1 | a g e

!"#$%&'()*(((((+,&-./(0123"#1(!,31$(
+1-%2.4(5"#'%2.4(6&%3(
72"31(81$9%#.3,#/(:.%4"#1(
1. 8esplraLory fallure: aC2 less Lhan 30mm Pg (hypoxla), aCC2 > 30mm (normal 33-43), and a
pP less Lhan 7.33
a. 8esLlessness, faLlgue, headache, dyspnea, alr hunger, Lachycardla, lncreased blood
pressure, confuslon, use of accessory muscles
2. Apnea noL readlly reverslble
3. nurslng managemenL
a. MalnLaln mechanlcal venLllaLlon, monlLor LCC, blood gasses, SaC2, vlLal slgns, Lurnlng
schedule, mouLh and skln care, range of moLlon exerclses.
;<#,&%2(81$9%#.3,#/(:.%4"#1(
72"31(81$9%#.3,#/(=%$3#1$$(5/&-#,>1(
1. Severe form of acuLe lung ln[ury
2. CharacLerlzed by sudden and progresslve pulmonary edema. (lncreaslng bllaLeral lnfllLraLes on
chesL x-ray),
3. Pypoxla unresponslve Lo oxygen, regardless of peep.
4. Cccurs as a resulL of d|ffuse a|veo|ar damage.
3. uyspnea, arLerlal hypoxemla, cardlogenlc pulmonary edema, lncreased alveolar dead space.
6. Cllnlcal manlfesLaLlons
a. A8uS ls an acuLe evenL
l. uevelops ln 4 Lo 48 hours
b. Closely resembles severe hemodynamlc pulmonary edema.
c. AcuLe phase marked by rapld onseL of severe dyspnea 12-48 hours afLer Lhe lnlLlaLlng
evenL.
d. lncreased alveolar dead space, sLlff lungs"
7. AssessmenL
a. lasma braln naLrlureLlc pepLlde (8n) levels
l. 1hls ls helpful Lo dlsLlngulsh A8uS from a cardlac evenL
b. Lchocardlography, and pulmonary arLery caLheLerlzaLlon (Lhe deflnlLlve LesL)
8. nuLrlLlon
a. A8uS paLlenLs requlre 33-43 kcal/kg/day
9. nurslng managemenL
2 | a g e

a. Cxygen, nebullzer LreaLmenLs, physloLherapy, lnLubaLlon, LracheosLomy, sucLlonlng,
bronchoscopy
b. oslLlonlng ls lmporLanL : oxygenaLlon ln paLlenLs wlLh A8uS ls someLlmes lmproved by
placlng Lhe paLlenL ln Lhe prone poslLlon
10. venLllaLor conslderaLlons
a. SedaLlves so Lhe paLlenL does noL buck" Lhe venLllaLor
l. Lorazepam (ALlvan), versed, recedex, propofol (ulprlvan)
b. aralyLlcs
l. ancuronlum, vecuronlum, aLracurlum, rocuronlum
11. Ma[or cause of deaLh ls mulLlple organ fallure
+12<.&%2.4(*1&3%4.3%,&(!"#$$%"&'(()''*(
1. lndlcaLlons: aC2 <30 mm Pg wlLh llC2 >0.60
a. aC2 >30 mm Pg wlLh pP <7.23
b. vlLal capaclLy < 2 Llmes Lldal volume
c. kesp|ratory rate >3S]m|n (Adu|t)
2. ClasslflcaLlon of venLllaLors
a. negaLlve ressure (lron lung)
b. oslLlve ressure (mosL common)
c. CA - conLlnuos poslLlve pressure
d. 8lA - mask or nasal
e. L1 Lube up Lo 2 Weeks, 1rach afLer LhaL.
f. Llngo
l. 88 = 8esplraLory 8aLe v1=1ldal volume 10-13ml/kg (amounL expelled
on explraLlon. eak flow raLe: when alr enLers lung
ll. lnsplraLory ressure llmlL C2= of oxygen dellvered wlLh each breaLh
lll. llC2= fracLlonal measure of lnsplred C2=70, llC2=70
lv. LL=oslLlve end-explraLory pressure (very lmporLanL)
v. 8M-8reaLh per mlnuLe SeL raLe=mandaLory raLe dellvered by venL
vl. 1oLal 8aLe=sponLaneous Anu seL breaLhs.
3. volume cycled venLllaLor : mosL commonly used
4. venLllaLor Modes (breaLh lnlLlaLlon)
a. Ass|st contro| Vent||at|on [A]C]
l. uellvers a preseL Lldal volume and raLe. lf Lhe paLlenL lnlLlaLes, Lhen Lhe
machlne dellvers Lhe seL volume. (more chance of bucklng)
b. Interm|ttent mandatory vent||at|on [IMV]
l. ComblnaLlon of mechanlcally asslsLed breaLhs and sponLaneous breaLhs.
uellvers preseL lnLerval and t|da| vo|ume (breaLh ouL) regardless of paLlenL
efforL. lL lowers mean alrway pressure Lo decrease baroLrauma.
c. Synchron|zed |nterm|ttent mandatory vent||at|on [SIMV]
3 | a g e

l. uellvers preseL volume and raLe, buL lL Lhe paLlenL breaLhs sponLaneously, lL
provldes no asslsLance.
d. ressure supporL venLllaLlon [Sv]
l. Applles a pressure plaLeau Lo alrway LhroughouL paLlenL Lrlggered resplraLlon.
ressure ls reduced over Llme as paLlenL's sLrengLh ls lncreased.
e. Alrway ressure release venLllaLlon [A8v]
l. 1lme Lrlggered, pressure llmlLed, Llme cycled. Allows unresLrlcLed, sponLaneous
breaLhlng LhroughouL Lhe venLllaLory cycle.
f. roporLlonal asslsL venLllaLlon [Av]
l. rovldes parLlal venLllaLory supporL. venLllaLor provldes pressure ln proporLlon
Lo Lhe paLlenL's efforL. 1he venLllaLor synchronlzes Lhe venLllaLlon wlLh Lhe
paLlenL's, provldlng addlLlonal muscle"
3. Coal: Ad[usL venLllaLor so Lhe paLlenL ls comforLable and breaLhes ln sync" wlLh Lhe machlne.
6. lnlLlal seLLlng
a. 1ldal volume 10 Lo 13 ml/kg
b. 8ecord peak lnsplraLory pressure
c. 8ecord mlnuLe volume.
d. SenslLlvlLy - 2-cm P2C lnsplraLory force should Lrlgger venLllaLlon
7. SucLlonlng: 10-13 seconds, 100 C2 prlor Lo sucLlonlng (buLLon on venL)
a. Can cause slnus bradycardla (aLroplne)
8. nurslng rocess
a. LvaluaLe Lhe paLlenL's psychologlcal sLaLus
l. Pow are Lhey coplng, how ls Lhe famlly coplng
b. ln depLh focus on Lhe resplraLory sysLem
l. vlLals, resplraLory raLe, volume, quallLy, breaLh sounds, paLLern
ll. oLenLlal evldence of hypoxla
c. 1wo ma[or lnLervenLlons:
l. ulmonary ausculLaLlon
ll. lnLerpreLaLlon of arLerlal blood gasses
d. oLenLlal compllcaLlons
l. 8aroLrauma
ll. ulmonary lnfecLlon
lll. Sepsls
e. Coals : achlevemenL of opLlmal gas exchange
f. 8lsk for uv1, L, skln breakdown
l. Close monlLorlng, Lurn & reposlLlon, neuro checks, A8Cs
9. Weanlng rocess
a. aLlenL assessmenL
b. 1rlal by decreaslng supporL
c. lf P8 > by 20, Lhey go back on Lhe venL
d. lf 8 sysLollc > by 20, Lhey go back on Lhe venL
e. Cardlac dysrhyLhmla, Lhey go back on Lhe venL
4 | a g e

