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A comprehensive q&a format covering key aspects of shock, sepsis, and burn management. it details various types of shock, their clinical manifestations, and management strategies. furthermore, it explores sepsis pathophysiology, clinical features, and treatment approaches, including the use of parkland's formula for fluid resuscitation in burn patients. The document also includes questions on the timing of organ failure in sepsis and the management of smoke inhalation.
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Shock - ANSWER Inadequate delivery of O2 to cells Patho of shock - ANSWER - Hypotension
heart pump the blood
When does the GIT system start to fail? - ANSWER 10-15 days
When do the kidneys begin to fail? - ANSWER 11-17 days
Sepsis patho - ANSWER Ineffective material that enters systemic circulation leading to decreased tissue perfusion and o2 from WBC's
Characteristics of burns - ANSWER Injury resulting from exposure to heat, chemicals, radiation, cold injuries and electric current
Thermal burns - ANSWER Exposure to dry heat (flames) or moist heat (steam or hot liquids)
Chemical burns - ANSWER Direct skin contact with acids, alkaline agents, toxic compounds
Electrical burns - ANSWER Contact with an electric current lower than <1000v or >
Radiation burns - ANSWER Mediated by energy transferrence
Cold burns - ANSWER Decreased blood flow causes tissue necrosis
Patho of burns - ANSWER Inflammatory reaction leading to rapid oedema formation due to increased microvascular permeability, vasodilation & increased extravascular osmotic activity. Earliest stage of vasodilation and increased venous permeability is due to histamine release
Parkland's formula - ANSWER 3ml Hartmann's x body weight x %TBSA
Rule of Nine's - ANSWER - Arms, head and neck = 9% each
Airway management of burns - ANSWER Maintain patent airway. Inspect for foreign material. Insert guedel if compromised
Breathing management of burns - ANSWER Administer 100% o2. Expose chest for bilateral and adequate chest movement. Consider CO2 poisoning
Background pain - ANSWER Constant burning or throbbing sensation. Treat with NSAID's & paracetamol or PCA w/ morphine
Breakthrough pain - ANSWER Sudden increase in pain. Treat with ket, morphine, fetanyl or IV opioid
Procedural pain - ANSWER Prior to commencing a procedure
Epidermal burns - ANSWER Dry, red blances w/ pressure, no blisters. Heals with no scarring
Superficial dermal - ANSWER Pale pink, extremely painful, low risk of scarring
Mid-dermal - ANSWER Dark pink, large blisters, cap refill sluggish. Painful, Mod risk of scarring
Deep-dermal - ANSWER Blotchy red, may blister, no cap refill, increased risk of scarrin
Full-thick burn - ANSWER No blisters, no cap refill. Will scar
Smoke Inhalation - ANSWER Airway or pulmonary injury resulting from the inhalation of toxic products
Patho of smoke inhalation - ANSWER Thermal injury, chemical irritation of the respiratory tract, systemic toxicity due to CO and cyanide = inflammatory response = increased fluid resus volumes, progressive pulmonary dysfunction, prolonged ventilator
days, risk of pneumonia and acute respiratory syndrome
Risk factors for smoke inhalation - ANSWER - Being in an enclosed space for more than 5 minutes
V:Q mismatch - ANSWER An imbalance in the amount of oxygen received in the alveoli and the amount of blood flowing through the alveolar capillaries
Intubation - ANSWER insertion of a tube into the trachea
Mechanical ventilator - ANSWER a machine used to inflate and deflate the lungs when a person cannot breathe on his own
carbon monoxide poisoning - ANSWER a toxic condition that results from inhaling and absorbing carbon monoxide gas. CO molecules with replace the O
Symptoms of smoke inhalation - ANSWER - Increased RR, worsening hypoxia
Airway management of S.I - ANSWER Maintain patent airway. Look for airway obstructions and listen for upper airway noises. Use a guedel airway to open the airway and remove secretions
Breathing management of S.I. - ANSWER Listen for rapid breathing, shallow breaths, wheezing. Administer 100% O2 via a NRBM
Unintelligble sounds
Motor (GCS) - ANSWER Obeys= Localizing pain= Withdrawal form pain= Flexion to pain= Extension to pain= None=
Cerebral Perfusion Pressure (CPP) - ANSWER MAP-ICP
intra cranial pressure - ANSWER 0-15 mmHg. Growing pressure inside the skull
Taking a hx (neuro assessment) - ANSWER - MOI
Subjective data (Neuro assess) - ANSWER - When it occured?
