Exam 3 review sheet Flashcards

Question

normal BUN

Answer 1

130-170 ml/min

Answer 2

* Peak levels occur 1-4 hours * Doubling in 2 hours ++ MI * Reference range: \< 90 mcg/L

Answer 3

Pt. placed in semi-fowlers position - ECG and Cardiac Enzyme Assessment - IV line started (at least 18 guage) - ASA 325 mg given: Four baby ASA, Clopidogrel (Plavix) 300 mg (becomes an issue if they need to go to surgery) - Oxygen - Beta Blockers - ACE inhibitors (if CHF present): watch out for asthma patients -NTG titrate to releive chest pain but keep SBP above 90 mm/Hg - start drip 5 mics per min, can titrate as high as 400 - Works as a vasodilator - Decreases peripheral resistance - Increased coronary blood flow _Heparin vs Lovenox_ - Neither lyse the clot only prevents new clots - Heparin increased risk of HTP - Lovenox longer more predictable action - Not preferred if Surgery anticipated

Answer 4

* Procedure which involves placement of a catheter into RT or LT side of heart. * Invasive * Coronary angiography is often included together with cardiac catheterization * Diagnostic procedure and/or * a therapeutic procedure * Adults & Children

Answer 5

* This procedures provides the doctor with a "road map" of the arteries in the heart * To find any areas of blockage in the arteries that supply the heart with blood. * May also look at the valves, chambers & heart muscle * Can help in making decisions about the treatment of heart disease.

Answer 6

* femoral, brachial or carotid artery to the knob of the aorta for coronary arteries * It may be advanced to the left heart to look at the LT ventricle

Answer 7

* Balloon Angioplasty is a technique used to dilate an area of arterial blockage with the help of a balloon catheter. * It is a way of opening a blocked blood vessel * Not highly effective, can rupture wall of vessel, or the plaque can just move right back

Answer 8

* Internal Bleeding * Cerebral Aneurysm * AV malformation * Previous Cerebral Hemorrhage * Pregnant * CVA recent * Uncontrolled HTN * Aortic Dissection * Traumatic CPR

Answer 9

_Lifestyle Change_ Healthy diet adequate exercise No Smoking Medicine coated stents (apirin, plavix, cholesterol medicine)

Answer 10

INDICATIONS * Atrial Fibrillation * Atrial Flutter * AV Nodal Reentrant Tachycardia * AV Reentrant Tachycardia * Atrial Tachycardia Most often, cardiac ablation is used to treat rapid heartbeats that begin in the upper chambers, or atria, of the heart. As a group, these are know as supraventricular tachycardias, or SVTs. Types of SVTs are: Minimally invasive treatment for arrhythmias * Live fluoroscopy and angiography techniques are used along with special electro physiologic equipment and catheters

Answer 11

Minimally invasive surgery does not use CPB * Smaller incision * Emerging as a replacement for conventional CABG * Starting in 1990’s, MIDCAB has gained popularity * Usually conducted for LIMA to LDA grafts Advantages * no sternotomy or CPB * operating time is 2-3 hours * recovery time 1-2 weeks * effectiveness 90% * incision only 10cm * reduced need for blood transfusion * less time on anesthesia * less pain * less expensive

Answer 12

* New instruments must be developed * Requires highly skilled surgeon and learning curve for surgeons limits number performed * Small incision * Beating heart * Blood in field * Can only be used with patients having blockages in one or two coronary arteries on the front of the heart * Attempts at operating on other arteries have been moderately successful, but requires even greater skill and practice

Answer 13

Uses CPB Balloon catheter system for aortic occlusion and cardioplegic arrest 5-8 cm left anterior thoracotomy incision No sternotomy!!! uses LIMA Benefits: * Bloodless field * Heart arrested * allows more accurate anastomoses than MIDCAB * Smaller incision than CABG * No sternotomy Drawbacks * Uses CPB * Technically very difficult

Answer 14

* Saphenous vein used for bypassing right coranry artery and circumflex coronary artery * Internal mammary artery (IMA) used for bypassing left anterior descending coronary artery (patency rate over 90% after 10 years) * If more veins are needed, alternative sites such as upper extremity veins can be used (patency rate as low as 47% after 4.6 years)

Answer 15

* What to expect at home * Pain in your chest around the incision area * Swelling in the leg at harvest site * Itchiness or tingling feeling at incision site * Weakness * Cardiac rehabilitation * Lifestyle & diet modification * Smoking cessation * Cardiac diet (Low salt, low cholesterol, low fat)

Answer 16

* physical exam: 85% have audible friction rub during the course of their disease: lean them forward, hear Left sternal border, loudest during expiration * The rub is high pitched scratchy or squeaky * Chest pain * Pericardial friction rub: pericardial friction rub is audible throughout the respiratory cycle, whereas the pleural rub disappears when respirations are on hold * diffuse ST segment elevation on EKG * Pericardial effusion * \*Presence of at least two of the above feature is necessary to make the dx

Answer 17

pericarditis

Answer 18

* uncomplicated acute pericarditis can undergo iinitial evaluation in a same day hospital facility or clinic, with an outpatient follow up features of high risk include: * subacute symptoms (eg. developing over several days or weeks) * high fever (.38 C, 100.4 F) and leukocytosis * evidence suggesting cardiac tamponade * a larg pericardial effusion * immunosupressed state * a history of oral anticoagulant therapy * acute trauma * failure to respond within seven days to NSAID therapy, a generous allocation of time * elevated cardiac troponin, suggestive of myopericarditis

Answer 19

Stages of pericarditis: 1: diffuse ST elevation and PR segment depression (seen in more than 80%) 2: Normalization of the ST and PR 3: Eidespread T-wave inversion 4: normalization of the T waves * *_Pericarditis_** **_ Angina, Ischemia_** **\*PR depression** Frequent Almost never **\*Q waves **not usual, common with Q unless infarct wave infarct **\*T waves** inverted after J inverted while returns to baseline ST still elevated **\*Arrhythmia** Rare frequent **\*Conduction** Rare frequent **Disturbances**

Answer 20

* worse when breathing in * retrosternal pain * sudden * sharp and stabbing continuous * worse when sleeping, best up leaning forward * does not respons to nitro * friction rub * pr segment depression with ST elevation * normally in trapezius and back

