In skin, GI,and lungs.
IgE is produced after exposure to allergen, then anitbodies are produed and then can cause an alleric reaction.
H1 and H2 receptors
+ capillary permiability (edema or third spacing)
loss of intravascular fluid
+ gastric secretion
likely to cause severe allergic reactions
S/S Anaphylactic shock
edema in throat
S/S of mild allergic reaction
inflammed nose, itching adn local edema
blocks actions of histamine
can also bind to some muscarinic receptors
Effects: reversal of vasodilation, stops the capillary "leak", reduced itching and pain, sedation(1st gen)
Anticholinergic effects- dry mouth, tachy, etc.
Can laso be used for motion sickness--vestibular part of ear
S/E: paradoxyl excitation, sedation, palpitations.
Do not use with alchol or in pregnancy
first generation antihistamines
2nd generation antihistamines
do not cross the blood brain barrier
no anthicholinergic responses
Usefule in allergic responses from leukotrine release.
Only gives about 15 min of releif- must go to hospital.
S/e: palpitations, tachy, nervousness, h/e, nausea.
remove cap, jab pen in outer thigh, massage area.
Dose: 0.15mg for children between 33 adn 66 pounds. Above 66lbs 0.30 mg
Severity of burns
Determined by depth, Total body surface area.
superficial, 2nd degree, 3rd, 4th (full thickness).
Consider respiratory involvement
Use Lund and Browder chart (*not rule of 9's)
Treatment of burns
MOA of burns
Damage to vessels cause fluid leak, +capillary permiability, and vasodilation.
Fluid shifts from intravascular to interstitial.
-perfusion to perifery and kidneys, acidosis.
capillary "seal" generally fixed at 24-48 hrs
Goal of fluid replacement
Compensate for loss of Na and water
Replace adequate perfusion
Encourage renal perfusion
Fluid replacement therapy
LR (crytalloid), use of colloids is controversial.
To determine effectiveness: URINE OUTPUT, LOC, CAP REFILL.
used to determine how much fluid is needed.
Give 1/2 total fluids over 1st 8 hrs, then 1/4 total fluids over next 8 hrs, then last 1/4 over 3rd 8hrs.
Good urine output- Adults ~50ml/hr
Children 1-2 ml/kg/hr
Example fluid replacement
14 kg patient with 35%TBSA burned
4ml x 14kg x 35% = 1960mL total
So Give 980ml in 1st 8 hrs, then 490ml for 2nd 8 hrs, then 490 for the next 8 hrs.
tx must be able to penetrate eschar, not harm surrounding healthy tissue, be inexpensive, ans easy to apply.
Iv ABX not used since vessels adn tissue near burn are damaged.
Pros- cheap, doesnt evaporate, doesnt affect healing process, staph and pseudo.
Cons- dressing impedes joint movement, does not go through eschar, stings, pulls out e+.
Silvadine (silver sulfadiazine)
Pros- easy to apply, little pain, *gram- and +, non toxic.
Cons- *contains Sulfa, does not penetrate eschar, itching, gel on wound may be painful to remove, neutropenia.
cream and solution form
Pros: *penetrates eschar, broad use of burns adn organisms.
cons: painful to removes, met. acidosis, may inhibit wound healing.
pros: low toxicity, painless, easy
Cons:allergic rections, limited against gram -