Module 3 Flashcards
Parkland formula
4ml x KG x % of TBSA = fluid over 24h
First half over first 8 hours
titrate for urine output 30-50 cc/hr
Vent settings that impact ventilation
RR
TV
Vent settings that impact oxygenation
FiO2
Peep
TV setting
6-8ml/KG IBW
Assessments of burns
- Depth of burns
- Determine extent of burn
- Weight of pt
- Determine concomitant injuries
- Comorbities
Depths of burns
Superficial
Partial thickness
Full thickness
Superficial thickness
simple erythema without blistering (rapid healing)
Partial thickness
Skin loss
blistering
pain from exposed nerves
Full thickness
Skin loss penetrating deep layers of dermis
leathery, waxy, in elastic
Basic first aid of burns
Remove jewelry Remove clothes and debris Active cooling x20-30mins for small burns Don't cool in extensive burns >10% TBSA Cool burns warm core Dress burns Control pain
Why are burns worse in children
Children have thinner skin and larger body surface area
Greater fluid loss
Why are burns worse in old people
Old peeps thin dermis, reduced microcirculation and poor capacity for tissue regeneration results in deeper more complex burns and prolonged healing time
Flames cause
mixed depth burns
contact burns always cause
deep burns
cold/frostbite
severe drop in temp
causes formation of ice crystals and consequent intra cellular freezing leading to severe cellular damage and cell death
formation of micro clots cut off circulation
Chemical burns
cause progressive damage to the skin
remove irritant and irrigate
Acid chemical exposure
coagulative necrosis with swift formation limiting further tissue penetration
Alkalotic chemical exposure
results in liquefactive necrosis which allows deeper penetration of the chemical
Palmar estimation for burns
used for small or patchy burns
palm with fingers is 1%
Rule of Nines
moderate to severe burns in adults
not useful in kids unless its modified
each area of the body represents 9% TBSA front of legs- 9% Back of legs- 9% whole arm front and back - 9% entire head 9% abd 9% chest 9% upper back 9, lower back 9 groin 1%
Lund and Browder chart
accurate for use in adults and kids
vascular changes in thermal injury
Capillary leakage and massive fluid shifts
leads to decreased tissue perfusion
at what percentage of TBSA do people become hypotensive
> 15-20%
Burns Acute phase
hypovolemia
increased capillary permeability
fluid shifts
Hypermetabolic phase
hypoproteinaemia—- edema
cardiac dysfunction
Pulm complications with burns
inhalation injuries Airway burns/mucosal burns subglottic injury pneumonia infection ARD
Signs and symptoms of inhalation injury (5)
carbonaceous sputum facial burns singed facial hair wheezes/ stridor Resp changes
Fire with synthetic material increases the risk of…
cyanide poisoning
antidote is Hydroxocobalamin
Burns assessment Airway
Prevent hypoxia and treat smoke inhalation
Cspine
Early administration of O2
Inhalation injury = supreglottic edema
Burns assessment Breathing
smoke inhalation
high risk of ARDS
Circumfrentail burns prevent expansion
assume carbon monoxide poisoning (carboxyhemoglobin >30%)
Burns assessment Disability
consider noxious exposure
blood glucose due to hypermetabolic state
PAIN CONTROL (multimodal)
Burns assessment Circulation
parkland formula
smoke inhalation means increased fluid requirements
Vit C infusion reduces fluid requirements
What type of fluid should be used for burn pts
crystalloids and blood
albumin to decrease compartment syndrome
fluid creep
need to balance fluids to prevent shock but we can’t over resuscitate or we cause compartment syndrome via extra vascular fluid loss
Burns assessment expose
rapid heat loss
need invasive temp monitoring
prevent hypothermia
Assist control VOLUME
Healthy lung mode
SET: VOLUME
Can breath above the set RR but always get a set VOLUME
Need to monitor pressure
Assist control PRESSURE
Sick lung mode- needed with decreased lung compliance
SET: PRESSURE
Can breath above the set RR but always get a set PRESSURE
Need to monitor volumes
Pressure support
Weaning mode
Pt only gets pressure with a spontaneous breath (5-20)
No set RR or VT
Similar to BiPAP but with an ETT
SIMV
used to bridge or wean
combo of AC and PC each breath gets pressure support
set RR and AC
Min Ventilation
TV xRR ( how much gas in exchanging in a minute)
Ventilation effects of Hemodynamics
Increased intrathoracic pressure causes decrease in venous return
Ventilation effects of Hemodynamics
Increased intrathoracic pressure causes decrease in venous return to rt side of heart
decreased preload causes decrease in cardiac output
Positive pressure impairs venous outflow from the brain and increases the ICP
What do we assess in its that are deteriorating while ventilated (DOPE)
Displacement/Dislodgement
Obstruction
Pneumothorax
Equipment
Pt safety checks on vent (8)
Tube position securement position of circuit cuff suction BVM end tidal sedation
Ideal end tidal Co2
35-45
High pressure vent alarm
tube obstruction
asynchrony with vent
Bronchospasm
decreased lung compliance
Low pressure alarm
Disconect
High RR alarm
pt tiring while in weaning mode
Hypoxia
anxiety or pain
Apnea
no breath x20 sec
Low minute volume/ ventilation
cuff leak
tiring while in weaning mode
Pressure limit being reached ( worsening lung compliance)
Low exhaled Tidal volume
leak in circuit
tiring pt
inappropriate alarm settings
pressure limit reached
Rnhabdomylosis
destruction of a significant amount of muscle
increase CK and Potassium and phosphate
myoglobin
AKI
decreased renal function
Lab marker for Rhabdo
High CK
high potassium
high phosphate
Complications of positive pressure ventilation
Barotrauma Decreased CO2/Increased ICP O2 toxicity Decreased nitrogen ( keeps alveoli open) Diaphragm weakend VAP
The mechanism of thermal injury most likely to be under resuscitated with fluids based on %TBSA calculations is?
Electrical
The information needed to calculate fluid requirements based on the Parkland formula on a patient with a superficial erythema thermal burn is:
We don’t include superficial erythema thermal burns
A patient is unconscious from a house fire and has not regained consciousness with high flow oxygen. The patient has severe metabolic acidosis. The most likely cause is?
cyanide toxicity.
The cardiac arrhythmia most likely in a lightning strike is:
asystole.
Your patient has a high voltage electrical burn. Which diagnostic test will be elevated indicating massive muscle tissue damage
CK
