Shock, sepsis and burns Flashcards
(28 cards)
A wound that a ruptured appendix has passed through can be closed. T or F
F, it cannot be closed
Inguinal hernia repair = ____ wound.
Clean
Elective colon resection = ____ wound
Clean contaminated
FIrst degree burn
Erythema of skin
Minimal surrounding edema
Minimal pain
2nd degree burn
Deeper, partial thickness
Hot liquids, very deep sunborn
Must more painful than 3rd degree
Third degree burn
Damage to all skin layers
Pale white, charred, leathery
Fat exposed
Painless to pinprick
Inhalation burns
Carbon around nose, burns involving mouth
Fires in enclosed areas
CO, cyanide
Intubate early
Chemical burns
Do not try to neutralize
Irrigate often
Alkali burns are worse than acid burns
Electrical burns
Always more serious than they appear
Deeper structures generally effected
Can cause rhabdo and acute renal failure
What % BSA needs NG tube?
> 20% because of ileus risk
FOley and burn patients
Every pt w/ significant burns gets one for renal observation
Ointment for burns
1% silver sulfadiazine (silvadene)
Change dressing BID until wounds stops weeping
Earliest manifestation of shock?
Tachycardia
Preferred resuscitation fluids for shock?
NS
RBC’s if hemorrhagic
Pulse pressure will be ____ in shock.
Narrow
Preferred gauge for IV’s in shock
16 at least
Initial fluid bolus amt
1-2 liters wide open in audlt
20 mg/kg in child
__ml of crystalloid is required for every 1 ml of blood loss.
3 ml per 1 ml
Normal urine output for adults
30 - 50 ml/hr
Cardiogenic chock
10-20% due to MI with >50% fatality
Weak, thready pulse
Cool, clammy skin
Septic shock
Usually due to gram- bacteria
Usually have comorbidities (DM, AIDS, leukemia)
Increased capillary permeability leads to relative fluid loss.
Can isolated head injuries cause shock?
No, if head injured pt has shock look for another cause.
Neurogenic shock most often caused by …
Spinal cord injury
Vasomotor regulation fauls and blood pools because of decreased PVR
Can colloids be used in septic shock?
No, will cause pulmonary edema
