Flashcards in Burns/Ortho Deck (72)
Three tiers of triage
emergent, urgent, non-urgent
if not treated immediately will threaten life, limb, sight
if not treated in the next 1-2 hours there is potential for significant medical morbidity, pain
stable but requires care in next 4-6 hours , with NO risk of mortality or permanent functional loss
Three steps of triage
physiology, anatomy, mechanism of injury
responsiveness, evidence of poor perfusion, abnormal heart rate, resp rate and/or cap refill
Abnormal Heart rate for child < or equal to 5 yo
180 per min
Abnormal Heart rate for child less than or equal to 6 yo
If patient has RR > 60 , in respiratory distress, or apnea, what are you going to do ?
Send to trauma center with ALS if available (ALS= air lift support)
Examples of anatomy issues that would indicate triage to trauma center
penetrating injuries (head, neck, torso, extremities above elbow and knee), flail chest, difficulty or inability to maintain patent airway, fractures > 1 involving the humerus and/or femur, pelvic fracture, paralysis or evidence of spinal cord injury, amputation above the wrist or ankle, burn w/ major injuries, seat belt mark on torso
What are the 7 mechanisms of injury you would call a trauma center?
ejection from motor vehicle, falls?3x patient height, extrication time ?20 mins w/ an injury, high voltage electrical injury, unrestrained passenger in vehicle roll over, anyone thrown or run over, and front seat passenger w/ deployment of air bag (same side)
If you find someone in cardiopulmonary arrest, respiratory failure, status epilepticus and/or unresponsive, what are you going to do?
bring directly into ED room and immediate resuscitation
What is an emergent case?
Any alteration in LOC, mod-severe dehydration or resp. distress, febrile infant under 3 months. *think emergent-emergency situation
Examples of emergent cases
toxic ingestion, asthma in distress, DKA, r/o sepsis, and suspected abuse
What is an urgent case?
A patient require interventions such as antibiotics, pain meds, sutures, wound repair, cast, febrile child over 3 months.
Examples of urgent cases
minor burn, simple fracture, pneumonia, post seizure, mild resp distress, and simple trauma
What is a non-urgent case? And what are the 7 examples
require little intervention. Upper resp. infection, diaper rash, thrush, impetigo, conjunctivitis, sore throat, and ear infection
average age of pediatric burn patient
A child is brought into the ED with burn to face, chest, and anterior legs, what do you involve in your assessment?
depth, percentage of body surface area, and involvement of certain body parts
Examples of major burns
face, hands, feet, perianal, anterior chest and circumferencial
What is a circumferencial burn?
A burn that goes all the way around a body part
Burns are the 2nd leading cause of accidental death in children under 15, what is 1st?
What percent of burns are preventable?
First degree burns. Affect only the epidermis /outer skin. Usually red, painful, dry, with no blisters. Usually heal on their own within a week by cold compresses, lotions/ointments, and NSAIDS or ibuprofen
Example of minor burn
mild sunburn and flash burn (a sudden, brief burst of heat)
Second degree burns. Involve the epidermis and part of the dermis layer of skin. Burn will appear red, blistered and may be swollen and painful.
How is a moderate burn treated?
If 2nd degree burn does not cover more than 10 percent of skin's surface, can be treated in outpatient setting with antibiotic ointments, dressing changes 1-2x per day depending on severity of the burn, daily cleaning of the wound to remove dead skin or ointment, and possibly systemic antibiotics
Examples of moderate burns
scald injuries, flames, and skin that briefly comes in contact with a hot object
You are the advice nurse at Kaiser, a patient calls in about her child who was burned by a scalding hot liquid. She describes the skin as dry and leathery, with blackish/whitish skin, and states it does not hurt. What do you advise her to do?
Bring child to ED because child has a severe, third-degree burn