Glossary

BP - This is the abbreviation for blood pressure. The normal range of blood pressure is 90-140/60-90. This patient's blood pressure is showing both systolic (154/110) and diastolic hypertension (154/110). The systolic pressure is the highest pressure attained in the artery and is determined by stroke volume, rate of blood ejected from the left ventricle and the elasticity of the arterial system. The diastolic pressure is the lowest pressure attained in the artery and is determined by the magnitude of the preceding systolic pressure, length of ventricular diastole and peripheral resistance. In the burn patient hypertension is often due to uncontrolled pain

BUN: This is an abbreviation for blood urea nitrogen. The normal range is 8 to 20 mg/dL. The patient's BUN is 22 mg/dL which is slightly increased. The BUN is a measure of the major end product of protein metabolism (urea). The BUN rises when renal functional impairment is present (decreased glomerular filtration) or when the rate of urea production increases. In individuals with stable renal function, BUN may also be increased by ingestion of large amounts of protein and also in situations in which protein breakdown is occurring, i.e. gastrointestinal bleeding, extensive trauma (burns), infection, and major surgery.

Burns: 2nd and 3rd degree burns - Second degree burns are deep partial thickness injury to the skin. It involves varying degrees of the dermal layer. The dermis contains structures essential to normal skin function such as capillaries, hair follicles, sweat and sebaceous glands, and sensory and motor nerves. A deep partial thickness burn is pinkish-red, with blisters and is very painful. Depending on the depth, these burns will heal spontaneously within 2 months. If the injured area becomes infected the burn could convert to a third degree burn. Third degree burns are full-thickness burns that involve the entire dermis and expose the fat layer of the skin. The fat layer contains the roots of the sweat glands and hair follicles. The burns may appear white, red, brown, or black. Third degree burns are anesthetic because the sensory nerve receptors have been destroyed. The patient is still in pain but this is attributed to the second degree burn that abuts the third degree burn. Burns that are >4 cm should be closed by skin grafting so that the integrity of the skin can be restored. Ungrafted third degree burns leave the patient vulnerable to infection.

• Rules of Nines: Used for estimating percentage of body burned in adults. Each arm equals 9%, the head equals 9%, the anterior and posterior trunk each equal 18% and the perineum equals 1%.

Calcium:This is the concentration of calcium within the serum. The normal range is 9.0 to 11.0 mg/dL. This patient's serum calcium is 9.5 mg/dL and is within the normal range. Calcium is present in the blood in two forms: ionized and calcium bound to protein. The concentration of bound calcium depends upon the concentration of plasma proteins. Normally 50-75% of serum calcium is ionized with the remainder bound to protein (mainly serum albumin). When interpreting a total calcium value, the patient's total protein and his albumin must be known. With this knowledge the corrected total calcium can be calculated.

Chest: coarse. Commonly used term which usually refers to breath sounds in which low-pitched inspiratory and expiratory wheezes (rhonchi) are heard during auscultation of the chest. Coarse breath sounds that partially clear after suctioning probably indicate that both wheezes and crackles are present. Technically the term 'coarse' should be used in conjunction with wheezes (continuous) and/or crackles (discontinuous) breath sounds

Chloride:This is the concentration of chloride within the serum. The normal value is between 98-110 mEq/L or mmol/L. This patient's serum chloride is 105 mEq/L and is within the normal range. Serum chloride can increase in many different clinical situations such as diarrhea, mineralocorticoid insufficiency, and medications. Chloride levels can decrease in response to vomiting, diabetes mellitus with complicating ketoacidosis, mineralocorticoid excess, and renal disease with sodium loss.

Compliance Compliance of a patient on a ventilator is the corrected tidal volume divided by the plateau-PEEP pressure. Compliance is the distensibility of the lungs and chest wall. Good compliance for a ventilator patient is between 50-70 mL per cm H20 pressure. Poor compliance is 20 mL/cm H20 or less.

CPAP Continuous Positive Airway Pressure allows the patient to breathe spontaneously at a preset level of pressure above ambient pressure. CPAP increases functional residual capacity and prevents the small airways and alveoli from collapsing at end exhalation. It is used to improve oxygenation. Maximal alveolar recruitment is typically around 10-15 cm H20 pressure.

