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411 Adult 3 > Exam 3 > Flashcards

Exam 3 Flashcards

1
Q

Functional changes of burn injury

A

Risk for infection
Massive fluid loss
Vitamin D deficiency (full thickness burns cannot activate vitamin D)

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2
Q

Cardiovascular changes with burns
Respiratory changes
GI changes

A

Decreased cardiac output, fluids go into tissue leading to Hypovolemia & Hyponatremia (3rd spacing)
- patient can go into ARDS due to inflammatory response
- reduced GI blood flow leads to curlings ulcer (use proton pump inhibitors & early NG feeding)

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3
Q

Electrolyte imbalances
Diuretic phase begins
When to transfuse a patient

A

Hypovolemia, Hyponatremia, hyperkalemia (direct cell damage), hemoconcentration (increased blood viscosity - high risk for clots)
- in 48-72 hrs & fluid shifts back to normal
- when Hgb is <8 & symptomatic

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4
Q

Superficial thickness burn involves
Color
Edema
Pain
Blisters / eschar
Healing time
Ex.

A

Only epidermal layer
Pink to red
Yes
No / no
3-6 days
Sunburn, flash burn

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5
Q

Superficial partial thickness involves
Color
Edema
Pain
Blisters / eschar
Healing time
Ex.

A

Upper 3rd of dermis
Pink to red
Mild to moderate
Yes
Yes / no
About 2 weeks
Scalds, flames, brief contact w hot objects

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6
Q

Deep partial thickness involves
Color
Edema
Pain
Blisters / eschar
Healing time
Grafts?
Ex.
What can happen

A

Deeper into dermis
Red to white
Moderate
Yes
Rare / soft & dry
2-6 weeks
Can be used if healing is prolonged
Scalds, flames, tar, grease, chemicals
- infection, hypoxia, or ischemia can convert wound to full thickness

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7
Q

Full thickens burn involves
Color
Edema
Pain
Blisters / eschar
Healing time
Grafts required
Ex

A

Destruction of epidermis & dermis
Black, brown, yellow, white, red
Severe
Yes & no
No / hard & elastic
Weeks to months
Yes
Scalds, flames, tar, grease, chemicals, electricity

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8
Q

Deep full thickness involves
Color
Edema
Pain
Blisters / eschar
Healing time
Grafts required
Ex

A

Beyond skin, damages muscle, bone & tendons
Black
Absent
Absent
No / hard & elastic
Weeks to months
Yes
Flames, electricity, grease, tar, chemicals

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9
Q

Contact burns
Chemical injury
Radiation injury
Electrical injury

A
  • hot metal, tar or grease (tar & asphalt go up to 400 degrees)
  • severity depends on duration, concentration, amount of skin exposed & action of chemical
  • when exposed to radiation, cover patient & contain them, once cleared they can be scrubbed down
  • heart stops during electrical injury, shock goes into body & spreads around causing internal damage before exiting
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10
Q

Electrical burn severity
What happens to organs in path
What shouldn’t you do
What should you always do

A

Longer electricity in contact w body = greater the damage
- organs in path of current may become ischemic or necrotic
- never directly touch a patient being electrocuted
- always do an EKG & immobilize C spine, always remove jewelry cs of swelling

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11
Q

Emergency management of burns
Flame burns
Chemical burns
Radiation burns

A

Always assess airway patency, always prophylactically intubate & and administer tetanus toxoid, cover patient, begin fluid replacement
- remove smoldering clothing & metal objects
- DO NOT WET dry chemicals brush them off, remove clothing
- use tongs to remove radiation clothing

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12
Q

Factors affecting airway

A

Injured in closed space
Extensive burns on face
Intra-oral charcoal
Unconscious at time of injury
Singed scalp hair, eyelids, eyelashes
Changes in voice
Use of accessory muscles
Edema & ulceration of airway mucosa

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13
Q

Carbon monoxide poisoning is
Characterized by

A

Leading cause of death from fire
- cherry red color (vasodilation), severe headache & vomiting, AMS - coma - death

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14
Q

Percentage of burns
Head front / back
Chest
Back
Arms front / back
Legs front / back
Private

A

4.5 / 4.5
18
18
4.5 / 4.5
9 / 9
1

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15
Q

Parkland formula for monitoring fluid status

A

4ml x kg x % of burn
50% over first 8 hours from time of injury
50% over second 16 hours

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16
Q

Burns interventions
Non surgical management
Medications
Surgical management

A

Suction airway, keep head of bed at 30 with a ventilator, check chest movement - eschar, humidified oxygen
- IV fluids, monitor preload with CVP line to ensure adequate fluid therapy
- paralytic meds ONLY given by doctors (tracrium, norcuron)
- escharotomy (incision that relieves pressure on chest & improves circulation ; non-painful) / fasciotomy (deeper incision extending through fascia; painful)

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17
Q

Nutrition required during acute phase of burn injury
Local indicators of infection
Systemic indicators

