Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Principles of Anesthesia II - Fall 2024 > Anesthesia Implications for Burns - Exam 1 > Flashcards

Anesthesia Implications for Burns - Exam 1 Flashcards

1
Q

What are the 5 types of burn injury/damage to skin or tissue?

A
  1. Heat
  2. Electrical
  3. Friction
  4. Chemical
  5. Radiation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Heat Burns

What 3 things are the depth of the thermal injury r/t?

A
  1. contact temperature (very cold/hot)
  2. Duration of contact
  3. Thickness of skin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Heat Burns

What are the “thin skin areas of the body”?

A
  1. joints
  2. hands
  3. face
  4. genitals
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Heat Burns

The ____ ____ ____ determines the extent of the damage to the patient.
Except in what 2 special circumstances?

A
  1. depth of injury
  • trapped in a fire - toxic exposure
  • electrical burns
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Heat Burns usually involve the ____ and ____.

A
  • epidermis & dermis
    can involve muscle/bone
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the 4 most common examples of Heat Burns?

A
  • Flame
  • Hot liquid
  • Hot solid
  • Steam
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

5Ts of heat burn risks: LOL.

A
  1. Testoterone
  2. Tequila
  3. Tattoos
  4. Tooth:Tattoo Ratio
  5. Teeth
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

In electrical burns, ____ ____ is transformed to ____ as current passes through body tissues

A
  • electrical energy
  • heat
  • basically the body is turned into a conduction pathway
  • membrane potential disrupted
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Electrical burns

What 3 things does the magnitude of the electrical burn depend on?

A
  1. pathway of current
  2. resistance to current flow
  3. strength and duration of current flow
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Electrical Burns

Is DC or AC worse?

A
  • DC worse - stays into contact w/ source longer
  • most houses have AC
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How do electrical burns often happen?

A
  • lightning
  • line men - high tension
  • POC: head/arm
  • POG: the feet/ground
  • travels through whole body
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What cardiac dysrhythmia do electrical burn pts commonly present with?
Tx:

A
  • V-fib
  • quick defibrillation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Friction burns are a combo of ________ disruption & ____ generated by friction.
Ex:

A
  • mechanical disruption
  • heat
  • ex: rope around arms/legs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Chemical Burns

What 3 caustic reactions happen with chemical burns?

A
  1. pH alteration d/o compound
  2. widespread cellular disruption = electrolyte disruption
  3. direct toxic effect on metabolic process
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What types of chemicals cause chemical burns?

A
  • liquids/powders
  • aerosol
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Chemical Burns

What 2 things are the magnitude of chemical burns related to?

A
  1. Duration of exposure - decontamination
  2. Nature of the agent (acid/base)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Chemical Burns

aCids cause necrosis by:

A

Coagulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Chemical Burns

Alkali cause necrosis by:

A

Liquefacation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

________ causes damage w/ radiation burns.

A
  • ionization
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Radiation burns

what 2 things does the magnitude depend on?

A
  1. dose and time of exposure
  2. type of particles
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Radiation Burns

What are 4 common examples?

A
  1. sunburns
  2. therapeutic radiation
  3. diagnostic procedures (cataracts, neuropathy exposure risk)
  4. nuclear industry workers
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

How long does it take for burns to declare themselves?

A

24-72 hours
* may progress from 2nd degree - 3rd degree

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Are burns usually uniform in depth?

Where is the most concentrated damage usually?

A
  • not uniform in depth (mix of superifcial and deep)
  • center of exposure = inreased concentrated damage
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What degree of burns are included in the TBSA % calculation?

