Final Coaching By: Melted E.

Sales
hiccup
Pancuronium Bromide (Pavulon)
 neuromuscular blocking agent
 “paralytic / plegic drug”
- prevents patient from “bucking” the ventilator
(out of phase with the machine)
/ Kraske
 INTERVENTIONS:

1. Place patient in low Fowler’s position

to avoid further protrusion.
2. Cover the wound with a saline soaked
sterile dressing.
3. Notify the physician.

Do NOT to push the organ back inside.

DEHISCENCE EVISCERATION
CELIAC DISEASE
 “gluten-sensitive enteropathy” / “sprue”
 avoid:
B arley
R ye
O at
W heat
ACHALASIA
- a condition in which esophagus
muscles do not contract properly
and do not help propel food down
toward the stomach
 iliac fossa
side of lower abdomen
supine
side lying
Rule of Nines
* Head 9 %
* R. arm 9 %
* L. arm 9 %
* Anterior trunk 18 %
* Posterior trunk 18 %
* R. leg 18 %
* L. leg 18 %
* Genital 1 %
Palm Method
used for scattered burn injuries
note:
* size of the palm of patient = 1 %
Lund and Browder
 most precise / accurate
 % corresponds to anatomic parts based on client’s age
 ideally used for pediatric clients
Baxter Formula
aka: Parkland Formula
used to estimate the amount of IVF to be administered
in a burn client
formula:
4 mL x weight in kg x % TBSA
Note:
- computed amount should be administered
within 24 hours
- example:
A 50-kg patient sustained burn injury with 10% TBSA.
How much fluid is to be administered per hour on the
first 8 hours?

4 mL x 50 x 10 = 2000 mL

* 1st 8 hours: 50%

* 2nd 8 hours: 25%
* 3rd 8 hours: 25%
- example:
A 50-kg patient sustained burn injury with 10% TBSA.
How much fluid is to be administered per hour on the
first 8 hours?

4 mL x 50 x 10 = 2000 mL

* 1st 8 hours: 50% = 1000 mL / 8 = 125 mL per hour

* 2nd 8 hours: 25% = 500 mL / 8 = 62.5 mL per hour
* 3rd 8 hours: 25% = 500 mL / 8 = 62.5 mL per hour
Depth of Burn Injury

* Superficial Partial Thickness

* Deep Partial Thickness
* Full Thickness
Depth of Burn Injury

* Superficial Partial Thickness

* Deep Partial Thickness
* Full Thickness
Characteristics 1st Degree (SPT) 2nd Degree (DPT) 3rd / 4th Degree (FT)
Layer - Epidermis - Epidermis - Epidermis, dermis
- Partial Dermis - Entire dermis - Adipose, muscle
Appearance -Red - Blisters - Brown, black or
- Dry - “Weeping” pale
- Minimal to no - Edematous - Leathery, dry
edema - Eschar
Sensation - Painful - Painful - Painless
- Soothed by - Sensitive to cold
cooling
Recovery - 1 week - 2-4 weeks - Non-specific
UNIVERSAL ALGORITHM IN CASE OF FIRE
R escue
 evacuate clients / victims
A mbulatory
B ed-ridden
C ritically - ill
A larm
C onfine
 close the windows and doors
E xtiguish
SURGEON
“captain” of the ship
assesses of client’s readiness
#1 psychologic
#2 physiologic
obtains consent
performs the actual surgery
ASST. SURGEON
 same with surgeon’s duty

ANESTHESIOLOGIST
 selects the type of anesthesia
 administers anesthesia
 monitors VS
* “guardian” of patient during surgery
 ensures safe transfer of patient to PACU
SCRUB NURSE
“guardian” of sterile field
assists surgeon and asst. surgeon
surgical count
CIRCULATOR
receives patient in OR
#1 verify patient’s identity
coordinates the activities of the team
surgical count
SURGICAL COUNT
done at least 3x
1. Baseline Count
 pre – incision
2. Closing Count
 before closing a cavity
3. Final Count
 skin closure
In case of missing instrument:
1. Recount
2. Search
3. X-ray
4. IR
ANESTHESIA
1. local
* ex. Lidocaine, Xylocaine, Nupercaine
2. regional
* epidural – epidural space
* spinal – subarachnoid space
* intrathecal – spinal canal
3. General
- state of:
* analgesia – loss of sensation
* amnesia – loss of memory
* narcosis – CNS depression
* loss of consciousness
- route:
* inhalation
- true gas (Nitrous Oxide)
- volatile liquid (Sevoflurane)
* intravenous
(Propofol, Methohexital, Ketamine)
- stages:
*B–E–S–M
1. Beginning
- “induction stage”
- patient is conscious but lies quietly
- exaggerated perception of sound
2. Excitement
- patient’s movement escalates
* struggling, shouting, crying, laughing
- rapid pulse, irregular respiration
- dilated pupils (reactive to light)
3. Surgical
- “operative stage”
- patient is unconscious
- stable VS
- surgery is performed
4. Medullary Depression
- “danger stage”
- d/t over-administration of anesth. agent
- weak pulse, shallow respiration, low BP,
- dilated pupils (non-reactive to light)
- stop anesthesia administration
- prepare to administer narcotic antagonist
* Naloxone (Narcan)
 Barbiturate
- sedative
 Morphine
- analgesic
 Succinylcholine
- muscle relaxant
 Atropine
- anti-cholinergic
* decreases body secretions = aspir’n.
* relaxes smooth muscles
* increases HR
* bronchodilation effect
 “parachute” reflex