Local/minor burns: Cooling of ___ BSA may subject patient to the risk of ___.
larger ; hypothermia
Local/minor burns: Evaluate ___ ___ and ___ frequently during care and transport.
distal circulation ; sensation
Local/minor burns: Consider ___ or ___ ___ ___ in sever cases to help calm/alleviate pain of patient
fentanyl ; morphine sulfate analgesia
Local/minor burns: It is important to cover local/minor burns only with a ___ ___ until a definitive hospital management decision has been reached.
clean sheet
Local/minor burns: Encourage patient to keep the burn ___.
elevated
Local/minor burns: Full-thickness burns are open wounds, so patients with out-of-date ___ immunization are given a booster.
tetanus
Moderate to severe burns: Use ___, ___ (not necessarily sterile) dressings to cover partial-thickness burns that involve more than ___% BSA or full-thickness burns involving more than ___% of the BSA.
clean, dry ; 15%; 5%
Moderate to severe burns: It is important to keep the patient ___ with large BSA because the patient loses the ability to effectively control ___ ___.
warm ; body temperature
Moderate to severe burns: When treating full-thickness burns to fingers, toes, or other locations where burned surfaces may contact each other, what should you do? Why?
Place soft, non-adherent bandages between the burned skin areas; disrupted and wet wounds can stick together and cause further damage when pulled apart for care
Moderate to severe burns: Early and aggressive fluid therapy (at medical direction) can effectively reduce the impact of ___ ___.
fluid loss
Moderate to severe burns: Why is it advantageous to use aggressive fluid therapy early in the burn cycle?
Hypovolemia is not an early development after a burn, so fluid migration into the wound later during the burn cycle eventually leads to serious fluid loss.
Moderate to severe burns: How can full-thickness burns impact IV usage?
Full-thickness burns usually damage the blood vessels or coagulate the blood making intravenous cannulation difficult and possibly impeding effective fluid flow
Moderate to severe burns: In the event full-thickness burns cover all of the normal IV access sites, what do you do?
Place the catheter through tissue with partial-thickness burns, proximal to any more serious injury.
Moderate to severe burns: Moderate to severe burns: Current fluid resuscitation formulas recommend ___ ___ of fluid for every ___ of patient weight multiplied by the ___ of BSA burned.
4 mL ; kilogram ; percentage
4 mL x Patient weight in kg x BSA burned = Amount of fluid over 24 hours
Moderate to severe burns: What is the Parkland formula?
Fluid resuscitation protocol that states the patient needs half the resuscitation fluid amount in the first 8 hours after the burn.
EX: For a 70-kg patient with 30% BSA burned-
total resuscitation needed: 4 mL X 70 kg X 30 = 8,400 mL
Parkland formula: 8,400 / 2 = 4,200 needed in the first 8 hours
Moderate to severe burns: What is the generally accepted calculation for initial resuscitation fluid calculation for short (less than 1 hour) transports?
- 25 mL of fluid for every kg of patient weight multiplied by the percentage of BSA burned
- 25 mL x Patient weight in kg x BSA burned = Amount of fluid
EX: For an 80-kg patient with 20% BSA burned-
0.25 mL x 80 kg patient x 20 = 400 mL
Moderate to severe burns: Be cautious/conservative when administering fluids to burn patients if possibility of ___ or ___ injury because rapid fluid administration may worsen airway swelling or edema accompanying toxic inhalation.
airway ; lung
Moderate to severe burns: Use ___ with caution as it may depress the respiratory drive and increase any existing hypovolemia when treating burn patients.
morphine
Moderate to severe burns: Consider using ___ in ___ IV increments every 5 minutes until pain is relieved.
morphine ; 2-mg
Moderate to severe burns: Start with a loading does of ___ to ___ ___ IV and administer repeat does of ____ ___ IV as needed of ___.
25 to 50 mcg ; 25 mcg ; fentanyl
Moderate to severe burns: Avoid ___ ___ because their early use has been shown to worsen outcomes for burn patients despite concern for infection.
prophylactic antibiotics
Moderate to severe burns: What might a medical director instruct you to do in order to return adequate respiration or distal pulses?