Creatinine: This is the concentration of creatinine in the extracellular water. The normal range is 0.5 to 1.2 mg/dL. This patient's creatinine is 0.9 mg/dL which is within normal range. Creatinine is the most quantitative estimate of kidney function. Creatinine is an inert substance formed from the dehydration of creatine in the muscle. This substance is not metabolized further and is excreted by the process of glomerular filtration by the kidney. The normal production of creatinine is a function of the individual's muscle mass. The greater the muscle mass the greater the creatinine production. Since this patient has a normal creatinine with a slightly elevated BUN, the patient does not have renal impairment. The slightly elevated BUN may be secondary to trauma or dehydration. This type of condition is called prerenal azotemia and means that non-renal factors are accountable for a rise in the BUN.

CV: RRR - This is the cardiovascular assessment of the patient and the ECG. The abbreviation represents Regular Rate and Rhythm. It is an observation of the regularity of the patient's heart rate and the rhythm. The heart rate does not vary, i.e. decrease or increase, and the patient's heart rhythm remains constant. This indicates some element of stability in the patient's cardiovascular function. This does NOT mean that the patient has a normal ECG rate or pattern. It means that the underlying pattern is not changing.

Escharotomy An escharotomy is a surgical incision through charred, burned skin (eschar). Badly burned skin becomes tight and leathery, inhibiting movement and cutting off circulation to underlying structures.

extubate Extubation is the removal of an endotracheal tube. The patient is usually suctioned endotracheally and then orally before the tube is removed. The cuff on the endotracheal tube is deflated after suctioning and prior to pulling the tube out.

Flow-by: Flow-by allows the patient to initiate a spontaneous or mandatory breath from a ventilator by creating a drop in flow rather than a drop in pressure. 3/5 indicates that the flow sensitivity is 3 LPM, and the baseline flow is 5 LPM. A continuous baseline flow of 5 LPM, adjustable up to 20 LPM, is provided through the ventilator circuit during exhalation. A flow sensitivity of 3 LPM means that when the patient starts to breathe in, the ventilator will trigger into inspiration when the baseline flow returning to the ventilator drops by 3 LPM. The patient can continue to inhale additional flow during the short period of time that it takes the ventilator to respond. Flow-by reduces the work of breathing by providing gas flow immediately to the patient.

Glucose: This is the serum concentration of glucose. The normal range is 70-110 mg/dl. The patient has an elevated glucose of 122 mg/dl. An increased glucose is seen in diabetes mellitus, increased epinephrine secondary to stress, burns, etc., elderly patients, acute pancreatitis, and IV dextrose.

HR - The abbreviation for heart rate. The normal range of heart rate is 60-100. This patient's heart rate is classified as a tachycardia. An elevated heart rate could be caused by many reasons i.e. fear, anxiety, pain, low blood pressure, response to certain medications, fever, anemia, and hypoxemia. Considering the type of injury this patient sustained likely causes are anxiety, pain, and hypoxemia.

IV fluids started - This means that the patient has an intravenous line in place and that the patient is now receiving intravenous fluids. There are many formulas for calculating fluid replacement needs of the burn patient. One such formula is the Parkland Formula. Parkland Formula: Total fluid required during the first 24 hours = (%body burn) x (body weight in kg) x 4 ml. Replace with lactated Ringer's solution over 24 hours. Use:

1/2 total over first 8 hours (from time of burn)
1/4 total over second 8 hours 1/4 total over third 8 hours

Magnesium: This is the concentration of magnesium ions in extracellular water. The normal range is 1.4 to 2.3 mEq/L. The patients serum magnesium is 1.9 mEq/L and is within the normal range. As with potassium, magnesium is found primarily in the intracellular compartment. Magnesium has many important roles in the body. Magnesium acts as an activator for enzymes that need thiamine pyrophosphate as a cofactor and it also has a role in carbohydrate and protein metabolism.

Mode: A/C - Assist/Control mode or CMV means that all breaths are machine breaths in which the inspiratory phase and cycle variable are determined by the ventilator settings. The machine breaths may be initiated (triggered) by the patient, called 'assisted', or by the machine, called 'controlled'.

PD&V Postural drainage and vibration. Sometimes called CPT - chest physical therapy. Also PD&C for postural drainage and clapping. Postural drainage means placing the patient in specific positions to facilitate the draining of secretions from lung segments via gravity. Manual or mechancial vibrations applied to the chest wall while the patient is in position loosens secretions and facilitates their removal. Clapping refers to rapidly striking the chest wall with cupped hands to loosen secretions.