Answer 21

* Goals of accute therapy: relieve pain, treat inflammation, prevent cardiac tampenade * most viral infections are self-limited * treat the underlying disease process * drain purulent effusions * symptomatic therapy * NSAIDS: Aspirin (2-5g/day), Ibuprofen (300-800 mg q6-8hr), ketorolac * Colchicine (0.5-1mg/day) may prevent reoccurance * Glucocorticoids (prednisone 1mg/kg/day): increased rate of complications. Should be restricted to acute pericarditis due to conncetive tissue disease, autoreactive pericarditis, uremic pericarditis

Answer 22

* assess pain frequently: evaluate pain within 30 minutes, notify MD if analgesics not effective * Position of comfort: sit up and leand forward * Administer medications as ordered: give NSAIDs and steroids with food, monitor for GI bleeding, give antibiotics on time, reassure pt. that chest pain is not a MI

Answer 23

* inflammatory immune response * only develops in kids and adolescents following group a beta-hemolytic strep pharyngitis * genetic studies show strong correlation b/w progression to rheumatic heart disease and human leukocyte antigen (HLA)-DR class II alleles and the inflammatory protein-encoding genes MBL2 and TNFA

Answer 24

* valve insufficiency * most common are: apical pansystolic, apicial diastolic, basal diastolic * permanent heart valve damage (mitral #1, aortic #2)

Answer 25

The jones criteria require the presence of 2 major or 1 major and 2 minor criteria for the diagnosis of rheumatic fever Major Criteria * Subcutaneous nodules * pancraditis * migratory polyArthritisSyndenham * Chorea * Erythema Marginatum of Skin Minor Criteria * Fever * Arthralgia * Leukocytosis and raised ESR (erythrocyte sedimentation rate)

Answer 26

* occurs in 5-13% of patients with acute rheumatic fever * begins as 1-3 cm in diameter or papules located on the trunk and proximal limbs but never on the face * the lesions spread outward to form a serpiginous ring with erythmatous raised margins and central clearing * the rash may fade and reappear within hours and is exacerbated by head

Answer 27

* PO penicillin is drug of choice, but ampicillin and amoxicillin are equally effective * can use single dose of IM benzathine penicillin G or benzathine/procain penicillin combination is therapeutic * do not use tetracyclines or sulfonamides to treat GABHS pharyngitis

Answer 28

* the amount of blood the heart must pump with each beat * determined by: venous return to heart and strength of muscle fibers * increasing preload--\>increased stroke volume in normal heart * increasing preload--\>impaired heart--\>decreased SV. Blood is trapped--\>chamber becomes enlarged

Answer 29

* the pressure that must be overcome for the heart to pump blood into the arterial system * dependent on the systemic vascular resistance * with increased afterload the heart muscles must work harder to overcome the constricted vascular bed--\>chamber enlargement * increasing the afterload will eventually decrease the cardiac output

Answer 30

heart muscle disorders in which the ventricles enlarge but are not able to pump enough blood for the body's needs, resulting in HG (example: CAD, myocarditis, etoh, HIV)

Answer 31

heart disorders in which the walls of the ventricles thicken and become stiff, even though the worklaod of the heart is not increased. Ex: congenital HCM, or acquired

Answer 32

heart disorders in which the walls of the ventricles become stiff but not necessarily thickened and resist normal filling with blood between heartbeats. EX: ratiation, amyloidosis

Answer 33

* frank sterlin mechanism * ventricular hypertrophy : increased mass of contractile elemts cuases increased strength of contraction * increased sympathetic adrenergic activity: increased HR, increased contractility * increased activity of R-A-A system

Answer 34

when the heart muscle doesn't contract with enough force so there is not enough oxygen rich blood to be pumped throughout the body

Answer 35

when the heart contracts normally, but the ventricle doesn't relax properly so less blood can enter the heart

Answer 36

* epi and norepi releases which increases HR and contractility which increases myocardial work load * decrease in salt and water excretion from kidneys which helps maintain BP by increased BV, this leads to stretching of heart's chambers which can impair ability to contract * hypertophy and thickening of heart muscle which initially increases contractility but over time leads to stiff chambers * HF pts have higher levels of epi, norepi, aldosterone, angiotensin 2, enothelin, inflammatory cytokines, and vasopressin which contributes to heart remodeling, progression of HF, and higher levels are associated wiht increased mortality

Answer 37

* Stimulated by decreased perfusion leadin gto secretion of hormones * Epi: increases contractility, increases rate and pressure, vasoconstriction leads to SVR * Vasopressin: pituitary gland, mild vasoconstriction, renal water retention

Answer 38

* Decreased renal blood flow secondary to low cardiac output triggers renin secretion by thte kidneys * aldosterone is released--\> increased sodium retention and water retention * preload increases * worsening failure

Answer 39

* long term compensatory mechanism * increases size due to increase in work load ie skeletal muscle * potential reasons * alternation in ventricular distensibility * valvular regurgitation * pericardial restrain * cardiac rhythm * conduction abnormalities * rv function * also several non-cardiac factors including peripheral vascula fxn, reflex autonomic activity, renal sodium handling, etc

Answer 40

* dyspnea * pnd * orthopnea * cough * exercise intolerance * edema * fatigue * nausea * abdominal fullness * rales (usally starts at bases) * s3 (position patient left lateral to hear) * pulmonary edema * jvd * tachycardia * cardiomegaly * hepatojugular reflex (apply pressure, see distention, let go it stays pretty long) * peripheral edema * hepatomegaly

Answer 41

* tachycardia * third heart sound (listen LL recumbent) * increased jugular venous pressure * positive hepatojugular reflux * bilateral rales (not always present, only in L sided HF) * peripheral edema not due to venous insufficiency * laterally displaced apical impulse (from midclavicular (normal) to mid-axillary) * weight gain

Answer 42

* reduced LVEF, LVH, and elevated LV filling pressure, and acute MI * evidence supports getting baseline BNP

Answer 43

* levels below 100 may indicate no heart failure * levels 100-300 suggest heart failure is present * levels above 300 indicate mild heart failure * levels above 600 indicate moderate hf * levels above 900 indicate severe HF

Answer 44

* Severe resp distress evidenced by orthopnea, dyspnea, hx of parozsymal nocturnal dyspnea * severe apprehension, agitation, confusion, resulting from hypoxia, feels like he is smothering * cyanosis * diaphoresi results from sympathetic stimulation * pulmonary congestion: rales, rhonchi, wheezes * JVD from backed up pressure * vital signs: BP elevated, pulse elevated, resp rapid and labored * LOC may vary, depends on level of hypoxia * chest pain may be present, masked by the RDs

Answer 45

* Marked JVD * clear chest * hypotension * marked peripheral edema * ascites, hepatomegaly * poor exercise tolerance * often will be on lasix, digoxin * have chronic pump failure

Answer 46

* thin white sputum * pink frothy hemoptysis * PND within oone hour * common pedal edema with chronic * orthopnea at night * substernal crushing pain * progressing cyanosis * diaphoresis mild to heavy * jvd mild to severe * bp high * crackles fine to coarse, being in gravity dependent areas

Answer 47

* Sodium intake: limit, 203 g a day over 3 meals, recheck sodium intake when weigth gain experienced * Fluid intake: HF patients wiht hyponatremia, high dose diuretics, severe HF. LImit to 6-8 glasses a day. Fruit=1/2 cup liquid * exercise: hf patients with stable heart and stable voume status. 5-10 minutes a day 2-3 times a day to start * monitor wieght gain. Report gain of 2.5 kg a week.

Answer 48

* dilate blood vessels * ace inhibitors (prils): block production of chemicals that cause bp to narrow, decreasing the heart pumping easier. Side effects: cough, hyperkalemia (blood tests every 6 weeks), angioedema, orthostasis * nitrates (african american patients respond well)

Answer 49

* lasix (can develop tolerance to lasix) * hydrochlorothiazide: works as a vasodilator primarliy at low doses * spironolactone: for patients with stage 3 or 4 heart failure Watch for hyperkalemia * loop diuretics (furosemide, bumentanide, torsemide) to treat volume overload. No effect on mortality

Answer 50

* digoxin, lanoxin * decreased heart rate increases stroke volume, increaseing the CO * 10-20% develop toxicity * side effects include arrhythmias, cisual changes, gi complaints, altered mental status * therapeutic range: 0.8-2.0 * steady state : 7-10 days * toxic: 2.4 * half life: 33-51 hours * obtaining levels: determine serum digoxin levels at least 4 hours after IV 6 hours after oral

Answer 51

* slow conduction, allows more time for filling pressures, counteracts natural response to increase hr, relaxing of peripheral blood vessels * used in pts wiht diastolic bp * ex: nifedipine, diltiazem, verapamil, amlodipine, felodipine

Answer 52

* useful by blocking beta-adrenergic receptors of the sympathetic nercous system,the heart rate and force of conractility are decreasd * may worsen HF * ex: metoproplol, atenolol, propanolol, amiodarone

Answer 53

* most commonly asymptomatic * essentials for dx: right ventricular heave, s2 widely split and usually fixed, grade 1-4/4 systolic murmer at the pulmonary area, widely ratiading systolic murmuer cardiac enlargement on cxr * treated: closure generally recommended when ratio of pulmonary to systemic bf is .2:1. Operation performed 1-3 years of age * previously surgical, no often closed interventionally

Answer 54

* ostium secundum: most common, in the middle of the septum in the region of the foramen ovale * ostium primum: low position, form of av septal defect * sinus venosus: least common, positioned high in the atrial septum, frequently associated with papvr

Answer 55

* single most common congenital malformation * can occur both the membranous portion of the septum and the muscular portion * 3 types * small hemodunamically insignificant: between 80% and 85% of vsds, less than 3mm, all close spontaneously in school years, muscular close sooner than membranous * Moderate: 3-5 mm, least common group of children, without evidence of CHF or pulmonary htn, may be followed until spontaneous closure occurs * large VSD with normal PVR: 6-10 mm in diameter, usually requires surger, otherwise chf and fft by afe 3-6 months

Answer 56

grade 2-3/4, medium to high pitched, harsh pansystolic murmer heard best at the left sternal border with radiation over the entire precordium

Answer 57

* persistence of normal fetal vessel joining the pulmonary artery to the aorta * closes spontaneously in normal term infants at 3-5 days of age * higher incidence at higher altitueds * more common in females * clinical findings course depend on size of the shunt and the degree associated pulmonary htn * pulses bound and pulse pressure widens * characteristically has a rough machinery murmer which peaks at s2 and becomes a decreascendo murmur and fades before the s1

Answer 58

* cyanosis result of a small number of cardiac malformations well determines, one is much more frequent than the others. Consissts of stenosis of pulm artery, interventricular communication, deviation of the origin of the aorta to the right, hypertrophy almost always concentric type of the right ventricle. Fialure of obliteration of the foramen ovale may occasionally be added in whilly accessory manner

Answer 59

* cyanosis after the neonatal period * hypoxemic spells during infancy * right sided aortic arch in 25% of all patients * systolic ejection murmur at the upper LSB * most patients are cyanotic by 4 months * hypoxemic spells are one of the hallmarks of severe tetrology

Answer 60

multiple ribs by each other that are compromised and the lung doesn't expand correctly. Pt. has paradoxical chest movement

Answer 61

lung completely collapses. That lung presses against the good lung and the heart

Answer 62

Best is Trauma Center level 1\*: all the time have a special group of people who are trained to help

Answer 63

Patients are assessed and treatment priorities established based on their injuries, vital signs, and injury mechanisms ABCDEs of trauma care * A Airway and c-spine protection * B Breathing and ventilation * C Circulation with hemorrhage control * D Disability/Neurologic status * E Exposure/Environmental control

Answer 64

\*Airway patency alone does not ensure adequate ventilation \*Inspect, palpate, and auscultate * Deviated trachea, crepitus, flail chest, sucking chest wound, absence of breath sounds, decreased, or diminished, in and out wheezing (or lost all together) \*CXR to evaluate lung fields

Answer 65

* Ventilate with 100% oxygen * Needle decompression if tension pneumothorax suspected: only if severe, then insert chest tube after * Chest tubes for pneumothorax / hemothorax * Occlusive dressing to sucking chest wound * If intubated, evaluate ETT position

Answer 66

* more lateral, at 5th intercostal space: for fluid (draining blood) * for pneumo, it's the 2nd intercostal space, anterior

Answer 67

* lung field on right is wiped out * heart is being pushed over * trachea is deviated * TENSION PNEUMOTHORAX * Needle decompression needed with this as well as subsequent chest tube placement * You will find trachae deviated away from pneumothorax, tachypnea, tachycardia, cardiac output decreased, narrowed pulse pressure, crepitus

