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How does a superficial thickness burn presentlike
sunburn
what layer of skin is involved with a superficial thickness burn
epidermis
tx for superficial thickness burn
aloe, mild analgesics
How does a superficial partial thickness burn present
blister, red, moist glisten
How does a deep partial thickness burn present
waxy, may be moist or white
How does a full thickness burn present
hard, leathery eschar
define eschar
dead tissue
what part of the skin is damaged in a superficial partial thickness burn
the entire epidermis, potentially the dermis
what part of the skin is damaged in a deep partial thickness burn
the entire epidermis, the dermis
what part of the skin is damaged in a full thickness burn
the entire epidermis, entire dermis and may extend to subcutaneous tissue
your patient presents with a full thickness burn with lots of eschar, you know that for proper wound healing what needs to happen
debridement of the eschar
Are full thickness burns painful?
no because of the nerve damage
how long do full thickness burns take to heal?
depends on the restablishment of good blood supply to area of the burn
How is the extent of a burn measured
rule of 9's
A 25 year old female patient has sustained burns to the back of the right arm, posterior trunk, front of the left leg, anterior head and neck, and perineum. Using the Rule of Nines, calculate the total body surface area percentage that is burned?
*37%
A 68 year old male patient has partial thickness burns to the front and back of the right and left leg, front of right arm, and anterior trunk. Using the Rule of Nines, calculate the total body surface area percentage that is burned?
*58.5%
A 66 year old female patient has deep partial thickness burns to both of the legs on the back, front and back of the trunk, both arms on the front and back, and front and back of the head and neck. Using the Rule of Nines, calculate the total body surface area percentage that is burned?
81%
most common complication of burns
fluid shift and loss
describe the fluid shift that occurs with burns
fluid moves from the intracellular and intravascular space into the interstitial space
fluid shift r/t burns leads to
hypovolemia
s/sx of hypovolemia
thread pulse, tachycardia, hypotension
hypovolemia r/t burns is also called
burn shock
how long does burn shock usually last
can continue for up to 36 hours
what labs should you be concerned if you have a burn patient
hyperkalemia, hyponatremia, H&H may be increased d/t fluid loss
Parkland (Baxter) formula for fluid replacement
4ml Kg %burn
how much fluid is given based off the parkland (baxter) formula for fluid replacement during the first 8 hours
50%
how to evaluate the effectiveness of fluid resuscitation
increase in blood pressure, urine output should be relative to the amount of fluid received
what is the priority with burns
protect airway, treat hypovolemia
when should a burn patient be intubated
if there are burns to face, neck or chest, if there is any suspicion of inhalation injury such as dark sputum
what are some other complications of burns besides fluid loss
infection and compartment syndrome
what bacteria are usually at fault for infections with a burn
staph and strep
complication of infection in a burn
sepsis
what are some examples of antibiotics that can be used s/p infection in a burn
penicillin's, cephalosporins
how to apply creams to a burn
with a sterile glove
define surgical debridement
removal of eschar to level of healthy tissue, bleeding should occur
define an escharotomy/fasciotomy
incision in the fascia to relieve pressure in compartment syndrome
how to evaluate the effectiveness of a fasciotomy
check distal pulses
describe skin grafts
skin is removed from a healthy part of the body and applied to the burn
your patient is 3 days s/p skin grafting, what do you expect
immobilization of the area where the graft was supplied 4-5 days
your patient is 5 days s/p skin grafting, what do you expect for ROM
can resume in area of graft
most common cause of SCI
trauma (MVA)
risk factors for SCI
male, young, alcohol or drug use
primary concern with a cervical injury
respiratory dysfunction
describe the relationship with level of SCI and respiratory dysfunctionthe higher the level (cervical vs thoracic)
the higher the chance of respiratory dysfunction
what level of SCI is correlated with autonomic dysreflexia
