Final: lectures Flashcards
rule of nines
body is divided into areas that are multiples of 9% to calculate burn injury in adults
rule of nine: major sections
head
each arm
chest and back
each leg
rules of nine: head
-whole head: 9%
front: 4.5%
back: 4.5%
rules of nine: each arm
whole: 9%
front: 4.5%
back: 4.5%
rule of nine: chest and back
chest: 18%
back: 18%
rule of nine: each leg
whole: 18%
front: 9%
back:9%
Parkland/Consensus formula starts calculating at time of:
injury
Consensus formula:
1st half given:
2nd half given:
(2-4 mL)(kg)(TBSA%)
1st half: first 8 hrs
2nd: 16 hours
primary assessment of burn patients focuses on (5)
airway
breathing
circulation
disability
environment
secondary assessment of burn patients focuses on: (6)
total body scan to determine extent of burns
fluid resuscitation
labs (BMP, CBC, ABG)
Foley placement
Pain management
Administering tetanus/other necessary vaccines
pain management consideration w/ burn patients
higher dose/more frequent administration because metabolic rate will be higher
burn complications (circulatory) (5)
Massive edema
-electrolyte imbalances
-decreased cardiac output
-hypotension
-hypovolemic shock
burn complications (non circulatory) (5)
carbon monoxide impacts
impaired immunity/infection
impaired temperature regulation
decreased GI motility
stress/injury ulcers (GI)
burn is painful with mild edema
superficial
burn is painful with blisters and mild-moderate edema
partial-thickness burn
burn causes little to no pain and severe edema
full-thickness burn
burn is painless with little to no edema
deep-full thickness
burn effects only epidermis layer
superficial
burn effects epidermis and 1/3 of dermis
superficial partial thickness
burn effects epidermis and more than 1/3 (but not whole) dermis
deep partial thickness
burn effects epidermis and all of dermis
full-thickness
burn effects all skin layers
deep full-thickness
TBI priority action
apply C-collar and don’t remove until provider has assess and cleared patient
Glasgow coma scale:
less than 8:
9-12
more than 13:
<8: severe head injury/coma
9-12: moderate head injury
>13: minor head trauma
____________ pupils indicate severe brainstem injury and possible brain death
bilateral, fixed pupils
assessment for TBI (4)
Glasgow coma scale
cranial nerves
pupillary assessment
reflex assessment
_______ and _______ are both posturing indicating life-threatening brain damage with _________ being most severe
decorticate and decerebrate
decerebrate more severe
TBI monitoring: (5)
ICP
CPP
airway
circulation
neuro
Cerebral perfusion pressure formula
MAP - ICP
CPP should always be greater than _______, if less than, indicates _____________
60 mmHg
brain ischemia
normal CPP
60-100 mmHg
Normal ICP
10-15
________ and _______ indicates increased ICP and is a potential sign of brain __________
projectile vomiting and severe headache
brain herniation
TBI airway management: if GCS is 8 or less _______
intubate
With TBIs NEVER insert ____________
nasogastric tube
PaO2 should be over:
100 mmHg
_________ is one of the first signs of impending herniation
unilateral pupil dilation
Contraindication of HOB being elevated 30 degrees
spinal cord injury
_____________ is used if herniation is indicated as its a potent vasodilator and lowers CPP/ICP
hyperventilation
medications to reduce ICP (2)
Mannitol: osmotic diuretic
Vecuronium: neuromuscular blocking agent
_____ is the most common type of stroke (80-85%)
ischemic
ischemic strokes are caused by ________ generally coming from __________ following ___(3)_____
local thrombus/emboli
heart or large arteries
a-fib, acute MI, or surgery
Time goal for stroke management ED door - needle
60 minutes
NIHSS Score interpretation
0
1-4
5-15
16-20
21-42
no stroke
minor stroke
moderate to severe stroke
sever stroke
when to use NIHSS (4)
when patient arrives
following any intervention
when significant changes in pt status occurs
prior to discharge from ED
when to treat BP and BG before giving TPA:
-BG: <50mg/dL
-BP: S > 185; D>110 mmHg
Once TPA is initiated ________ can not be done
insertion of any tubes (foley, NG, IV, etc)
complications of thrombolytic therapy (4)
bleeding
angioedema
anaphylactic reaction
further deterioration in neurological status
assessment before/during/after TPA (6)
-Neuro assessment & vitals every 15 minutes for 2 hours than every 30 minutes for 4-6hrs
-Record I&Os
-Don’t administer any thrombotic for first 24 hours
-fall precautions
-telemetry
-monitor hemoglobin and platelets