Answer 68

away from the pneumothorax

Answer 69

Cardiac monitor \*Apply pressure to sites of external hemorrhage \*Establish IV access * 2 large bore IVs (at least 18 guage for potential of giving blood) * Central lines if indicated \*Cardiac tamponade decompression if indicated \*Volume resuscitation * Have blood ready if needed * Level One infusers available (put volume into machine which compresses it to push it in very fast, like a PRBc's in 2 minutes for the whole bag. Also warms the fluid). * Foley catheter to monitor resuscitation

Answer 70

* class 1: mild blood loss. May not even be symptomatic less than 15 * class 2: 15-30% blood loss, systolic not greatly affected, drip in MAP * class 3: 30-40% blood loss. See a drop 20mmhg in BP. Tachy above 120 * class 4: more than 40% blood loss. Significant tachycardia, significant drops, MAP less than 60

Answer 71

* 2 liters isotonic solution first * followed by as need the 2:1:1 ratio (2 prbs, 1 ffp, 1 platelets) * pediatrics: based on weight 20ml/kg x 2 of isotonic solution. Need at lease 2 liters of this before you think about blood.

Answer 72

Abbreviated neurological exam * Level of consciousness * Pupil size and reactivity * Motor function * GCS: Utilized to determine severity of injury. Guide for urgency of head CT and ICP monitoring * AVPU scale: looking at their level of conciousness. A: alert, responding to verbal stimuli. V: they're responding to verbal stimuli (not alert) P: Only respond to painful stimuli U: no response to even painful stimuli

Answer 73

* Complete disrobing of patient * Logroll to inspect back * Rectal temperature * Warm blankets/external warming device to prevent hypothermia

Answer 74

Hemorrhagic shock should be assumed in any hypotensive trauma patient \*Rapid assessment of hemodynamic status * Level of consciousness * Skin color * Pulses in four extremities * Blood pressure and pulse pressur

Answer 75

F: vital signs & family members G: give comfort comfort to your patient. H: head to toe assessment & history I: insepcting the posterior surfaces * Ample history:Allergies, medications, PMH, last meal, events * Physical exam from head to toe, including rectal exam * Frequent reassessment of vitals * Diagnostic studies at this time simultaneously: X-rays, lab work, CT orders if indicated, FAST exam

Answer 76

* Focused Abdominal Scanning in Trauma * 4 views: Cardiac, RUQ, LUQ, suprapubic looking at liver, spleen, bladder, heart * Goal: evaluate for free fluid * Bruising retroperitoneal : liver/kidney * pain in shoulder: spleen

Answer 77

* Pre-emptive counseling of families essential * Decreasewater heater temperature from 54oC to 49oC (130--\>120oF) increases time for full thick-ness scald from * Cigarette misuse responsible for \>30% of house fires * Smoke detector installation/maintenance

Answer 78

* Thermal burns are caused by steam, fire, hot objects or hot liquids. * Most common burns for children and the elderly * Electrical burns are the result of direct contact with electricity or lightning * Chemical burns occur when the skin comes in contact with household or industrial chemicals * Radiation burns are caused by over-exposure to the sun, tanning booths, sun lamps, X-rays or radiation from cancer treatments * Friction burns occur when skin rubs against a hard surface, e.g. carpet, gym floor, concrete or a treadmill

Answer 79

The most common burns\*\* \*Exposure to heat -Fire -Friction (contact with hot objects) -Scaling: Steam, liquids

Answer 80

* Small cutaneous lesions may overlie extensive areas of damaged muscle → myoglobin--\>ARF. * Monitor for at least 48 hours after injury for cardiopulmonary arrest * May see vertebral compression fractures from tetanic contractions or other fractures from a fall. * Visceral injury is rare but liver necrosis, GI perforation, focal pancreatic necrosis and gallbladder necrosis have been reported. * Look for motor and sensory deficits—motor nerves are affected more than sensory nerves. * Thrombosis of nutrient vessels of the nerve trunks or spinal cord can cause late onset deficits. Early deficits are direct neuronal injury. * Delayed hemorrhage can occur from affected vessels * Cataracts may form up to 3 or more years after electrical injury * Microwave radiation damages tissues via a heating effect. Subcutaneous fatty tissue is often spared given its lower water content.

Answer 81

* Burns are characteristically superficial and present as a spidery or arborescent pattern. * Cardiopulmonary arrest is common following lightning injury. * Coma and neurologic defects are also common but usually clear in a few hours or days. * Watch for tympanic membrane rupture * Usually lethal in 1/3 of patients. * World record for surviving lightning strikes is Roy C. Sullivan who was a park ranger from VA. Roy was struck 7 times from 1942-1977.

Answer 82

* coagulation necrosis: denaturing proteins upon tissue contact * area of coagulation is formed and limits extension of injury * exception is hydrofluoric acid, which produces a liquefaction necrosis similar to alkalis. * Acid damaged skin can look tanned and smooth; do not mistake for a suntan.

Answer 83

* liquefaction necrosis * potentially more dangerous than acid burns: liquefy tissue by denaturation of proteins and saponification of fats * In contrast to acids, whose tissue penetration is limited by the formation of a coagulum, alkalis can continue to penetrate very deeply into tissue * Can cause severe precipitous airway edema or obstruction.

Answer 84

* Child: 18% for head, front/back torso, head, 9% each arm, 14% each leg, subtract 1% each year over the age of 1, add 1/2% each year for each year over 1 * Adult: Front/back torso, each leg: 18%, head, each arms:9%, 1% for perineum * Looks at body percentage

Answer 85

1% of his body surface area.

Answer 86

* burns are limited to the epidermis. * A typical sunburn is a first-degree burn. * Painful, but self-limiting. * First-degree burns do not lead to scarring and require only local wound care.

Answer 87

* point of injury extends into the dermis, with some residual dermis remaining viable * Partial thickness or Full thickness * those requiring surgery vs those which do not

Answer 88

full-thickness burns involve destruction of the entire dermis, leaving only subcutaneous tissue exposed.

