Closed room fires or house fires at huge risk for

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Closed room fires or house fires at huge risk for carbon monoxide poisoning. Pts in house fires are dealing with burn issues and Carbon Monoxide poisoning. Carbon monoxide takes place O2 on hgb tissues starve because not getting oxygen See neuro changes, HA, hyperventilation, lethargic, nauseous, red face (cardinal sign; skin look very bright red or pink like cherry color typically on cheeks) Way to know for sure: check carboxyhemoglobin level = tells you % of hgb that has carbon monoxide on it. >10% is high. Treatment: give O2 (100%) reduces half-life of carbon monoxide
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Critical Care Test 3 (10) Decreased wound healing & huge risk for infection. Pts are hypermetabolic (bc body is trying to heal self). Bc pt is hypermetabolic , it is important they get calories they need (ensure). Other Info: Circumphrential burn is burn that circulates entire arm (worried about pulses/perfusion to hand) develop compartment syndrome . Pts with burn on trunk can develop intra-abdominal compartment syndrome . Pts with burn, we do escharotomy (same as fasciotomy but not as deep) Sometimes you can see burns secondary to abuse . Burns should not have a solid start and stop line. If a burn has a solid start or stop line , it is probably sign of abuse. Ex. Take child and dip child in hot bath. Child will have solid line. Treatment: There are 3 phases of care: resuscitative, acute, rehab 1. Resuscitative : think primary survey (ABCDE). First 48 hrs after burn (up to 72 hrs). Is airway intact? If not, intubate. Breathing? If not, intervene. Circulation (fluids). Neuro status. Warm them up. Fluid replacement: when we do fluid replacement, we use Parkland Formula. This is how we determine how much fluid pt needs within first 48 hrs of resuscitative phase. 4 ml x kg x % TBSA (total body surface area that has been burned). Take total and divide by 2 (you only divide by 2 once) Ex. 8400 ml is given 1 st 8 hours after burn. 8400 ml is given next 16 hrs after burn. 8400 / 8 = 1050 ml/hr. 8400 / 16 = 525 ml/hr. People with burns can have other comorbidity. Take pts urine output in consideration as well. We don’t want to pt in pulmonary edema or HF. 2. Acute Phase : 48-72 hrs after resuscitative phase. Pt has moved into acute phase when they start to diuresis . Continuing what you were doing in resuscitative phase. Concerns: Pain!! Pt starts to recover and pain control is important. If you can give pt, PCA that is preferred. Infection!! Wound care: debridement (burns have to be debrided). Anything old & dead needs to removed. Can be painful. Can be done in variety of ways like in surgery or use hydrotherapy (sit pt in tub and warm water helps loosen up skin allowing dead skin to fall off. Sometimes they use scrub brush too to take off dead skin). Grafting and dressing depends on burns. Deeper burns will need grafting (deep thickness). There are different types of grafting like temporary grafts (xenograft from pigs. Allografting coming from someone else (pts with extra skin after weight loss). Biobrain (synthetic graft; white plastic thing; only used for superficial partial and superficial burns. Temporary. Acts like a scab). Autograft (take skin from you like from buttocks or thigh). Silver cream has antimicrobial properties (helps reduce infection).
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  • Fall '18
  • Traumatic brain injury

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