Orion's CFRN/CTRN Exam prep
- Kerhr's sign (internal bleeding) - ANS-Referred Left shoulder pain indicating Splenic injury or
ectopic pregnancy.
Acid-Base disturbance - High anion gap acidosis (MUDPILES) - ANS-M-Methanol
U- Uremia
D- DKA
P- Propylene Glycol (agent used in benzos/phenobarbitol)
I- Isoniazid or iron
L- Lactate
E- Ethylene glycol (antifreeze)
S- Salicylates (ASA)
Airway - Calculate ideal bodyweight - ANS-22 × ([the actual patient's height in meters]^2)
(Example: 22 x (1.83m)^2 = 73.7kg)
Airway - Cormack-Lehane grading scale (View during intubation) - ANS-I - Full view of glottis
and vocal cords
II - Partial view of glottis/ arytenoid cartilage
III - Only epiglottis seen/ Neither glottis nor epiglottis seen
IV - None of glottis seen
Airway - How to anticipate a difficult airway - ANS-LEMONS:
L: Look externally; unusual face or neck finding may precede difficult intubation.
E: Evaluate using the 3-3-2 rule. A patient who is a good candidate for intubation using direct
laryngoscopy is able to place 3 of their own fingers between their front upper and lower teeth
with their mouth fully open, fit 3 fingers along their mandible from the tip of the chin and
positioned then posteriorly, and should also be able to place 2 of their own fingers from the
laryngeal prominence to the floor of their mouth.
M: Mallampati score.
O: Obstruction; look in the airway to assess for any obstructions from foreign body presence or
for the presence of soft tissue masses, etc.
N: Neck mobility
S: Saturation; should be able to keep the oxygen saturation above 93% during intubation
attempts.
Airway - Mallampati score (Airway assessment) - ANS-I - Full view of glottis
II - Partial view of glottis/ arytenoid cartilage
III - Only epiglottis seen/ Neither glottis nor epiglottis seen
IV - None of glottis seen
Airway (Pediatric) - Estimating ETT depth - ANS-Typically a pediatric ETT is taped at a depth of
3 x the tube size in a child (i.e., a 4.0 ETT commonly gets taped at around 12cm depth).
*Weight based estimation of ETT size: weight (kg)/10 + 3.5 mm].
, Airway (Pediatric) - Estimating ETT size by age - ANS-(Age/4)+4 Uncuffed
(Age/4)+3.5 Cuffed = mm tube
*Example (8yo/4)+3.5 = 5.5mm Cuffed ETT
BURNS - Consensus formula - ANS-(2-4 mL Ringers Lactate) x (weight in kg) x (% TBSA) =
mLs in first 24 hours.
Give half of this total in the first 8 hours post burn.
BURN PEARL: Adults use 2 mL: Pediatrics use 3 mL: Electrical injuries use 4mL. Do not give
dextrose solutions (except for maintenance fluids in children) —it may cause an osmotic diuresis
and confuse adequacy of resuscitation assessment.
BURNS - Rule of Nines - ANS-Adult - Head: 9%
Adult - Front 18%
Adult - Back 18%
Adult - Arm 9%
Adult - Leg 18%
Adult - Groin 1%
Child - Head 18%
Child - Front 18%
Child - Back 18%
Child - Arm 9%
Child - Leg 14%
Child - Groin 1%
https://plasticsurgerykey.com/case-49-acute-burn-injury/
BURNS - The Parkland formula - ANS-4ml x TBSA (%) x body weight (kg) = Total fluid
requirement in 24 hours
50% given in first eight hours
50% given in next 16 hours.
- Adequate urine output for adults is 30 mL/hr and children <30kg should be 1-1.5ml/kg/h.
Cardiac Index values
CVP/RA:
CI:
PAS:
PAD:
PAWP:
SVR: - ANS-CVP/RA: 2-6
CI: 2.5-4.4
PAS: 15-25
PAD: 8-15
- Kerhr's sign (internal bleeding) - ANS-Referred Left shoulder pain indicating Splenic injury or
ectopic pregnancy.
