Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

N934 Advanced Principles II - Christine > Burn Injuries > Flashcards

Burn Injuries Flashcards

1
Q

functions of the skin

A 
barrier (body fluids and infection)
temperature 
elasticity
appearance
sensory organ
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

layers of skin

A

stratum coreneum, epidermis, dermis, subcutaneous tissue

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

types of burn injury

A

thermal (flash, flame, scald)
chemical (can progress until flushed out or neutralized)
electrical
radiological (alpha, beta, gamma radiation)

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

severity of burn injury and how they are classified

A

depth - extent of skin and tissue destruction (superficial, partial thickness, full thickness)
total body surface area involved (rule of nines)

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

superficial burn 1st degree

A

depth - destruction of epidermis
pain level - very painful
appearance - red
characteristics - dry, flaky, will heal spontaneously in 3-5 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

partial thickness burn 2nd degree

A

depth - superficial or deep, epidermis up to deep dermal element
pain level - very painful
appearance - bright cherry red, pink or pale ivory, usually with fluid filled blistering
characteristics - hair follicle intact, may require skin graft

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

full thickness burn 3rd degree

A

depth - all of the epidermis, dermis, down into the subcutaneous tissue
pain level - little or no pain
appearance - khaki brown, white, or charred/cherry red is pediatrics
characteristics - loss of hair follicles, will require skin graft

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

fourth degree

A

depth - full thickness extending into muscle and bone

will require skin graft or amputation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

rule of 9’s for adults

A 
head = 9 %
upper extremities = 18% (each arm 9%)
trunk = 36% (front = 18%, back = 18%)
lower extremities = 36% (each leg 18%)
genitalia = 1%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

rule of 9’s for pediatrics

A 
head = 18%
upper extremities = 20% (each arm 10%)
trunk = 32% (front = 16%, back = 16%)
lower extremities = 28% (each leg 14%)
genitalia = 1%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

burns that should be transferred to burn center

A

full thickness burns in any age group
partial thickness >10% TBSA
burns of special areas (extreme of age, burns of face, hands, feet, perineum or major joints, inhalation, chemical, electrical burns, those burns associated with co-existing disease)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

determining mortality with age and TBSA

A

if the age of the patient plus the TBSA is greater than 115 the mortality is greater than 80%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

in a closed space thermal injury think…

A

airway injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

electrical injury may lead to occult

A

severe fracture, hematoma, visceral injury, skeletal, cardiac injury, neurologic injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

signs and symptoms of airway complications

A

singed facial hair, facial burns, dysphonia/hoarseness, cough/carbonaceous sputum, soot in mouth/nose, swallowing impairment, oropharynx inflammation, CXR initially normal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

inhalation injury refers to

A

damage to the respiratory tract or lung tissue from heat, smoke, or chemical irritants carried into the airway during inspiration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

upper airway inhalation injury involvement

A

thermal damage to soft tissues of the respiratory tract and trachea can make intubation difficult
increased risk of glottic edema with injury and fluid resuscitation

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

lower airway inhalation injury involvement

A

pulmonary edema/ARDS develops 1-5 days post burn

pneumonia and pulmonary embolism > 5 days post burn

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

smoke inhalation occurs in conjunction with

A

face/neck burns and closed space fires

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

chemical pneumonitis occurs after

A

smoke/toxic fume inhalation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

honeymoon period for smoke inhalation that will show clear CXR

A

1st 48 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

symptoms of smoke inhalation

A

increased sputum and rales/wheezing

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

hypoxia in the first 36 hours after inhalational injury

A

high risk of pulmonary edema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

hypoxia in day 2-5 after inhalational injury

A

expect atelectasis, bronchopneumonia, airway edema maximum secondary to sloughing of airway mucosa, thick secretions, distal airway obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

hypoxia >5 days post inhalational injury

A

nosocomial pneumonia, respiratory failure, ARDS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

implications of circumferential burns of chest/upper abdomen

A

restricted chest wall motion as eschar contracts and hardens

27
Q

if inhalation injury or facial burns are suspected or known

A

intubate and secure the airway early!

28
Q

ETT indicated in a burn patient if

A

pediatric, massive burn, stridor, respiratory distress, hypoxia/hypercarbia, altered level of consciousness, if deterioration likely

29
Q

safest approach for intubation in burn patient

A

fiberoptic intubation under adequate topical anesthesia

30
Q

treatment of hypoxia in burn patient with inhalational injury

A

PEEP, airway humidification, bronchial suctioning/lavage, bronchodilators, antibiotics, chest physiotherapy

31
Q

restriction of respiratory excursion may necessitate

A

escharotomy

32
Q

carbon monoxide is ____ times the affinity for Hgb as O2

A

200

33
Q

CO shifts the hemoglobin dissociation curve to the ___

A

left impairing O2 unloading at the tissue level

34
Q

CO interferes with

A

mitochondrial function, uncouples oxidative phosphorylation, reduces ATP production = metabolic acidosis