PEEP - Positive End Expiratory Pressure maintains a positive pressure in the lungs to increase functional residual capacity (FRC) and prevent alveolar collapse. The difference between PEEP and CPAP is that the term PEEP is reserved for patients also receiving mechanical ventilation.

Phosphorus:This is the concentration of phosphate ions in extracellular water. The normal range is 2.0 to 4.0 mg/dL. The patients serum phosphorus is 3.6 and is within the normal range. Phosphorus is found in the body in the form of inorganic and organic salts. Only inorganic phosphorus is found within the extracellular water. Phosphate ions are needed in many stages of intermediary metabolism, in bone formation and as a constituent of nucleic acids, phosphoproteins and phospholipids.

Plateau pressure The airway pressure measured during an end-inspiratory hold when airway pressure equals alveolar pressure. Plateau or pause pressure is used in calculating pulmonary compliance.

Potassium:This is the concentration of potassium within the serum. The normal range is 3.7 to 5.0 mEq/L or mmol/L. This patient's serum potassium is 4.1 mEq/L and is within the normal range. Serum potassium can increase in many different clinical situations such as acidosis, renal failure, drugs, dehydration, massive tissue injury, and excess intake. Potassium levels can decrease in response to diuretics, vomiting, nasogastric suction, diarrhea and metabolic alkalosis.

Pressure Support Pressure support supplies a preset level of positive pressure for a length of time determined by the patient's effort and inspiratory flow. A pressure supported breath ends when the inspiratory flow has fallen to a low level. The actual flow rate varies with the type of ventilator. The volume received by the patient is determined by the level of pressure support, the patient's compliance and resistance, and inspiratory efffort.

Resistance Airway resistance is the pressure created from gas flow through the endotracheal tube and airways. In volume controlled ventilation with a rectangular flow waveform, resistance is typically recorded as Peak Pressure minus Plateau Pressure which will reflect changes in the patient's airway resistance as long as the set peak flow on the ventilator remains the same.

rhonchi Rhonchi are low-pitched continuous breath sounds heard predominately during exhalation. The most recent breath sounds terminology classification would call rhonchi low-pitched wheezes, since both sounds are produced by a narrowing of the airway.

RR - This is the abbreviation for respiratory rate. The normal adult respiratory rate is 12-20 breaths per minute. A respiratory rate of greater than 20 is called tachypnea and lower than 12 is bradypnea. This patient has tachypnea. Causes of an elevated respiratory rate are hypoxemia, fever, metabolic acidosis, fear, anxiety and interstitial alveolar edema. This patient's tachypnea may be secondary to fear, anxiety and hypoxemia. The patient may also have interstitial alveolar edema secondary inhalation injury or shifts between the fluid compartments of the body.

SIMV A mode of ventilation in which the number of ventilator breaths is fixed. The ventilator breaths may be initiated by the ventilator or triggered by the patient. Any additional breaths over the set SIMV Rate taken by the patient will be spontaneous.

Sodium:This is the concentration of sodium within the serum. The normal value is > 137 and < 147 mEq/L or mmol/L. This patient's serum sodium is 141 mEq/L and is within the normal range. Abnormalities in serum sodium can exist with low, normal or high total body sodium. The serum level is a reflection of the solute/solvent ratio and the value reflects the concentration of sodium within the patient's body water. As long as the ratio is normal, serum sodium will be normal regardless of the actual total body sodium.

trachshield trials Trachshield trials are periods of time in which the patient breathes spontaneously off the ventilator. A trachshield is a tracheostomy mask that supplies humidity and oxygen to the patient's tracheostomy tube during spontaneous breathing.

WBC - This is the abbreviation for white blood cell count. The normal range is 4.5 to 11.0 x 10⁹/L. An elevated WBC occurs in bacterial infections, pulmonary infarction, crush injury, burn injury, non-infective tissue injury such as myocardial infarction, metabolic disorders ( diabetic ketoacidosis, uremia, gout, eclampsia) and leukemia. There are different types of white blood cells. Rather than performing a manual differential white count, many clinical labs now rely on a three cell differential count that is automatically performed with newer laboratory instruments.