EDN DAY 2

IM

Contraindicated route for severe burn

Morphine (strong opioids)

Drug of choice for pain management in burns

IV

Route for morphine

Respiratory Depression

In taking morphine drug, watch out for

Naloxone. Intranasal

antidote for morphine and the route

Avoid for 48 hours; due to the risk of paralytic ileus

For how long should nutrition be avoided (NPO - No Oral) in burns management, and what is the reason behind this?

High calorie and high carbohydrate; due to the hypermetabolic state caused by inflammation.

After the initial NPO period (48 hours), what type of diet should be given to a burn patient regarding calorie and carbohydrate intake, and why?

Vitamin A (Retinol)

Which vitamin is important for skin and mucous integrity in burn patients?

Metabolism.

primary role of Vitamin B in burns management?

Vitamin C

Which vitamin helps to prevent infection in burn patients?

Curling's ulcer

What type of ulcer is commonly associated with severe burns?

Proton Pump Inhibitors ("-prazole") and H2 Blockers ("-tidine").

What two classes of medications are used to prevent or treat Curling's ulcer, and what are common suffixes for drugs in these classes?

Hypothermia

primary thermoregulation concern in the emergent phase of burns

Due to skin loss

Why is hypothermia a concern in the emergent phase of burns?

Low-grade fever, due to inflammation

What kind of fever might be observed during the acute and recovery phases of burns, and what causes it?

Remove wet clothing

first step in preventing hypothermia in a burn patient regarding their clothing

A warm blanket

What should be used to cover a burn patient to prevent hypothermia?

Increased

How should the room temperature be adjusted for a burn patient to help with thermoregulation?

Heat lamp

What bedside equipment can be used to provide warmth to a burn patient?

Warmed

How should fluids be administered to a burn patient to assist with thermoregulation?

Reverse Isolation.

What type of precaution is typically used for burn patients to prevent infection?

Handwashing.

What is the most effective method for preventing infection in burn patients?

Tetanus.

Which vaccine is important to administer to burn patients?

NSS (Normal Saline Solution), which is isotonic

What type of solution is used for wound irrigation in burns management?

S. aureus (Staphylococcus aureus)

most common Gram-positive bacteria found in burn wound infections

P. aeruginosa (Pseudomonas aeruginosa)

What is the most common Gram-negative bacteria found in burn wound infections?

Wet to Dry; the first action is to administer analgesics.

What type of debridement method is mentioned, and what is the first action to take before performing it?

Perfusion ↓ → ↓ O2 to all tissues → damage → multi-organ failure → death.

Explain the progression of events that occurs during shock, starting with perfusion and ending with death

Hypovolemic shock

What is the most common type of shock?

Blood is involved; caused by decreased blood volume

body component is primarily involved in Hypovolemic Shock, and what is its main cause

Heart is involved; caused by decreased cardiac output.

body component is primarily involved in Cardiogenic Shock, and what is its main cause?

Blood vessel is involved; caused by massive vasodilation.

body component is primarily involved in Distributive Shock, and what is its main cause?

Septic, Anaphylactic, Neurogenic.

List the three main types of Distributive Shock.

Infection → Cytokines

What is the cause of Septic Shock?

Allergy → Histamine.

What is the cause of Anaphylactic Shock?

No SNS (Sympathetic Nervous System) response (spinal cord injury).

What is the cause of Neurogenic Shock?

To maintain perfusion and oxygenation to achieve homeostasis.

primary goal of the Compensatory Stage of shock

SNS increases epinephrine, leading to increased HR and RR (exhaling CO2), which can cause Respiratory Alkalosis.

In the Compensatory Stage, how does the Sympathetic Nervous System (SNS) respond to maintain homeostasis, and what is a potential acid-base imbalance that can occur?

Vasoconstriction occurs, shunting blood flow to vital organs like the brain and heart.

What circulatory changes occur due to SNS activation in the Compensatory Stage, and what organs are prioritized for blood flow?

ADH and RAAS increase, leading to increased Na+ (sodium) and K+ (potassium) retention.

In the Compensatory Stage, how do ADH (Antidiuretic Hormone) and RAAS (Renin-Angiotensin-Aldosterone System) contribute to maintaining homeostasis?

Homeostasis fails, leading to severe perfusion and severe oxygen deprivation.

What characterizes the Progressive Stage of shock?

Kidneys experience oliguria, the brain experiences altered mental status (AMS), and the heart may experience an MI (Myocardial Infarction); leading to lactic acid accumulation and metabolic acidosis.

In the Progressive Stage, what specific organ dysfunctions can occur in the kidneys, brain, and heart, and what metabolic imbalance is a common result?

BP becomes low/decreased

What happens to blood pressure (BP) in the Progressive Stage of shock?

Prolonged hypoxia leading to multi-organ failure and ultimately death.

What characterizes the Irreversible Stage of shock?

Asystole, Apnea, and Coma

What are three critical signs indicating the Irreversible Stage of shock?

Intubation, 100% O2 via NRB (Non-Rebreather mask), and mechanical ventilation

key components of respiratory support in shock management

Two large bore IVs, ≤ 18 gauge

What type and size of IV access is preferred for fluid replacement in shock?

considered the "best fluids" for fluid replacement in shock

Crystalloids

PLR (likely referring to Plasma-Lyte or similar balanced crystalloids, though Lactated Ringer's is a common first-line).

first-line crystalloid fluid for fluid replacement in shock

Pulmonary Edema; signs include shortness of breath (SDB) and crackles.

