Burns, Shock, Sepsis

Question 1

What type of wound classification for a patient who has an inguinal hernia repair (no strangulation)?

Answer 1

clean

Question 2

A patient has an elective colon resection for colon cancer. What type of wound is this??

Answer 2

clean contaminated

Question 3

What is the most common cause of burns in children?

Answer 3

scalding from hot drinks or bath

Question 4

What are consequences of burn shock?

Answer 4

depression of myocardium and metabolic acidosis

Question 5

What cellular changes occur with electrolytes of burn patients?

Answer 5

intracellular influx of Na/H20, extracellular migration of K+. Failure of Na pump

Question 6

What are the hematologic changes of burns?

Answer 6

increased hematocrit but anemia due to RBC destruction

Question 7

breaks portions of body into multiples of 9 with the perineum being 1%

Answer 7

rule of 9’s

Question 8

Severity of burn characterized by erythema, minimal surrounding edema, minimal pain

Answer 8

first degree

Question 9

Severity of burn that involves partial thickness. Skin is red/mottled, blistered, swollen, wet/weeping, painful, sensitive to air

Answer 9

second degree

Question 10

Severity of burn that involves damage to all skin layers, subq, and nerve endings. Skin is pale or charred with fat exposed. Painless to pinprick. edema

Answer 10

third degree

Question 11

This type of burn involves the mouth and pt develops resp. problems. Can be caused by fire in enclosed areas or chemical products of combustion (cyanide).

Answer 11

inhalation–> intubate early!

Question 12

Why are alkali burns more serious than acid burns?

Answer 12

alkalis penetrate deeper

Question 13

What is the treatment for alkali burn?

Answer 13

DO NOT NEUTRALIZE. “The solution to pollution is dilution” - - IRRIGATE, IRRIGATE, IRRIGATE!

Question 14

Why are electrical burns more serious than they appear?

Answer 14

Skin has more resistance than bone, muscle, blood vessels or nerves; therefore deeper structures have more damage

Question 15

Cause of acute renal failure in patient with electrical burn

Answer 15

Occult destruction of muscle can cause rhabdomyolysis which causes the release of myoglobin

Question 16

What should you do if a patient who has an electrical burn starts urinating dark urine?

Answer 16

assume myoglobin and increase fluids to achieve a urine output of 100ml/hr. If that doesn’t work, mannitol

Question 17

Initial treatment steps of a burn patient

Answer 17

Start 2 large bore IVs, look at eyes for corneal damage, estimate depth/extent of burn

Question 18

What % of BSA partial-thickness burn needs NG tube placed due to high likelihood of ileus?

Answer 18

20%

Question 19

Critical in monitoring resuscitation. Until a swan or CVP line is placed, it is the only way to ensure adequate renal perfusion

Answer 19

foley catheter

Question 20

Dressing treatment for minimal burns or burns being treated as outpatient

Answer 20

1% silver sulfadiazine (silvadene). Check q 24 hrs until full extent is known, change dressings BID until weeping stops

Question 21

Defined as inadequate tissue/organ perfusion due to either pump failure, loss of peripheral resisitance, and hemorrhage

Answer 21

shock

Question 22

Cardiac response to shock

Answer 22

tachycardia, increased contractility, vessel constriction

Question 23

Renal response to shock

Answer 23

increase renin and aldosterone, vasoconstriction,

Question 24

Neuroedocrine response to shock

Answer 24

increase circulating ADH

Question 25

Type of shock due to decreased vascular volume or hemorrhage

Answer 25

hypovolemic

Question 26

Type of shock due to systemic infections that lead to hypoperfusion and decreased vascular volume

Answer 26

septic

Question 27

What is the earliest manifestation of shock?

Answer 27

tachycardia

Question 28

What is the cause of peripheral edema in shock?

Answer 28

acute dilutional hypoalbuminemia

Question 29

Released by platelets and causes increased vessel contraction for wound healing

Answer 29

thromboxane A2

Question 30

Minimum gage needle you can use for IVs in a pt who is in hemorrhagic shock

Answer 30

16 gauge

Question 31

How many ml cyrstalloid should be given for every ml of blood loss?

Answer 31

3 ml

Question 32

What do you need to monitor in patients receiving large volumes of blood transfusions?

Answer 32

calcium and coagulopathy

Question 33

What is the hallmark of cardiogenic shock with signs of increased PVR (weak pulse, clammy skin)

Answer 33

hypotension

Question 34

What type of bacteria usually causes endotoxic shock?

Answer 34

gram negatives

Question 35

occurs in septic shock due to pooling of blood in microcirculation and loss of fluid into interstital spaces due to increased capillary permeability

Answer 35

relative hypovolemia

Question 36

Type of septic shock characterized by diffuse red rash, thrombocytopenia, and usually within 5 days of menses

Answer 36

Toxic shock syndrome

Question 37

Most common injury responsible for neurogenic shock due to failure of vasomotor regulation and pooling of blood in dilated capacitance vessels

Answer 37

spinal cord injury

Question 38

Why should you not use colloids in septic shock?

Answer 38

Increased capillary permeability will cause pulmonary edema

Question 39

Why should you not use in any shock state except septic shock unless the CVP shows patient to by normovolemic yet they’re hypotensive?

Answer 39

inotropic agents (vasopressors)

Question 40

Defined by presence of 2 of the following: fever or hypothermia, tachypnea, tachycardia, leukocytosis

Answer 40

Systemic Inflammatory Response Syndrome (SIRS)

Question 41

Severe Sepsis (organ dysfunction) with hypotension (defined by arterial SBP < 90 mmHg or 40 mmHg less than patient’s normal BP) that is unresponsive to fluid resuscitation

Answer 41

septic shock

Question 42

Septic shock that lasts for > 1 hour and does not respond to fluid or pressor administration

Answer 42

refractory septic shock