week 7 Flashcards
BP management during a stroke
you want to keep it around 160 to keep adequate CPP
who is most commonly effected by thermal burns
- kids
- older adults
- diabetics
priorities for a chemical burn
- remove cloths
- chemical stay in the cloths - rinse skin dont but dont use cold b/c youll cause vasoconstriction
what are the two types of smoke inhalation
- above glottis
2. below glottis
what does a below glottis injury indicate
longer exposure
what is the main complication for smoke inhalation injury
carbon monoxie poisoning
what are the main sources of smoke inhalation injuries
gas leak and old cars inside a garage
why cannot we let go when we recieve an electrical shock
- muscle contract
2. instant nerve damage
what is the iceberg effect
extensive deep tissue damage
what are the types of 2nd degree burns
superficial-the first part of the dermis
Deep-the whole dermis
how can you tell you have a deep second degree burn
youll see blisters, this is automatically considered a 2nd stage wound and requires a wound consult
3rd degree burn characteristics
you see open skin
rule of 9s
chest is 18, face 9, thigh 9 etc
priority for burns in the head neck or chest
ABC
priority for burns in the hands feet, joint, eyes
self care
priority for burns in the ears nose, butt, perinonium
infection
what is the emergent phase
the phase right after the burn, strong inflammatory process happening, lasts 72 hours
what do you do after intubation
bronchoscopy to see how bad the lung damage is
what happens when the chest is burnt
any skin that is burnt gets hard (feels leathery) therefore lung expansion becomes very hard
Escharotomies
removal of skin from the chest wall
facial edema
is expected after a burn b/c of the fluid replacement
complications after burns
dysrhthias due to electrolyte imbalances
how do you do fluid therapy for burns patients
two large bore IVs for >15% TBSA
parkland (baxter) formula
kg x 4mL x Body % burned
give first half in 8 hours then the rest over 16 hours
how do you treat 3rd spacing
albumin and lasix
how do you prevent ear pressure ulcer
put a towel under the heal to keep ears floated
what is given to all burns patients
tetanus
what is the goal for acute phase
start ambulation and fix the fluid shift. Also watch for ileus (no gas, no BMs, no Bowel sounds)
what are the main causes of sepsis
- UTI
- pneumonia
- pressure ulcers
Vancomycin considerations
dont give faster then 1g/hr b/c you can cause acute tubular necrosis (ATN)
this applys for all -mycin drugs (the aminoglycosides)
-Contrast also puts patients at risk for ATN
you suction a sepsis patient and get blood what does this indicate what should you do
DIC -> fresh frozen plasma
what does low platelets indicate for burns patients
myelosuppression
how do you diagnose DIC
all the clotting factors go up and D-Dimer is elevated
how do you treat hyperkalemia in CKD
kaxelate with D5W and IV insulin. Try not to give lasixs b/c it can cause ATN. Give calcium gluconate, Bicarb and albuterol to move k+ into the cell
3 phases of acute renal failure
- diuretic
- oliguric (less then 400 ml in 24 hours)
- anuric (less then 40mL in 24 hours)
when do you give blood transfusions for CKD patients
during dialysis
what is the normal urine output
0.5 ml/kg/hr
how do you diagnose CKD
GFR < 60 for 3 months
but really we diagnose using the albumin-creatinine ratio
how do you diagnose ESKF
GFR <15 (normal is 125+)
when do you give epogen
HgB less then 7
magnesium considerations
dont give faster then 1g/hr or youll cause heart block
potassium considerations
dont give faster then 10 mEq /hr
what drug do you give for infiltration
Regitine
how is the albumin-creatinine ratio done
use the first void of the morning b/c any exercise will effect the ratio
who cannot recieve a kidney transplant
cardiomegaly patients b/c the BP will be to low and the kidney will fail
what drug should patients recieving a kidney be on
steriods prior to transplant and antibiotics in the bladder prior too
urine output post transplant
should be very high, higher then normal. Needs to be replaced 1:1 ratio.
