Ch 37: Disorders Related to Environmental Emergencies

Question 1

Heat exchange between the body and the environment occurs via 4 common processes:

Answer 1

radiation
evaporation
conduction
convection

(p. 1561)

Question 2

In extreme temperatures, the body’s _______________ may fail, resulting in movement of the core body temperature towards the temperature of the ________ ___________.

Answer 2

thermoregulation

external environment

Question 3

What is the definition of heat stroke?

Answer 3

Hyperthermia with cerebral dysfunction in a patient with significant heat exposure.

Question 4

What are the 2 keys to decreasing morbidity and mortality in heat stroke victims?

Answer 4

Implement cooling as quickly as possible, and avoid shivering.

Question 5

What are the primary methods of the body to cool itself down?

Answer 5

sweating and peripheral vasodilation

Question 6

The transfer of heat to the surrounding air (convection) occurs with diminishing efficiency as ambient temperature rises, especially above ___ _, which is the point at which heat transfer ________ _________.

Answer 6

37.2 C

reverses direction

Question 7

With vigorous exertion, sweat loss can be as much as….

Answer 7

….2.5 L/h

p. 1562

Question 8

Evaporation (aka sweating) account for only __% of heat loss at normal temperatures, but with vigorous exertion, evaporation becomes the major mechanism for dissipation of heat. This mechanism diminishes as ________ rises.

Answer 8

20%

humidity

Question 9

In the setting of hyperthermia, name 3 factors that can reduce cutaneous blood flow.

Answer 9

vasoconstrictors
beta-adrenergic blocking agents
dehydration

Question 10

The first __ hours of burn care offer the greatest impact on morbidity and mortality of a burn victim.

Answer 10

48

Question 11

Explain the “Rule of Nines” which is useful for rapidly assessing the extent of a burn.

Answer 11

Entire head and neck -- 9%
Posterior surface of upper trunk -- 9%
Anterior surface of upper trunk -- 9% 
Posterior surface of lower trunk -- 9%
Anterior surface of lower trunk -- 9%
Right arm -- 9%
Left arm -- 9%
Right leg -- 18%
Left leg -- 18%
Groin -- 1% 

(p. 1568)

Question 12

One rule of thumb is that the palm of an open hand constitutes _% total body surface area in adults.
Also, only ______ and _____ degree burns are included in calculating the total burn surface area.

Answer 12

1%

second and third

Question 13

Keep in mind that first or second degree burns may convert to deeper burns, especially if treatment is _______ or _________ ____________ or ______________ occurs.

Answer 13

delayed
bacterial colonization
superinfection

(p. 1568)

Question 14

Judgment of depth of burn injury is difficult. The first degree burn may be ___ or ____, but will demonstrate excellent _________ ______. They are also not _________ initially.

Answer 14

red or gray
capillary refill
blistered

Question 15

If a burn wound is blistered, this represents _______-_________ injury to the ______, which is referred to as a ______-degree burn.

Answer 15

partial-thickness
dermis
second

Question 16

As the degree of burn is progressively deeper, there is a progressive loss of _______ __________, referred to as a _____-degree burn.
Hairs can be easily extracted or are ______, sweat glands become less _______, and the skin appears ________.

Answer 16

adnexal structures
third 
absent
visible
smoother

(p. 1568)

Question 17

Deep second- and third-degree burns are treated in a similar fashion. Neither will heal appropriately without _____ ___________ and ________.

Answer 17

early debridement

grafting

Question 18

Why are only second- and third-degree burns included in calculating the total burn surface area?

Answer 18

First-degree burns usually do not represent significant injury in terms of prognosis or fluid and electrolyte management.

Question 19

The benefits of hyperbaric oxygen for treatment of acute burns remain ________ and __________.

Answer 19

unproven and anecdotal

Question 20

The Prognostic Burn Index is the sum of…

An additional __% mortality is added if inhalation injury is present.

Answer 20

…the patient’s age and percentage of full thickness or deep partial thickness burns.

20%

Question 21

The Prognostic Burn Index is most useful at…

Answer 21

….the extremes of age.

Question 22

Transfer to a burn unit is indicated for 4 main reasons:

Answer 22

large burn size
circumferential burn
burn involving a joint or high-risk body part
patients with comorbidities.

Question 23

Smoke inhalation should be suspected when a burn victim….

Answer 23

….is found in an enclosed space, or in close proximity to the fire.

Question 24

Clinical findings related to smoke inhalation include….

Answer 24

….singed nasal or facial hairs, carbonaceous sputum, or an elevated carboxyhemoglobin level.

Question 25

When burns greater than approximately __% of total body surface area are present, systemic metabolic derangements (including generalized _________ ____) may occur and require intensive support.

Answer 25

20%

capillary leak

Question 26

What can the inflammatory cascade associated with burns lead to?

Answer 26

shock and coagulopathy

Question 27

A patient with an inhalation injury needs to be intubated _____ to maintain airway patency even though he or she may appear to be _________ ________. Airway assessment and management is the _____ priority.