A
  • 2nd and 3rd degree
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
# Classification of Burn Depth Why do kids < 5 have deeper burns?
* thinner skin (more adipose tissue) * leads to deeper burns
26
# Classification of burn depth Why do adults >55 have deeper burns?
* less tissue there to disrupt the thermal effects * thinner skin - less adipose tissue
27
# Classification of Burn Depth Characteristics of Superficial (1st degree burn):
* epidermis only * skin intact, red * dry skin, no blisters * painful & hypersensitive (extreme temps cause pain) * heal time: 3-6 days
28
# Classifications of Burn Depth Characteristics of Superficial Partial Thickness (2nd degree burn)
* epidermis & part of dermis * mottled, red * blisters/weeping * very painful - exposed nerve endings * Heal time: 10-14 days * minimal scarring
29
# Classifications of Burn Depth Characteristics of Deep Partial Thickness (2nd degree burn)
* extends deeply into dermis * decreased moisture (sweat glands destroyed) * pale color * absent/prolonged blanching * less painful - nerve endings damaged * Heal time: 21-28 days * requires skin grafting
30
# Classifications of Burn Depth Characteristics of Full Thickness (3rd degree) burns:
* dermis is destroyed * translucent, dry, painless, charred * non-blanching (decreased perfusion) * requires grafting/amputation
31
# Rule of 9s Head (adult)
9%
32
# Rule of 9s (adult) Each arm
9% * 4.5% anterior * 4.5% posterior
33
# Rule of 9s (adult) Each leg
18% * 9% anterior * 9% posterior
34
# Rule of 9s (adult) Ant/Post Trunk
36% * 18% Anterior * 18% Posterior
35
# Rule of 9s (adult) Perineum
1%
36
# Rule of 9s (infant) Head/Neck: Abdomen: Each arm: Each leg: Back: Buttocks: Genital Area:
* head/neck: 21% * Abdomen: 13% * Each arm: 10% * Each leg: 13.5% * Back: 13% * Buttocks: 5% * Genital Area: 1% **head % larger b/c disproportionate to body**
37
# Estimation of TBSA How accurate is the Rule of 9s?
* 60-70% accurate - various depths
38
# Estimation of TBSA % Palmer method -
* useful for irregular areas * patients palm w/ fingers together * 1% per palm
39
# Estimation of Burn TBSA% **Inaccuracies** larger burn SA: women w/ large breasts: obese:
* larger burn SA: underestimated - longer to declare * large breasts: larger SA compared to other areas * Obese: underestimate torso, overestimate extremity
40
# Pathophysiology of Burns What are the 2 conflicting priorities happening?
* shock & edema * d/o where they are in the burn process
41
# Pathophys burns early on: (hypovolemia)
1. hypovolemic shock & decreased perfusion 2. plasma loss from microvasculature into interstitium (increased permeability) 3. relative hypovolemia
42
# pathophys burns Edematous state:
* pt becomes edematous from loss of plasma into interstitium * **fluid load & edematous/volume depletion intravascularly**
43
# Pathophys of burns What is fluid loss a funtion of?
* burn size * pt weight * type of burn * **visible burn SA may not be directly r/t extent of burn (inhalation - Lung SA tennis court)**
44
# Pathophys of Burns Patients w/ what TBSA develop burn shock and need IV resuscitation in ICU?
>20% TBSA
45
# Pathophys of burns What does under resuscitation lead to?
**decreased intravascular vol.** * decreased perfusion * burn shock * end organ failure (kidneys susceptible)
46
# Pathophys of burns What does over resuscitation lead to?
* abdominal compartment syndrome (mesenteric edema, esp. crystalloid) * pulmonary edema * ARDS
47
What is the generic metabolic response in burns?
**Auto-cannibalism - hypermetabolic**
48
What 6 things does Autocannablism lead to?
1. loss of fat 2. loss of lean body mass (proteolysis) 3. gluconeogenesis (lose glucose) 4. lipolysis 5. hypermetabolism 6. insulin resistance
49
What 2 things make the intensity & duration of auto-cannabilism (hypermetabolic state) worse?
* the magnitude of the injury * degree of pain
50
# Autocannabilsm How long can cannibalism last? What do we need to ensure in these pts?
* metabolic rate doubles in 40% TBSA - can last for 3-6 months or longer * **meeting nutritional needs** * **continue tube feeds, clear carb liquids 2hrs pre-op, TPN!**
51
# Burn Metabolism What happens w/ carbohydrate metabolism?
* **increases in cortisol, catecholamines, and glucagon** * accelerated hepatic gluconeogenesis * peripheral insulin resistance
52