35
Q

carbon monoxide treatment

A

high FiO2

hyperbaric chamber if > 30% and patient is hemodynamically and neurologically stabilized

36
Q

a COHbg greater than ___ is incompatible with life

A

60%

37
Q

CO < 15-20% symptoms

A

HA, dizziness, confusion

38
Q

CO 20-40% symptoms

A

nausea, vomiting, disorientation and visual impairment

39
Q

CO 40-60% symptoms

A

agitation, combative, hallucinations, coma, shock

40
Q

blood cyanide levels of ____ confirm diagnosis of cyanide toxicity

A

> 0.2 mg/L

41
Q

lethal blood cyanide level

A

1.0 mL/L

42
Q

cyanide has a half life of

A

60 minutes

43
Q

treatment for cyanide toxicity

A

O2, hydroxycobalamine, amyl nitrate, sodium nitrate, thiosulfate

44
Q

burns and systemic effects

A

release of inflammatory mediators locally and systemically = edema
increase in microvascular permeability = fluid leak and loss of proteins
increased intravascular hydrostatic pressure and decreased interstitial hydrostatic pressure
increased interstitial osmotic pressure

45
Q

cardiovascular stresses with burn injury

A

severe decrease in CO lasts 1st 24 hours
circulation tumor necrosis factor = myocardial depression
diminished response to catecholamines
increased microvascular permeability = hypovolemia
intense vasoconstriction compensation = decrease flow to tissues
decreased tissue O2 supply and coronary blood flow

46
Q

after 24-48 hours of burn patients are in a ____ state

A

hyperdynamic state (high output CHF), CO is 2x normal

47
Q

metabolism in burn patient

A

increased metabolic rate is proportional to TBSA burned
increased core body temp reflects increased metabolic thermostat, loss of skin = loss of vasoactivity, piloerection, insulation functions

48
Q

GI complications

A

ileus, ulceration, cholecystitis

49
Q

Renal complications

A

decreased GFR, RBF, loss of Ca, K, Mg with retention of Na, H2O

50
Q

endocrine complications

A

increased corticotropin, ADH, renin, angiotensin, aldosterone, increased glucagon, insulin resistance, hyperglycemia

51
Q

blood and coagulation complications

A

increased viscosity, increase in clotting factors including fibrinogen, V and VIII, fibrin split products at risk of DIC development, HCT usually decreases (RBCs decreased half life)

52
Q

fluid resuscitation 1st 24 hours

A

crystalloid only
replace with 2-4 mL/kg for each 1% TBSA burned
titrate fluids to U/O 0.5 - 1 mL/kg/hr

53
Q

over aggressive fluid resuscitation can lead to

A

airway edema, increase chest wall restriction, and contribute to abdominal compartment syndrome

54
Q

fluid resuscitation after 1st 24 hours

A

use colloids at 0.3-0.5 mL/kg/% burn with 5% dextrose in water

55
Q

Parkland formula

A

4 mL of LR/kg/% burn/1st 24 hours

56
Q

Modified Brooke formula

A

2 mL of LR/kg/% burn/1st 24 hours

57
Q

calculated volumes are given in the 1st 24 hours

A

50% first 8 hours
25% second 8 hours
25% third 8 hours

58
Q

goals of resuscitation

A 
urine output = 0.5-1 mL/kg/hr
HR = 80-140 
MAP = >60 in adults
base deficit = < 2
normal Hct
59
Q

what can we give if fluids are not enough?

A

low dose Dopamine 5 mcg/kg/min

60
Q

anesthesia considerations/concerns

A 
often need repeated surgeries
maintain Hct
coagulopathy
temperature
fluids and electrolytes
hypermetabolic state 
increased risk for GI ileus
61
Q

challenges for anesthesia in burn patients

A

burned tissue = limited access for ECG, SaO2, PNS, NIBP
need large bore IV
compensate for evaporative/exposure heat loss (room temp 28-32 C)
minimize blood loss (topical/SQ epi, only 15-20% TBSA each procedure, tourniquets)
treat complications of massive transfusion (coagulopathy, hypocalcemia)

62
Q

anesthesia considerations for high voltage electrical injury

A

follows path of least resistance (bone most resistant)
cardiac arrhythmias
respiratory arrest
seizure
fractures
muscle damage = myoglobinurea and renal failure

63
Q

muscle relaxants in 1st 24 hours

A

unaltered response to depolarizing and non-depolarizing muscle relaxants

64
Q

muscle relaxants in 24 hours to 1 year post burn

A 
avoid succinylcholine (massive release of K)
may be due to the proliferation of acetylcholine receptors along the entire muscle membrane 
resistance to most NDMR if >30% TBSA burned

N934 Advanced Principles II - Christine (3 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions