Shock, sepsis and burns

Question 1

A wound that a ruptured appendix has passed through can be closed. T or F

Answer 1

F, it cannot be closed

Question 2

Inguinal hernia repair = ____ wound.

Answer 2

Clean

Question 3

Elective colon resection = ____ wound

Answer 3

Clean contaminated

Question 4

FIrst degree burn

Answer 4

Erythema of skin
Minimal surrounding edema
Minimal pain

Question 5

2nd degree burn

Answer 5

Deeper, partial thickness
Hot liquids, very deep sunborn
Must more painful than 3rd degree

Question 6

Third degree burn

Answer 6

Damage to all skin layers
Pale white, charred, leathery
Fat exposed
Painless to pinprick

Question 7

Inhalation burns

Answer 7

Carbon around nose, burns involving mouth
Fires in enclosed areas
CO, cyanide
Intubate early

Question 8

Chemical burns

Answer 8

Do not try to neutralize
Irrigate often
Alkali burns are worse than acid burns

Question 9

Electrical burns

Answer 9

Always more serious than they appear
Deeper structures generally effected
Can cause rhabdo and acute renal failure

Question 10

What % BSA needs NG tube?

Answer 10

> 20% because of ileus risk

Question 11

FOley and burn patients

Answer 11

Every pt w/ significant burns gets one for renal observation

Question 12

Ointment for burns

Answer 12

1% silver sulfadiazine (silvadene)

Change dressing BID until wounds stops weeping

Question 13

Earliest manifestation of shock?

Answer 13

Tachycardia

Question 14

Preferred resuscitation fluids for shock?

Answer 14

NS

RBC’s if hemorrhagic

Question 15

Pulse pressure will be ____ in shock.

Answer 15

Narrow

Question 16

Preferred gauge for IV’s in shock

Answer 16

16 at least

Question 17

Initial fluid bolus amt

Answer 17

1-2 liters wide open in audlt

20 mg/kg in child

Question 18

__ml of crystalloid is required for every 1 ml of blood loss.

Answer 18

3 ml per 1 ml

Question 19

Normal urine output for adults

Answer 19

30 - 50 ml/hr

Question 20

Cardiogenic chock

Answer 20

10-20% due to MI with >50% fatality
Weak, thready pulse
Cool, clammy skin

Question 21

Septic shock

Answer 21

Usually due to gram- bacteria
Usually have comorbidities (DM, AIDS, leukemia)
Increased capillary permeability leads to relative fluid loss.

Question 22

Can isolated head injuries cause shock?

Answer 22

No, if head injured pt has shock look for another cause.

Question 23

Neurogenic shock most often caused by …

Answer 23

Spinal cord injury

Vasomotor regulation fauls and blood pools because of decreased PVR

Question 24

Can colloids be used in septic shock?

Answer 24

No, will cause pulmonary edema

Question 25

Can pressors be used in shock?

Answer 25

No, unless they are proven to be normovolemic and hypotensive.

Question 26

Risk factors for severe sepsis

Answer 26

Age >50
Primary pulm dz
Abd site infxn
CNS infxn

Question 27

Acrocyanosis

Answer 27

Cyanosis of the extremities

Question 28

Toxic shock syndrome is caused by?

Answer 28

Staphylococcal toxin

Long-term tampon in place