# Burn metabolism - carbs What causes peripheral insulin resistance? What is it related to? How long can it last? **what can we do for them?**
* post-receptor defect hindering the uptake of insulin & impaired intracellular glucose transport * r/t extent of burn * can last 3 yrs (3-6mos common) * **keep an eye on glucose levels & be mindful of carb status**
53
# Burn Metabolism What happens w/ lipid metabolism?
* accelerated lipolysis
54
# Burn Metabolism What causes accelerated lipolysis associated w/ burn injuries?
* B2 and B2 adrenergic stimulation - increased cAMP * elevated glucagon, TNF, IL * elevated levels of FFA.. produce ATP
55
# Burn metabolism What is the Tx for accelerated lipolysis?
* daily dose of BB * they will struggle more w/ BP * MOA: decreases lipid oxidation & metabolic rate
56
# Burn Metabolism What happens with protein metabolism?
* accelerated proteolysis of skeletal muscle * provides substrate for hepatic gluconeogenesis
57
# Burn Metabolism What is the degree of protein loss proportional to?
* degree of stress * **doubled in severe burns**
58
# Burn Metabolism What is the treatment for proteolysis/what can improve it? What makes it worse?
* encourage early PT * caution w/ positioning in OR * improved by cortisol (anti-inflammatory) * TNF, IL-1, IL-6 (inflammatory mediators - cytokines)
59
# Initial Stabilization of Burns When should we intubate the patient?
* **prophylactically** * airway soft tissues swell overtime & edema gets worse
60
# Initial Stabilization of Burns When is fluid resuscitation most important?
* **early on** * communicate w/ primary team to determine pt. specific goals
61
# Initial Stabilization of Burns CV stabilization - what does the increased catecholamine surge lead to?
* increased HR * increased metabolic demand & metabolism * **problematic for elderly w/ comorbidities**
62
# Secondary Priorities for Burn Pts What are the pain control methods in initial and long-term management?
* initial: IV * long-term: nerve blocks, SR options (methadone, oxycodone), NSAIDs, PCA, IV ketamine (procedural) * **supplement w/ anxiolytics**
63
# Secondary Priorties for Burn Pts Why are burn pts @ increased risk of DVT?
* fluid shifts * thromboprophylaxis important
64
# Secondary Priorities for Burn Pts What are the concerns w/ wound closure and burn patients?
* multiple OR trips * fluid/blood loss!
64
# Secondary Priorities of Burn Pts What do we need to ensure for pts nutrition and hypermetabolic state?
* ensure adequate nutrition * control hypermetabolic state w/ BB, early PT, glucose control
65
# Secondary Priorities of Burn Pts How can we help prevent infections in burn injuries?
* keep warm * keep hemostatic * maintain normal glucose * **minimal indications for Abx early on**
66
# Secondary Priorities for Burn Pts What pts do we need to use caution in fluid resuscitation?
* CHI - fluids/head injury can kill them
67
# Secondary Priorties for Burn Pts What are the concerns w/ spinal injuries and burns?
* they may need for fluids than just a burn pt * the spinal injury causes peripheral vasodilation = compounding factors * use vasopressors as well!
68
What are the 2 possible PK/PD alterations in burn pts?
1. May need less doses/drugs to avoid toxicity 2. May need more dose/drugs b/c of the hypermetabolic state causing decreased efficacy
69
# Causes of Intravascular Vol Loss in Burns 1. Impaired ________ ________. 2. Increased ________ ________. 3. Loss of intravascular ________ ________. What else causes dilation of vessels in burns?
1. impaired endothelial barrier 2. increased capillary permeability 3. loss of intravascular oncotic pressure **systemic inflammatory reactions - histamine, PG, cytokines**
70
# Fluid Resuscitation What is the Parkland Formula?
**starts at time of injury** * 4 ml/kg/%TBSA (1st 24 hrs) * 2mL/kg/%TBSA in 1st 8 hrs * 2mL/kg/%TBSA in next 16 hrs
71
# Fluid Resuscitation - Parkland What types of burn injury may need higher volumes?
* inhalation * electrical * delayed initial resuscitation
72
# Fluid Resuscitation What is the US Army ISR Rule of 10 (adult)?
* 10mL/hr x TBSA * > 80kg = add 100mL/10kg over 80kg
73
# Fluid Resuscitation What is the US Army ISR Rule of 10 (pedi)?
* 3 x TBSA x kg = vol. for 1st 24 hrs * 1/2 total vol. over 8 hrs
74
What are the 5 criteria for need to transfer to a burn center?
1. Full thickness > 10% BSA 2. high voltage electrical burns 3. chemical burns 4. associated inhalation injury 5. face, hands, feet, perineum, major joints
75
# Fluid Resuscitation How long are the formulas good for? Who may they not be appropriate for?
* good for 1st 24 hrs * not good for pts w/ comorbidities or non-responders to fluid
