Burn Anesthesia

Question 1

Signs indicative of inhalation injury:

Answer 1

Facial burns
airway soot
singed nasal hair

Question 2

Symptoms of impending obstruction:

Answer 2

increasing RR

increased secretions

Question 3

Indictions for immediate intubation in burn pts:

Answer 3

CV instability, CNS depression, massibe burns greater than 60% of total body surface area

Question 4

Sux is usually considered safe in the first ___ after a burn

Answer 4

24 hours, but i wouldn’t use it

Question 5

Always pre what with burn pts?

Answer 5

Always pre-oxygenate!!!

Question 6

opioids prior to securing airway in burn pts?

If pt won’t go for an awake intubation

Answer 6

be careful, excessive opioid sedation may worsen obstruction
If pt won’t do awake intubation, consider going to OR for inhalational induction with spon ventilation

Question 7

Why is CO bad?
How is it diagnosed?
CO and Percentages?
Clinical pic closest to:

Answer 7

Because it has an affinity for hgb that is 250x that of oxygen. CO binds with hemoglobin molecule. and prevents O2 from getting on
Diagnosed by arterial blood gas and measurement of carboxyhemoglobin levels with co-oximeter blood gas analysis
At 15% or less, no signs,
15-20% the patient will confusion, headache,
CO 20-40% : nausea, fatigue, disorientation
40-60%: hallucinations
above 60%: death
Clinical pic closest to: ARDS

Question 8

Pre-op in burn pts:

Once in OR:

Answer 8

minimum of 2 large bore IVs 
Central venous catheter 
A line (not necessarily awake) 
IV lines should always be connected to rapid infusion fluid warmers 
Foley catheter 
can put pulse ox on tongue 

Once in OR-send off ABG

Question 9

Temp in room for burn pts:

Fluid of choice

Answer 9

OR: 28 degrees celsius
Fluids warmed 38 degrees celsius

Fluids of choice:LR for adults
Kids under 2 yo-5% dextrose ringers lactate

Question 10

Parkland burn formula:

Answer 10

4 ml x BSA% x Kg