Acid-Base disturbance - High anion gap acidosis (MUDPILES) - ANS-M-Methanol
U- Uremia
D- DKA
P- Propylene Glycol (agent used in benzos/phenobarbitol)
I- Isoniazid or iron
L- Lactate
E- Ethylene glycol (antifreeze)
S- Salicylates (ASA)
Airway - Calculate ideal bodyweight - ANS-22 × ([the actual patient's height in meters]^2)
(Example: 22 x (1.83m)^2 = 73.7kg)
Airway - Cormack-Lehane grading scale (View during intubation) - ANS-I - Full view of glottis
and vocal cords
II - Partial view of glottis/ arytenoid cartilage
III - Only epiglottis seen/ Neither glottis nor epiglottis seen
IV - None of glottis seen
Airway - How to anticipate a difficult airway - ANS-LEMONS:
L: Look externally; unusual face or neck finding may precede difficult intubation.
E: Evaluate using the 3-3-2 rule. A patient who is a good candidate for intubation using direct
laryngoscopy is able to place 3 of their own fingers between their front upper and lower teeth
with their mouth fully open, fit 3 fingers along their mandible from the tip of the chin and
positioned then posteriorly, and should also be able to place 2 of their own fingers from the
laryngeal prominence to the floor of their mouth.
M: Mallampati score.
O: Obstruction; look in the airway to assess for any obstructions from foreign body presence or
for the presence of soft tissue masses, etc.
N: Neck mobility
S: Saturation; should be able to keep the oxygen saturation above 93% during intubation
attempts.
Airway - Mallampati score (Airway assessment) - ANS-I - Full view of glottis
II - Partial view of glottis/ arytenoid cartilage
III - Only epiglottis seen/ Neither glottis nor epiglottis seen
IV - None of glottis seen
Airway (Pediatric) - Estimating ETT depth - ANS-Typically a pediatric ETT is taped at a depth of
3 x the tube size in a child (i.e., a 4.0 ETT commonly gets taped at around 12cm depth).
*Weight based estimation of ETT size: weight (kg)/10 + 3.5 mm].
, Airway (Pediatric) - Estimating ETT size by age - ANS-(Age/4)+4 Uncuffed
(Age/4)+3.5 Cuffed = mm tube
*Example (8yo/4)+3.5 = 5.5mm Cuffed ETT
BURNS - Consensus formula - ANS-(2-4 mL Ringers Lactate) x (weight in kg) x (% TBSA) =
mLs in first 24 hours.
Give half of this total in the first 8 hours post burn.
BURN PEARL: Adults use 2 mL: Pediatrics use 3 mL: Electrical injuries use 4mL. Do not give
dextrose solutions (except for maintenance fluids in children) —it may cause an osmotic diuresis
and confuse adequacy of resuscitation assessment.
BURNS - Rule of Nines - ANS-Adult - Head: 9%
Adult - Front 18%
Adult - Back 18%
Adult - Arm 9%
Adult - Leg 18%
Adult - Groin 1%
Child - Head 18%
Child - Front 18%
Child - Back 18%
Child - Arm 9%
Child - Leg 14%
Child - Groin 1%
https://plasticsurgerykey.com/case-49-acute-burn-injury/
BURNS - The Parkland formula - ANS-4ml x TBSA (%) x body weight (kg) = Total fluid
requirement in 24 hours
50% given in first eight hours
50% given in next 16 hours.
- Adequate urine output for adults is 30 mL/hr and children <30kg should be 1-1.5ml/kg/h.
Cardiac Index values
CVP/RA:
CI:
PAS:
PAD:
PAWP:
SVR: - ANS-CVP/RA: 2-6
CI: 2.5-4.4
PAS: 15-25
PAD: 8-15
