Burn Flashcards
what are the 4 functions of the skin? (S, PI, F/E B, TR)
sensation, prevents infection, fluid/electrolyte balance, thermal regulation
why is the Lund & Browder burn chart preferred over Rule of Nines?
because it takes into account the proportional difference in adults and children
what enzyme does cyanide inhibit?
cytochrome oxidase
cyanide concentration of > 100 ppm causes what 3 s/s? (L, S, RF)
lethargy, seizures, resp failure
for cyanide toxicity, what 2 meds do you give?
sodium nitrate, sodium thiosulfate
how many mg of sodium nitrate do you give?
300 mg
how many grams of sodium thiosulfate do you give?
12.5 grams
repeat what percent of the sodium nitrate and sodium thiosulfate doses if s/s reoccur within 2 hours?
50%
what carbon monoxide s/s are seen at these % levels?
- 15-20% (H,T,C)
- 20-40% (N,F,D)
- 40-60% (H,C,CI)
- > 60% (D)
- HA, tinnitus, confusion
- nausea, fatigue, disorientation
- hallucination, combativeness, C/V instability
- death
immediately after a major burn, are these increased or decreased:
- CO and arterial BP
- SVR and PVR
- contractility
- capillary permeability
- response to catecholamines
- decreased
- increased
- decreased
- increased
- decreased
what factors cause decrease contractility and increase capillary permeability? (HMF)
humor mediated factors
2-5 days after a burn, O2 consumption and cardiac output are increased how many times for weeks to months? (range)
2-3 times
what are 3 vascular s/s the first 24 hours after injury? (V,H,H)
vasoconstricted, hypercoagulable, hemoconcentrated
what is a potential SE of silver nitrate 0.5%? (M)
methemoglobinemia
what are the 2 fluid resuscitation formulas? (PMH, BAH)
parkland memorial hospital, brooke army hospital
what is the formula for first 24 hours?
4mL x kg x % burn
4 x 100kg x 80% = 32,000 mL
what % of fluid do you give in the first 8 hours?
50%
what % of fluid do you give in the next 16 hours?
50%
after first 24 hours, maintenance rate of D5W with colloids is what? (mL/kg/%TBSA)
0.5 mL/kg/%TBSA
what is the drug of choice for burn procedures?
ketamine
what degree range do you keep the OR?
98-100 degrees
initial burns are considered what and require what?
full stomachs, RSI
Succs may be used up to how many hours?
24 hours
burn pts may require how many times more non-depolarizing muscle relaxants d/t increased Vd and plasma protein binding? (range)
2-3 times
are narcotic requirements increased or decreased in burns?
increased
what is max epi dose with these agents? (mcg/kg)
- sevoflurane
- isoflurane
- desflurane
- 5 mcg/kg
- 6.7 mcg/kg
- 7 mcg/kg
Criteria for adequate fluid resuscitation:
- UO how many ml/kg/hr? (range)
- blood lactate less than how many mmol/L
- base deficit less than what?
- gastric intramucosal pH greater than what?
- cardiac index of what? (L/min/m^2)
- oxygen delivery index (mL/min/m^2)
- 1-2 mL/kg/hr
- 2 mmol/L
- -5
- 7.32
- 4.5 L/min/m^2
- 600 mL/min/m^2
do burn pts require more or less NMBs?
more
what is the major cause of inhalation injury in burn pts?
carbon monoxide
what type of metabolic state are burn pts in:
- first 24 hours post burn
- 2-5 days post burn
- hypodynamic
2. hyperdynamic
cyanide concentration > how many ppm cause seizures, lethargy and respiratory failure?
> 100 ppm
are induction agents (ketamine, propofol, etomidate) stand doses for burns?
yes
during debridement, pts may lose what range of mLs per 1% TBSA excised?
200-400 mL
after ABCs, what is the #1 priority?
temperature
for burns, maintain UO greater than what mL?kg/hr?
> 0.5 mL/kg/hr
reasons why burn pts need more NDMRs:
- reason related to Vd
- reason related to plasma protein
- what are the 2 reasons related to NMJ receptors?
- increased Vd
- increased plasma protein
- increased # of NMJ receptors and decreased affinity
avoid what two muscle relaxants in burn pts? (T, A)
tubocurarine (DTC), atracurium
why avoid tubocurarine (DTC) and atracurium in burn pts? (HR)
histamine release
