accidents and injury

Question 1

How are burns surface area calculated in a child?

Answer 1

face: 18%; trunk 18%, back 18%, total arms 18% (9% per arm), legs 14% each
this means that face is greater % body surface area than adults, and legs are less

Question 2

How is body surface area calculated in an adult?

Answer 2

trunk and back 18%, (9 for top, 9 for bottom on each section), face 9%, 9% for each leg in front, 9% for each leg in back. genitals 1%

Question 3

What is the Parkland formula?

Answer 3

used to determine IV fluid resucitation need.

4 mL x Kg body weight x 1% body surface area burned

Question 4

When should pts be treated inpatient for burns?

Answer 4

2nd degree burns >10%, third degree burns >2%, or burns of the face, hands, genitalia,

Question 5

What are special tx considerations for large burns (>25% BSA) or involving the face? General burn considerations?

Answer 5

airway management, IV fluids, temperature control. If pts have smoke inhalation (diagnosed via incr. carboxyhemoglobin levels), they should get O2 and monitoring for resp failure
give tetanus if immunization status is unknown or out of date; use abx agents like silver sulfadiazine or bacitracin in dressings

Question 6

What are the complications of burns?

Answer 6

infection (esp pseudomonas, sepsis), stress ulcers (curling type), aspiration, dehydration, ileus, renal insufficiency, compartment syndrome, contractures

Question 7

How is fresh water drowning different from salt water drowning?

Answer 7

Fresh water: hypotonic fluid absorbed from alveoli into vasculature, resulting in decr. electrolyte concentrations and RBC lysis
salt water: hypertonic fluid creates and osmotic gradient that draws fluid from pulm capillaries into alveoli and cuases pulm edeman and incr. serum electrolyte concentrations

Question 8

What is the difference btw heat exhaustion and heat stroke?

Answer 8

exhaustion is less severe: pt are weak with HA and sweating, slightly incr body temp, and normal labs. they are treated with hydration and electrolyte replacement
heat stroke: pts are confused, with blurry vision, nausea, and little or no sweating; body temp is substantially elevated, incr WBC, incr BUN/crt common. treatment involves cool environment, benzos to relax muscles. can lead to rhabdomyolysis, seizures, brain damage,and death

Question 9

What is the definition of hypothermia? risk factors?

Answer 9

temp

Question 10

What are the manifestations of final stage hypothermia?

Answer 10

pt will stop shivering, be unable to maintain body temp, and undergo a fatal incr of blood viscosity. pts may have Vtach or Vfib, may have J waves (little bump right at the end of the QRS complex)

Question 11

Complications of snake bites

Answer 11

toxin induced DIC, progressive dyspnea. antivenin may be needed

Question 12

black widow sx , tx, complications

Answer 12

muscle pain and spasms, diaphoresis, abd pain, autonomic stimulation. give benzos, antivenin. can cause CV collapse, hemolytic anemia, DIC, rhabdo

Question 13

brown recluse sx, tx, complicatons

Answer 13

pain at site, possible ulceration/necrosis. tx with dapsone to prevent tissue necrosis
few complications