10. Comprehenslve nurslng Care lan
a. romoLlng gas exchange
l. SucLlon Lhe paLlenL whenever aC2 decreases below a seL level
ll. 1urn and reposlLlon paLlenL every 2 hours
b. romoLlng effecLlve alrway clearance
l. SucLlon Lhe paLlenL as needed
c. revenLlng Lrauma and lnfecLlon
l. Lnforce sLrlcL asepLlc Lechnlque and hand hyglene
ll. MonlLor and record cuff pressure
d. romoLlng opLlmal level of moblllLy
l. aLlenL ln chalr
e. romoLlng opLlmal communlcaLlon
l. use nonverbal, board
f. romoLlng coplng ablllLy
l. MalnLaln sedaLlon level
ll. LducaLlon: explaln procedures and sLaLus of paLlenL
lll. LducaLe famlly members
11. CompllcaLlons of venLs
a. Cardlac
l. uurlng Lhe lnsplraLlon, hearL and greaL vessels are compressed: decreased venus
reLurn, Lherefore decrease ln cardlac ouLpuL and Lhereby decrease Llssue
perfuslon. uLs Lhe paLlenL aL greaLer rlsk for cardlac dysrhyLhmlas
b. 8aroLrauma / pneumoLhorax
l. revenLlon: 1urn and reposlLlon, chesL 1, head of bed elevaLed (Lhls also
decreases Lhe rlsk of gasLrlc secreLlon compllcaLlons)
1. CasLrlc secreLlon rlsk also decreased wlLh P2 hlsLamlne blockers
(epcld)
c. ulmonary lnfecLlon: slmllar Lo baroLrauma.
12. Labs (A8C) need Lo Lell lab LhaL Lhey are on Lhe venL/oxygen/how long.
a. pP 7.33-7.43
b. aCC!"" 33-43 mmPC
c. PCC#"$ 22-26 mLq/L
d. aC!""""""80-100 mmPg
e. SaC!"""""""""""greaLer Lhan 93 (pulse ox)
f. 8L (base excess) -3.0-+3.0
13. CompensaLlon
a. When boLh Lhe aCC2 and PCC3- are abnormal, one reflecLs a prlmary dlsorder and Lhe
oLher reflecLs a compensaLory response.
b. ueLermlne whaL has caused Lhe change ln pP : LhaL ls Lhe prlmary dlsorder. 1he oLher
abnormal value ls compensaLlng for Lhe prlmary abnormallLy.
c. non-compensaLlon: an alLeraLlon of elLher pCC2 or PCC3-.
d. arLlal compensaLlon: an alLeraLlon of boLh aCC2 and PCC3-.
S | a g e

e. CompleLe (full) compensaLlon: an alLeraLlon of boLh aCo2 and PCC3-, buL Lhe pP ls
normal: ph of 7.33-7.40 acldosls and 7.40-7.43 alkalosls.
+1-%2.3%,&$(
1. lenLanyl
2. versed
3. ulprlvan
a. used a loL ln surgery wlLh general anesLhesla
b. urug of cholce for venLed paLlenLs
4. ALlvan
3. Modlfled 8amsay SedaLlon Scale (see sLudy gulde supplemenL)
a. used wlLh adulL populaLlon
b. used Lo LlLraLe medlcaLlons
c. MonlLor vlLal slgns closely (breaLh sounds, Lurn and reposlLlon)
d. neuro checks
e. MonlLor arLerlal blood gasses
5?@;A(
-wldespread perfuslon Lo Lhe cells ls lnadequaLe Lo dellver oxygen and nuLrlenLs Lo supporL vlLal organs
and cellular funcLlon. (uecreased 1lssue erfuslon)
MA (mean arLerlal pressure) = cardlac ouLpuL x perlpheral reslsLance. normal >63
o 1o calculaLe approx MA: (ulse ressure/3) + dlasLollc pressure
o (2 x dlasLollc + sysLollc) / 3
aLhophyslology
o Cellular changes resulL ln a decrease ln adequaLe blood supply, decreased oxygen,
decreased energy Lo Lhe cell. (anaeroblc)
o uecrease ln A1, body wlll evenLually eaL lL's muscle Lone (glucogenesls)
o vascular 8esponses : vasodllaLlon and a vasoconsLrlcLlon.
o 8lood ressure regulaLlon: Cardlac ouLpuL wlll evenLually depleLe
53.'1$(,B($<,2C(
1. CompensaLory (CharL on 313 8runner)
a. SnS causes vasoconsLrlcLlon
b. 8 wlLhln normal llmlLs
c. Cllnlcal slgns : P8 > 100, 8esp >20, Skln cold, clammy, urlnary ouLpuL decreased,
confused, resplraLory alkalosls (compensaLory)
l. Serum sodlum and blood glucose are elevaLed (aldosLerone and caLecholamlne
release)
ll. ulse pressure wlLhln normal llmlLs (30-40 mm ng)
6 | a g e

d. nurse musL sysLemaLlcally assess Lhe paLlenL aL rlsk for shock Lo recognlze Lhe subLle
cllnlcal slgns of Lhe compensaLory sLage 8LlC8L Lhe 8 drops.
2. rogresslve
a. Mechanlsm LhaL regulaLes 8 can no longer compensaLe, MA falls below normal
l. 8 < 90 or decrease of 40 sysLollc below paLlenL's norm.
ll. vasoconsLrlcLlon conLlnues
b. Mechanlcal venLllaLlon may be needed, resplraLlons are rapld and shallow
c. 8n can be used Lo assess venLrlcular funcLlon ln paLlenLs ln shock sLaLes
d. When Lhe MA falls below 70, glomerular fllLraLlon cannoL be malnLalned, changes ln
renal funcLlon occur.
l. lncrease ln 8un and serum creaLlnlne levels
e. uecreased blood flow Lo Lhe llver: AS1 and AL1 and blllrubln levels elevaLed
f. ulC may occur as a cause or compllcaLlon of shock
3. lrreverslble SLage
a. usually noL dlagnosed unLll deaLh occurs, LreaLmenL same as progresslve
b. AL Lhls polnL organ damage ls so severe Lhe paLlenL wlll noL survlve.
5<,2C(+.&.'1>1&3(
1. Larly ldenLlflcaLlon and Llmely LreaLmenL: ldenLlfy and LreaL Lhe underlylng cause
a. 1he sequence of evenLs for dlfferenL Lypes of shock wlll vary.
2. SupporL Lhe resplraLory sysLem
a. CxygenaLlon ls flrsL llne LreaLmenL
3. lluld replacemenL Lo resLore lnLravascular volume
a. lv crysLallolds commonly used: 0.9 sodlum chlorlde, LacLaLed rlngers
l. LacLaLed rlngers conLalns lacLaLe lon LhaL ls converLed by Lhe body Lo
blcarbonaLe, whlch helps buffer acldosls LhaL occurs wlLh shock
b. Collolds (usually albumln, a plasma proLeln) expand lnLravascular volume by exerLlng
oncoLlc pressure, pulllng fluld lnLo Lhe lnLravascular space.
l. SynLheLlc collolds (PeLasLarch, and dexLran) can be used buL dexLran may
lnLerfere wlLh plaLeleL aggregaLlon and ls noL lndlcaLed lf hemorrhage ls Lhe
cause of hypovolemlc shock.
c. 8lood Lransfuslon : Lhe need for blood ls based on Lhe paLlenL's oxygenaLlon needs
d. CompllcaLlons can occur when fluld ls replaced Loo rapldly: Lhe nurse musL monlLor Lhe
paLlenL closely.
l. Cardlovascular overload, pulmonary edema (waLch for SC8, Crackles, !vu,
elevaLed 8)
ll. MonlLor hemodynamlc pressures, vlLal slgns, arLerlal blood gases, serum lacLaLe
levels, hemoglobln and hemaLocrlL levels, and l&Cs. 1emp. should be
monlLored closely (hypoLhermla from cold flulds)
4. vasoacLlve medlcaLlons : should be admlnlsLered Lhrough a cenLral llne (brunner p321)
3. nuLrlLlonal supporL (3000 cal per day needed)
7 | a g e