76
# Fluid needs What types of fluids do we use? What is a risk w/ high saline amount?
* crystalloid (LR/isotonic) * saline - hypernatremic hyperchloremic metabolic acidosis * **no boluses w/ crystalloid**
77
# Fluid Needs How are crystalloids/fluids titrated?
* every hour according to UOP goal * 30-50mL/hr or 1mL/kg/hr * titrate 20-25% up or down
78
At what amount of fluid administration do we start to see fluid overload symptoms? What are the symptoms?
* 1500mL/hr or 250mL/kg in 24hrs * ACS, pulmonary edema
79
# Fluid Needs At what weight do we use the adult formula for fluids? What is the formula for kids <14kg and <40kg? What do we need to add for kids <20kg? What is the UO goal for pedi?
* >40kg use adult formula * 2-4mL x kg x % TBSA (2nd and 3rd) * maintenance of D5LR for <20kg * 0.5-1mL/kg/hr
80
# Fluid Status in Burns When should we start colloid infusions? What is the DOC?
* 8-12 hrs post burn if >1500mL/hr **or** * projected 24 hr total volume >250mL/kg in 24 hrs **use albumin 5%**
81
# Fluid Status What is the pedi albumin rate? What do we need to reduce?
* 4-7mL/kg * rate: 0.5mL/min * reduce maintenance isotonic crystalloid by equal volume per hour
82
# Cardiac Status What happens in the hypodynamic "ebb" state?
* CO low (reduced by 60% of baseline) * relative hypovolemia * reduced response to catecholamines * increased SVR d/t vasopressin levels * myocardial ischemia (decreased coronary flow) * **very risky period for someone w/ cardiac disease**
83
# Cardiac Status What happens in the "hyperdynamic state"?
* increased CO, tachycardia * increased myocardial O2 consumption = myocardial ischemia * decreased SVR * **give BB**
84
# Pulmonary Status What leads to pulmonary HTN/edema?
**systemic inflammatory processes** * pulmonary capillary alveolar membrane disruption * decreased plasma oncotic pressure * extravascular lung water - impairs gas exchange * bronchospasm common
84
# Pulmonary Status What can be used to maintain pulmonary integrity in intubated burn pts? What is the tx for bronchospasm?
* PEEP * scheduled bronchodilator therapy - give before induction esp. if instrumenting airway
85
# Pulmonary Status What restrictive lung defects happen with burn injuries?
* impaired ventilation from circumferential burns/scars * monitor airway pressure * **pt will get relative hypoxia/hypercarbia** * **intra-op escharotomy**
86
What are the symptoms of inhalation injury?
* singeing of face/nasal hairs, black soot in mouth * oropharyngeal carbon * Carboxyhemoglobin levels >10% * wheezing * confirm w/ bronch
87
What are the main concerns for facial burns?
* management of devices difficult * umbilical ties for ETT securement * remove contacts * optho consult: globe/corneal injury
88
# Facial Burns Where is bacitracin applied? Where is erythromycin applied? What is NOT applied to the face?
* baci - eyelids * erythro - eyes * **no silvadene**
89
Symptoms of CO poisoning:
* HA, nausea, seizing, ARF, myocardial ischemia/depression
90
Treatment for CO:
100% O2 *caused by fuels*
91
Treatment for CN:
* cyanokit * B12 (cyanocobalamin) *caused by plastics*
92
What are the nutrition concerns after burn injuries? (elevated....) What can we do to meet their needs?
* elevated protein, vitamin, energy needs * insulin resistance * tube feeds to jejunum (decreased asp. risk)
93
What are the main 3 causes of PK/PD changes in burn pts?
1. changes in plasma protein concentration (albumin) = **increased free fraction and Vd** 2. Alterations in drug receptors (nAch) 3. CO changes (ebb/flow)
94
What happens w/ burn pts and nAch R's?
* upregulation of receptors (increased # and sensitivity) * **resistant to non-depolarizers** (>25% TBSA) * **sensitive to depolarizers** (after 24-72hrs)
95
# Intra-op care of Burns **Monitoring Standards** * EKG: * pulse-ox: * BP cuffs: * ABG: * UOP:
* EKG: stapled, alligator clips * pulse-ox: accuracy w/ COHb? edema/weeping interference * BP cuffs: inaccuracy from edema * ABG: Base Deficit alternative to lactate, used for oxygenation * UOP: watch trends!
96
# Intra-op Care of Burns: monitoring What temperature changes happen? What interventions can we provide?
* loss of up to 1 degree C every 15 min b/c loss of skin integrity * **warm IVF, warm OR, convection warming devices**
97
# Intra-op Care of Burns What are 5 indications of inhalation injury? What do these necessitate?
1. Hoarseness, wheezing, SOB 2. carbonaceous sputum 3. singed nasal & facial hair 4. comatose pt 5. >40% TBSA **early intubation**
