Ch 37: Disorders Related to Environmental Emergencies Flashcards
Heat exchange between the body and the environment occurs via 4 common processes:
radiation
evaporation
conduction
convection
(p. 1561)
In extreme temperatures, the body’s _______________ may fail, resulting in movement of the core body temperature towards the temperature of the ________ ___________.
thermoregulation
external environment
What is the definition of heat stroke?
Hyperthermia with cerebral dysfunction in a patient with significant heat exposure.
What are the 2 keys to decreasing morbidity and mortality in heat stroke victims?
Implement cooling as quickly as possible, and avoid shivering.
What are the primary methods of the body to cool itself down?
sweating and peripheral vasodilation
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 ________ _________.
37.2 C
reverses direction
With vigorous exertion, sweat loss can be as much as….
….2.5 L/h
p. 1562
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.
20%
humidity
In the setting of hyperthermia, name 3 factors that can reduce cutaneous blood flow.
vasoconstrictors
beta-adrenergic blocking agents
dehydration
The first __ hours of burn care offer the greatest impact on morbidity and mortality of a burn victim.
48
Explain the “Rule of Nines” which is useful for rapidly assessing the extent of a burn.
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)
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.
1%
second and third
Keep in mind that first or second degree burns may convert to deeper burns, especially if treatment is _______ or _________ ____________ or ______________ occurs.
delayed
bacterial colonization
superinfection
(p. 1568)
Judgment of depth of burn injury is difficult. The first degree burn may be ___ or ____, but will demonstrate excellent _________ ______. They are also not _________ initially.
red or gray
capillary refill
blistered
If a burn wound is blistered, this represents _______-_________ injury to the ______, which is referred to as a ______-degree burn.
partial-thickness
dermis
second
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 ________.
adnexal structures third absent visible smoother
(p. 1568)
Deep second- and third-degree burns are treated in a similar fashion. Neither will heal appropriately without _____ ___________ and ________.
early debridement
grafting
Why are only second- and third-degree burns included in calculating the total burn surface area?
First-degree burns usually do not represent significant injury in terms of prognosis or fluid and electrolyte management.
The benefits of hyperbaric oxygen for treatment of acute burns remain ________ and __________.
unproven and anecdotal
The Prognostic Burn Index is the sum of…
An additional __% mortality is added if inhalation injury is present.
…the patient’s age and percentage of full thickness or deep partial thickness burns.
20%
The Prognostic Burn Index is most useful at…
….the extremes of age.
Transfer to a burn unit is indicated for 4 main reasons:
large burn size
circumferential burn
burn involving a joint or high-risk body part
patients with comorbidities.
Smoke inhalation should be suspected when a burn victim….
….is found in an enclosed space, or in close proximity to the fire.
Clinical findings related to smoke inhalation include….
….singed nasal or facial hairs, carbonaceous sputum, or an elevated carboxyhemoglobin level.
When burns greater than approximately __% of total body surface area are present, systemic metabolic derangements (including generalized _________ ____) may occur and require intensive support.
20%
capillary leak
What can the inflammatory cascade associated with burns lead to?
shock and coagulopathy
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.
early
breathing normally
first
Chest radiographs of patients with inhalation injury are typically ______ initially, but may develop an ____ picture in __ - __ hours, especially with severe inhalation injury.
normal
ARDS
24 - 48
(p. 1569)
What kind of pain control medications are usually needed in burn victims?
opioids and NSAIDs
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 _________.
tetanus
topical
indicated
(p. 1569)
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.
circumferential
Escharotomy incisions
What other limb-threatening conditions can develop in patients with circumferential burns?
compartment syndrome
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.
debrided
depth
as needed
(p. 1569)
The goal of burn wound management is to protect the wound from ___________ and avoid further injury or _________.
desiccation (extreme dryness)
infection
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 _______ ___.
30 mm Hg
decompression
remains low
Why is nutritional support such an important component in the treatment of burn patients?
Because burn patients have higher metabolic needs and require more energy, nutrients, and antioxidants for wound healing.
With electrical injury, extent of injury is determined by the ____, ______, _______, and _______ of electrical current.
type
amount
duration
pathway
(p. 1570)
In electrical injury, skin findings are __________ and are not indicative of the degree of deeper tissue injury.
misleading
p. 1570
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 ________.
alternating; direct
bidirectional; duration; amount
lightning; batteries; automotive
muscle contraction; tetany
Electricity causes acute damage by direct ______ damage, muscle ______, direct thermal injury and ___________ necrosis, and associated trauma.
tissue
tetany
coagulation
(p. 1570)
Lightning differs from other high-voltage electrical shock in that it is massive DC current of ________ of volts lasting a ________ of a second.
millions; fraction
Tissue resistance to electricity varies throughout the body. _____ cells are the most vulnerable, and ____ is the most resistant.
nerve; bone
What are the 3 types of electrical burns?
flash (arcing) burns
flame (clothing) burns
direct heating effect of tissues by the electrical current
If an electrical current passes through the heart or brainstem, death may be immediate due to _ ___, ________, or _____.
V fib, asystole, apnea
p. 1570
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.
internal injuries
tingling; myalgias; coma; paralysis
The presence of entrance and exit wounds signifies…
These entrance and exit wounds on the skin are…
…an increased risk of deep tissue damage.
….the most damaged.
(p. 1570)
Electrical current passing through skeletal muscle can cause muscle necrosis and contractions severe enough to result in ____ ________.
bone fracture
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.
deceptive; dead
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.
unrecognized compartment
kidney injury
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.
tissue swelling
devitalized, tetanus
(p. 1571)
Current is the most important determinant of tissue damage. Current passes through the tissues of _____ _________, and this energy produces heat causing direct thermal injury.
least resistance