a. AdmlnlsLraLlon of gluLamlne
b. P2 blockers or proLon pump lnhlblLors.
6. Pypovolemlc shock : mosL common Lype : uecreased 8lood volume
a. Cccurs wlLh 13 - 30 reducLlon ln lnLravascular volume (abouL 730-1300 ml of blood ln
a 70kg person)
b. Llderly paLlenL: dehydraLlon may be Lhe cause
c. 1reaLmenL
l. 8esLore lnLravascular volume
ll. lnsulln lf dehydraLlon secondary Lo hyperglycemla
lll. Modlfled 1rendelenburg
lv. uesmopressln (uuAv) for dlabeLes lnslpldus: decreased vasopressln ln Lhe
body and Lherefore lncreased urlne ouLpuL
7. Cardlogenlc Shock:
a. Coronary cardlogenlc shock ls more common Lhan non-coronary, and ls seen mosL ofLen
wlLh an Ml, speclflcally, anLerlor wall Ml because of Lhe poLenLlal damage Lo Lhe lefL
venLrlcle. (pump ls lmpalred)
b. non-coronary cardlogenlc shock ls relaLed Lo condlLlons LhaL sLress Lhe myocardlum:
severe hypoxla, acldosls, hypoglycemla, hypocalcemla, Lenslon neumoLhorax,
cardlomyopaLhles, valvular damage, cardlac Lamponade, dysrhyLhmlas.
c. 1reaLmenL:
l. Cxygen flrsL llne
ll. aln conLrol
1. Morphlne: drug of cholce
a. aln rellef, dllaLes blood vessels reduclng cardlac workload by
decreaslng preload and afLerload. Also decreases anxleLy.
lll. Vasoact|ve meds - mulLlple sLraLegles: lmprove conLracLlllLy, decrease preload
and afLerload, sLablllze raLe and rhyLhm.
1. used when fluld Lherapy does noL malnLaln MA
2. Clven Lhrough a cenLral llne.
3. 1lLraLed Lhrough Lhe paLlenL's response (hemodynamlc monlLorlng
Lhrough an lnvaslve caLheLer)
4. MosL common: dobuLamlne, nlLroglycerln, and dopamlne.
3. uobuLamlne: lncrease sLrengLh of conLracLlon, lmproves sLroke volume,
and cardlac ouLpuL
6. Lplnephrlne: lncrease conLracLlllLy, raLe
7. nlLroglycerln: venous dllaLor - reduces preload and aL hlgher doses
causes arLerlal vasodllaLlon and Lhereby reduces afLerload.
8. uopamlne: sympaLhomlmeLlc agenL wlLh varylng effecLs dependanL on
dosage. 2 - 8 mlcrograms/kg/mln lmprove conLracLlllLy (low dose for
renal (2mlcrograms/kg/mln). Plgher Lhan 8 mlcrograms/kg/mln cause
vasoconsLrlcLlon whlch lncreases afLerload Lhls lncreases cardlac
workload. (hlgh doses(10mcg/kg/mln) used Lo lncrease cardlac ouLpuL)
8 | a g e

a. WlLh severe meLabollc acldosls, dopamlne ls noL as effecLlve.
9. vasopressors (neo-synephrlne) - lncrease blood pressure by
consLrlcLlon of blood vessels. (322)
10. AnLl arrhyLhmlcs
a. ALroplne
b. AmloLarone.
d. nurslng ManagemenL
l. MonlLor hemodynamlc and cardlac sLaLus.
ll. Look for advenLlLlous breaLh sounds, changes ln cardlac rhyLhm and oLher
abnormal assessmenL flndlngs.
lll. lMC81An1: monlLor for decreased 8 afLer admln morphlne and nlLro
lv. lMC81An1: neurologlc assessmenL afLer admln of LhrombolyLlc Lherapy.
v. Check Lhe neurovascular sLaLus of Lhe lower exLremlLles frequenLly when
paLlenL ls on lnLra-aorLlc balloon counLerpulsaLlon.
8. ClrculaLory Shock: when blood pools ln perlpheral blood vessels. [decreased venous reLurn]
a. varled mechanlsm can lead Lo Lhree sub-Lypes
l. SepLlc Shock: mosL common - caused by
wldespread lnfecLlon
1. 8educed by uslng sLrlcL lnfecLlon conLrol
pracLlces
2. Larly sLage 8 may be wlLhln normal llmlLs,
or Lhe paLlenL may be hypoLenslve, buL
responslve Lo flulds
3. Slgns of hypermeLabollsm lnclude lncreased
serum glucose and lnsulln reslsLance.
4. CCALS: ldenLlfy and LreaL early sepsls wlLhln
6 hours Lo opLlmlze ouLcome.
3. Confuslon may be Lhe flrsL slgn ln elderly
paLlenLs
6. ldenLlfy Lhe source of sepsls
7. Sl8S - sysLemlc lnflammaLory response
syndrome: unknown source
ll. neurogenlc shock
1. lMC81An1: elevaLe and malnLaln Lhe head of bed aL leasL 30 degrees
Lo prevenL neurogenlc shock when paLlenL recelves splnal or epldural
anesLhesla. (brunner p331) Muscle Lone effecLed. (lracLure above 1-6)
2. 8esLore sympaLheLlc Lone
lll. AnaphylacLlc shock
1. Assess all paLlenLs for allergles or prevlous reacLlons Lo anLlgens
9. MulLlple organ dysfuncLlon syndrome (MCuS)
a. lrequenLly occurs Loward Lhe end of Lhe conLlnuum of sepLlc shock
b. lnsldlous onseL
9 | a g e

c. Crgan fallure usually beglns wlLh Lhe lung.
d. aLlenL experlences progresslve dyspnea and resplraLory fallure requlrlng lnLubaLlon and
mechanlcal venLllaLlon.
e. ManagemenL
l. revenLlon ls Lhe Lop prlorlLy ln managlng MCuS
ll. SupporLlng Lhe paLlenL
lll. MoLorlng organ perfuslon
lv. rovldlng lnformaLlon Lo Lhe paLlenL
v. SupporL Lhe famlly
1. AnxleLy, supporL coplng, paLlenL and famlly educaLlon, communlcaLlon,
end-of-llfe lssues, grlef processes
=%$$1>%&.31-()&3#.D.$2"4.#(;,.'"4.3%,&(
-noL a dlsease buL a slgn of an underlylng condlLlon. 1rlggered by sepsls, Lrauma, cancer, shock,
abrupLlo placenLae, Loxlns, or allerglc reacLlons, SeverlLy ls varlable, may be llfe LhreaLenlng
1. lnlLlaLes Lhe process of coagulaLlon wlLhln vasculaLure.
a. Masslve amounL of Llny cloLs form ln Lhe mlcroclrculaLlon.
b. As Lhe plaLeleLs and cloLLlng facLors are consumed Lo form mlcroLhrombl, coagulaLlon
falls. 1herefore a paradoxlcal resulL of excesslve cloLLlng ls bleedlng.
c. MorLallLy raLe can exceed 80 ln paLlenLs who develop severe ulC wlLh lschemlc
Lhrombosls and frank hemorrhage.
l. aLlenLs wlLh frank ulC may bleed from mucous membranes, venlpuncLure slLes,
and Lhe Cl and urlnary LracLs.
d. 1reaL underlylng cause
e. 1reaL lschemla
f. 8eplace flulds, correcL elecLrolyLe lmbalances
g. xlgrls for 96 hours (LhrombolyLlc enzyme)
h. Peparln for Lhrombosls process
?1>,-/&.>%2(+,&%3,#%&'(E(<,F(%$(3<1(<1.#3(B"&23%,&%&'(
1. ueLermlnes cardlovascular assessmenL
2. rlmary purpose of lnvaslve monlLorlng ls Lhe early deLecLlon, ldenLlflcaLlon, and LreaLmenL of
llfe-LhreaLenlng condlLlons, such as hearL fallure.
a. Can also be used Lo monlLor cerLaln meds
3. 1ypes
a. Cv: cenLral venous pressure (2-6mm Pg)
l. MeasuremenL of pressure ln Lhe vena Cava, or rlghL aLrlum.
ll. lf greaLer Lhan 6mm Pg = hearL fallure
lll. lf less Lhan 2mm Pg = hypovolemla
10 | a g e

