thermal injuries
Terms
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- test for Carbonmonoxide poisoning
- carboxyhemoglobin in serum
- Fluid of choice for rehydration?
- Lactated Ringers
- Half life of carbonmonoxide with 100% O2?
- 40-60 min
- Parkland Formula
- 4ml x wt (kg) x % burn
- Patho of burn shock
- Hypovolemic shock → capillary and sm vessel dilation → Local and systemic mediators (histamine, prostaglandins, kinins, O2 free radicals, & others) → ↓myocardial contractility → ↓CO → ↑ systemic and pulmonary resistance → complications of renal failure, cardiovascular collapse, and death
- Watch for ... in TBSA > 20%
- paralytic ileus (function usu returns within 24-48 hrs)
- Prophylaxis of paralytic ileus
- H2 blockers or sucralfate
- Superficial Burn (First degree burn)
- - involves only the first 2-3 layers of the 5 layers of the epidermis - pain = chief symptom; usu resolves in 48-72 hrs - erythmea and mild discomfort are characteristic
- Superficial Burn (First degree burn) Healing time
- usu 10 days to 2 weeks blanches with pressure
- Superficial Burn (First degree burn) TX
- only pain relief and oral fluids needed cool compresses ibuprofen no butter no petroleum no ice b/c = vasoconstriction
- Partial thickness (superficial, mid-dermal, or deep dermal partial thickness) 2nd Degree burns: appearance
- (partial thickness or superficial) red and wet with blister formations; may appear wet and weeping, may contain bullae, are extremely painful and sensitive to air currents; (deep dermal partial thickness) involve the entire epidermal layer and part o fthe dermis, generally not characterized by blisterformation, wound surface is usually red with patchy white areas that blanch with pressure; over time, surface will change from white to yellow; prolonged healing time; can heal spontaneously or may need skin graft; can become full thickness if INFECTION occurrs; Ex: contact with hot liquids or solids with intense radiant energy
- Partial thickness (superficial, mid-dermal, or deep dermal partial thickness) 2nd Degree burns: Partial thickness (superficial, mid-dermal, or deep dermal partial thickness) 2nd Degree burns:
- involves the upper 3rd of the dermis
- Third degree: Full thickness
- includes sub-q tissue; appears pale white or charred, red or brown, or leathery; may be dry, broken open to expose fat below; painless and insensitive to palpation; less than 4cm area can heal by a contracture - all others require skin grafting for closure
- Maximum edema occurs ____ hrs after injury with upper airway injuries
- 24 hrs
- You may have ARDS with in _______ with smoke inhalation
- 2-3 weeks
- _____ HOB to ______ to _______
- elevate; 30 degrees; reduce throat edema
- Increased cal & protein in diet; inc cal to what?
- 5000-6000
- Pt will have Anemia r/t what?
- suppression of RBC's made by the bone marrow
- Carboxyhemoglobin norm levels
- 10-15 = smokers >15 = O2 via nonrebreather
- _______ ________ is the leading cause of fire-related deaths
- inhalation injury
- It takes _____ for capillaries to recover from fluid deficit
- 72 hrs
- You will have an ___ HGB and ____ HCT r/t _____
- increased, increased, hemoconcentration
- Oxyhemogolobin levels
- <2% = normal 10-15% = possible headache (level found in smokers) 15-40% = results in CNS dysfunction of varying degrees 40-60% = obtundation or unresponsiveness
- First part of burn shock?
- Hypovolemic shock
- Burn injuries > ___ % of TBSA can result in burn shock
- >35%