A
  • high caloric needs 5K/day, high protein diets for healing
  • ulceration of healthy skin, lesions in uninvolved/healed skin, excessive wound drainage, pale boggy granulation tissue, odor
  • altered LOC, changes in vitals, oliguria, GI dysfunction, hyperglycemia, Thrombocytopenia, hypoxemia, change in WBC
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18
Q

Topical meds
Surgical management wound covering
Proper positioning

A
  • Silvadene (contra in sulfa allergy), gentamicin sulfate, anticoat (soak to remove)
  • autograft; piece of skin from unburned area, bulky pressure dressing for 3-5 days for vascularization, DO NOT DISTURB DRESSING
  • maintain in neutral body position with minimal flexion to prevent contractures
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19
Q

Hypertrophic scar pressure garment

A

Help prevent contractures
Inhibit venous stasis & edema
Must be worn 23hrs a day, every day for 12-24 months

20
Q

Viral meningitis is
Diagnostic testing of

A

Self limiting - symptoms subside in a few days
- CSF ; must do CT brain for bleeding before a lumbar puncture

21
Q

Bacterial meningitis is
Clinical manifestations
Kernigs & brudzinskis sign
Complications
Care for patient
Treatment

A

Most contagious & most lethal type
- petechiae rash, stiff neck, photophobia, altered LOC, increased ICP (projectile vomiting)
- Kernigs (extension of knee on flexed hip) / brudzin (flexing neck causes flexed hip & knees)
- seizures due to ICP, dysfunction of cranial nerves
- maintain ABC, neuro checks, never medicate for pain with change in LOC, raise HOB to 30 for ICP, lay flat after lumbar puncture
- antibiotics : vancomycin (can cause MRSA) , anti-epileptic drug (#1 is phenytoin: range 10-20, necrotic to tissue, never give fast)

22
Q

Patient position for lumbar puncture
CSF findings in bacterial VS viral

A

Fetal position
Bacterial : cloudy fluid, with decreased glucose & elevated CSF pressure, increased protein

Viral: clear fluid, with normal glucose & normal CSF pressure, slightly increased protein

23
Q

TIA is
Treatment
Key features
TIA work up

A

Temporary neuro dysfunction, warning sign of a stroke
-Preventative - decrease HTN, apspirin or plavix, glycemic control <140
- visual deficits, motor deficits (face droop, ataxia), numbness, aphasia or dysarthria (slurred speech)
- CT brain, Carotid U/S for obstruction, EKG for a fib

24
Q

Thrombotic stroke is due to
Evolution
Onset
Contributing factors
Prodromal symptoms
Neuro deficits
Duration

A

A clot already present in carotid
- Intermittent… worsen symptoms
- Gradual (minutes - hours)
- HTN - atherosclerosis
- TIAs
- Speech deficits, visual problems, confusion
- Improve weeks - months or permanent deficits

25
Q

Embolic stroke is due to
Evolution
Onset
Contributing factors
Prodromal symptoms
Neuro deficits
Duration

INR for heart valve

A

Dislodged thrombus (mainly cardiac)
- complete stroke… steady progression
- sudden onset
- cardiac disease
- no symptoms
- paralysis, expressive aphasia
- rapid improvements

3-3.5

26
Q

Hemorrhagic stroke is due to
Evolution
Onset
LOC
Contributing factors
Prodromal symptoms
Neuro deficits
CSF
Seizures
Duration

What should we never do with hemorrhagic stroke

A

Interrupted vessel integrity
- usually abrupt
- sudden, gradual if due to HTN
- stupor or coma
- HTN, vessel disease
- focal deficits
- bloody CSF
- usually have seizures
- variable-permanent deficits

Never do a lumbar puncture

27
Q

Key features with ICP
What is Cushing’s triad

A

Decreased LOC (lethargy to coma)
Changes in speech (aphasia)
Blown pupils (dilated & non-reactive)
Seizures
Decerebrate or decorticate position
- Cushing’s triad: severe HTN, widened pulse pressure >40, bradycardia (bad sign of ICP)

28
Q

Presentation of left side stroke
Language
Memory
Vision
Behavior
Hearing

A
  • aphasia, agraphia
  • possible deficit
  • can’t discriminate words & letters, reading problems, right visual field deficit
  • slowness, cautiousness, anxiety, depression, worthlessness, intellectual impairment
  • no deficit
29
Q

Presentation of Right side stroke
Language
Memory
Vision
Behavior
Hearing

A
  • impaired sense of humor
  • disoriented to time, place & person, can’t recognize faces
  • loss of depth perception, neglect of left visual fields
  • impulsiveness, lack of awareness, euphoria, constant smiling, overestimates abilities
  • loss of tonal variations
30
Q

Stroke lab diagnostics
Thrombolytics for stroke
Stroke meds
Impaired verbal communication

A
  • CT brain (priority), carotid U/S, clotting factors
  • inclusion: stroke less than 4.5hrs / exclusion: INR <1.7, Hx of stroke & diabetes
  • warfarin for a-fib, antiplatelets (aspirin & plavix), aspiring is not given within 24 hrs of thrombolytics
  • expressive aphasia; damage to frontal lobe (broca’s)
    Receptive aphasia; damage to temporal lobe (wernicke’s)
31
Q

TBI is
Acceleration / deceleration injury
Open fracture
Battle sign
Raccoon eyes
Basilar skull fracture can cause

A

Damage to brain from external force
- A : external force suddenly puts head in motion / D: moving head is suddenly stopped
- highest risk for meningitis
- bruising behind ears due to middle cranial fossa fracture
- bruising around eyes due to basilar skull fracture
- leakage of CSF (halo sign) must test fluid for glucose, potential for hemorrhage

32
Q

Mild TBI - concussion findings
Contusion is
Laceration is
Diffuse axonal injury

A
  • LOC <30 mins, dazed, difficulty remembering or concentrating, sleeping problems, irritability
  • bruising without tearing of tissue (coup & countercoup)
  • more serious, tearing of vessels ; can cause hemorrhage or edema
  • widespread injury due to high speed accident; loss of visual fields, impaired cognitive fxn
33
Q

LOC & GCS in
Mild TBI
Moderate TBI
Severe TBI

A
  • LOC <30 min, GCS 13-15
  • LOC 30min - 6hrs, GCS 9-12
  • LOC > 6hrs, GCS 3-8
34
Q

As ICP increases
Keep what in check
Manifestations
Management
Surgical management

A

Cerebral perfusion pressure drops (CPP) leading to brain ischemia
- keep CPP > 70 & maintain MAP (CPP = MAP - ICP)
- decreased LOC, Pupillary changes, projectile vomiting, posturing
- propofol (sedative to assess neuro), barbiturate coma for continuous seizure (epilepticus > 20 min), HOB 30 degrees
- intraventricular catheter (IVC) ; risk of infection & drainage / decompression: removal of section of skull or craniotomy

35
Q

Subdural hematoma
Brain death criteria

A

Highest mortality because of slow bleeding & going unrecognized
- GCS <3, no pupil response, no reflexes

36
Q

Spinal cord injury - secondary injury
Spinal shock syndrome patient
Symptoms

A

Hemorrhage or hypovolemia results in shock, decreased perfusion
- flaccid paralysis, loss of reflexes below lesion, temporary loss of functions
- hypotension, bradycardia, urinary retention, flaccid paralysis

37
Q

Initial assessment patient with SCI
Complete injury results in
Incomplete injury
How do you determine severity

A
  • priority is airway, C3-5 injury requires emergency intubation, assess LOC with GCS
  • complete loss of motor & sensory fxn below lvl of injury
  • varying degrees of motor & sensory fxn
  • must wait for edema to resolve before determining severity
38
Q

Autonomic dysreflexia is
Finding 1
Finding 2
Treatment
Key features

A

Exaggerated sympathetic response to noxious stimuli in high level SCI
- massive vasoconstriction below lvl of injury : HTN, headache, blurry vision, goosebumps (piloerection)
- vagal stimulation leads to vasodilation above injury: diaphoresis
- Elevate HOB, remove stimulus
- sudden rise in BP, profuse sweating, goosebumps, flushing of skin, blurred vision

39
Q

Oncologic emergencies
Sepsis results from
SIADH results from
Hypercalcemia // treatment

A
  • neutropenia, impaired immunity
  • small cell lung cancer
  • increased parathyroid hormone, bone metastasis // biphosphonates: zometa, xgeva, pamidronate
40
Q

DIC
Most Common problem
Presentations
Lab findings
Management

A
  • high mortality rate
  • hemorrhage due to decreased platelets <150 & no clotting factors
  • petechiae & purpura (bleeding under skin)
  • increased D-dimer, PT/PTT increased, decreased fibrinogen, decreased Hgb
  • blood products: FFP, platelets, cryoprecipitate, whole blood
41
Q

Superior vena cava syndrome is
Signs & symptoms
Late signs

A
  • obstruction of SVC by tumor or thrombus
  • facial/neck edema, vein distention in head, neck & chest
  • hemorrhage, cyanosis, decreased BP & LOC
42
Q

Tumor lysis syndrome is
4 hallmark signs
Treatments for each

A
  • rapid release of intracellular contents due to chemotherapy
  • Hyperuricemia, hyperphosphatemia, hyperkalemia, hypocalcemia
  • colchicine, allopurinol
    Renagel, calcium carbonate or acetate
    Glucose w insulin, sodium polystyrene
    Calcium electrolyte (kyexelate must have bowel movement)
43
Q

Thrombocytopenia is
Signs & symptoms

A

Platelet count < 150,000 / when below <120,000 risk for spontaneous bleeding
- bleeding, blood in emesis urine or feces

44
Q

Rule of thumb for any cancer

A

Early detection is key to effective treatment & survival

45
Q

Head & neck cancer clinical manifestations
Post-op considerations

A
  • hoarseness or change in voice, lump in mouth throat or neck, Dysphagia
  • airway patency #1 priority, skin graft over carotid (protect carotid), report large increases in drainage or purulent / foul smelling drainage

411 Adult 3 (3 decks)

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