b. ulmonary arLery pressure
l. use Allan 1esL" Lo deLermlne arLerlal blood flow ln exLremlLy
c. lnLra-arLerlal 8 monlLorlng
4. CompllcaLlons of lnvaslve pressure monlLorlng
a. neumoLhorax
b. lnfecLlon
l. 1emp, > P8, >breaLhlng,
dlaphoreLlc, shock slgns
c. Alr embollsm
3. Cv lnserLed under sLerlle Lechnlque
a. 1hrough anLecublLal veln, lnLo vena cava,
rlghL aLrlum
b. need pressure bag on an lv bag aL 300
l. Wlll lnsLlll 3-3 ml of sallne lnLo Lhe
caLheLer.

SLop-cock on Lransducer needs Lo be aL Lhe phlebosLaLlc level. (zero polnL)

;.#-%.2(-/$#</3<>%.$((
-uysrhyLhmlas: dlsorders of Lhe formaLlon or conducLlon of Lhe elecLrlcal lmpulses ln Lhe hearL
1hese dlsorders can cause dlsLurbances of
8aLe
11 | a g e

8hyLhm
8oLh






23mm per second
0.04 per llLLle box, 0.20 per blg box
1300 llLLle boxes per mlnuLe, 300
8 - 8 = venLrlcular rhyLhm
- = aLrlal rhyLhm
lmpulse vs ConducLlvlLy
1. AlLeraLlon of Lhe lmpulses
a. 1ach or 8rady
2. ConducLlon
a. PearL blocks
A. ALrlal fluLLer - usually a regular raLe
a. PypoLhyrold, chronlc CP8 are aL hlgher rlsk for A - fluLLer
b. 1reaLed wlLh adenoslne: Lhen rapld flush Lhen ralse arm
c. uecreased cardlac ouLpuL - decreased oxygen Lo Llssues
l. lschemla, shock
8. ALrlal llbrlllaLlon
a. lncreased chance of blood cloLs
b. unsLable hemodynamlcally
c. Caused by alcohol, elecLrolyLe lmbalance, drugs (cocalne)
l. LlecLrocuLlon, burns (cause elecLrolyLe lmbalance)
d. 1reaLmenL
l. Cardlo converslon - synchronlzed
ll. Amlodarone, verapamll, dlglLalls, qulnldlne, warfarln
C. remaLure venLrlcular ConLracLlon - lmpulse sLarLs ln and conducLs Lhrough Lhe venLrlcle
a. ulg 1oxlclLy, acldosls, sleep apnea are more apL for vCs
12 | a g e

b. Amlodarone
u. venLrlcular 1achycardla
a. 1reaL Lhe cause
b. Amlodarone ls Lhe drug of cholce.
c. lasLer Lhan 100 8M
L. venLrlcular llbrlllaLlon
a. MosL common dysrhyLhmla for cardlac arresL
b. 8apld, dlsorganlzed, venLrlcular rhyLhm
c. C8 unLll deflbrlllaLor ls avallable
l. AsysLole
a. C8, lnLubaLe, lv Access
b. AfLer 2 mlnuLes of C8, Lpl, vasopressln, ALroplne
C. llrsL uegree Av 8lock
a. ConducLlon slowed Lhrough Lhe Av node
b. no LreaLmenL lf noL sympLomaLlc
P. Second uegree Av 8lock
a. Some lmpulses do noL make lL Lhrough Lhe Av node
l. 1hlrd uegree Av 8lock
a. no lmpulses make lL Lhrough Lhe Av node
b. ALroplne
c. acemaker
!. nurslng rocess: Care of paLlenL wlLh dysrhyLhmla
a. AssessmenL
l. Aplcal P8, vlLals, LCC, raLe and rhyLhm, hearL sounds, breaLh sounds
ll. Check for !vu
lll. 8runner 728 for medlcaLlon llsL
1. Amlodarone, 8eLapace, aLroplne, Lopressor
k. lmplanLed 1ransvenous pacemaker
a. LCC on-demand paclng
b. CompllcaLlons
l. lnfecLlon, bleedlng or hemaLoma formaLlon, dlslocaLlon of Lhe lead, skeleLal
muscle or phrenlc nerve sLlmulaLlon, cardlac Lamponade, malfuncLlon
ll. aln aL pacemaker slLe & lncreased W8Cs
L. ueflbrlllaLlon
a. 8lphaslc - currenL goes back Lo Lhe paddles
M.
)&2#1.$1-()&3#.2#.&%.4(G#1$$"#1(
1387, 1864-1869, 1923-1924, 1977-1978
1. aLhophyslology : change ln pressure due Lo lncreased flulds, or sollds ln Lhe lnLracranlal vaulL
13 | a g e

a. lncrease 80 braln, 10 blood, 10 csf
l. 8raln, 8lood, CSl
ll. MalnLaln SAC2 aL 93 and hlgher
b. Monroe/kelly hypoLhesls: lf one ls alLered, Lhe oLher needs Lo compensaLe.
c. normal pressure 0-10 mm Pg, Lop normal 13mm Pg
2. LLlology
a. 8raln 1rauma
b. 8raln Lumor
c. lnLracranlal Pemorrhage
!" Slgns and sympLoms #$%&'()*&)+,#)*-).$()/*0-.)-*'&)))12#).$(&)123)456&/7-*6&)60)*&50(%-(8)
8069-*&(--)$%-)&(706:6'*5%:)-*'&*/*5%&5(;)
a. 8esLlessness
b. lrrlLablllLy
c. uecrease ln LCC
d. PypervenLllaLlon
e. upll Changes
f. LaLe slgns
l. osLurlng
1. uecorLlcaLe: hands ln Loward body: legs lnLernally roLaLed, arms
adducLed
2. uecerebraLe: WrlsLs and flngers flexed, forearms pronaLed, elbows
exLended, arms adducLed. leeL planLar flexed.
ll. lncreased 8, uecreased pulse, uecreased resplraLlon
lll. 1emp lncrease
g. Cushlng's 8esponse: occurs when cerebral blood flow ls slgnlflcanLly decreased.
l. Wldenlng of pulse pressure
ll. Slowlng of Lhe hearL
lll. lncrease ln sysLollc 8
lv. CuSPlnCS 18lAu: 8radycardla, PyperLenslon, 8radypnea
h. ulabeLes lnslpldus from decreased secreLlon of anLldlureLlc hormone
4. lC MonlLorlng
a. venLrlculosLomy: sensor placed lnLo Lhe lC for consLanL monlLorlng (some meds)
l. Can remove fluld
ll. lnserLed lnLo Lhe laLeral venLrlcle.
lll. 8lggesL compllcaLlon: lnfecLlon
lv. Can collapse venLrlcle
b. Subarachnold bolL - less lnvaslve
l. CompllcaLlons lnclude lnfecLlon & blockage by cloL.
3. 1reaLmenL
a. MannlLol: osmoLlc dlureLlc
l. ulls waLer ouL, reduces pressure
ll. Crosses blood/braln barrler easlly
14 | a g e

