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139 Cards in this Set
- Front
- Back
% of burns that are preventable
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75-90
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mortability rate with inhalation injuries
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4%
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causes damage to skin and underlying tissues (6)
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- heat
-flame - contact with hot objects/liquids/ steam - chemicals - electricity - sun |
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what are the functions of the skin (5)
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- protect from infection and inj
- prevent loss of body fluids - temp regulation - appearance -sensation |
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how is burn depth determined (3)
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- temp
- length of exposure/duration of contact - dermal thickness/location of inj |
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important to remember with children and older adults (2)
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-thinner skin
-deeper burn at shorter duration of contact |
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what are the burn zones (3)
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-zone of coagulation
- zone of stasis - zone of hyperemia |
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what can effect he zone of stasis (3)
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- hypothermia
- inadequate fluid resuscitation - ineadequate tissue perfusion |
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why should ice be avoided in burns
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makes it worse by decreasing blood flow and converting stasis to coagulation
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normal vasculature with fluid loss
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zone of hyperemia
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deeper areas with no blood flow
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zone of coagulation
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what is a local reaction: immediate (all burns) (2)
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- cap and cell wall destruction
- increased cap permeability |
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what happens with a local reaction with cap and cell wall destruction (4)
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- vasoconstriction
- thrombosis - ischemia -worse if hypothermic |
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what happens with a local reaction to a burn with increased cap permeability (2)
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- seepage of plasma proteins, F&E into interstitial tissues
- blister and edema formation |
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occurs with a major burn (burn size >20%)
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systemic reaction
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happens with a systemic reaction (15)
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- immune suppression
- hyper-metabolism - decreased circulating volume - decreased cardiac output - hypo-tension-perfusion-volemia - tachycardia - tissue damage w/ local edema (lungs) - increased shunting - increased 02 requirements - decreased peristalsis/absorption - low blood flow - decreased UO - hgb and myoglobin clogging - low fluid volumes - diuresis after 48-72 hrs |
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why do pts with burns need increased amts of food
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hyper-metabolism
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what happens with the GI system in sytemic reactions
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shuts down
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characteristics of a first degree burn (superficial) (5)
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-epidermis only
- pink to red - painful - no blisters - heals in 3-5 days(no scarring) |
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important with 1st degree burns
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not included when calculating TBSA burn
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Tx for 1st degree burns (6)
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- fluids
- over the counter pain meds (NSAIDS) - mtr for fever (infection) - cool showers or baths - moisturization (aloe vera, plain lotion) - avoid re-exposure |
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what are black buds
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new skin formin
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characteristics of 2nd degree burns (partial thickness) (6)
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- epidermis and part of dermis
- heal w/o surgical intervention - blisters - wet and weepy - very painful - blaches (cap refill may be prolonged) |
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some can turn into 3rd degree burns
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2nd
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wet and weepy
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2nd
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dry
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3rd
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tx of 2nd degree burns
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- topicals (decrease risk of sepsis)
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what are the topicals used to tx 2nd degree burns (5)
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- vaseline
- Abx ointment - SSD - ABx soak dsg - sustained release silver |
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what do topicals do
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protect from infection while the body does the healing
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used to debride dirt
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SSD
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what is SSD aka
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marshmallow cream
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petroleum based and dry dsg
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zeroform
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irrigates fluid through dsg
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soak dressings
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temp covering over partial thickness burns and works good with donor sites
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silver impregnated dsg
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characteristics of 3rd degree burns (full thickness) (6)
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- epidermis/dermis/subQ tissue
- surgical intervention - insensate (no pain) - no blanching/cap refill - charred, bright red, marbled, leathery, tan, waxy, or pearly white - tight, non-elastic |
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cut on both sides (non burn to non burn) start at hand and go up or at foot and go up
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escharotomy
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what are the Sx of circulatory compromise (2)
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- 5Ps (pain,pallor,paresthesia, pulselessness, paralysis)
- cold |
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used to assess peripheral pulses (2)
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-doppler
- pulse ox |
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mgnt of circumferential burns(4)
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- elevate burned extremities
- remove clothing/jewelry - mtr closely - escharotomy only in consultation with burn center |
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what are the tx options for full thickness burns (2)
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- debridement/ surgical interven
- temp coverings |
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what are the types of debridement (3)