Answer 89

* burn is usually associated with lethal injury. * Extend beyond the subcutaneous tissue, involving the muscle, fascia, and bone. * Occasionally termed transmural burns, these injuries often are associated with complete transection of an extremity

Answer 90

* Circumferential zones radiating from primarily burned tissues, as follows: 1. Zone of coagulation - A nonviable area of tissue at the epicenter of the burn 2. Zone of ischemia or stasis - Surrounding tissues (both deep and peripheral) to the coagulated areas, which are not devitalized initially but, 2° microvascular insult, can progress irreversibly to necrosis over several days if not resuscitated properly 3. Zone of hyperemia - Peripheral tissues that undergo vasodilatory changes due to neighboring inflammatory mediator release but are not injured thermally and remain viable

Answer 91

* Accelerated fluid loss 2° leaky capillaries * Decreases Host resistance to infection * Multisystem Organ Failure * Infections in burns * \> 40% TBSA with infection has very low survival rate * Initially decreases CO, subsequent hypermetabolic state w/ doubling of CO in 24 – 48 hours

Answer 92

* Heat dispersed in upper airways leads to edema * Cooled smoke and toxins carried distally * Increased blood flow to bronchial arteries causes edema * Increased lung neutrophils – mediators of lung damage – release proteases and oxygen free radicals (ROS) * Exudate in upper airways – formation of fibrin casts

Answer 93

Stage 1 – acute pulmonary insufficiency, Signs of pulmonary failure at presentation \*Stage 2 – 72-96 hrs after presentation (ARDS picture) increased extravasation of water, Hypoxemia, Lobar infiltrates Stage 3 – bronchopneumonia -Early – Staph pneumonia (frequently PCN resistant) -Late - Pseudomonas

Answer 94

* Usually symptoms not present until 15% of the hemoglobin is bound to carbon monoxide rather than to oxygen. * Early symptoms are neurological in nature due to impairment in cerebral oxygenation * Confused, irritable, restless * Headache * Tachycardia, arrhythmias or infarction * Vomiting / incontinence * Dilated pupils * Bounding pulse * Pale or cyanotic complexion * Seizures * Overall cherry red color – rarely seen

Answer 95

* Remove patient from source of exposure. * Administer 100% high flow oxygen Half life of Carboxyhemoglobin in patients: * Breathing room air: 120-200 minutes * Breathing 100% O2: 30 minutes

Answer 96

* 0 – 5: Normal Value * 15 – 20: Headach/confusion * 20 – 40: Disorientation, fatigue, nausea, visual changes * 40 - 60: Hallucinations, coma, shock state, combativeness * \> 60: Mortality \> 50%

Answer 97

* Changes in voice * Wheezing / labored respirations * Excessive, continuous coughing * Altered mental status * Carbonaceous sputum * Singed facial or nasal hairs * Facial burns * Oro-pharyngeal edema / stridor * Assume inhalation injury in any patient confined in a fire environment * Extensive burns of the face / neck * Eyes swollen shut * Burns of 50% TBSA or greater

Answer 98

* Normally have smaller airways than adults * Small margin for error * If intubation is required, an uncuffed ETT should be placed * Intubation should be performed by experienced individual – failed attempts can create edema and further obstruct the airway * AGE/4 + 4 = ETT size

Answer 99

* Deep Partial Thickness burns\>10% TBSA * Burns that involve the face, hands, feet, genitalia, perineum, or major joints * Full thickness burns in any age group * Electrical burns, including lightning * Inhalation burns requiring intubation * Chemical burns that involve deep and extensive TBSA burned

Answer 100

* Autograft: get it from another portion of a patients body. Donor site is much more painful for patient * Allograft * Cultured Epithelial Autograft (CEA)

Answer 101

* Integra: skin generated from cadavers * Alloderm: a soft-tissue implant fabricated by a proprietary method of processing cadaveric skin. This method produces an acellular dermis that is free of the cells responsible for the antigenic response to allograft skin. After processing, the skin is reduced to a basement membrane and properly oriented dermal collagen matrix. The end result is an acellular human dermis that theoretically will not be rejected. * Biobrane: Like a sleeve (membrane) kind of like a sausage. Protects the area as if it's a second skin

Answer 102

* Aquacel: for deeper wounds, in a string or ribbon. Can fill cavity with that * Acticoat: antimicrobial compound on it, black sheet looking that is applied to skin * Duoderm: thick with absorbant component for drainage, waterproof film on the top, thickened and coated so it works as a barrier * mepilexAG: protective barrier, antimicrobial pad * Artificial substances that have been generated

Answer 103

1st 8 hours= 3600 or 450 cc/hr 2nd 8 hours= 1800 or 225 cc/hr 3rd 8 hours= 1800 or 225 cc/hr ## Footnote 24 hour total: 7200 (4cc X pt kg x % burned=total gluids in 24 hours. 1/2 infused in first 8 hours, 1/4 infused in second 8 hours, 1/4 last 8 hours)

Answer 104

* after capillary permeability decreases and returns to normal * proteins will escape through increased permeability of the membranes initially, which is why we don't use until later

Answer 105

albumin, dextran, FFP

Answer 106

* How do we know if this is too much fluid, or too little? * Monitor at least: urine output - in adults, around 50 cc / hr * Decreasing urine output = need for more fluids.

Answer 107

Use same formula for fluids to replace loss from burns. In children, add this amount to normal maintenance rate: -10 kg - about 40 cc / hr maintenance fluids -20 kg - about 60 cc / hr -30 kg - about 70 cc / hr ## Footnote -Expected urine output for child: 1 cc / kg /hr for infant: 2 cc/ kg / hr

Answer 108

* Patients with severe burns (\>30 percent total body surface area) with or without concomitant trauma are also at risk for ACS * ACS impairs the: Cardiovascular system, Respiratory system, Renal system, GI system, Hepatic System, CNS

Answer 109

Supportive * Decompression: Nasogastric decompression, Rectal decompression, Percutaneous abdominal decompression, Surgical decompression * Ventilatory support * hemodynamic support * Attention should be paid to patient positioning and the patient should be placed in a supine position since elevation of the head of the bed (\>20°), which is commonly used to reduce the risk of ventilator-associated pneumonia, increases intraabdominal pressure and also impacts the measurement of intraabdominal pressure

Answer 110

* Pain * Pallor * Paralysis * Paresthesia * Pulselessness * Poikilothermia: If something attempts to achieve room temperature

Answer 111

* Circulation to distal limb is in danger due to swelling. * Progressive loss of sensation / motion in hand / foot. * Progressive loss of pulses in the distal extremity by palpation or doppler. * In circumferential chest burn, patient might not be able to expand his chest enough to ventilate, and might need escharotomy of the skin of the chest.

Answer 112

COMPLICATIONS * Bleeding: might require ligation of superficial veins * Injury to other structures: arteries, nerves, tendons * NOT every circumferential burn requires escharotomy. * In fact, most DO NOT need escharotomy. * Repeatedly assess neuro-vascular status of the limb. * Those that lose circulation and sensation need escharotomy.