b. PyperLonlc Sallne
c. ClucocorLlcolds : uecreases lnflammaLlon (Solu-Medrol , uecadron(menlnglLls))
d. PypervenLllaLlon : push Loward alkalosls wanL ACC2 beLween 26 and 30
e. 8arblLuraLes: sedaLlon -
f. 1herapeuLlc hypoLhermla
g. uecompresslve CranlecLomy
h. 8emoval of CSl
6. nurslng ulagnosls
a. lneffecLlve alrway clearance relaLed Lo dlmlnlshed proLecLlve reflexes
b. lneffecLlve breaLhlng paLLerns relaLed Lo neurologlcal dysfuncLlon
c. lneffecLlve cerebral Llssue perfuslon relaLed Lo effecLs of lncreased lC
d. ueflclenL fluld volume relaLed Lo fluld resLrlcLlon
e. 8lsk for lnfecLlon relaLed Lo lC monlLorlng sysLem
7. lnLervenLlons
a. SucLlon alrway secreLlons
l. Coughlng ls dlscouraged!
b. LlevaLlng Lhe head of bed Lo ald ln clearlng secreLlons and lmprove venous dralnage of
braln.
51%H"#1$(
Sudden, abnormal, and excesslve elecLrlcal dlscharges from Lhe braln LhaL can change moLor or
auLonomlc funcLlon, consclousness, or sensaLlon.
1. arLlal: 8egln on one parL of Lhe braln
a. 8egln on one slde of cerebral corLex
b. 1ypes
l. Slmple parLlal selzures
ll. Complex parLlal selzures
2. Cenerallzed
a. 8oLh hemlspheres lnvolved
b. Convulslve or non-convulslve (generally 1-2 mlnuLes)
3. LLlology
a. ldlopaLhlc: no cause ldenLlfled
b. Acqulred
l. underlylng neurologlcal dlsorder
ll. 8raln ln[ury
1. Alcohol wlLhdrawal, head ln[ury, ukA, renal fallure, Low Ca, nA, sugar.
2. 8raln Lumors
3. Allergles
4. Slgns and sympLoms
a. Aura
1S | a g e

l. vlsual dlsLorLlon, odor, sound
b. art|a| se|zures
l. AuLomaLlsms - nor responslve Lo consclousness
ll. MalnLalns consclousness
lll. usually < 1 mlnuLe
lv. aresLheslas
v. vlsual dlsLurbances
c. Complex parLlal
l. Loss of consclousness
d. Genera||zed Se|zures
l. Absence (peLlL Mal)
1. SLarlng
ll. 1onlc clonlc
1. May have aura
2. usually lose consclousness
3. 8lgldlLy followed by muscle conLracLlon and relaxaLlon
4. lnconLlnence
3. osLlcLal perlod
3. ulagnosls
a. ulagnosLlc assessmenL Lo deLermlne Lype
l. lrequency
ll. SeverlLy facLors LhaL preclplLaLe
b. LLC
c. Look for underlylng cause
d. Medlcal hlsLory
l. ln[urles
ll. regnancles or blrLhs
lll. lllness
6. 1herapeuLlc lnLervenLlons
a. CorrecL cause
b. AnLlconvulsanL medlcaLlon
c. Surglcal resecLlon
7. Lmergency Care: selzure
a. ad slde ralls
b. revenL ln[ury
c. MonlLor alrway
d. uo noL resLraln
e. 1urn on slde Lo prevenL asplraLlon
f. SucLlon 8n
g. Cbserve and documenL
8. SLaLus epllepLlcus
a. 30 mlnuLes of selzure acLlvlLy
16 | a g e

b. 1herapeuLlc lnLervenLlons
l. Lnsure alrway and oxygenaLlon
ll. AdmlnlsLer lv dlazepam, or ALlvan, losphenyLoln.
9. AnLlselzure medlcaLlons)<=>>?)@%A:()B=CD
a. Carbamazep|ne (1egreto|)
b. C|onazepam (k|onop|n)
c. LLhosuxlmlde (ZaronLln)
d. lelbamaLe (lelbaLol)
e. Gabapent|n (Neuront|n)
f. Lamotr|g|ne (Lam|cta|)
g. LeveLlraceLam (Lumlnal)
$" henyto|n (D||ant|n) -)'7E)F06A:(E-)4'*&'*G%:)$HF(0F:%-*%;)'668)60%:)5%0()*-)50*.*5%:)
l. rlmldone (Mysollne)
[. 1lagablne (CablLrll)
k. 1oplramaLe (1opamax)
|. Va|proate (Depakote)
m. Zonlsamlde (Zonegran)
10. Lpllepsy
a. unprovoked, recurrlng selzures
b. rlmary or secondary
c. ux LLC
11. Long Lerm anLl selzure medlcaLlons are aL rlsk for osLeoporosls
a. Plgh lncldence, new onseL ln aglng paLlenLs
b. Cerebrovascular dlsease leadlng cause of selzures ln elderly.
c. llnanclal conslderaLlons of medlcaLlons.
d. use one pharmacy (Lhey know Lhe paLlenLs)
12. ulagnosls
a. 8lsk for ln[ury
b. 8lsk for lneffecLlve managemenL of LherapeuLlc reglmen
c. lear relaLed Lo posslblllLy of a selzure
d. ueflclenL knowledge relaLed Lo epllepsy and lLs conLrol.
13. LxpecLed ouLcomes
a. SusLaln no ln[ury durlng selzure acLlvlLy
b. lndlcaLes a decreased fear
c. ulsplays effecLlve lndlvldual coplng
d. LxhlblLs knowledge and undersLandlng of epllepsy (ldenLlfles Lhe slde effecLs of meds,
avolds facLors LhaL may cause selzure, follows healLhy llfesLyle.)
14. nurslng ManagemenL
a. MA!C8 8LSCnSl8lLl1?: observe and record Lhe sequence of slgns
l. le. ClrcumsLances, aura, flrsL acLlon, Lype or parL of body, puplls, presence or
absence of lnvolunLary moLor acLlvlLy, lnconLlnence, duraLlon of each phase,
unconsclousness, posL selzure acLlons.
17 | a g e

b. aLlenL safeLy
13. lannlng and goals: prevenLlon of ln[ury (prlmary), conLrol of selzures.
I#.">.3%2(J#.%&()&K"#/(
1. 1rauma
a. Pemorrhage
b. ConLuslon
c. LaceraLlon
2. Can cause
a. Cerebral edema
b. Pyperemla
c. Pydrocephalus
d. 8raln hernlaLlon
e. ueaLh
3. LLlology
a. MvA mosL common
b. lalls
c. AssaulLs
d. SporLs relaLed ln[urles
4. Mechanlsm of ln[ury
a. AcceleraLlon
b. ueceleraLlon
c. AcceleraLlon-deceleraLlon
d. 8oLaLlonal
3. 1ypes of ln[ury
a. Concusslon
b. ConLuslon
c. PemaLoma
d. Subdural - fasL change of veloclLy usual cause
e. Lpldural - beLween dura maLLer and skull
6. ulagnosls ls done wlLh a C1 or M8l
a. C1 ls qulcker
b. 1reaLmenL ls based on Lhe raLe of growLh.
c. neuropsychologlcal LesLlng
7. 1herapeuLlc lnLervenLlon
a. Surglcal 8emoval of hemaLoma
b. ConLrol lC
l. lC monlLorlng
ll. CsmoLlc dlureLlc (mannlLol)
lll. Mechanlcal hypervenLllaLlon
c. 1herapeuLlc coma
d. 1hree
l. ACu1L - A8Cs
ll. SubacuLe - ln hosplLal (rehab)
lll. Chronlc - long Lerm, placemenL or rehablllLaLlon
18 | a g e

