Chapter 28
Name the two most common chronic medical conditions patients frequently are diagnosed in addition to kidney failure.
Diabetes and High Blood Pressure (Hypertension).
Know the major types of shock a body can experience (especially related to the kidneys)
Hypovolemic shock, Cardiogenic Shock, Obstructive Shock, Distributive Shock.
What is the rule of palm and how much percentage does the palm equal the patient's BSA (body surface area)?
The rule of palm, also known as the palmar method or the rule of ones, is a technique used to estimate the extent of a burn on a patient's body. By comparing the size of the burn to the size of the patient's palm and fingers, you can estimate the percentage of the body affected. For example, if a burn covers an area equivalent to five palms, it would be about 5% of the body surface area.
EXTRA: Review how to treat amputated body parts.
Wrap in sterile dressing, keep cool, avoid immersion and transport.
How do we treat a musculoskeletal injury of the shoulder?
Assessment, immobilization, and finally transport.
List the kidneys major functions.
Filtration of blood, fluid balance, waste removal, pH regulation, Fluid Retention (the kidneys help retain necessary fluids to prevent further dehydration.)
What is neurogenic shock caused by?
Spinal cord injury.
How do you manage chemical burns? What if you notice chemical powder still on their skin?
Remove Contaminants: If chemical powder is present, gently brush it off without raising a cloud. Avoid using water initially for dry chemicals like dry lime, as it can create a corrosive liquid.
Wash the Area: For liquid chemicals, continuously flood the affected area with a gentle flow of water for at least 20 minutes. This helps remove the chemical and prevent further damage.
Protect Unaffected Skin: Remove contaminated clothing and jewelry carefully to avoid spreading the chemical to unaffected areas.
Treat and Transport: Apply a sterile dressing, treat for shock, and transport the patient to a medical facility. Be alert for delayed reactions.
What must you look for if you treat a patient with a gunshot wound?
Assess the wound, control the bleeding, evaluate for shock, spinal motion restriction, transport and documentation.
What must you check prior to immobilizing an extremity in splinting?
Circulation, Sensation, Movement and Position.
What is the difference between the two main types of dialysis?
Peritoneal Dialysis (PD) is done at home while Hemodialysis (HD) is used at dialysis centers. HD uses big needles and PD Involves a permanent catheter in the abdominal wall. Etc.
Review types of open tissue injuries, and how to manage these injuries.
Abrasions: Clean the wound to reduce contamination and cover with a sterile dressing.
Lacerations: Control bleeding with direct pressure and cover with a dressing.
Puncture Wounds: Control bleeding and stabilize the object if necessary.
Avulsions: Clean the area, reposition the skin if possible, and cover with a dressing.
Amputations: Control bleeding, wrap the amputated part in a sterile dressing, and keep it cool.
Review electrical burns and what you should be looking for.
Airway and Breathing: Electrical shock can lead to severe airway swelling and respiratory failure. Be ready to provide positive pressure ventilations.
Cardiac Care: Cardiac rhythm disturbances are common. Be prepared for defibrillation and basic cardiac life support.
Spinal and Muscular Injuries: Severe muscle contractions can cause fractures or spinal injuries. Stabilize the spine if necessary.
Burn Assessment: Look for entry and exit burn sites. Cool the burn areas and apply dry sterile dressings.
Transport: Quickly transport the patient, as internal injuries may develop over time.
Know how to recognize and treat a sucking chest wound
Recognize: Look for an open wound on the chest, often accompanied by a sucking sound as air moves in and out. The patient may have difficulty breathing and show signs of shock or hypoxia.
Treatment: Seal the wound, provide support, monitor and transport.
How do we manage a shoulder dislocation that "pops back into place?"
Check Distal CSM, apply a sling, swathe and transport the patient.
What is hemodialysis for and how does it work?
Hemodialysis is a treatment for kidney failure, where it helps remove toxins and balance fluids when the kidneys can no longer function properly.
HOW: Blood is drawn through a catheter, filtered by a dialysis machine (dialyzer) to remove waste and excess fluids, and then returned to the body.
What is epistaxis and how do we manage it? What should we avoid doing?
What: Medical term for a nosebleed.
Manage: Have the patient lean forward while sitting, apply pressure to the fleshy part around nostrils for at least 5 mins without checking if the bleeding has stopped. Keep patient calm and avoid snorting or wiping the nose forcefully after releasing pressure.
Avoid: Avoid Leaning Back, Recovery Position: (If the patient becomes unconscious)
Know the differences between adults and infants where burns are concerned.
Body Surface Area: Infants have a larger body surface area relative to their body size, leading to more significant fluid and heat loss from burns compared to adults.
Risk Factors: Infants are at a higher risk of shock, airway problems, and hypothermia following burns. Their smaller airways and less developed thermoregulation systems make them more vulnerable.
Healing Patterns: Infants and children have different healing patterns, often requiring specialized care and equipment that some hospitals may not provide.
Severity Assessment: Burns that might be minor in adults can be severe or even fatal in infants due to their physiological differences.
What injuries produce distended neck veins?
Tension Pneumothorax, Cardiac Tamponade, and Traumatic Asphyxia.
Know the difference between direct and indirect force when dealing with injuries.
Direct Force: Force applied directly to a specific area of the body, causing injury at the point of impact.
Indirect Force: Force applied away from the injury site, but causes damage through transmission.
Why do we give aspirin to patients? How does it work?
Administered to patients experiencing chest pain suspected to be of cardiac origin. It prevents blood from clotting and maintains blood flow reducing the risk of a heart attack.
Review the rule of nine EXTENSIVELY and have a clear understanding of how to calculate the rule of nines.
Adult Calculation:
Head and Neck: 9%
Each Upper Extremity: 9%
Chest: 9%
Abdomen: 9%
Upper Back: 9%
Lower Back and Buttocks: 9%
Front of Each Lower Extremity: 9%
Back of Each Lower Extremity: 9%
Genital Region: 1%
Infants and Young Children:
Head and Neck: 18%
Each Upper Extremity: 9%
Chest and Abdomen: 18%
Entire Back: 18%
Each Lower Extremity: 14%
Genital Region: 1%
Know the different types of burns and what classifies them as such
By Depth:
Superficial Burns (First-degree): Affect only the outer layer of skin (epidermis), causing redness and pain.
Partial Thickness Burns (Second-degree): Damage extends into the dermis, leading to blisters and swelling.
Full Thickness Burns (Third-degree): Penetrate through the dermis, affecting deeper tissues, and may appear charred.
By Agent and Source:
Burns can be caused by various agents like chemicals or electricity. Identifying the source, such as dry lime or alternating current, helps in specific classification.
By Severity:
Severity determines the urgency and type of care. Conditions may require treatment at specialized burn centers, especially for critical burns.
EXTRA: Review types of closed tissue injuries, and how to manage these injuries
Contusions (Bruises), Hematomas, Crush Injuries, Blast Injuries
EXTRA: When do the kidneys help the body retain fluid?
When the body senses a lack of adequate fluid, the kidneys adjust their function to conserve water. This is achieved by reducing the amount of urine produced.