Burns, Shock, & Sepsis Flashcards Preview

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Flashcards in Burns, Shock, & Sepsis Deck (89)
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1

Epidemiology of Burns

65+ is highest in mortality
18-35 years old 2:1 (M:F)

2

Cellular Changes in Burns

Intracellular influx of Na/H2O
Extracellular migration of K
Disruption of cell membrane function
Failure of "sodium pump"

3

Hematologic Changes in Burns

Increased hematocrit
Increase in blood viscosity
Anemia due to RBC destruction

4

At what temperature does cell damage occur?

113+ F
Denatures protein

5

What happens to the zone of coagulation with a burn?

Irreversibly destroyed

6

What happens in the zone of stasis with a burn?

Stagnation of microcirculation
Can/will extend if not treated appropriately

7

What occurs in the zone of hyperemia with a burn?

Increase blood flow

8

How to Determine What Percentage of Patient is Burned

9%: each arm
9%: front of each leg
9%: back of each leg
9%: chest
9%: abdomen
18%: back
9%: head
1%: genitals

9

1st Degree Burn

Erythema of skin
Minimal surrounding edema
Minimal pain

10

2nd Degree Burn

Partial thickness
Painful
Red or mottled skin
Blisters with broken epidermis
Edema
Wet/weeping surfaces
Sensitive to air

11

3rd Degree Burn

Full thickness
Damage to all skin layers, subQ tissues, & nerve endings
Pale white or charred appearance
Leathery
Broken skin with fat exposed
Dry surface
Painless to pinprick
Edema

12

Specific Issues with Burn Management

Carbon around nose
Burns involving the mouth
Significant respiratory problems
Fires in enclosed places
CO exposure
Toxic gases from combustion (cyanide)
Intubate early

13

Chemical Burns

Irrigate
Alkali burns more serious

14

Why are alkali burns more serious than acid burns?

Alkali's penetrate deeper

15

Electrical Burns

Always more serious than they appear
Deeper structures have more damage
Rhabdomyolysis -> acute renal failure
Dark urine: assume rhabdomyolysis

16

What can you do to help clear up the urine from rhabdomyolysis?

Increase fluids to achieve a UO of 100 mL/hr
Mannitol if necessary

17

ABCDE of Burn Patients

A: airway
B: breathing
C: circulation or control of hemorrhage
D: disability (neurologic)
E: environmental control/exposure

18

What needs to be observed in a burn patient?

Eyes: corneal ulcers
Need 2 large bore IVs
Estimate depth & extent of burn

19

Management of the Burn Victim

20%+ BSA partial thickness burn: NG tube placement
CBC, CMP
ABGs, carboxyhemaglobin level
CXR & EKG on suspected inhalation injury
Urine: myoglobin & CPK
Tetanus status
Remove jewelry
Foley placement
Pain control

20

Dressings for Burn Victims

1% silver sulfadiazine (sivadene)
Re-evaluate every 24 hours until full extent is known
Dressing changes BID until weeping stops
Honey shown to be effective

21

Guidelines for Transferring Burn Patients

Partial thickness >10% BSA
Burns involving the face, hands, feet, genitalia, perineum, or major joints
Third-degree burns in any age group
Electrical burns
Burns with complicated co-morbidities
Children with significant burn that are not in a children's hospital

22

Define Shock

Inadequate tissue/organ perfusion

23

Reasons for Shock

Pump failure
Decreased peripheral resistance
Hemorrhage

24

Cardiac Response to Shock

Tachycardia
Increased myocardial contractility/oxygen demand
Constriction of peripheral blood vessels

25

Renal Response to Shock

Stimulating an increase in renin secretion
Vasoconstriction of arteriolar smooth muscle
Stimulation of aldosterone secretion by the adrenal cortex

26

Neuroendocrine Response to Shock

Increase in circulating antidiuretic hormone

27

Types of Shock

Hypovolemic
Septic
Cardiogenic
Neurogenic

28

Reasons for Hypovolemic Shock

Decreased vascular volume
Hemorrhagic

29

Reasons for Septic Shock

Systemic infections lead to hypotension & decreased vascular volume

30

Reasons for Cariogenic Shock

Some abnormal cardiac function