8. CompllcaLlons of 18l
a. 8raln hernlaLlon
b. ulabeLes lnslpldus (lnadequaLe
release of AuP due Lo damaged
plLulLary)
c. AcuLe hydrocephalus
d. Lablle vlLal slgns
e. osLLraumaLlc syndrome
f. Selzures
g. 8raln lnfecLlons
h. CognlLlve and personallLy
changes
9. nurslng ulagnosls
a. lneffecLlve alrway clearance and lmpalred gas exchange relaLed Lo braln ln[ury
b. lneffecLlve cerebral Llssue perfuslon relaLed Lo lncreased lC, decreased C
c. ueflclenL fluld volume relaLed Lo decreased LCC and hormonal dysfuncLlon
d. lmbalanced nuLrlLlon, less Lhan body requlremenLs relaLed Lo lncreased meLabollc
demands, fluld resLrlcLlons, and lnadequaLe lnLake.
e. 8lsk for ln[ury relaLed Lo selzures, dlsorlenLaLlon, braln damage
f. ulsLurbed LhoughL process
J#.%&(I">,#$(
1918, 1933-1947, 1881-1889 (8runner). London 1688-1689
1. Cllomas - mosL common
2. Menlnglomas
a. usually benlgn
3. AcousLlc neuromas
a. Always on Lhe elghLh cranlal nerve
4. lLulLary adenomas and anglomas
a. 10-13 of all Lumors
b. 83 on cerebellum (balance and moLlon)
3. Slgns and sympLoms
a. Selzures
b. MoLor and sensory deflclLs
c. Peadaches
d. vlsual dlsLurbances
l. apllledema (edema of
Lhe opLlc dlsk)
e. vomlLlng
f. Pormone dlsLurbances
6. ulagnosls
a. M8l, C1, Anglogram, M8A, Pormone levels
7. 1herapeuLlc lnLervenLlons
a. Surglcal removal
b. 8adlaLlon Lherapy
c. ChemoLherapy
d. SympLom conLrol
l. AnLlconvulsanLs
ll. uexameLhasone or prednlsone
19 | a g e

lll. MannlLol
8. nurslng ulagnosls
a. ulsLurbed LhoughL processes
b. Self care deflclL
c. aln
d. Sensory percepLual dlsLurbance
e. lmpalred physlcal moblllLy
f. 8lsk for ln[ury
9. lnLracranlal Surgery
a. lndlcaLlons
l. PemaLoma
ll. 1umor
lll. Av malformaLlon
lv. 1rauma
v. Selzures
10. 1ypes of Surgery
a. CranloLomy
b. CranlecLomy
c. CranloplasLy
11. reoperaLlve Care
a. aLlenL educaLlon
b. AnxleLy conLrol
c. lCu vlslL (preplan Lhelr vlslL)
12. osLoperaLlve Care
a. nurslng dlagnosls
l. 8lsk for lneffecLlve cerebral Llssue perfuslon
ll. 8lsk for lnfecLlon
lll. 8ody lmage dlsLurbance
lv. ueflclenL knowledge
59%&.4(;,#-(%&K"#/(
1. CompllcaLlons
a. lnfecLlon
b. uv1 & skln breakdown
c. CrLhosLaLlc hypoLenslon
d. uepresslon and subsLance abuse
e. AuLonomlc dysreflexla
2. ln[ury see page 1936 Lable 63-3
a. ueflclL may appear laLer.
3. ulagnosls
a. x-8ay
b. C1 scan
c. M8l
d. LMC laLer on (LlecLro Myogram) -deLermlnes Lhe level of ln[ury
4. Lmergency ManagemenL
a. A8Cs Lhen A8Cs
b. CasLrolnLesLlnal
20 | a g e

c. CenlLourlnary
d. lmmoblllzaLlon
3. Surglcal managemenL
a. SLablllze splne
l. Palo
ll. 8ods
lll. CorseL
lv. 8race
v. 8ody casL
6. Splnal Shock
a. Cccurs lmmedlaLely afLer Lhe ln[ury
b. erlpheral vasodllaLlon
l. normal Lo low hearL raLe
c. ulmonary relaLed problems are Lhe mosL common cause of morLallLy
l. More prone Lo lnfecLlons
ll. 1he hlgher up Lhe ln[ury Lhe greaLer Lhe resplraLory LhreaL
lll. Accessory muscles Lo breaLh.
lv. C-4 and hlgher usually needs a mechanlcal venLllaLor
d. SnS dlsrupLlon
l. vasodllaLlon
ll. PypoLenslon
lll. 8radycardla
lv. PypoLhermla
v. urlne and feces reLenLlon
e. Autonom|c dysref|ex|a: Llfe LhreaLenlng emergency ln splnal cord ln[ured paLlenLs LhaL
causes a hyperLenslve emergency.
l. usually from an ln[ury above 1-6
ll. 8owel and bladder may cause alLeraLlons
lll. Pemorrhage , sLroke, selzure and arresL
lv. Sudden and severe poundlng headache, profuse sweaLlng, nasal congesLlon,
plloerecLlon (goose bumps), bradycardla, hyperLenslon.
v. ulaphoresls and flushlng above Lhe ln[ury wlLh pallor or coolness below Lhe level
of Lhe ln[ury
vl. uramaLlc drop of pulse wlLh dramaLlc lncrease ln 8
f. Look aL sLablllLy Lo swallow and deflclL
g. Muscles for aLrophy
h. ulagnosls
l. Self care deflclL
ll. 8lsk for lmpalred skln lnLegrlLy
lll. 8lsk for lneffecLlve role-performance
lv. 8lsk for sexual dysfuncLlon
v. AnxleLy
21 | a g e

k.marLens[hvcc.edu
;,&'1$3%D1(?1.#3(:.%4"#1(
1. CongesLlve PearL lallure
a. Cardlac ouLpuL ls lnadequaLe Lo supporL Lhe body's needs
b. 90 of lnfanLs wlLh uncorrecLed hearL defecLs develop CPl
c. ManlfesLaLlons : subLle aL flrsL
l. 1lres easlly (especlally durlng feedlng)
ll. WelghL loss, or lack of normal galn, lrrlLablllLy, frequenL lnfecLlons, dlaphoresls.
lll. Clder chlldren: exerclse lnLolerance, dyspnea, abdomlnal paln or dlsLenLlon,
perlpheral edema
d. rogresslon leads Lo Lachypnea, Lachycardla, pallor, cyanosls, nasal flarlng, cough,
crackles. erlorblLal and faclal edema and hepaLomegaly (fluld excess).
e. Cardlomegaly : enlargemenL of Lhe hearL by hyperLrophy of lLs walls.
f. Coals of medlcal managemenL are Lo make Lhe hearL work more efflclenLly Lo remove
excess fluld.
l. ulureLlcs are glven along wlLh lnoLroplc and afLerload reduclng medlcaLlons.
ll. ulgoxln: lncrease cardlac conLracLlllLy
lll. lurosemlde: rapld dlureLlc
lv. 1hlazldes: dlureLlcs (monlLor poLasslum)
v. SplronolacLone: poLasslum sparlng dlureLlc
vl. ropranolol: lncreases conLracLlllLy
vll. Carvedllol: lmproves lefL venLrlcle funcLlon, promoLes vasodllaLlon of sysLemlc
clrculaLlon for chronlc hearL fallure and dllaLed cardlomyopaLhy.
g. nurslng assessmenL
l. Assess vlLal slgns, behavlor paLLerns, cardlac funcLlon, resplraLory funcLlon, and
fluld sLaLus.
ll. PlsLory of prevlous hosplLallzaLlons
lll. uevelopmenLal assessmenL
h. nurslng dlagnosls
l. uecreased cardlac ouLpuL relaLed Lo cardlac anomaly (prlmary)
l. lmplemenLaLlon
l. Croup assessmenL and lnLervenLlons LogeLher Lo ensure Lhe chlld has
unlnLerrupLed resL each hour.
ll. leedlng no longer Lhan 20 Lo 30 mlnuLes. lrequenL small feedlngs are besL
lll. oslLlon baby ln baby seaL aL 43 degrees decreases venous reLurn and lowers
meLabollc demand.
2. ulgoxln + lnoLrope : lncreases force, slows P8
a. 8efore glvlng: basellne vlLals, quallLy of perlpheral pulses, cllnlcal sympLoms, LCC, check
serum elecLrolyLes, hepaLlc funcLlon, and renal funcLlon. Assess hydraLlon sLaLus and
hydraLe lf hypovolemlc.
22 | a g e

