Burns/Sepsis/IVF 10 Q Flashcards
A patient with carbon monoxide poisoning is described as being ____ ____ in appearance
“cherry red”
Carbon monoxide poisoning is treated with _______.
100% humidified O2
Upper airway injury occurs ____ the glottis
above
Upper airway injury presents with…
redness, blistering, swelling, dysphagia, stridor, retractions
Why is an upper airway injury considered a medical emergency?
Mechanical obstruction can occur rapidly!
Lower airway injury occurs below the glottis and presents with…
facial burns, singed nasal hairs/eyebrows, dark sputum, wheezing, stridor, hoarseness, painful swallowing, presence of soot, altered mental status
The treatment for smoke inhalation injury is ____ _____ before the airway becomes occluded.
early intubation
What chemical burns are more difficult to manage? why?
alkali burns because they adhere to the tissue; (damage continues after the alkali is neutralized)
How do you manage a chemical burn?
brush solid particles off the skin, remove clothing containing the chemical, flush area with copious amounts of water.
How do you manage an electrical burn?
remove pt from contact with source, remove clothing/jewelry
How do you manage small thermal burns?
cover with clean, cool, tap water-dampened towel
How do you manage large thermal burns?
provide supplemental O2, remove burned clothing, wrap in clean and dry sheet/blanket, elevate extremities above the level of the heart (if burned), do NOT immerse in cool water or pack with ice.
What is the greatest threat of burns?
hypovolemic shock - result of increased capillary permeability (edema, hypotension, tachycardia)
What is the treatment for hypovolemic shock?
crystalloid solutions (LR)
What degree of burn is localized to the epidermis, is sensitive/painful, and has red/dry skin that blanches with pressure?
first degree
what degree of burn extends into the epidermis and possible dermis, is red, wet/shiny with the presence of fluid-filled blisters, and is sensitive to cold air?
second degree
What degree of burn extends through the epidermis, dermis, and into the subcutaneous tissue, is white/charred, and nerve endings are destroyed in deep part of wound?
third degree
What degree of burn extended through the subcutaneous tissue and includes muscle, fascia, or bone, and is pain free in deep part of wound?
fourth degree
Severity of burn is determined by the…
depth of burn, extent of burn, and location of burn
A burn of the face, neck, or chest can result in…
respiratory obstruction
A burn of the hands, feet, joints, or eyes can result in…
self-care difficulty
A burn of the ears, nose, buttocks, or perineum can result in…
infection
The emergent phase of care lasts up to 72 hours from the time of burn, begins with _____ and ______ and continues until fluid mobilization and diuresis begin
fluid loss; edema formation
What is the Parkland formula for fluid replacement?
4 mL LR x weight (kg) x affected TBSA
The parkland formula gives us the total fluid requirements needed for the first _____ hrs
24 hrs
Adequacy of fluid replacement is assessed with a UOP of…
> 0.5 to 1 mL/kg/hr
What drug therapy is included for burns?
analgesics/sedatives, H2 receptor antagonists, tetanus immunizations, and antimicrobial agents (topical)
Diet for a burn pt is one of high ____ and high ____
protein; calorie
What is the name of the procedure when an incision is made into the eschar to relieve pressure and improve circulation
escharotomy
Custom-fitted pressure garments are worn for ________ for 12 - 18 months
24 hrs/day
____ the the inflammatory process that occurs with or without an infection
SIRS
What is the criteria for SIRS?
Has 2 or more of the following:
- temp > 100.4 or < 96.8
- HR > 100 bpm
- RR > 20 or PaCO2 < 32
- WBC > 12,000 or < 4,000 or > 10% immature band forms
True or False: It is considered sepsis when there is SIRS with an infection.
TRUE
What occurs in sepsis?
- VASODILATION
- increased capillary permeability (third-spacing, appear hypovolemic and hypotensive)
- Increased coagulation (results in microthrombi and occlusion of microvasculature, decreased perfusion to tissues)
True or false: Severe sepsis occurs when there is sepsis PLUS organ dysfunction, hypoperfusion, or hypertension
FALSE: HYPOtension not HYPERtension
What occurs with severe sepsis?
- VASOCONSTRICTION (temp rises, changing from warm and flushed to cool and pale)
- Lactic Acidosis ( > 4)
What is the result of uncontrolled sepsis?
Septic shock
What is seen with septic shock?
- refractory hypotension despite adequate fluid resuscitation
- systolic BP < 90 mmHg
- MAP < 60 mmHg
- OR a drop in pt’s baseline of > 40 mmHg
- Pt is only able to maintain BP and CO with vasopressors
MODS occurs when there is failure of ____ or more organ systems
2
A group of evidence0based interventions related to a specific disease process that, when initiated together, results in better outcomes than if implemented individually.
sepsis bundle
Vasopressors are used to try to ____ the BP
increase
What are the vasopressor agents used?
dobutamine dopamine epinephrine phenylephrine norepinephrine
_______ are recommended for pts in septic shock requiring vasopressors
Corticosteroids
The patient on antibiotics and a vasopressor is in severe _____ ______
septic shock
Lactate levels are used to monitor for…
occult tissue hypoxia
Maintain glucose levels between
80 and 120