Perform an emergency escharotomy
To do this - incise the burned tissue through the eschar, perpendicular to the constriction; incise about 1 cm deeper than the developing eschar to ensure the release of pressure
Inhalation injury: Once patient’s airway is ensured, provide ___-___, ___-___ oxygen by ___ ___ at ___ lpm.
high-flow ; high-concentration ; nonrebreather mask ; 15
Inhalation injury: ___ ___ drives carbon monoxide from the hemoglobin, shortening the time to recovery (if available).
Hyperbaric oxygenation
Inhalation injury: Suspect___ ___ in patients with severe symptoms such as dyspnea, chest pain, altered mental status, seizures, and unconsciousness.
cyanide toxicity
Inhalation injury: Rapid airway intervention with ____ ___ and ventilatory support with a ___-___ mask are initial priorities when treating suspected cyanide toxicity. ___ therapy is critical to save the patient though.
endotracheal intubation ; bag-valve ; antidotal
Inhalation injury: What is the two-stage process for administration of the cyanide antidote?
(1) Use the nitrate compound, which acts by converting the hemoglobin (primary oxygen-carrying protein in the blood) to methemoglobin; methemoglobin binds to the cyanide and removes it from the cytochrome (enzyme needed for oxygen processing by cells).
(2) Use the sulfur-containing compound, which removes the cyanide by forming a nontoxic compound excreted in the urine
* Antidote administration should be reserved for patients with a history of acute cyanide inhalation and frank signs/symptoms of serious exposure because nitrates binding to hemoglobin produces an effect similar to carbon monoxide poisoning.
Inhalation injury: In addition to cyanide antidotal therapy, keep the patient ___ and administer ___-___, ___-___ oxygen.
supine ; high-flow, high-concentration
Electrical injuries: Do not approach the patient until all sources of ___ have been shut off and the scene is deemed safe.
power
Electrical injuries: Search for an ___ and ___ wound, and look specifically for possible contact points with the ___ and the ___ ___. There might be multiple.
entrance ; exit ; ground ; electrical source
Electrical injuries: Electrical current passes ___ the body and may result in significant ___ burns, especially to ___ ___ and ___ despite initial superficial assessment findings.
through ; internal ; blood vessels ; nerves
Electrical injuries: Rapidly progressive ___ collapse can follow contact with an electrical source. Look for ___ resulting from forceful ___ ___ cause by the current’s passage, as well.
cardiovascular ; fractures ; muscle contractions
Electrical injuries: What are key things to do when treating an electrical burn patient?
- Remove any clothing or jewelry articles to prevent continuing the burn process
- Perform ECG monitoring for possible cardia disturbances; electrical currents can induce dysrhythmias including bradycardia, tachycardias, ventricular fibrillation, and asystole
- Consider any significant electrical burn/exposure patient as high pririty for immediate transport
Electrical injuries: What are some effects lightning strikes can have on people?
Sudden cessation of breathing; apneic; pulseless; cardiac arrest
Electrical injuries: Initiate at least ___ large bore IVs and administer ___ mL of fluid per hour in ___ mL/kg boluses. Consider the use of ___ and ___ (usually at discretion of medical director) to prevent complications of rhabdomyolysis and hyperkalemia; usual starting does is 1 mEq/kg for ___ and 10 g for ___.
2 ; 1,000 ; 0.20 ; sodium bicarbonate ; mannitol ; sodium bicarbonate ; mannitol
Chemical burns: What should you do when arriving on scene to a chemical spill/contamination?
Seek out personnel who are familiar with the agent and consult with them regarding dangers posed by the agent and any specific medical care/handling procedures required with it.
Chemical burns: What precautions should be taken during patient assessment?