l. Aplcal pulse for one mlnuLe: wlLhhold lf bradycardlc
ll. Cbserve for dlg LoxlclLy
;,&'1&%3.4(?1.#3(=%$1.$1(
uefecL ln Lhe hearL or greaL vessels, or perslsLence of feLal sLrucLure afLer blrLh.
Cccurs ln approxlmaLely 1 of all pregnancles and 1 ln 170 llve blrLhs
MosL occur durlng Lhe flrsL 8 weeks of gesLaLlon
o leLal exposure Lo drugs such as phenyLoln, llLhlum and alcohol
o MaLernal vlral lnfecLlons of 8ubella and Coxsackle 83
o ulabeLes melllLus and hypercalcemla
o MoLher of lncreased age and anLeparLal bleedlng
o CeneLlc facLors
o Chromosomal abnormallLles: 22q11 mosL frequenL slLe
! 1urner Syndrome
! noonan Syndrome
! Marfan syndrome
! ulCeorge syndrome
nurslng ulagnosls
o uelayed growLh and developmenL relaLed Lo effecLs of physlcal dlsablllLy
o lneffecLlve LherapeuLlc reglmen managemenL relaLed Lo complexlLy of LherapeuLlc
reglmen
o lmbalanced nuLrlLlon: less Lhan body requlremenLs relaLed Lo chronlc lllness and Llrlng
whlle feedlng.
o AcLlvlLy lnLolerance relaLed Lo poor cardlac ouLpuL
o Careglver role sLraln (parenL) relaLed Lo 24-hour responslblllLy for chlld's care
1. Congenlal hearL defecLs caLegorlzed by paLhophyslology and hemodynamlcs. : presence of a
hearL murmur ls ofLen Lhe flrsL lndlcaLor
a. lncreased pulmonary blood flow
l. 1achypnea, Lachycardla, murmur, CPl, poor welghL galn, dlaphoresls, perlorblLal
edema, frequenL resplraLory lnfecLlons
b. uecreased pulmonary blood flow
l. Cyanosls, hypercyanoLlc spells, poor welghL galn, polycyLhemla
c. CbsLrucLed sysLemlc blood flow
l. ulmlnlshed pulses, poor color, delayed cap reflll, decreased urlne ouLpuL, CPl
wlLh pulmonary edema
d. Mlxed defecLs
l. Cyanosls, poor welghL galn, pulmonary congesLlon, CPl may occur
8LL8S Plgh rlsk for elderly
AnLlhlsLamlnes, benzodlazeplnes, nSAlus, ulglLalls, 1rlcycllc anLldepressanLs.
23 | a g e

J"#&()&K"#%1$(

1. 1hlrd leadlng cause of deaLh ln chlldren age 1 Lo 9 years old (mosL ln home)
2. Llderly are also aL hlgh rlsk
3. ClasslflcaLlon of 8urns
a. Superflclal parLlal Lhlckness (1
sL
uegree)
l. Lpldermls
ll. 8ed, blanches wlLh pressure, dry, usually mlnlmal or no edema.
lll. osslble bllsLers (do noL pop)
b. ueep arLlal Lhlckness (2
nd
uegree)
l. Ldema (bllsLers)
ll. MoLLled red appearance, surface usually weeplng
lll. very palnful
c. lull 1hlckness (3
rd
uegree)
l. Lpldermls, dermls, subcuLanlous, muscle.
ll. ury, pale whlLe, leaLhery, broken skln, someLlmes faL
exposed.
4. Zones
a. Zone of coagulaLlon (zone of deaLh)
b. Zone of sLaLls (comprlmlsed blood supply)
c. Zone of hyperemla (susLalns leasL damage)
3. lacLors Lo conslder ln deLermlng burn depLh
a. Pow dld Lhe ln[ury occur
l. CauslLlve agenL (Lhermal, chemlcal, elecLrlcal, radlaLlon)
b. 1emperaLure of Lhe agenL
c. 1hlckness of Lhe skln
d. 8urn ln[ury usually resulLs ln energy Lransferred from a heaL source Lo Lhe body.
6. Area MeasuremenL: 8ule of 9s (mosL commonly used)
a. Lund and 8owder meLhod - mosL accuraLe
l. 8evlsed 72 hours laLer : demarcaLlon ls seen more clearly
7. 1ypes of burns
a. 1hermal
b. Chemlcal (aclds, ammonla)
l. ConLacL Llme
c. LlecLrlcal
l. 1ype of currenL, amounL, paLhway, how long Lhey Louched
lL, area of burn.
d. 8adlaLlon
8. hyslologlc changes.
a. 8urns less Lhan 23 18SA (LoLal body surface area) produce a
prlmarlly local response
24 | a g e

b. 8urns more Lhan 23 may produce a local and sysLemlc response and are consldered
ma[or burns.
c. SysLemlc response lncludes release of cyLoklnes and oLher medlaLors lnLoL he sysLemlc
clrculaLlon
d. lluld shlfLs and shock resulL ln Llssue hyoperfuslon and organ hypofuncLlon
l. Pemodynamlc lnsLablllLy resulLs from loss of capllary lnLegrlLy
ll. Sodlum and poLaslum shlfLs
lll. lluld resuslLaLlon ls exLremely lmporLanL
9. LffecLs of ma[or burn ln[ury
a. lluld and elecLrolyLe shlfLsw
b. Cardlovascular effecLs
l. Pypovolemlc : hypoLlssue perfuslon
1. uysrupLlve shock (hypovolemlc and sepLlc, and/or neurogenlc)
ll. llulds Lo keep sysLollc pressure above 100
lll. erlpheral vaso consLrlcLlon (decreased cardlac ln[ury)
c. ulmonary ln[ury
l. upper alrway
ll. lnhalaLlon below Lhe gloLLls
1. Lnclosed space, burn of face, slnged nasal halr, hoarseness,
lll. Carbon monoxlde polsonlng
lv. 8esLrlcLlve deflclLs
v. ChesL x-ray, A8C, ulse Cx
d. 8enal and Cl alLeraLlons
l. Myoglobulln excreLed
ll. 20 or hlgher burns needs a nasogasLrlc Lube (hlgher rlsk of nausea, sLress
ulcers, rlsk of asplraLlon)
e. lmmunologlc alLeraLlons
l. needs meLlculous skln care Lo prevenL lnfecLlon
f. 1hermoregulaLlon
l. llrsL Lhey are hypoLhermlc, Lhan core body LemperaLure goes up.
1. uue Lo lnflammaLory response, lack of coollng ablllLy, lnablllLy Lo
regulaLe
10. hases of burn ln[ury
a. LmergenL or resusclLaLlve phase
l. CnseL of ln[ury Lo compleLlon of fluld resusclLaLlon
ll. revenL ln[ury Lo rescuer
lll. SLop ln[ury: exLlngulsh flames, cool Lhe burn, lrrlgaLe chemlcal burn
lv. A8Cs
v. SLarL oxygen, large bore lvs, 8emove resLrlcLlve ob[ecLs and cover Lhe wound,
assessmenL: surveylng all body sysLems, and obLaln a hlsLory of Lhe lncldenL and
perLlnenL paLlenL hlsLory.
vl. L broughL Lo Lhe L8 : 10 full Lhlckness - burn cenLer
2S | a g e