T6 and above
what to check before your patient receives a CT with contrast
allergies to iodine, renal function
What to think about before your patient receives an MRI
metal on or in the patient, claustrophobia
tx for SCI
assess airway, apply C collar for immobilization and stabilization of head and neck, potentially steroids'
side effects of steriods
hyperglycemia, increased risk of infection
when does spinal cord shock occur
may begin with in 1 hour of injury
How long does spinal cord shock lasts
varies, could be minutes to months, usually lasts between 1-6 weeks
how do you know when spinal shock is over
when reflexes return
s/sx of spinal cord shock
flaccid paralysis below level of injury, loss of reflexes, loss of sensation of touch, temperature, pressure and pain, bowel and bladder dysfunction, loss of ability to perspire
s/sx of neurogenic shock
bradycardia, hypotension, temperature dysregulation
tx of neurogenic shock
fluids (usually 2L) then a vasopressor if still hypotensive
Describe autonomic dysreflexia
exaggerated sympathetic response
Result of Autonomic Dysreflexiamassive
severe vasoconstriction
S/Sx of autonomic dysreflexia
pounding headache, severe HTN, bradycardia, flushed skin,
complication of untreated autonomic dysreflexia
stroke, MI, seizures
common cause of autonomic dysreflexia
bowel or bladder problems
your patient is in a gardner wells device following a SCI, what is important to remember about this device
do not move device or change weights after the device has been applied
how to clean the pins of a halo
with a 1/4 strength hydrogen peroxide every 4 hours
ABCDE approach to primary survey
airway, breathing, circulation, disability, exposure/evaluation
FGHI approach to secondary survey
full set of vitals, give comfort, head to toe assessment, identify all injuries
tx of traumatic shock
large bore IV, followed by crystalloids then blood
what to think about with pediatric trauma
smaller body sizegreater relative surface area, less subq fat
tx of blood loss in trauma
transfuse 1:1:1
what is the ratio for FFP:PRBCs:PLTS for resuscitation
1:1:1
for 1 unit of blood you can expect the H&H to rise
Hbg +1 Hct +3
common cause of respiratory failure in trauma
rib fractures
presentation of pain with a rib fracture
pain increases with inspiration
Presentation of flail chest
paradoxical chest expansion, chest retractions
tx of flail chest
prepare for chest tube followed by intubation
cause of pneumothorax in terms of trauma
any injury that lets air/blood/fluid into the pleural space
tx of pneumothorax
chest tube
complications of untreated pneumothorax
trapped air pushes on vena cava leading to decreased CO and eventually obstructive shock
s/sx of ARDS
dyspnea, profound hypoxemia, decreased lung compliance, diffuse bilateral infiltrates
first sign of ARDS
profound hypoxemia
tx of ARDSr
apid O2 titration, BIPAP, mechanical ventilation, sedatives, analgesics, possibly paralytics
diagnostics for ARDS
chest xray, will show diffuse infiltrates or "white out"
CPAP is comparable to
PEEP, only improves oxygenation
uses for CPAP
sleep apnea, cardiogenic pulmonary edema
describe IPAP
pressure for inhalation for BIPAP ventilation
describe EPAP
lower pressure for exhalation oxygenation
what does the IPAP do
decrease work of breathing or ventilation
Which number on a BIPAP represents the IPAP (ex 10/5)
the top number (10)
what does the EPAP correct
oxygenation
what is EPAP similar to
PEEP
what is a requirement for BIPAP
the patient must be able to spontaneously breath
define tidal volume
volume of air the patient receives with each breath
how much tidal volume for a mechanically ventilated adult
6-8L/kg
Ventilation is reflected by what values
ETCO2, PCO2, RR
Oxygenation is reflected by which values
FiO2, PEEP
describe PEEP
positive pressure exerted during the expiratory phrase that is prevents atelectasis
what is the result of too much tidal volume
barotrauma
describe PIP
pressure needed by the vent to deliver a set tidal volume, it is the highest pressure reached during the inspiratory phase
Good value for PIP
under 30 cmH2O
what is the PIP reflective of
pulmonary resistance in the upper airway
describe pPlat
pressure applied to lower airway during positive pressure ventilation
How to measure pPlat
measure during an inspiratory pause on the ventilator
Note
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