Always wear medical examination gloves (preferable tyvex) and applicable gear (i.e. gown, face mask, shield)
Chemical burns: Ensure the patient is ___ and fully ___; ___ and ___ are unaffected by the contact; and monitor the patient’s ___ and consider ___ monitoring. If patient is stable, begin rapid trauma assessment.
alert ; oriented; airway ; breathing ; heart-rate ; ECG
Chemical burns: Establish the depth, extent, and nature of the injury - phenol.
It is a gelatinous caustic powerful industrial cleaner; sticky and insoluble in water
Use alcohol to dissolve and remove the phenol; follow removal with irrigation using cool water
Chemical burns: Establish the depth, extent, and nature of the injury - dry lime.
Strong corrosive that reacts with water; produces heat and subsequent chemical/thermal injuries
Brush dry lime off the patient gently but completely; rinse the contaminated areas with large volumes of cool/cold water
—-While the remaining lime reacts with the water, it cools the contact area and removes the rest of the chemical and ensures it reacts with that water not the water in the patients soft tissues
Chemical burns: Establish the depth, extent, and nature of the injury - sodium.
Unstable metal that reacts destructively, especially water; creates extreme heat, explosive hydrogen gas, and possible ignition
Decontaminate patient by quickly and gently brushing the sodium off; cover the wound with the oil used to store the substance
Chemical burns: Establish the depth, extent, and nature of the injury - riot control agents.
Include CS, CN (Mace), and oleoresin capsicum (OC, pepper spray); cause intense irritation of the eyes, mucous membranes, and respiratory tract; no long term damage typically
Treatment is supportive - most spontaneously recover in 10-20 minutes; irrigate patient’s eyes with normal saline if suspect riot agent used
Chemical burns: How does water irrigation help treat chemical burns?
Rinses away offending material
Dilutes any water-soluble agents
Reduces the heat and rate of the chemical reaction and effects upon patient’s skin
Chemical burns: What Is the general process for treating chemical contamination?
- Irrigate (or douse if the contamination is wide-spread) with water
- Remove any possible recontaminates
- Wash burn with a mild soap (like ordinary dish detergent) and gentle brush/sponge - taking care not to further damage skin
- Gently and steadily irrigate the wound with constant flow of water until patient arrives at emergency department
- —Attempt to collect the label, products Material Safety Data Sheet (MSDS), or ample of the agent if able
Chemical burns: Do not use any ___ or neutralizing agent. Nuetralizing agents often react ___ with contaminates and may ____ the ___ of the reaction and induce thermal burns.
antidote ; violently ; increase ; heat
Chemical burns: What should you look for as evidence of burns or irritations to the eyes?
eyelid spasm (blepharospasm), junctival erythema, discoloration, tearing, eye pain, vision changes
Chemical burns: How do you irrigate the eyes?
Hang a bag of saline; use the flow regulator to control the flow of fluid into the nasal corner of the eye; turn the patient’s head to the side to facilitate drainage and avoid cross-contamination
*Be alert for contact lenses - remove and continue irrigation
Radiation burns: Why is radiation an endangerment to EMS personnel without proper precautions?
It cannot be seen or felt
Radiation burns: What are some key things to remember when arriving on a radiation scene?
- Seek knowledgeable personnel to address what the material is and appropriate precautions needed
- Potential exposure is reduced by distance and nature of materials (i.e. concrete, earth) between you and the radiation source
- Approach and remain upwind of the radiation source
Radiation burns: What is the general process for treating patients with radiation exposure and burns?
- Decontaminate patient by derobing, rinsing, washing with dish detergent, and scrubbing body hair.
- Save all clothing and decontamination materials for appropriate disposal
- Document the circumstances of the radioactive exposure, and if possible, identify the source and strength of the agent; determine patient’s proximity to the source and length of exposure
- —Note any patient complaints in their exact words and notate the time (helpful in determining patient’s degree of radiation exposure)
Radiation burns: How do you treat a radiation exposure/burn patient?
