HESI AH II

Question 1

Burns

Answer 1

• thermal, electrical, chemical, radiation
• first degree
• second degree-deep, partial thickness-heals in 10-21d
• third degree-full thickness (no feeling-nerve endings gone)-risk for compartment syndrome (may require fasciotomy)
• fourth degree-full thickness (to bone)
• complications=fluid loss, RBC’s and muscle destruction (myoglobin can cause kidney damage), thrombocytopenia (from prolonged clotting), fluid shift=capillary leak syndrome (24-48h post-burn, hypovolemic and edema)
• Burn Shock-due to fluid shift
• hyperkalemia, hyponatremia (sz’s)
• TBSA-rule of 9’s

Question 2

Burn Fluid

Replacement Formula

Answer 2

• 4ml LR x kg x BSA%
• LR’s
• half of total in first 8hr, 1/4 in next 8hr, 1/4 in third 8hr

Goals:

systolic >100

urine output 30-50 ml/hr (electrical 75-100 ml/hr due to myoglobin)

Question 3

Escharotomy/Fasciotomy

Answer 3

Escharotomy-relieve pressure caused by circumferential burns on extremity or chest, improve perfusion

Fasciotomy-open muscle to release compartment pressure, constriction, ischemia

Question 4

Triage

Answer 4

Emergent

Urgent (fever >101/38.5, asthma wo distress, kidney stones, displaced fx, abd pain)

Nonurgent (simple fx, simple lacerations)

Question 5

Primary Survey

Answer 5

immediately on entry

• Airway
• Breathing
• Circulation *pulse
• Disability (neuro, AVPU, GCS)
• Exposure (remove all clothing)

Question 6

Secondary Survey

Answer 6

Methodical head to toe assessment

Question 7

Mass Casualty Triage

Answer 7

Red = Emergency

Yellow = Urgent

Green = Nonurgent

Black/Blue = dying or dead (massive head trauma, extensive full thickness burns, high SCI requiring mech vent)