Answer 27

early
breathing normally
first

Question 28

Chest radiographs of patients with inhalation injury are typically ______ initially, but may develop an ____ picture in __ - __ hours, especially with severe inhalation injury.

Answer 28

normal
ARDS
24 - 48

(p. 1569)

Question 29

What kind of pain control medications are usually needed in burn victims?

Answer 29

opioids and NSAIDs

Question 30

In terms of chemoprophylaxis for burn patients, _______ status should be verified and updated in all burn patients. All nonsuperficial depth wounds should be covered with _______ antibiotics. Prophylaxis with systemic antibiotics is not _________.

Answer 30

tetanus
topical
indicated

(p. 1569)

Question 31

As edema fluid accumulates, ischemia may develop under any constricting eschar if the full-thickness burn is _______________. ___________ _________ through the anesthetic eschar can save life and limb.

Answer 31

circumferential

Escharotomy incisions

Question 32

What other limb-threatening conditions can develop in patients with circumferential burns?

Answer 32

compartment syndrome

Question 33

Minor burn wounds should be ________ at the bedside to determine the _____ of the burn and then thoroughly cleansed. Thereafter, daily wound care should consist of debridements __ ______, topical antibiotics, and wound dressing.

Answer 33

debrided
depth
as needed

(p. 1569)

Question 34

The goal of burn wound management is to protect the wound from ___________ and avoid further injury or _________.

Answer 34

desiccation (extreme dryness)

infection

Question 35

Abdominal compartment syndrome is emerging as a potentially lethal condition in severely burned patients. Bladder pressures over __ mm Hg establish the diagnosis. Surgical _____________ may be indicated, but even after this, survival _______ ___.

Answer 35

30 mm Hg
decompression
remains low

Question 36

Why is nutritional support such an important component in the treatment of burn patients?

Answer 36

Because burn patients have higher metabolic needs and require more energy, nutrients, and antioxidants for wound healing.

Question 37

With electrical injury, extent of injury is determined by the ____, ______, _______, and _______ of electrical current.

Answer 37

type
amount
duration
pathway

(p. 1570)

Question 38

In electrical injury, skin findings are __________ and are not indicative of the degree of deeper tissue injury.

Answer 38

misleading

p. 1570

Question 39

Electrical current type is either ___________ current (AC), or ______ (DC). Alternating current is _____________ electrical flow that may cause muscle tetany, which prolongs the ________ and ______ of current exposure.
Direct current is unidirectional electrical flow (i.e. _________, _________, and __________ electrical systems; it is more likely to cause a single intense ______ ___________ and ________.

Answer 39

alternating; direct
bidirectional; duration; amount
lightning; batteries; automotive
muscle contraction; tetany

Question 40

Electricity causes acute damage by direct ______ damage, muscle ______, direct thermal injury and ___________ necrosis, and associated trauma.

Answer 40

tissue
tetany
coagulation

(p. 1570)

Question 41

Lightning differs from other high-voltage electrical shock in that it is massive DC current of ________ of volts lasting a ________ of a second.

Answer 41

millions; fraction

Question 42

Tissue resistance to electricity varies throughout the body. _____ cells are the most vulnerable, and ____ is the most resistant.

Answer 42

nerve; bone

Question 43

What are the 3 types of electrical burns?

Answer 43

flash (arcing) burns
flame (clothing) burns
direct heating effect of tissues by the electrical current

Question 44

If an electrical current passes through the heart or brainstem, death may be immediate due to _ ___, ________, or _____.

Answer 44

V fib, asystole, apnea

p. 1570

Question 45

In electrical burns, there can be very little skin damage, but with massive ________ ________.
Symptoms and signs can range from superficial skin burns, ________, and ________ to ____, _________, and death.

Answer 45

internal injuries

tingling; myalgias; coma; paralysis

Question 46

The presence of entrance and exit wounds signifies…

These entrance and exit wounds on the skin are…

Answer 46

…an increased risk of deep tissue damage.

….the most damaged.

(p. 1570)

Question 47

Electrical current passing through skeletal muscle can cause muscle necrosis and contractions severe enough to result in ____ ________.

Answer 47

bone fracture

Question 48

Resuscitation should be initiated on all victims of electrical injury since clinical findings are _________ and unreliable and a viable victim of electrical current injury may appear ____ on examination.

Answer 48

deceptive; dead

Question 49

Electrical burn injury is the most underrecognized and devastating burn injury. They can lead to amputations (because of ____________ ___________ syndromes), and acute ______ ______, resulting in part from rhabdomyolysis.

Answer 49

unrecognized compartment

kidney injury

Question 50

Deep tissue necrosis leads to profound ______ ________, which results in a high risk of compartment syndrome.
Early debridement of ___________ tissues and _______ prophylaxis may reduce the risks of infection.

Answer 50

tissue swelling
devitalized, tetanus

(p. 1571)

Question 51

Current is the most important determinant of tissue damage. Current passes through the tissues of _____ _________, and this energy produces heat causing direct thermal injury.

Answer 51

least resistance