Sepsis S/S
Fever >101.3
HR 90 BPM
RR >20
Infection
Severe Sepsis S/S
Mottled skin Decreased UO Change in mental status Decrease in platelets Dyspnea
Septic shock criteria
S/S of severe sepsis
PLUS
Extremely low BP
DIC S/S
Pain Stroke-like appearance Dyspnea Tachycardia Reduced kidney function Bowel necrosis
DIC tx
Anticoagulants (heparin)
Cryoprecipitated clotting factors
FFP
Hypercalcemia early S/S
Fatigue
Loss of appetite
NV
Constipation, polyuria
Hypercalcemia more serious S/S
Severe muscle weakness Loss of DTR Paralytic ileus Dehydration EKG changes
Superior Vena Cava Syndrome
SVC is compressed by tumor or clots
Occurs most often in pts with lymphoma, lung cancer, & breast cancer
SVCS early S/S
Facial edema esp around eyes
Tightness of shirt collar
SVCS S/S worsening compression
Distended blood vessels Erythema of upper body Edema in upper extremities Dyspnea Epistaxis
SVCS late S/S
Hemorrhage
Cyanosis
Change in LOC
Hypotension
Tumor lysis syndrome
Large number of cells are destroyed
Intracellular contents are released faster than body can eliminate them
Very high potassium levels
Large amounts of purines (crystals in kidneys)
Tumor lysis syndrome S/S
NVD Elevated T wave, wide QRS HTN Decreased/absent UO Flank pain Hematuria Seizures Lethargy Paresthesias
Tumor lysis syndrome lab results
Elevated uric acid
Elevated potassium
Elevated phosphate
Decreased calcium
Tumor lysis syndrome tx
Antiemetics
Diuretics (mannitol, allopurinol)
Kayexalate (pulls potassium out)
IV with glucose & insulin
HIV Clinical A
Flu-like symptoms
Lymphadenopathy
Sometimes no S/S
HIV Clinical B
HIV+ with 1 or more infections that are complicated by HIV
HIV Clinical C
HIV+ with accompanying AIDS conditions
HIV 1
CD4 at least 500
HIV 2
CD4 200-499
HIV 3
CD4 < 200
HIV tx HAART
Highly active antiretroviral therapy
3 or 4 HIV meds with other antiretrovirals
HIV complications
Opportunistic infections
Wasting syndrome
Fluid/electrolyte imbalance
Seizures
Pneumocystis carinii pneumonis (PCP)
Protozoan infection Most common opportunistic infection Dyspnea with exertion Dry cough Fever/fatigue Crackles
Toxoplasmosis encephalitis
Protozoan infection Contact with contaminated cat feces Undercooked meat Change in LOC Headaches Fever Speech, gait, & vision problems
Cryptosporidiosis
Protozoan infection Intestinal infection Mild diarrhea to severe wasting Electrolyte imbalance Diarrhea may cause fluid loss of 15-20 L/day
Candida Albicans
Fungal infection Normal flora of GI tract Food tastes funny Mouth pain Difficulty swallowing
Tuberculosis
Bacterial infection Cough Dyspnea Chest pain Chest x-ray Sputum culture
Kaposi’s sarcoma
Most common malignancy
Small, purplish-brown, raised lesions
Occur anywhere on body
Not painful or pruritic
Pneumonia
Bacterial infection HIV & 2+ episodes of pneumonia in 1 yr is AIDS Chest pain Productive cough Fever
Herpes Simplex
Viral infection Perirectal, oral, or genital Numbness/tingling Chronic lesions Enlarged lymph nodes
Superficial thickness burns
Epidermis is injured
Epithelial cells & basement membranes still present
Heals 3-5 days
Superficial thickness burns S/S
Redness Mild edema Pain Increased sensitivity to heat Desquamation 2-3 days
Superficial partial-thickness burns
Involves entire epidermis
Small blood vessels injured–plasma leakage
Causes blister
Upper 1/3 dermis affected; skin has good blood supply
Heals 10-21 days
Superficial partial-thickness burns S/S
Redness Moist Blanchable Increased pain (nerve endings exposed) Blisters
Deep partial-thickness burns
Involves entire epidermis
Deeper into dermis
No blister
Heals 3-6 wks
Deep partial-thickness burns S/S
Red Dry White areas in deeper parts May or may not blanch Moderate edema Decreased pain (nerve endings damaged) May require skin grafts
Full-thickness burns
Destruction of epidermis & dermis
Grafting required
Healing time depends on blood supply (wks to mos)
Full thickness burns S/S
Hard, dry, leathery eschar Severe edema Waxy white, deep red, yellow, brown, or black No blood supply (avascular) Decreased sensation
Deep full-thickness burns
Extends beyond skin into underlying fascia & tissues
Damage & exposure of bones, muscles, tendons
Requires early excision & grafting
May have to amputate
Deep full-thickness burns S/S
Blackened
Depressed
Absence of sensation
Eschariotomy
Cut through eschar to relieve discomfort
Fasciotomy
Cut through eschar & fascia to increase blood flow & improve bleeding
Dry heat
Open flames
Clothing ignites
Moist heat
Scalding
Immersion injuries
More common in elderly
Contact burns
Contact with hot metal, tar, & grease
Deep injuries occur in seconds
Chemical burns
Dry chemicals should be brushed off skin & clothing
Remove wet clothing
Electrical injuries
Injuries look small on surface, but internal injuries can be huge
Radiation injuries
Exposure to large doses of radioactive material
Therapeutic radiation most common
Vascular changes
Fluid shift--capillary leak syndrome 1st 12 hrs Hyperkalemia Hyponatremia Hemoconcentration
Cardiac changes
Initial–cardiac output decreases, HR increases
Later–cardiac output increases
Pulmonary changes
Direct airway injury
CO poisoning
Thermal injury
Pulmonary fluid overload
GI changes
Curling’s ulcer–occurs from stress of severe injury due to decreased blood flow & mucosal damage
Metabolic changes
Hypermetabolism–increased need for 02 & calories
Core temp rises (low grade fever)
Resuscitation/Emergent Phase
First 24-48 hrs
Assessment (ABCs, head to toe)
Immediate measures to save life (cool, cover, carry)
Assess s/s inhalation injuries
Intubation
Fluid shift–fluid resuscitation for burns over 20%
Isotonic crystalloids (NS or LR)
Fluid replacement formulas
Calculated from time of INJURY
1st 1/2 given over 1st 8 hrs
2nd 1/2 given over next 16 hrs
4 mL/kg/% Total body surface area burn
Acute phase
36-48 hrs after burn
Assessment & maintenance of CV & resp systems
Prevent infection (tetanus shot, antibiotics)
Debridement
Antimicrobials (silvadene–may cause leukopenia)
Dressings
Grafting
Pressure garments
Open dressing
Open to air but covered with antimicrobial ointment
Closed dressing
Antimicrobial with gauze
May be kept wet or dry
Changed BID
Autograft
Permanent skin coverage
Healthy skin removed from victim & applied to burn
Homograft/allograft
Human skin harvested from cadaver
Usually rejected 2-3 wks
Temporary to allow site to heal
Heterograft/xenograft
Skin from another species, usually pig
High infection rate–silver nitrate
Support/pressure garments
Applied 5-7 days after graft
Wear 6mo-1yr
Rehabilitative phase
Begins when most of burn is healed
Ends when reconstructive & corrective procedures are complete
May last for years