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- mechanical
- surgical - enzymatic |
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peeling by hand
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mechanical
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SSD dsg (help clean it up)
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enzymatic
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types of temp coverings (2)
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- allograft- homograft (pig skin), cadaver
- dermal substitutes |
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what are dermal substitutes like
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seran wrap
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facts about dermal substitutes (3)
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- neodermis generation
- covered with ultra thin widely meshed STSG - "artificial skin" |
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growing of ones on skin
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neodermis generation
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used for larger areas (legs, thighs)
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mesh grafts
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facts about sheet grafts (3)
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- used for hands, face, feet
- not ran through mesh - remains flat |
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what does a mesh graft do
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creates holes
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own skin in petry dish and letting it grow
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cultured epithelial autografts (CEA)
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no surgical intervention and never truly heals
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secondary inention (scarring)
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what are the full thickness permanent coverings (3)
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- autografts (mesh/sheet)
- CEA - secondary intention |
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outcome of injury from burns dependent upon what (8)
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- age
- TBSA - depth of burn - inhalation injury - pre-existing medical Hx - timeliness of tx - appropriateness of tx - adequate fluid resuscitation |
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what never goes away with graft
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discoloration
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which burns can go systemic
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chemical full thickness burns (wash them really well)
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tricky with fluid resuscitation due to risk of overload
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heart issues
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takes precedence over burns (5)
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- airway obstruction (comes 1st)
- cardiac arrest (place on mtr) - spinal or head injury - open chest wounds - sever abd trauma |
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need to be careful with FR in what (2)
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-heart issues
- head injuries |
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what is included in the ABCDE assessment
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- airway (with C-spine)
- breathing - circulation, cardiac status, CPR) - disability, deformity, neurological deficit - expose, examine, environmental control (stop burning) |
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what is a significant predictor of mortality
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inhalation injury
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what are the 3 types of inhalation inj
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- carbon monoxide
- upper airway (thermal) - lower airway ( smoke, chemical) |
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gets down further bc its not as hot
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lower airway
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breathing in and damage causes it to constrict
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upper airway
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causes confusion d/t decrease 02
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carbon monoxide
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what does increases of carbon cause
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knocks off 02 and lets carbon adhere
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lower levels or carbon monoxide S&S (10)
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- Ha
-fatigue - flu-like sx - weakness - DIB - dizziness - nausea - blurred vision - may appear intoxicated -cherry red tongue |
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higher levels of carbon monxide S&S (4)
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- vomitting
- confusion - heart palpitations - progress to Sz, coma, death |
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tx of carbon monoxide inhalation
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100% 02 to displace carbon and increase 02
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S&S of inhalation injury (5)
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- burns of face or neck
- singed nasal of facial hair - hoarseness, sore throat, cough, difficulty swallowing, black sputum - SOB, dyspnea - signs of hypoxia |
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what are the signs of hypoxia (4)
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- disoriented
- restless -confused - agitated |
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mgnt of airway (5)
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- remove obstructions
- 100%02 per NRBM -assist with BVM - elevate head (aspiration) - consider intubation (in case swellin occurs) |
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swell up quick so often need intubation rapidly
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kids
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used to percuss to remove secretions and carbon
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VDR (high frequency ventilator)
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important with airway in peds (6)
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- obstruct easliy
- void hyperextension - smaller 02 reservoirs - limited compensatory mech - weaker accessory muscles - intubate with smaller size |
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late sign of hypovolemia
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hypotension
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type of fluid used with burns
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LR- to pull things back in and pump vasculature
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helps with healing
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high BP
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when are two large bore IVs needed (2)
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- adult burns > 20%
- peds burns > 15% |
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LOC can be affected by what (6)
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- hypoxia
- carbon monoxide - head injury - pre-existing mental conditions -drugs -ETOH |
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what is AVPU
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-alert
-responsiveness to VERBAL stimuli - responsiveness to PAINFUL stimuli - UNRESPONSIVE |
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important with stopping the burning process (4)
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- cool burn briefly (5min max)
- exceptions (chemical/tar/asphault) - no ice - cover with clean dry covering (sheets,pillowcases, dsg) |
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important to avoid shivering bc?