Answer 113

* Fascia = thick white covering of muscles. * Fasciotomy = fascia is incised (and often overlying skin) * Skin and fascia split open due to underlying swelling. * Blood flow to distal limb is improved. * Muscle can be inspected for viability.

Answer 114

* Hgb: * Normal levels are 11 to 16 g / dl * Panic levels are: * Less than 5 g / dl * More than 20 g / dl

Answer 115

* 35 to 44%. * Panic levels: * Hmct less than 15 % * Hmct greater than 60%

Answer 116

* Refers to an immune response against transfused blood cells. * Antigens, on the surface of red blood cells, are recognized as “foreign proteins” and can stimulate B lymphocytes to produce antibodies to the red blood cell antigens. * Symptoms: **_Flank pain_** 1. Fever 2. Chills 3. Bloody urine 4. Rash 5. Low blood pressure 6. Dizziness / fainting

Answer 117

* Stop the blood transfusion. * Start normal saline infusion. (with new tubing) * Take vital signs with blood pressure * Call the MD * Obtain blood sample and urine specimen. * Return blood to blood bank. * Document

Answer 118

* Often occurs after multiple blood transfusions. * Symptoms:fever, chills, and diaphoresis. * Interventions: * Slow transfusion and administer antipyretic. * Administer antipyretic prior to administration.

Answer 119

* Symptoms: rash, urticaria, respiratory distress, or anaphylaxis. * Interventions:administer antihistamine before transfusion. Physician may order washed rbc’s * What should you do? Stop the infusion. Call provider and ask what they want you to do.

Answer 120

Plasma RBC WBC Platelets ## Footnote

Answer 121

red blood cells- RBC’s

Answer 122

white blood cells – WBC’s

Answer 123

platelets – cell fragments

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Most abundant blood cell type \*Transport gases Shape is important Large surface to volume ratio Reversible deformability – can change shape Development is called erythopoiesis Erythropoietin is a hormone produced by the kidneys in response to low blood oxygen levels; signals bone marrow to increase RBC production \*RBC’s travel through the body delivering oxygen and removing waste. \*RBC’s are red because they contain a protein chemical called hemoglobin which is bright red in color. \*Hemoglobin contains iron, making it an excellent vehicle for transporting oxygen and carbon dioxide. \*Average life cycle is 120 days. \*The bones are continually producing new cells.

Answer 125

* hemoglobin (lacks organelles) * Made up of 4 peptide chains that form the globin portion and four molecules of the pigment heme which contains an atom of iron * If there is a problem with any part of the molecule it may not be functional.

Answer 126

* Platelets are irregularly-shaped, colorless bodies that are present in blood. * Their sticky surface lets them form clots to stop bleeding.

Answer 127

* The battling blood cells. * The white blood cells are continually on the look out for signs of disease. * When a germ appears the WBC will:: Produce protective antibodies.Surround it and devour the bacteria. * WBC life span is from a few days to a few weeks. * WBC’s will increase when fighting infection.

Answer 128

* Healthy RBC’s live about 120 days; we break down about 174 million per minute * RBC’s are removed from circulation by the liver and spleen * Broken down into heme and globin portions * Globin is broken down into amino acids * Iron is removed from heme and stored or recycled * Heme is broken down into biliverdin and then into bilirubin

Answer 129

* males only * Type A most common – factor VIII deficiency * Type B - lack of factor IX (Christmas Disease) (2nd most common) * Type C – lack of factor XI * Von Willebrand Disease – 1% of population – men or women – prolonged bleeding time. Significant for women who go on birthcontrol. If they have this and go on bc they end up stroking.

Answer 130

Diagnosis * Presenting symptoms * Prolonged activated aPTT and decreased levels of factor VIII or IX. * Genetic testing to identify carriers Treatment * Fresh frozen plasma and cryoprecipitate which are from single blood donors and require special freezing. * Second generation of factor VIII are made with animal or human proteins. * Pt;s with severe hemophilia given helmets to prevent falling, hitting their heads, and getting a bleed Nursing Diagnosis * Risk for injury * Pain with bleed especially into a joint * Impaired physical mobility * Knowledge deficit regarding disease and management of disease Nursing Intervention * No rectal temps. * Replace the factor as ordered by physician. * Manage pain utilizing analgesics as ordered. * Maintaining joint integrity during acute phase: immobilization, elevation, ice. * Physical therapy to prevent flexion contraction and to strengthen muscles and joints. * Provide opportunities for normal growth and development.

Answer 131

* Avoid aspirin which prolongs bleeding time in people with normal levels of factor VIII. * A fresh bleeding episode can start if the clot becomes dislodged. * Natural reactions in the body cause the clot that is no longer needed to “break down. This process occurs 5 days after the initial clot is formed.

Answer 132

* Medic-Alert bracelet * Injury prevention appropriate for age * Signs and symptoms of internal bleeding or hemarthrosis * Dental checkups * Medication administration

Answer 133

* DIC is an acquired coagulopathy that is characterized by both thrombosis and hemorrhage. * DIC is not a primary disorder but occurs as a result of a variety of alterations in health. Assessment findings * The most obvious clinical feature of DIC is bleeding. * Renal involvement = hematuria, oliguria, and anuria. * Pulmonary involvement = hemoptysis, tachypnea, dyspnea and chest pain. * Cutaneous involvement = petechiae, ecchymosis, jaundice, acrocyanosis and gangrene. * If they survive it will be altering physically for them

Answer 134

* Treatment of the precipitating disorder. * Supportive care with administration of platelet concentration and fresh frozen plasma and coagulation factors. * Administration of heparin (controversial in children). * Heparin potentates anti-thrombin III which inhibits thrombin and further development of thrombosis.

Answer 135

Nursing Diagnosis * Altered tissue perfusion * Risk for injury * Anxiety Nursing Interventions * Rigorous ongoing assessment of all body systems * Monitor bleeding * No rectal temps * Avoid trauma to delicate tissue areas * All injections sites and IV sites need to be treated like an arterial stick.