98
# Intra-op Care of Burns: Airway What are signs of impending airway obstruction?
* stridor * hoarseness * dysphagia
99
# Intra-op Care of Burns: Airway What makes laryngoscopy difficult? What makes BVM ventilation difficult?
**laryngoscopy:** * edema (inhalation) * limited mobility: pain, contractures, eschar **BVM ventilation:** * burn dressings prevent adequate seal ## Footnote consider awake intubation = sedate/topicalize airway
100
# Intra-op Care of Burns: Airway What size ETT is preferred for intubation and why?
* 8 or largest size possible * facilitates subsequent bronchoscopy & pulmonary toilet * decreases risk of occlusion from casts (blood, mucous, debris)
101
# Intra-op Care of Burns: Airway What are 2 ways the ETT can be secured?
1. cotton umbilical tape 2. wire to teeth 3. **no LMAs** - only a back up
102
# Intra-op Care of Burns: Airway **Induction** * when to use prop: * when to use ketamine: * concerns w/ etomidate: * opioids:
1. prop: hyperdynamic state 2. ketamine: hypodynamic state - **stimulates SNS** 3. etomidate: adrenal insufficiency concern, supplement w/ steroids 4. opioids: maintain hemodynamic stability but tx pain!
103
# Intra-Op Care of Burns What causes hemodynamic instability? What 2 things can we do in the OR?
* hypovolemia (decreased preload & CO) * Resuce TEE * R/O cardiogenic or distributive shock, MI
104
# intra-Op Care of Burns: Blood Transfusions How much blood volume can be lost? When do we transfuse? ACS?
* 2.6% total blood volume lost for every 1% burn excised or autograft harvested * transfuse: keep Hgb 7-8g/dL * ACS: Hgb 10g/dL
105
# Intra-Op Care of Burns: What MAP diagnoses burn shock?
* <55mmHg depsite fluid resuscitation
106
# Intra-Op Care of Burns: Blood Trasfusions How can we provide hemostasis in these pts?
* topical thrombin * staged procedures - mult. OR trips * subQ vasoconstrictors (bad for graft take!) * rFVII & TXA = **thrombosis risk**
107
# Intra-Op Care of Burns: What is the shock treatment?
**Vasopressors** * Vasopressin * Norepinephrine * CVP: only useful for trends (6-8mmHg)
108
# Intra-Op Care of Burns What is Tumescent LA used for?
1. used for taking the skin graft 2. infiltrated into subQ tissue **effects** * decreased blood loss * easy excision of granulation tissue * shorter surgical times * no hematoma or bruising post-op
109
# Intra-Op Care of Burns What is the Tumescent LA dose?
* Lidocaine 1g w/ epi + 10mEq NaHCO3/1000mL NaCl **55mg/kg max**
110
# Intra-op Care of Burns What is the target PCO2 and pH?
* PCO2: 30-35mmHg * pH: >7.20
111
# Intra-Op Care of Burns Why do we give intubated patients nebulized Heparin/Albuterol? How often?
* pts w/ inhalation have ulceration/sloughing of airways * Heparin prevents clumping of the epithelial cells * Albuterol: Heparin can cause bronchospasm **give q4h**
112
# Intra-Op Care of Burns What happens with ACS? What is the mortality rate of an open abdomen? What are the bladder pressures associated w/ ACS?
1. abdominal pressure displaces diaphragm up by bowel edema 2. 90% mortality 3. >12mmHg = early intra-abd. HTN; **>20mmHg = ACS**
113
# Post-op Care of Burns Why do we leave pts intubated post-op?
1. inhalation burn s 2. @ risk of continued bleeding 3. additional surgery plans 4. need to minimize movement/graft disruption
114
# Post-Op Care of Burns What other modalities need to be provided to burn pts?
* DVT prophylaxis * BB admin * nutritional support * temp control
115
# Post-op Care of Burns What pain treatment options do we provide to burn pts?
* long-acting meds * scheduled anxiolytics * IV, enteral, transmucosal, PO * additives PRN for burn care/dressing changes * NO 50/50 * peripheral nerve blocks
116
# Post-Op Care of Burns What special care is needed r/t extremities?
* elevate 30-45 degrees (pillows, slings) * examine pulses hourly
117
When are escharotomies performed?
* loss of perfusion to extremities * ventilator compromise/decreased CO
118
Adjuncts to Burn Resuscitation:
* GI prophylaxis * Sew/staple venous and arterial lines * insert foley immediately - maintain urethral patency * tetanus * IV Abx/steroids not indicated!
119
Burn dressings * topical Abx: * other dressings: * skin substitutes: * silvadene:
1. silvadene & sulfamylon 2. silver dressings, silverton water or saline q8hrs, silver nitrate 3. biobrane 4. NO SILVADENE TO FACE!!!

Principles of Anesthesia II - Fall 2024 (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions