first
Shock panel includes these labs
ABG, lactate, Hgb/Hct, K+, ionized Ca, NA, glucose
first degree/superficial burn involvement and treatment
Epidermis only, appears red maybe dry or flaky, painful
Heals w/minimal intervention within 3-6d, encourage hydration and sunscreen
Pressure support (PSV)
Spontaneous mode of ventilation in which each breath is initiated by the patient but is supported by constant pressure inflation
Right internal jugular vein leads you to this location
Right atrium
Hemodynamic changes associated w/cardiogenic shock
Increased HR, decrease CO, decrease BP, increased SVR, decrease SvO2
Some activation criteria for a rapid response
Heart rate <45 or systolic <80, RR <8, Sp02 <90%, HR >125, AMS, RR >30, chest pain, seizures, worker concern
Second degree/partial thickness burn involvement and treatment
Involves dermis (can be superficial or deep), varies in appearance w/blisters and edema --> superficial: pink, blanchable, hypersensitive --> deep: pearly white, dry, sometimes blanchable
Treat w/local wound care or inpatient w/skin grafting
Assist control: pressure
You set peak pressure, inspiration ends when peak pressure is reached --> can lead to hypo or hyperventilation depending on lung compliance
Cleanest and dirtiest cannulation sites
Subclavian (cleanest) and femoral (dirtiest)
Hemodynamic changes associated w/hypovolemic shock
Increased HR, decreased CO, decrease BP, increased SVR, decrease SvO2
Respiratory monitoring (3 items)
Pulse ox, ABG, end tidal CO2
Third degree/full thickness burns involvement and treatment
Injury to epidermis and deep dermal layers. Appears white or charred, waxy, leathery, insensate, edematous
Must be treated w/excision and skin grafting
Assist control: volume
You set tidal volume, inspiration ends once volume is reached --> can lead to high peak pressures as lung compliance decreases
Most common pathogen for central line associated blood stream infection (CLABSI)
S. epidermidis --> suspected when catheter in place >48h
Hemodynamic changes associated w/distributive shock
Indications for CPAP
Hypoxemia, pneumonia, cardiogenic pulmonary edema, OSA
Fourth degree burn involvement and treatment
Beyond skin, injury to muscle and sometimes bone
Requires amputaiton
PEEP
PEEP maintains the patient's airway pressure above the atmospheric level by exerting pressure that opposes passive emptying of the lung. This pressure is typically achieved by maintaining a positive pressure flow at the end of exhalation
Arterial line contraindications
Absent pulse, inad circulation, Raynauds, full thickness burns, infection at insertion site
Hemodynamic changes associated w/obstructive shock
Increase HR, decreased CO, decreased BP, increased SVR, decreased SvO2
Indications for BiPAP
Hypercapnea, COPD, asthma, CF, rib fractures
Supraglottic vs subglottic injury
Supraglottic: due to thermal injury, can lead to edema requiring intubation, usually occurs <24-36h
Subglottic: direct damage to the epithelium of the airways leading to edema, sloughing, pneumonia
Complications of mechanical ventilation
Vent associated pneumonia, barotrauma d/t high pressures, variations in CO
Contraindications for vascular access
Infection at insertion site, distorted anatomy d/t trauma, severe coagulopathy (esp. subclavian line as you can't really compress it), thrombus of vein
Hypovolemic: hemorrhagic and nonhemorrhagic
Distributive: septic, adrenal crisis, neurogenic, anaphylactic
Cardiogenic: myopathic, mechanical, arrhythmic
Obstructive: tamponade, tension pneumo, constrictive pericarditis, PE