Answer 136

* Idiopathic = cause is unknown * Thrombocytopenic = blood does not have enough platelets * Purpura = excessive bleeding / bruising * Antibodies destroy platelets * Antibodies see platelets as bacteria and work to eliminate them * ITP is preceded by a viral illness: URI, Varicella / measles vaccine, Mononucleosis, Flu

Answer 137

Symptoms * Random purpura * Epistaxis, hematuria, hematemesis, and menorrhagia * Petechiae and hemorrhagic bullae in mouth Diagnostic tests * Low platelet count * Peripheral blood smear * Antiplatelet antibodies

Answer 138

Normal platelet count: 150,000 to 400,000

Answer 139

* IV gamma globulin to block antibody production, reduce autoimmune problem * Corticosteroids to reduce inflammatory process * IV anti-D to stimulate platelet production

Answer 140

* Autosomal recessive disorder * Defect in hemoglobin molecule * Cells become sickle shaped and rigid * Lose ability to adapt shape to surroundings. * Sickling may be triggered by fever and emotional or physical stress * Patho: When exposed to diminished levels of oxygen, the hemoglobin in the RBC develops a sickle or crescent shape; the cells are rigid and obstruct capillary blood flow, leading to congestion and tissue hypoxia; clinically, this hypoxia causes additional sickling and extensive infarctions.

Answer 141

* Brain: CVA – paralysis - death * Eyes: retinopathy – blindness * Lungs: pneumonia * Abdomen: pain, hepatomegaly, splenomegaly (medical emergency due to possible rupture * Skeletal: joint pain, bone pain – osteomyelitis * Skin: chronic ulcers – poor wound healing

Answer 142

* Stasis of blood with clumping of cell in the microcirculation, ischemia, and infarction * Most common type of crisis; painful * Signs include fever, pain, tissue engorgement

Answer 143

* Life-threatening / death within hours * Pooling of blood in the spleen * Signs include profound anemia, hypovolemia, and shock * Abdominal distention, pallor, dyspnea, tachycardia, and hypotension

Answer 144

* Diminished production and increased destruction of red blood cells * Triggered by viral infection or depletion of folic acid * Signs include profound anemia, pallor

Answer 145

Nursing Diagnosis * Altered tissue perfusion * Pain * Risk for infection * Knowledge deficit regarding disease process Nursing Managment \*Increase tissue perfusion * Oxygen * Blood transfusion if ordered * Bed rest \*Pain management \*Hydration * IV fluids as ordered * Oral intake of fluids \*Adequate nutrition \*Emotional Support \*Discharge instructions * Information about disease management * Daily folic acid * Control of triggers * Prophylactic antibiotics * Immunizations / Pneumococcal

Answer 146

* Hereditary / autosomal defect * Genetic defect on chromosome 11 * Mediterranean descent * Defect in the beta globin gene * Beta globin chains are required for synthesis of hemoglobin A * Beta thalassemia is classified into two types depending on the severity of symptoms: * thalassemia major (also known as Cooley's anemia) most life threateningThe child born with thalassemia major has two genes for beta thalassemia and no normal beta-chain gene. The child is homozygous for beta thalassemia. This causes a striking deficiency in beta chain production and in the production of Hb A. Thalassemia major is, therefore, a serious disease. * thalassemia intermedia.

Answer 147

Microcytosis = small in size Hypochromia = decrease hemoglobin Poikilocytosis = abnormal shape

Answer 148

* Pallor * Fatigue * Pallor * Weakness; exercise intolerance * Dyspnea * Syncope (fainting) and dizziness * Angina * Tachycardia (increased heart rate) * Organ dysfunctions * Heart failure

Answer 149

* Characterized by abnormally large stem cells (megaloblasts) in the marrow that mature into erythrocytes that are unusually large in size, thickness and volume. The hemoglobin content is normal, so these are normochromic anemias. * These anemias are the result of: * Ineffective DNA synthesis * Commonly due to folate and B12 (cobalamin) deficiencies – malabsorption or malnutrition * These cells die prematurely, decreasing the numbers of RBC’s in circulation * DNA synthesis is blocked or delayed, but RNA replication and protein synthesis are normal.

Answer 150

* Common megaloblastic anemia * Caused by a Vitamin B12 deficiency * Pernicious means highly injurious or destructive – this condition was once fatal * Can be congenital – baby born with a deficiency in a protein , intrinsic factor, necessary to absorb B12 from the stomach * Adult onset – one example is an autoimmune dysfunction - * type A chronic atrophic gastritis – where there is destruction of the gastric mucosa * Most commonly affects people over 30 * Females are more prone to PA * AA females have an earlier onset. * Develops slowly – over 20 - 30 years * Usually severe by the time individual seeks treatment * Early symptoms ignored because they are nonspecific and vague- infections, mood swings, and gastrointestinal, cardiac or kidney ailments. * Usually a degree of neuropathy occurs * Untreated, it is fatal, usually due to heart failure

Answer 151

* Folic acid also needed for DNA synthesis * Demands are increased in pregnant and lactating females * Absorbed from small intestine and does not require any other elements for absorption. * Folate deficiency is more common than B12 deficiency * Folate deficiency is more common in alcoholics and those who are malnourished because of fad diets or diets low in vegetables. * Estimated that 10 % of North Americans are folate deficient.

Answer 152

cheilosis (scales and fissures of the mouth), inflammation of the mouth, and ulceration of the buccal mucosa and tongue. ## Footnote

Answer 153

Characterized by abnormally small RBC’s that contain reduced amounts of hemoglobin. Possible causes: * Disorders of iron metabolism * Disorders of porphyrin and heme synthesis * Disorders of globin synthesis

Answer 154

Most common nutritional deficiency Depletion of iron stores Most common type of anemia throughout the world. High risk: * Individuals living in poverty * Females of childbearing age * Children Common causes * Insufficient iron intake * Chronic blood loss – even 2- 4 ml/ day * In men –gastrointestinal bleeding * In women – profuse menstruation, pregnancy Other causes * Use of medications that cause GI bleeding * Surgical procedures that decrease stomach acidity, intestinal transit time, and absorption * Eating disorder

Answer 155

* Early symptoms are nonspecific (pica) * Later - changes in epithelial tissue: * Fingernails become brittle and concave (koilonychia) * Tongue papillae atrophy and cause soreness, redness and burning * Corners of mouth become dry and sore * Difficulty in swallowing due to web of mucus and inflammatory cells at opening of esophagus

Answer 156

* Hemoglobin levels less than 8 g/dL * Decreased levels of Serum Iron or Total Iron Binding or Serum Ferritin * Microcytic and hypochromic red blood cells

Answer 157

* Due to inefficient iron uptake, resulting in abnormal hemoglobin synthesis * Characterized by the presence of ringed sideroblasts in the bone marrow – red cells containing iron granules that have not been synthesized into hemoglobin, but instead are arranged in a circle around the nucleus. * Can be acquired or hereditary * Acquired SA is the most common * May be idiopathic or associated with other disorders * Reversible - secondary to alcoholism, drug reactions, copper deficiency and hypothermia * Hereditary SA –rare, almost always in males – probably X-linked recessive gene.