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uses up energy
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what should be done with powder substances/ tar/asphalt
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powder- brush off
- tar/asphalt- cool it longer |
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what happens to body with cold body temps
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shuts down
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very painful
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rewarming process
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AMPLET
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-allergies
- medications - past medical HX - last meal or drink - events and environment - tetanus (5yrs) |
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% of hand to burn
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each side is 1% and inner webbin .5%
1 hand =2.5 |
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FR with heart Hx
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2ml LR x kgs x %TBSA burned
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FR with normal pt
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4ml LR x kg x %TBSA
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facts for FR (4)
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- tx to pt response
- 2nd and 3rd degree burns only - 1/2 in first 8 hrs from time of injury - balance in next 16 hrs |
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average output for peds
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.75/ml/kg
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which pts will require more FR (8)
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- high voltage electrical injuries
- inhalation inj - delayed resuscitation - associated trauma - pre-existing dehydration - ETOH use or abuse - meth labs - elderly |
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urine output for pts with high voltage electrical injuries
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75-100ml/hr
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what happens with myoglobinuria
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peeing blood (rips apart kidneys)
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labs to mtr with burns (8)
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- ABGs
- carboxyhemoglobin - CBC - electrolytes - glucose - BUN/Creat - drug ad ETOH screen - type and cross for trauma |
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# that dies from fires and burns yearly
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1000
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children under what age twice as likely to die from fire
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under 5
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causes of burns in kids under 4 (3)
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-scalds (tap water/ cooking)
- contact burns (grill,iron) - low voltage electrical burns |
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causes of burns in kids 5-8 (3)
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- flame burns (fire play)
- matches/ lighters/ flammable liquids - high voltage electrical injuries |
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causes of burns in young adults (2)
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- cooking related (home and work
-MVCs (road rash) |
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child abuse (6)
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- scalds
- immersion - pour - running water - contact - other |
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recognition of child abuse scalds (7)
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- sock or glove like line
- even depth circumferential - definitive lines of demarcation - water level apparent - areas of sparin - v-shaped perineal burns - injuries inconsistent w/ story |
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documentation of abuse should include what (5)
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- initial hx
- repeat hx - social hx evaluation - photographs - parental interaction w/child |
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types of burns
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-thermal
- chemical - electrical |
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thermal burns include... (5)
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- flame
- contact - scald -steam - tar |
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chemical burns include... (3)
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- acid
- alkali - organic compounds |
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electrical burns include (3)
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- high voltage
- low voltage - lightening |
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tx options for thermal burns (2)
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- vaseline
- silver impregnated products |
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tx of tar and asphalt (4)
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- immediate colling
- stop the burning process - remove as much clothing as possible - do not attempt to remove tar or asphalt |
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characteristics of acids (3)
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- ph 1-4
- extensive tissue destruction - bathroom cleaners/rust removers/ pool cleaners |
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characteristics of alkalis (4)
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- ph 8-14
- oven and drain cleaners - fertilizers - line markers at sporting events |
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characteristics of organic compounds (3)
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- flammable
- phenois (disinfectants) - petroleum prodcts ( gas and cresote) |
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chemical injuries caused by what (3)
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- absorption
- inhalation - ingestions |
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determines severity of chemical injuries (7)
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- agent
- concentration - depth of injury - volume - extent of BSA involved - mechanism of action - duration of contact |
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Tx of chemical burns (4)
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- protect self
- stop progression of injury - remove all clothing - immediate irrigation (20-30 min) - |
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what can no chemical neutralization cause
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a new heat source w/ more burns
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% of electrical burns
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3%
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measurement of the amt of electrical currrent (what hurts/kills ppl)
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amps
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pressure of the current (affects how theyre hurt)
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volts
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earth or something in contact with the ground (completes the circuit)
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ground
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facts about alternating current (AC) (4)
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- more common and deadly
- ventricular fib - tetanic contraction of muscles - freeze to the source |
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what is an alternating current
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grabs you and pulls you in over and over
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facts about direct current (DC) (3)
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- car or industrial batteries
- electrosurgical devices - lighting |
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hits once and lets go
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direct current
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instant frostbite
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anhydrous ammonia
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tx for anhydrous ammonia
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flood with H20
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what does anhydrous ammonia smell like
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rotten eggs
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cause of mouth and hand burns to children
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low voltage
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results off low voltage injuries
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charred skin on top and white underneath
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current stops at bone and shoots somewhere else
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high voltage
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which is the worst with high voltage injuries
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exit wound
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helps with oxygenation, carbon and secretion removal
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VDR ventilation
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last option and few survive
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CRRT
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help with scar formation
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pressure garments
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typicallly length of stay =
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%of burn
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can sometimes heal on their own
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faces
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used to increase ROM and decrease contractions
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splints
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facts about CEA (6)
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- cultured from pts own cells
- no dermal component - very fragile - length of time to grow - expensive - can be combined with dermal substrates( cosmetic/ functional) |