Objective data (Neuro assess) - ANSWER - Memory
Vital Signs (Neuro assessment) - ANSWER - BGL <10mmOL (brain perfusion requires normal BGL level)
Assess LOC (neuro assessment) - ANSWER GCS, AVPU
Cushing's triad - ANSWER -Increase in systolic BP -Increase in pulse pressure (systolic and diastolic numbers get further apart) -Decrease in HR -Late sign -Seen with increased ICP -Adverse effect of prednisone
Compensating for raised ICP (Stage 1) - ANSWER Cerebral arteriole autoregulation (vasoconstriction)
Compensating for raised ICP (Stage 2) - ANSWER Monroe-Kellie Doctrine
Monroe-Kellie Doctrine - ANSWER when one content in the skull increases, another must decrease to compensate and maintain normal ICP
Clincal manifestations of ICP - ANSWER - Change in LOC, behavioural changes
Impaired cerebral perfsuion pressure - ANSWER -CT scan
Hypothermic related to drowning - ANSWER - Remove wet clothes
Acute Spinal Injury - ANSWER Degenerative loss of motor, sensory and autonomic function
Spinal Cord A&P - ANSWER - 31 pairs of spinal (8C, 12T, 5L, 5S, 1C)
Classification of a SCI - ANSWER - Vertebral level of injury
A (Impairment scale) - ANSWER Complete. Non-sensory or motor function is preserved in the sacral segments s4-
B (Impairment scale) - ANSWER Sensory incomplete. Sensory but no motor function is preserved below the neurological level
C (impairment scale) - ANSWER Motor incomplete. Motor function is preserved @ most caudal sacral segments (anal contraction)
D (impairment scale) - ANSWER Motor incomplete. 1/2 of key muscle functions below the lesion having muscle functions >
E (impairment scale) - ANSWER Normal
Functions affected by SCI - ANSWER Reflexes, ventilation, communication, autonomic control, sensorimotor function, skin integrity, bladder/bowel control and sexual function
Can the SC regenerate? - ANSWER No, neurons cannot undergo mitotic division to replace/renew themselves. Some capacity for axonal regrowth in PNS, some in CNS, but much slower and more inefficient
Primary SCI - ANSWER Irreversible damage sustained @ the time of injury. (Direct trauma, compression)
Secondary SCI - ANSWER Evolving injury vascular dysfunction and spreading wave of inflammation = ischemia & oedema
Spinal Shock - ANSWER Transient concussion of SC. "Physiological" rather than anatomical dysfunction. It lasts hours-weeks. Absence of all sensorimotor, autonomic and reflex neurologic activity below level of injury
Neurogenic shocK - ANSWER Haemodynamic changes resulting from a loss of autonomic tone due to SCI. Seen when SCI is above T
Autonomic Dysreflexia - ANSWER - SCI @T6 or above
Pathologic Fracture - ANSWER A break in the bone that is caused by a disease. E.G osteoporosis or cancer
Longitudinal Fracture - ANSWER Occurs parallel to the long axis of the bone. E.G. direct or high impact injury or stress overuse
Spiral Fracture - ANSWER Twisted shaped break that extends around the long axis of the bone. MOI: football injury
Greenstick Fracture - ANSWER One side of the bone is broken, while the other side remains intact. MOI: falling from a height
Simple Fracture - ANSWER The broken bone does not break through the skin
Compound Fracture - ANSWER Broken bone breaks through to the skin. MOI: significant trauma
Oblique Fracture - ANSWER Diagonal or angle break across the bone. MOI: twisting forces
comminuted fracture - ANSWER Bone breaking into 3 or more fragments
Transverse fracture - ANSWER Bone breaks into 2 separate fragments
The healing process - ANSWER 1. Fracture
Priority managements of open and closed fractures - ANSWER - Splinting: Align the bone and improve blood flow
Early complications of fractures - ANSWER - Arterial injury
Late complications of fractures - ANSWER - Osteomyelitis (infection in the bone)
Compartment syndrome - ANSWER High pressure built up in a group of muscles
6 P's of neurovascular assessment - ANSWER Pain Pulse Paralysis Pallor Paresthesia Pressure
Category 1 (Red) - ANSWER - Immediate
Category 2 (Orange) - ANSWER - 10 mins
Category 3 (Green) - ANSWER - 30 mins
Category 4 (Blue) - ANSWER - 60 mins
Category 5 (White) - ANSWER - 2hrs
Mass Disaster Triage (MIMMS) - Command - ANSWER One service has control @ the scene
Safety (MIMMS) - ANSWER Self, scene, survivors
Communication (MIMMS) - ANSWER Early arrangements
Assessment (MIMMS) - ANSWER - Estimate the number and severity of the injured
Triage (MIMMS) - ANSWER - Casualties prioritised
Treatment (MIMMS) - ANSWER Do the most for the most
Transport (MIMMS) - ANSWER - Ambulance
Acute Behavioural Disturbance - ANSWER Abnormal physiology behaviour E.G. delirium