Burns, Shock, Sepsis Flashcards
What type of wound classification for a patient who has an inguinal hernia repair (no strangulation)?
clean
A patient has an elective colon resection for colon cancer. What type of wound is this??
clean contaminated
What is the most common cause of burns in children?
scalding from hot drinks or bath
What are consequences of burn shock?
depression of myocardium and metabolic acidosis
What cellular changes occur with electrolytes of burn patients?
intracellular influx of Na/H20, extracellular migration of K+. Failure of Na pump
What are the hematologic changes of burns?
increased hematocrit but anemia due to RBC destruction
breaks portions of body into multiples of 9 with the perineum being 1%
rule of 9’s
Severity of burn characterized by erythema, minimal surrounding edema, minimal pain
first degree
Severity of burn that involves partial thickness. Skin is red/mottled, blistered, swollen, wet/weeping, painful, sensitive to air
second degree
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
third degree
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).
inhalation–> intubate early!
Why are alkali burns more serious than acid burns?
alkalis penetrate deeper
What is the treatment for alkali burn?
DO NOT NEUTRALIZE. “The solution to pollution is dilution” - - IRRIGATE, IRRIGATE, IRRIGATE!
Why are electrical burns more serious than they appear?
Skin has more resistance than bone, muscle, blood vessels or nerves; therefore deeper structures have more damage
Cause of acute renal failure in patient with electrical burn
Occult destruction of muscle can cause rhabdomyolysis which causes the release of myoglobin
What should you do if a patient who has an electrical burn starts urinating dark urine?
assume myoglobin and increase fluids to achieve a urine output of 100ml/hr. If that doesn’t work, mannitol
Initial treatment steps of a burn patient
Start 2 large bore IVs, look at eyes for corneal damage, estimate depth/extent of burn
What % of BSA partial-thickness burn needs NG tube placed due to high likelihood of ileus?
20%
Critical in monitoring resuscitation. Until a swan or CVP line is placed, it is the only way to ensure adequate renal perfusion
foley catheter
Dressing treatment for minimal burns or burns being treated as outpatient
1% silver sulfadiazine (silvadene). Check q 24 hrs until full extent is known, change dressings BID until weeping stops
Defined as inadequate tissue/organ perfusion due to either pump failure, loss of peripheral resisitance, and hemorrhage
shock
Cardiac response to shock
tachycardia, increased contractility, vessel constriction
Renal response to shock
increase renin and aldosterone, vasoconstriction,
Neuroedocrine response to shock
increase circulating ADH
Type of shock due to decreased vascular volume or hemorrhage
hypovolemic
Type of shock due to systemic infections that lead to hypoperfusion and decreased vascular volume
septic
What is the earliest manifestation of shock?
tachycardia
What is the cause of peripheral edema in shock?
acute dilutional hypoalbuminemia
Released by platelets and causes increased vessel contraction for wound healing
thromboxane A2
Minimum gage needle you can use for IVs in a pt who is in hemorrhagic shock
16 gauge
How many ml cyrstalloid should be given for every ml of blood loss?
3 ml
What do you need to monitor in patients receiving large volumes of blood transfusions?
calcium and coagulopathy
What is the hallmark of cardiogenic shock with signs of increased PVR (weak pulse, clammy skin)
hypotension
What type of bacteria usually causes endotoxic shock?
gram negatives
occurs in septic shock due to pooling of blood in microcirculation and loss of fluid into interstital spaces due to increased capillary permeability
relative hypovolemia
Type of septic shock characterized by diffuse red rash, thrombocytopenia, and usually within 5 days of menses
Toxic shock syndrome
Most common injury responsible for neurogenic shock due to failure of vasomotor regulation and pooling of blood in dilated capacitance vessels
spinal cord injury
Why should you not use colloids in septic shock?
Increased capillary permeability will cause pulmonary edema
Why should you not use in any shock state except septic shock unless the CVP shows patient to by normovolemic yet they’re hypotensive?
inotropic agents (vasopressors)
Defined by presence of 2 of the following: fever or hypothermia, tachypnea, tachycardia, leukocytosis
Systemic Inflammatory Response Syndrome (SIRS)
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
septic shock
Septic shock that lasts for > 1 hour and does not respond to fluid or pressor administration
refractory septic shock
