-
Indications for intubation post-burn
- 1. Burn to the face
- 2. Singed nares or eyebrows
- 3. Dark soot/mucus from nares and/or mouth
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Management of Acute non-severe burn
- 1. Submerse in clean water
- 2. Wrap in clean, wet towel and transport
- -no ice, lotions, toothpaste, lard, butter
- 3. Cleanse with NS (no betadine, alcohol, etc)
- 4. Maintain normal temp
- 5. Pain management (morphine, hydromorphone) and amnesia (midazolam)
-
How to remove tar from the skin
use petroleum based produce i.e. bacitracin, petroleum jelly, mayonnaise
-
Fluid resuscitation after a burn (Parkland formula)
- 4 ml/kg x %TBSA burned in the first 24 hours
- - 1/2 within 8 hours
- - 1/2 within the next 16 hours
-
Monitor for what post-burn?
- 1. Metabolic acidosis (early)
- 2. Hyperkalemia (first 24-48 hours)
- 3. Hypokalemia (3 days post-burn)
-
What % of a patient's TBSA is the palm?
1%
-
What type of bite is most infectious?
Cat
-
Irrigate bites with what?
High-pressure NS or LR using an 18-19G needle
-
Wounds of the hands or lower extremities should be left open, T or F?
True
-
What is the time lapse for when a bite should no longer be closed?
6 hours
-
What antibiotics should be prescribed for human and animal bites? How long?
- PO Augmentin for 3-7 days
- (coverage for staph and anaerobes)
-
Difference between first and second degree burn?
Blisters
-
Third degree burn
Full thickness burn, all the way to the bone, severed nerve endings
-
Toxicology Tests (fluids)
- 1. Serum
- 2. Gastric
- 3. Urinary
-
Agent of choice for forced emesis
Ipecac
-
Indication for Ipecac
"at home" ingestions of solid toxins (e.g. pills, capsules)
-
Contraindication for Ipecac
Corrosives, detergents
-
Indications for gastric lavage
Ingestions < 30 minutes ago
-
Method of gastric lavage
- "lavage until clear"
- Use 28-28 Fr oro or nasogastric tube
-may not work with large pill fragments
-
Dosage of activated charcoal
1 g/kg up to 50 g mixed with water. Repeat every 4 hours PRN.
First dose most effective if mixed with a cathartic (i.e. Sorbitol)
-
Procedures for severe ingestion
Forced diuresis, dialysis, hemoperfusion, plasmpheresis
-
S/S of acetaminophen intoxication
- 1. Usually asymptomatic in the early phase
- 2. Nausea/vomiting (24-48 hours)
- 3. RUQ pain
- 4. Signs of hepatotoxicity: jaundice, elevated LFTs, prolonged PT, AMS, delirium
-
Management of Acetaminophen toxicity
- 1. Emesis for recent ingestion: gastric lavage, activated charcoal
- 2. N-Acetylcysteine (Mucomyst) with a loading dose
-
S/S of salicylate intoxication
- 1. N/V
- 2. Tinnitus, dizziness, headache
- 3. Dehydration
- 4. Hyperthermia
- 5. Apnea, cyanosis, metabolic acidosis
- 6. Elevated LFTs
-
Management of salicylate intoxication
- 1. Emesis for recent ingestions: gastric lavage, activated charcoal
- 2. Sodium bicarbonate IV to correct severe acidosis
-
S/S of organophosphate (insecticide) poisoning
- 1. N/V, cramping, diarrhea
- 2. Excessive salivation
- 3. Headache
- 4. Blurred vision & miosis
- 5. Bradycardia
- 6. Mental confusion, slurred speech, coma
-
Miosis
Constricted pupils
-
-
Management of organophosphate (insecticide) poisoning
- 1. Wash skin thoroughly
- 2. If insecticide was ingested, activated charcoal should be ordered
- 3. Atropine
- 4. Pralidoxime reverses nicotinic signs such as muscle weakness and respiratory depression
-
S/S of antidepressant toxicity
- 1. Confusion, hallucinations, blurred vision
- 2. Urinary retention
- 3. Hypotension, tachycardia, dysrhythmias
- 4. Hypothermia
- 5. Seizures
-
Management of antidepressant toxicity
- 1. Admit to ICU if CNS or cardiac toxicity evident
- 2. Gastric lavage, activated charcoal
- 3. Sodium bicarbonate IV to counter dysrhythmias and maintain pH
- 4. Benzodiazepine IV PRN to control seizures
- 5. Treat Serotonin syndrome
-
Serotonin syndrome
Hyperthermia from antidepressants
-
Treatment of Serotonin Syndrome
Dantrolene sodium (Dantrium) for hyperthermia
Clonazepam (Klonopin) to treat rigor
Cooling blankets
-
S/S of narcotic toxicity
- 1. Drowsiness
- 2. Hypothermia
- 3. Respiratory depression, shallow respirations
- 4. Miosis
- 5. Coma
-
Management of narcotic toxicity
- 1. No emetics
- 2. Gastric lavage/activated charcoal
- 3. Naloxone (Narcan) IV
- 4. Butorphanol (Stadol)
-
S/S of benzodiazepine overdose
- 1. Drowsiness, confusion
- 2. Slurred speech
- 3. Respiratory depression
- 4. Hyporeflexia
-
Management of benzodiazepine overdose
- 1. Respiratory and blood pressure support
- 2. Flumazenil (Romazicon) IV
- 3. Gastric lavage, activated charcoal
-
Examples of benzodiazepines
- 1. diazepam (Valium)
- 2. clonazepam (Klonopin)
- 3. lorazepam (Ativan)
-
Examples of antidepressants
- 1. Amitriptyline
- 2. Fluoxetine
- 3. Imipramine
- 4. Nortriptyline
- 5. Bupropion
-
Examples of organophosphate
(insecticide)
-
Acute vesicular eruption due to infection with varicella-zoster virus
Herpes Zoster (shingles)
-
S/S of herpes zoster
- 1. Pain along a dermatomal distribution
- 2. Grouped vesicle eruption along the dermatomal pathway
- 3. Regional lymphadenopathy may be present
-
Management of Herpes Zoster
- 1. Pharm: acyclovir, famciclovir, valaciclovir
- 2. IV acyclovir for immunocompromised host
- 3. Foscarnet for acyclovir-resistant herpes zoster
- 4. For suspected ocular involvement, consult ophthalmology
- 5. Post-herpetic neuralgia: gabapentin (Neurontin), pregabalin (Lyrica)
-
S/S of acute rejection
- 1. Immediate failure of that organ
- 2. Flu-like symptoms (fever, chills, malaise)
-
Management of acute rejection
- 1. Immediate biopsy ASAP
- 2. Anti-rejection medications
- calcineurin inhibitor: Tacrolimus, cyclosporine
- +
- antimetabolite: azathioprine (Imuran), mycophenolate mofetil (Cellcept)
- +
- steroid: prednisone (Deltasone, Orasone, Meticorten)
-
Actinic ketatosis
- -small patches on sun-exposed parts of the body
- -premalignant, progresses to squamous cell carcinoma
- -rough, flesh-colored, pink, or hyperpigmented
-
Squamous cell carcinoma
- -From actinic keratoses
- -Firm irregular papule or nodule
- -develop over a few months
- -prolonged, sun-exposed areas in fair skin people
- -keratictic, scaly bleeding
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