Shock
The most reliable indicators of shock in a TFC setting are?
Altered Mental status in absence of head injury and an absent or weak radial pulse
What makes up the lethal triad?
Acidosis, coagulopathy, and hypothermia.
What are the indications for administering TXA?
severe hemorrhage, significant TBI, penetrating trauma
When do we suspect inhalation injury?
Within any kind of closed space (truck, building, etc.)
What TBSA burn requires fluid resuscitation?
For burns > 20% TBSA, initiate fluid resuscitation as soon as IV/IO access is established
What is the definition of shock?
Progressive cellular and tissue hypoxia leading to organ damage and, if not treated, death.
These intravenous fluids are commonly used for volume replacement in hypovolemic shock.
Normal saline, lactated ringers
What are the contraindications for administering TXA?
Subarachnoid hemorrhage and active intravascular clotting
What are the signs and symptoms of inhalation burns?
Facial burns, singed eyebrows, eyelashes, nasal hairs, carbon deposit, redness in mouth, oropharynx, sooty deposits in sputum, hoarseness, noisy inhalation, cough, dyspnea.
What should you do first when you encounter a casualty with an electrical burn?
Secure the power, if possible; otherwise, remove the casualty from the electrical source using a nonconductive object, such as a wooden stick.
Irreversible cell damage and organ failure characterize this final stage of shock
Refractory shock
When do we use a saline lock vs IV cannulation with fluid resuscitation?
Saline lock: significant injuries with present radial pulse and normal mental status.
IV cannulation: significant injuries with absent radial pulses and altered mental status.
What is the proper protocol for administering tranexamic acid?
2 gram of TXA should be administered via slow IV or IO push as soon as possible not later than 3 hours after injury.
What burn degree is....Partial thickness of skin, penetrates deeper, blisters, subcutaneous edema, and painful.
2nd degree burn
Why are petroleum-based products contraindicated for white phosphorus burns?
They are flammable and can worsen the burn
How do we treat refractory shock?
A NDC should be considered. If shock persists consider decompressing the opposite side of the chest if indicated.
How do we prevent the lethal triad?
-Correct hypovolemia by supporting oxygenation through administering blood products
-Prevent continued blood loss and treat for hypothermia
This balanced crystalloid solution is often used in trauma and burn patients experiencing hypovolemic shock as it closely resembles the electrolyte composition of blood.
Lactated Ringer's
What burn degree is...sub-dermal extending beyond subcutaneous tissue into muscle, fat, and bone?
4th degree burns
This is the target range for urine output (in cc/hour) to indicate adequate circulatory volume.
30-55cc/hour
*adjust IV fluid to obtain this.
What are active and passive forms of prevention in hypothermia?
Passive: covering exposed skin, shelter
Active: warming blankets, heated fluids
The lethal triad represents a dangerous feedback loop. Hypothermia impairs coagulation, worsening bleeding (coagulopathy). Both hypothermia and the resulting coagulopathy exacerbate this metabolic condition, further diminishing oxygen delivery and fueling the downward spiral
Acidosis
What would be the fluid infusion rate for a 90 kg person with a 40% burn?
500ml/hr.
The initial IV/IO fluid rate is the %TBSA x 10 ml/hr for adults weighing 40-80 kg. For every 10 kg above 80 kg, increase the initial rate by 100 ml/hr. 40% x 10 ml/hr = 400ml/hr 400ml/hr + 100ml/hr = 500ml/hr