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Lightening Strikes?
- reverse triage
- direct vs side strike
- Identify contact points
- neuro exam and doc over time
- EKG
- Ortho
- internal injuries
- assess for compartment syndrome
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Frostbite
- warm extremities slowly
- warm pt as much as possible
- narcotics (fentynil-->relax, pain/versed-->amnesia!)
- can heal without surge
- TPA: Tissue plasminogen activator
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What is a tub room
- Keeps pt warm
- has a tub for rub-a-dub-dub
- Has water hoses from ceiling.
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How does a burn systemically effect pt?
- catecholamines--> release of local and systemic mediators
- --histamines
- --serotonin
- --kinins
- --o2 free rads
- --prostaglandins
- --thromboxanes
- --interleukens
- --something else
Increased cap permeability-->supply damaged area-->edema-->can lead to pulmonary edema
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Hypotension?
- Immediate vasoconstricution due to catecholamies
- arterial bp may be mainteained even in sever hypovolemia due to massive catecholamines.
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Systemic effect of burns on gI
- paralytic ileus due to stress
- ng tube decompress and enteral feeds
- prophylax for stress curlings ulcer)
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Renal effects of burns?
- ATN caused by occlusion of tubules by hemoglobin.
- use of renal toxic antibx and vasopressors
- fluid resuscitation to open up.
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Immunologic effects of burns?
- infammatory--> masssive response--> v WBC because they are actually depleted. (24-48hrs)
- WBCs will spike, then drop-->immunosupressed pt.
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Inhalation injury?
- increased morbidity mortality
- bronchosopcy
- supportive treatment
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Management of partial thickness
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Topical treatments
- silver: moist, antibiotic action
- collagenase: soothing, breaks down collagen-->easy debridement.
- Abx
- Abx impregnated dressings, ie Mepilex.
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Management for full-thickness
- OR and graft
- Autograft: pt's own skin from another location transplanted to wound area.
- Mesh autograft: like autograft, but gets perforated to cover more area.
- CEA: Grow pt's own skin in volume to graft. Very expensive.
- Allograft: cadaver skin
- Xenograft: pig skin
- Autograft is preferred because has higher chance of taking.
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4th degree
- All the way through.
- Requires OR
- May require amputation of burned limb.
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Steven-Js and toxic epidermal necrolysis
- Mortality is higher than burn of same size
- usually Rx reaction
- Mucosal involvment often severe
- 1-6 weeks recovery
- NGT, prevent nfxn, full fluid resuscitation.
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Necrotizing fascitits
- swelling-->blisters tissue-->death
- treat nfxn, then graft dead tissue.
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Abdominal compartment syndrome
- caused by overaggressive fluids
- 3rd spaces into abd-->pressure on kidneys, bowel, lungs, and blood flow
- check bladder pressure q4h
- requires OR.
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Long term burn care?
- PT OT to resume ADLs
- compression garments for scar and edema
- follow up in burn clinics.
- Follow up with burn psychologist for body image or job place anxiety r/t source of injury.
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What is the most common cause of ALOC in a burn pt?
Smoke inhalation/CO2 poisoning.
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What is "slugging?"
The thickening of blood in response to fluid shift from vasculature to 3rd spacing and damage to small capillary beds.
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What is the leading cause of death for pt with inhalation burn injury?
Pneumonia.
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