Answer 158

Along with cardiovascular and respiratory manifestations of anemia, may also show signs of iron overload (hemosiderosis) * Enlargement of spleen and liver * Bronze tint to skin * Heart rhythm disturbances * Impaired growth and development in young children

Answer 159

* RBC’s are normal in size and hemoglobin content, but are too few in number. * Less common than the macrocytic and microcytic anemias * Several types that do not have anything else in common: * Aplastic * Posthemorrhagic * Hemolytic – covered with genetic link blood disorders * Sickle cell - covered with genetic link blood disorders

Answer 160

* Acquired or inherited * Normal production of blood cells in the bone marrow is absent or decreased. * A marked decrease in RBC’s, WBC’s and platelets. _Causes_ * Exposure to drugs * Exposure to chemicals * Exposure to toxins * Infection * Idiopathic in nature _Blood Characteristics of Aplastic Anemia_ * Neutophil less than 500 * Platelet less than 20,000 * Hemoglobin less than 7 * Reticulocytes 1% * Bone marrow reveals hypo-cellular and fatty marrow.

Answer 161

* Caused by sudden loss of blood. * Can be fatal if loss exceeds 40- 50 % of plasma volume. * Treatment is to restore blood volume by intravenous administration of saline, dextran, albumin, plasma or whole blood.

Answer 162

* excessive production of RBC’s * _Primary polycythemia_ – cause is unknown, but is in effect, a benign tumor of the marrow, leading to increased numbers of stem cells and therefore RBC’s, and splenomegally. * _Polycythemia vera_ – rare, mostly Northern European Jewish males between 60 – 80 yrs. * _secondary polycythemia_: Due to the overproduction of erythropoietin caused by hypoxia. This is more common. Seen in Persons living at high altitudes, Smokers, COPD patients, Congestive heart failure patients

Answer 163

* Increased blood volume and viscosity * Congestion of liver and spleen * Clotting * Thrombus formation * (last two may be due increased numbers of platelets along with the increase in RBC’s due to bone marrow dysfunction.)

Answer 164

* Reduce blood volume by phlebotomy – 300-500 ml. * Treat underlying condition - Stop smoking * Chemotherapy * Radioactive phosphorus injections * Prevent thrombosis

Answer 165

* Very yellow or orange skin tones (beginning at the head and spreading to the toes) * Increased sleepiness, so much that it is hard to wake the baby * High-pitched cry * Poor sucking or nursing * Weakness, limpness, or floppiness

Answer 166

* Monitor bilirubin levels * Assess activity level – muscle tone – infant reflexes * Encourage oral intake: May need to supplement with formula if inadequate breastfeeding * Weight daily to assess hydration status * Monitor stools – amount and number * Cover eyes while under bili-lights * Facilitate parent - infant bonding

Answer 167

Atropine -0.5mg IV bolus -Repeat every 5 min -Max dose 3 mg -Side effects: Dry mouth, Blurred vision, Urinary retention, Less than 0.5 mg, Slowed heart rate

Answer 168

ID cause and tx * Pain * Anxiety * Infection * CHF * MI

Answer 169

* sick sinus syndrome * symptomatic tx: ex: If too brady, give atropine and 02

Answer 170

supraventricular tachycardia (SVT) Treat with * Oxygen * Adenosine * -6mg IV push fast * -Repeat with 12mg if needed * -Causes asystole * -run a continuous strip

Answer 171

Atrial Flutter Adenosine Calcium Channel Blockers (Diltiazem) * -Slow conduction * -15-20 mg IVP slow Beta Blockers * -Decrease HR * -Decrease BP * -Slow IVP

Answer 172

atrial fibrillation ## Footnote _Adenosine_ _Calcium Channel Blockers (Diltiazem)_ -Slow conduction -15-20 mg IVP slow _Beta Blockers_ -Decrease HR -Decrease BP -Slow IVP _Warfarin INR 2-3_

Answer 173

junctional rhythm tx only if underlying problem

Answer 174

premature atrial contraction tx only if underlying problem

Answer 175

premature ventricular contraction * Check electrolytes * Treat if symptomatic

Answer 176

ventricular tachycardia _Lidociane_ 1-1.5mg/kg IV then a maintenance drip 1-3 mg/kg/min _Magnesium_ For long QT induced V-tak 1-2mg in 10ml of D5W over 10-20 min

Answer 177

ventricular fibrillation * CPR * ACLS

Answer 178

torsades de pointes * Magnesium * Treat underlying cause

Answer 179

first degree block treat underlying cause

Answer 180

second degree heart block/ Mobitz 1/ Wenckebach Tx if symptomatic * Pacing * Atropine

Answer 181

second degree block/Mobitz 2 pacing atropine

Answer 182

third degree complete block PACE!

Answer 183

Replacement volume. Colume can be replaced by packed cells or colloid solution depending on the cause of volume depletion

Answer 184

a decreased contractility, and inotropic support with an agent such as dobutamine or dopamine should be instituted

Answer 185

SVR may be low, and the pt. may need a constrictive agent such as pheylephrine.

Answer 186

turning off the PEEP and position changes to the Trendelenberg

Answer 187

* the surgical anastomosis or cannulation sites can be disruped. * Nitroprusside (vasodilator) administered to lower BP * Nitroglycerine used to cause vasodilation to lower BP * Both are started slowly with careful titration

Answer 188

inotropic support, replace volume

Answer 189

check for hypothermia or volume depletion

Answer 190

* A= Aspirin and antianginals * B=Beta blockers and blood pressure * C= Cholesterol and cigarettes * D= Diet and diabetes * E= Education and exercise

Answer 191

myocardial infarction

Answer 192

pericarditis

Answer 193

1. Thermal, majority of pediatric deaths result from scald injuries 2. Thermal 3. Flame injuries from skoking or scald injuries

Answer 194

* collection chamber * dry waterless chamber * suction control chamber * When tidaling ceases, it may indicate lung has fully expanded or there is a blockage in the chest tube

Exam 3 review sheet Flashcards

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