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46 Cards in this Set
- Front
- Back
What are the steps of neutralizing a burn?
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1. Stop the burning process
2. Remove clothing 3. Remove chemical 4. Irrigate for up to 60 min with warm tap water. 5. Avoid hypothermia |
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What is the leading cause of death associated with fires?
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CO
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What does carbon monoxide poisoning cause?
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oxyhemoglobin curve to shift left
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How do you treat carbon monoxide poisoning?
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100% oxygen until COHb less than 7%
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Does hyperbaric oxygen yild more rapid displacement of carbon monoxide?
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Yes
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What is the gaseous form of cyanide?
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hydrocyanide
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Where does cyanide come from?
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burning synthetics
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How does cyanide poisoning work?
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binds to cytochrome, inhibiting cell metabolism and ATP production.
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How do you treat cyanide poisoning?
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hydration
10-20cc of 3% sodium nitrite over 10 minutes 50cc of 25% sodium thiosulfate |
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How does hydration and sodium nitrite treat cyanide poisoning?
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converts cyanide to sodium thiosulfate --> excreted into urine
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What improves the outcome of inhalation injury?
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early intubation and positive pressure ventilation
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True or False: You can tell an inhalation injury as soon as you see the patient.
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False: inflammatory reaction evolves over period of hours to days
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Are prophylactic antibiotics indicated for suspected inhalation injury?
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No
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When would you suspect an inhalation injury?
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Injured in a closed space
Extensive burns or with burns on face Unconscious at time of injury Singed nasal hairs, hoarseness, or wheezing Coughing up carbonaceous sputum |
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When does edema-induced distortion peak?
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18-24 hours
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When do inhalation injury heals?
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a matter of a few days to weeks
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What pulmonary support is required for inhalation injuries?
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Humidified oxygen
Elevation head and chest 20-30 degrees Bronchodilators - manage bronchospasm |
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Why do you elevate a patients head in inhalation injuries?
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increases tidal volume and allows for increase perfusion/diffusion
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True or False: IV steroids are found to decrease the degree of inhalation injury.
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False: not found to decrease injury
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What role do steroids have in inhalation injuries?
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Aerosolized steroid can decrease airway hyperreactivity
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What are the rules of nines?
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Each arm: 9%
Each leg: 18% Anterior trunk: 18% Posterior trunk: 18% Head: 9% Genitalia: 1% |
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How do you resuscitate a burn patient?
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Isotonic fluids
Excess of 20% TBS (intestinal ileus) No glucose |
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Do you give glucose in resuscitation of a burn victim? Why/why not?
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No; intolerance due to catecholamines
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What is the Parkland formula?
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Lactated Ringers:
4mL/kg/%TBS plus maintenance |
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When resuscitating a burn victim, what do you want to keep their urine output at?
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0.5cc/kg/hr
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Can you use hypertonic solutions in resuscitation of burn victims?
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Yes: they have some good reports
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What constitutes a first degree burn?
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outer epidermis
erythema and mild discomfort no residual scarring |
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In a first degree burn, when does pain resolve? When does the damaged tissue peel away?
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48-72 hours; 5-10 days
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What is injured in a superficial second-degree burn?
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variable portions of dermis destroyed
-microvessels injured and permeability increased |
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Blisters first appear in what degree burn?
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superficial second-degree
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How long does it take superficial second degree burns to heal?
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7-14 days from repopulation epithelial cells from hair follicles, sweat glands
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Do you give tetanus prophylaxis for second degree burns?
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Yes
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Do you give tetanus prophylaxis for first degree burns?
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No
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What are the characteristics of a deep second-degree burn?
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well into dermal layer
epithelialization slow (months) no blister formation dense scarring results pain |
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What are the characteristics of third degree burns?
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entire dermis destroyed
waxy white color absence of pain |
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True or False: Topical antibiotics in burn victims decrease rate of wound healing.
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True
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What is the role of topical antibiotics in burn victims?
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Deep burns are protected from early bacterial invasion which converts wound to deeper injury.
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What does Silvadene cover?
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gram-negative organisms with some antifungal effects
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What is the primary complication of Silvadene?
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Transient Leucopoenia
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What do high-voltage injuries resemble?
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crush injuries
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With a high-voltage injury, why do you correct the acidosis?
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to prevent myoglobin in renal tubules
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How do you treat myoglobinurea?
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Mannitol 25g bolus, then 12.5g every 2-4 hours
Sodium bicarbonate to keep urine pH >7 Low-dose dopamine Loop diuretic if pigment load persists >8 hours |
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What complications can occur from a high-voltage injury?
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Cardiac - ventricular fibrillation
Lung - respiratory distress CNS - seizures, coma, mental changes Eye - retinal detachment, cataract (delayed) Muscle necrosis, renal failure |
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What are complications for low-voltage injury?
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Cardiac - ventricular fibrillation
Tetany and muscle spasm leads to fractures and suffocation CNS - result of hypoxia |
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What causes the CNS symptoms in a low-voltage injury?
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hypoxia
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Who will be transferred to a burn unit?
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2nd degree > 30% TBS
3rd degree > 10% TBS Complicated by respiratory tract injury, fractures, or critical areas (face, hands, feet, perineum) High-voltage electrical burns Significant preexisting disease Children |