1. lluld resusclLaLlon ls begun
2. loley caLheLer ls lnserLed: renal perfuslon, color of urlne, glycourlne
(hlgh levels of sugar ln urlne)
vll. LlecLrlcal burns - LCC
vlll. Address paln: only lv medlcaLlon only, Morphlne drug of cholce.
lx. sychosoclal conslderaLlon and emoLlonal supporL needed for paLlenL and fam.
b. AcuLe or lnLermedlaLe phase
l. 48-72 hours afLer ln[ury
ll. ConLlnue assessmenL and malnLaln resplraLory and clrculaLory supporL
1. lluld shlfLs as caplllarles Lry Lo regaln Lhelr lnLegrlLy
2. aLlenL aL hlgher rlsk of CPl
3. lever - resulL of Lhe body Lrylng Lo regulaLe lLself: malnLaln body
LemperaLure beLween 99-101 when hypoLhermlc, Lhen Lemp develops
and coollng wlll be necessary.
c. 8ehab phase
l. up Lo Lwo years afLer dlscharge
ll. locus ls upon wound heallng, psychosoclal supporL, self-lmage, llfesLyle, and
resLorlng maxlmal funcLlonal ablllLles so Lhe paLlenL can have Lhe besL quallLy
llfe.
lll. 8econsLrucLlve surgery
11. ManagemenL of shock: fluld resusclLaLlon
a. MalnLaln 8 above 100 sysLollc, urlne ouLpuLs of 30-30 ml/hr. MalnLaln serum sodlum
aL near normal levels. need Cv llne
b. PyperLonlc sallne (3 nS) 4ml/kg/hr
c. arkland 8axLer lormula
l. 2- 4 (ml/kg) x 18SA) x fluld ln flrsL 8 hours, resL over nexL 16 hours
d. lluld and LlecLrolyLe shlfLs (emergenL phase)
l. Cenerallzed dehydraLlon
ll. 8educed blood volume and hemoconcenLraLlon
lll. uecreased urlne ouLpuL
lv. 1rauma causes release of poLasslum lnLo exLracellular fluld: hyponaLremla
12. 8urn Wound Care
a. Wound cleanlng
l. PydroLherapy : 8oom 80-83 degrees WaLer 100 degrees
b. 1oplcal agenLs
l. Sllver conLalnlng Loplcals are hlghly effecLlve.: waLch for leukopenla (decreased
W8C)
c. Wound debrldemenL
l. naLural - separaLes naLurally (someLlmes occur wlLh Loplcal agenLs)
ll. Mechanlcal debrldemenL
1. 8emoval of necroLlc eschar (black necroLlc area) wlLh scalpel
lll. Chemlcal - sllver
26 | a g e

lv. Surglcal debrldemenL
1. CperaLlve procedure of exclslng Lhe ln[ured area.
d. Wound dresslng, dresslng changes, and skln grafLlng
l. Sllverlon - cannoL be used on Lhe face
ll. MeplLel - goes over Lhe burn, anoLher dresslng goes overLop
lll. CLA - culLured
13. aln managemenL
a. 8urn paln: mosL severe forms of acuLe paln
b. 8reakLhrough - eplsodlc and severe (acLlvlLy)
c. 8ackground - resLlng - lnLense
d. rocedural
e. urugs
l. Morphlne, versed, ercoceL,
f. non pharmacologlcal measures
14. nuLrlLlonal supporL
a. 8urn ln[urles produce profound meLabollc abnormallLles. aLlenLs wlLh burns have greaL
nuLrlLlonal needs relaLed Lo sLress response, hypermeLabollsm, and wound heallng.
b. Coal of nuLrlLlonal supporL ls Lo promoLe a sLaLe of nlLrogen balance and maLch nuLrlenL
uLlllzaLlon.
c. nuLrlLlonal supporL ls based on paLlenL's preburn sLaLus and of 18SA burned.
d. LnLeral rouLe ls preferred. !e[unal feedlngs are frequenLly used Lo malnLaln nuLrlLlonal
sLaLus wlLh lower rlsk of asplraLlon ln a paLlenL wlLh poor appeLlLe, weakness, or oLher
problems.
1ransfuslon
1. lnfuslon of blood producLs :
a. ls lL needed? P&P
2. Whole 8lood
a. used Lo LreaL shock, low blood volumes, low hemaLocrlL and hemoglobln, hemorrhage.
b. Cnly 1 ls plaLeleLs, need 180 donors for 1 bag of plaLeleLs.
3. uonaLlon: every 36 days.
4. uemand ls mosL ln summer and holldays.
3. acked 88Cs - mosL common
a. 1reaLs anemla, reduce rlsk of volume overload.
b. Can be refrlgeraLed for 42 days.
c. AbouL 220ml ln a bag. 1ransfused ln less Lhan 4 hours.
6. lresh frozen plasma
a. used Lo resLore plasma volume, LreaL some bleedlng problems
b. 1hawed ln Lhe lab and good for 24 hours
7. laLeleLs
a. MalnLaln normal coagulablllLy of blood
27 | a g e

b. used Lo LreaL some bleedlng dlsorders, and Lo compensaLe when marrow can noL
produce enough
c. laLeleLs: 80-60ml/pack: usually 4-6 packs are pooled for Lransfuslons, lnfuses as qulckly
as Lhe pL LoleraLes.
d. SLerolds lncrease producLlon of blood.
8. CryopreclplLaLe
a. 10-13ml bag, usually 10 bags pooled.
9. 1ype undergoes Lype and crossmaLch
a. 8lood Lype, 8h, and anLlgens
b. AnLlgen: subsLance LhaL prompL Lhe generaLlon of anLlbodles and can cause an lmmune
response.
10. AlLernaLlves
a. volume bullders
l. CrysLallolds
ll. ArLlflclal crysLallolds: uexLran
1. Can cause bleed problems or allerglc reacLlons
2. 1hey only replace volume
11. 8lsks
a. ulsease 1ransmlsslon
l. PepaLlLls 8 1:140,000
ll. PepaLlLls C 1:223,000
lll. PepaLlLls A 1:1 mllllon
lv. Plv 1:1.3 mllllon
v. Syphllls 1:1 mllllon
b. 8acLerlal conLamlnaLlon
c. AcuLe or delayed Lransfuslon reacLlons
l. MlsmaLched A8C 1:33,000
ll. lncompaLlble deaLh raLe 1:600,000
d. ClrculaLory overload
12. lnfuslon
a. Lach unlL of blood currenLly undergoes LesLs for nlne dlseases
b. 8acLerlal conLamlnaLlon ls very rare, buL may occur aL any polnL
l. 8efrlgeraLlon helps prevenL bacLerlal growLh
c. 1ransfuslon reacLlons
l. Allerglc reacLlons, lncompaLlblllLles, anaphylacLlc response Lo plasma proLelns
d. Some rlsks speclflc Lo masslve Lransfuslon (more Lhan 1 unlL ln 24 hours)
l. PypoLhermla
ll. PemodlluLlon
lll. laLeleL dysfuncLlon
lv. LlecLrolyLe problems (Calclum-low) sLarLs ln flngers
1. lron overload
13. nonlnfecLlous serlous hazards
28 | a g e

a. Mls-Lransfuslon and A8C/8h lncompaLlblllLy
14. AdmlnlsLraLlon
a. Assess Lransfuslon hlsLory
l. revlous Lransfuslons, allergles and reacLlons
ll. 1ype of Lransfuslon reacLlon, manlfesLaLlons.
b. 8lood musL be Lransfused wlLhln 30 mlnuLes.
l. oslLlve paLlenL ldenLlflcaLlon
ll. ApproprlaLeness of blood componenL
lll. 8lood producL lnspecLlon
lv. verlflcaLlon of donor-reclplenL compaLlblllLy
v. verlflcaLlon of producL explraLlon daLe
A can geL A and C
8 can geL 8 and C
C can geL C