Surgery week 2 Flashcards
what is most common burn to children
scalding injuries from hot drinks or bath
if urine is dark after burn
assume electrical burn and affected the muscle and pt is in rhabdomyolysis releasing myoglobin.
increase fluid to achieve a urine output of 100ml/hr
if urine doesn’t clear up then use mannitol to continue diuresis
Control metabolic acidosis by perfusion and add sodium bicarbonate as needed to alkalinize urine to solubilize myoglobin
one thing to look for in secondary survey
eyes for corneal burns
what does any patient with > 20% BSA partial-thickness burn needs
NG tube due to ileus is likely
what labs should be done
CBC, electrolytes, BUN, Creatinine, Glucose (Chem 7)
what should you get for suspected inhalation injury
ABGs, carboxyhemaglobin level, Chest XRay, and EKG
systemic inflammatory response syndrome
need 2 of they following
fever (>38 or decrease in temp 90)
tachypnea (>24- earliest sign)
leukoctyosis (>12,00) or leukopenia (10%)
severe sepsis defined as
either 1 or 2 1. sepsis with one of the following organ dysfunct Metabolic acidosis Acute encephalopathy Oliguria Hypoxemia Disseminated intravascular coagulation (DIC) 2. hypotension
sepsis shock is
Severe Sepsis (organ dysfunction) with hypotension (defined by arterial SBP < 90 mmHg or 40 mmHg less than patient’s normal BP) that is unresponsive to fluid resuscitation
tx of hemorrhagic shock
give 1-2 L bolus to adults give 20mL/kg to kids monitor by urine output 30-50 ml/hr urine output for kids 1ml/kg/hr (for kids younger then 1 yrs is 2mL/kg/hr)
how to know if correcting shock
look at urine output, heart rate, blood pressure, cns function, skin color
signs of cardiogenic shock
hallmark is hypotension w/ signs of increased pvr:
cool clammy
weak thready pulse
what pulse pressure does septic shock have
wide pulse pressure
hemorrhagic shock is narrow
when is the only time you can use inotropic agents w/ shock
septic shock
or if know normovolemic and hypotensive
which is earliest sign of systemic sepsis
tachypnea
what can cause acrocyanosis
dic and hypotension
skin lesions tell which bug
Petechiae/purpura -> N. meningitis (and H. influenzae)
Tick bites in endemic areas -> petechiae -> RMSF
Erythema gangrenosum lesions (bullous lesion surrounded by edema that undergoes central hemorrhagic necrosis ) -> neutropenia & usually Ps. aeruginoa
major complications of sepsis
hypotenision hypoxemia hypercapnia acute respiratory distress syndrome oliguria/azotemia/proteinuria/polyuria renal failure secondary to ATN due to hypotension and capillary injury thrombocytopenia dic neurological comp (occur weeks to months later)
what factors decrease healing
ischemia (PAD) dry wound infxn too much anti inflammatory therapy foreign bodies nutritional deficiency
factors affecting wound healing
mechanical injury infxn edema ischemia topical agents ionizing radiation low oxygen tension foreign bodies
essential nutrients for wound healing
Calories Carbs Protein Fats Vitamin A Vitamin C Zinc Water
what must be included in wound healing physical
check for pulses
prophylactic abx
cefazolin
for bowl-cefoxitin or ampicilli/sulbactam
pcn allergic- vanco
colorectal- oral neomycin + erythromycin; iv- Cefoxitin or cefotetan or Cefazolin + metranidazole
indications for rbc transfusion
bleeding
chronic anemia that is symptomatic
peri operative managment