What is a significant complication of fluid replacement (WOF), and what are its signs?

Modified Trendelenburg; to improve venous return and blood flow to vital organs, while also allowing for lung expansion

specific patient position is recommended for shock management, and why

Sodium Bicarbonate

medication is used to treat acidosis in shock

Stop bleeding

What is the primary action to treat the underlying cause of Hypovolemic Shock?

Positive Inotropes; examples include Dobutamine and Dopamine

What type of medications are used to treat Cardiogenic Shock, and name two examples?

Epinephrine (IM - Intramuscular).

medication of choice for treating Anaphylactic Shock

Antibiotics

primary treatment for the underlying cause of Septic Shock

Immobilize the spinal cord (SCI - Spinal Cord Injury).

What is the primary action to treat the underlying cause of Neurogenic Shock?

To increase Blood Pressure (BP)

What is the main goal of using Vasopressors in shock management?

Norepinephrine

Drug of Choice (DOC) and first-line vasopressor for shock

≥ 65 mmHg.

What is the target Mean Arterial Pressure (MAP) in shock management?

Allergic Reaction (leading to Anaphylaxis), Infection (leading to Epiglottitis), and Angioedema (often drug-induced, e.g., by "prils").

What are three common causes of airway obstruction?

Hypoxemia

term for low oxygen in the blood, which results from absent ventilation

Hypercapnia

term for high carbon dioxide in the blood, which results from absent ventilation

Cardio Pulmonary Arrest and Brain Damage.

two severe conditions can result from the combination of hypoxia and acidosis due to airway obstruction

able to cough, wheezing, encourage pt. to cough forcefully

Partial to cough

Unable to cough, speak, and breathe, Universal sign: clutching of neck, cyanosis, stridor and Heimlich maneuver

Complete airway obstruction

Abdominal thrusts (Heimlich maneuver)

recommended maneuver for a conscious adult or child experiencing an airway obstruction

Back blows and chest thrusts

For a conscious infant (less than 1 year old) with an airway obstruction, what two maneuvers should be performed?

Chest thrusts.

What maneuver is recommended for a conscious pregnant or obese individual experiencing an airway obstruction?

Continue CPR (Cardiopulmonary Resuscitation)

If an individual with an airway obstruction becomes unconscious, what action should be continuously performed?

ONLY if the obstruction is visible

When managing an unconscious individual with an airway obstruction, when is a finger sweep method indicated?

If the obstruction is invisible

a contraindication for performing a finger sweep in an unconscious individual with an airway obstruction

Older Adults

patient population is particularly susceptible to heat exhaustion and heat stroke

Hot environment, Inadequate fluid intake, and Physical Activity

three main causes of heat-induced illness

Loss of electrolytes

What is the underlying physiological issue common to all heat illnesses?

Prolonged exposure to heat for hours/days, leading to fluid/electrolyte loss

What defines Heat Exhaustion in terms of exposure and physiological changes?

Untreated heat exhaustion leads to hypothalamus failure

How does Heat Stroke develop, and what vital organ failure is a key characteristic

Anhidrosis (absence of sweating)

What is often the first sign of hypothalamus failure in heat stroke?

> 40°C.

What is the core body temperature defining hyperthermia in heat stroke?

Hyperthermia, encephalopathy, Anhidrosis, tachy tachy hypo

Heat Stroke

< 40°C.

characteristic body temperature for Heat Exhaustion

Diaphoresis (sweating) → F + E (Fluid + Electrolyte) loss.

Describe the skin presentation in Heat Exhaustion

Severe symptoms → coma, seizures.

What are the characteristic Central Nervous System (CNS) symptoms in Heat Stroke?

Mild symptoms → anxiety, restlessness, headache.

What are the characteristic Central Nervous System (CNS) symptoms in Heat Exhaustion?

Goosebumps (SNS response), orthostasis (orthostatic hypotension), muscle cramps.

List other symptoms associated with Heat Exhaustion (besides skin and CNS).

Emergency.

What is the overall severity level of Heat Stroke?

Less severe

What is the overall severity level of Heat Exhaustion?

Hot.

What type of environment should be avoided to prevent heat-induced illness?

10 am - 2 pm

During what time frame should individuals particularly avoid hot environments?

Stay hydrated

What is a crucial daily habit to prevent heat-induced illness?

Sports Drinks

What type of drinks can help replace electrolytes lost due to heat?

Loose, light-colored.

Describe the ideal clothing to prevent heat-induced illness

Airconditioned, shaded

What kind of room is recommended to avoid heat-induced illness?

Caffeine and Alcohol

What two types of beverages should be avoided as they act as diuretics and can worsen dehydration in hot conditions?

Rapid Temperature Reduction.

the number one priority in Heat Stroke Management

39°C

What is the target core body temperature for Heat Stroke management?

Cool environment and interventions (both passive and active).

What kind of environment and interventions are necessary for effective heat stroke management?

Hypoxia

primary physiological consequence of submersion injury

Non-fatal drowning

Survival for greater than 24 hours after submersion, resulting in respiratory arrest.

Children.

What patient population is most vulnerable to submersion injuries?