Treat the symptoms of the radiation injury (i.e. nausea, vomiting, malaise); make patient comfortable as possible; offer psychological support
Cover burns with sterile dressing; provide oxygen and IV as needed for general symptoms
During the healing process for burns, scar tissue is laid down and remodeled, and the patient beings to rehabilitate and return to normal function. This is called the:
Resolution phase
Chemical burns caused by ___ usually continue to destroy cell membranes through liquefaction necrosis, allowing them to penetrate underlying tissue and causing deeper burns.
alkalis
The type of radiation that can travel through 6 to 10 feet of air, penetrate a few layers of clothing, and cause both external and internal injuries is:
Beta radiation
Airway edema s a major concern when dealing with inhalation injuries. to provide the best protection and prevent patient deterioration, it is important to initiate early:
Endotracheal intubation
To reduce the patient’s exposure to infectious pathogens, the paramedic must carefully:
Employ body substance isolation; use sterile dressings and clean equipment; and avoid gross contamination of the burn
For pediatric or geriatric patients and patients suffering from other trauma/medical conditions, aways:
Increase burn severity one level
Your patient is experiencing airway compromise due o an inhalation injury. You elect to perform rapid-sequence intubation to protect the patient’s airway. Which of the following paralytics should you use with caution, if at all, because it may worsen hyperkalemia?
Succinylcholine
Which of the following burns would be classified as a moderate burn?
a. full-thickness burns 30% BSA
d. partial-thickness burns
d. partial-thickness burns
Fluid resplacement is indicated in the care of patients with moderate to severe burns grerater than 15 to 20% total BSA. The Parkland formula sets up a calculation for determining the amount of fluid to infuse over 24 hours. What is the accurate Parkland formula?
4 mL x patient weight in kg x BSA involved
In general, how should dry lime be removed from the skin?
Brush dry lime away and then flush with water
Your 45-year-old male patient was working on his roof, came into contact with power lines, and has experienced possible electrocution. the patient has an irregular pulse of 124 BPM and his respiratory rate is 22 and irregular. the patients blood pressure is 106/76. You note both entrance and exit wounds. You immediately manage the airway and decide to start an IV. You realize you should administer an initial fluid bolus of:
20 mL/kg
The burn patient’s injured tissue will swell. Therefore, with this knowledge, you realize that it is important to:
Remove restrictive jewelry
All of the following are basic principles that allow resuce personnel and patients to limit exposure to ionizing radiation except:
a. time
b. distance
c. weight
d. shielding
c. weight
What is the first 10 minutes of a hemorrhage?
Vasoconstriction
_____ activator stimulates _____ into thrombin which converts fibrinogen into fibrin threads.
Prothrombin
Clots form in ____ to ____ minutes.
3-6
What is the rule for determining lost blood volume in contusions?
One fist = 10% blood volume
What are the signs and symptoms of a crush wound?
5 PS PAIN PARESIS PARESTHESIA PALLOR PULselessness
What is the formula for calculating fluid replacement for a burn within first 24 hours?
4ml/kg times amount of burn as follows:
50% over the first 8 hours
25% over second 8 hours
25% over third 8 hours
A first degree burn is?
A sunburn
EPIDERMIS
A second degree burn is?
Sunburn with blisters
DERMIS
A third degree burn is?
Charred, open blister skin
SUBCUTANEOUS
What burns go to a burn center?
Burns to:
Hands,Feet,Groin,Chest,Face,Lungs
Circumferential
Burns to under 5 yrs and over 55 yrs
2nd degree burns over 15%
3rd degree burns to 5%
How should a burn less than 9-10% be dressed?
Local cooling through burn sheet bandage and dressing
How should a burn over 9-10% be dressed?
Dry
What type of burn is cared for with subQ injection of calcium gluconate into burn site?
Hydrologic acid
What type of burn is treated by being flushed with water then cleaned with glycerol, vegetable oil, soap, and water?
Phenol
What rhythm is mostly seen post electrocution?
VFIB
What are the pathways for electrocution?
Hand to hand
Hand to leg
Leg to leg
What part of be skin maintains fluid balance and protection against bacteria?
Dermis
