Brainscape's Knowledge GenomeTM

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


See full index

Thermal Injury > Burn pathophysiology, immunology, nutrition and resuscitation > Flashcards

Burn pathophysiology, immunology, nutrition and resuscitation Flashcards

1
Q

Whata re 3 phases of burn metabolism in the burn patient

A
  • Acute phase: Acut ephase proteins, cytokines, insulin, cortisol, catecholamines
  • Hypermetabolic: insulin resistance, high glucose production, lipolysis, catabolism
  • Recovery: scar formation, muscle building
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What happens to caloric requirement with burn injury

A
  • 20% TBSA - results in 50% increase in caloric needs
  • 40% TBSA - results in 100% increase in caloric needs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How do you assess energy expenditure or energy expenditure?

A
  • Anthropometry / body weight
  • Blood test: urea nitrogen
  • Indirect calorimetry
    • Respiratory Quotient : Co2 produced/O2 consumed, normal 0.7-0.85. If RQ >0.85 = high caloric intake, if <0.7 = inadequate calories
  • Predictive formulae
    • Currerri Adult total EE: 25kcal/kg + 40kcal/%TBSA
    • Currerri kids total EE: 40kcal/kg + 40kcal/%TBSA
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is an estimate of protein requirement for a burn patient?

A
  • Adult = 1g/kg ideal BW + 1g/%TBSA
  • Kids = 3g/kg ideal BW + 1g/%TBSA
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

List supplements for burn patients and their function

A

Anti-catabolics

  • ornithine
  • oxandralone (decrease APP) 10mg bid for TBSA>40%
  • propanolol

Immune enhancing

  • Glutamine 40G daily
  • ornithine
  • Arginine

Wound healing

  • Vitaminc 500mg bid
  • vitamin a 10 000IU daily
  • omega 3 fatty acid - anti cytokines/PGE2
  • Zinc
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are indications and benefits of enteral feeding and indications for TPN

A

INDICATIONS FOR ENTERAL FEEDING

  • TBSA>20%
  • inadeaute oral intake/preburn nutritional deficiency

BENEfits of enteral feeding

  • reduce gut atrophy, bacterial trasnlocation
  • ulcer prophylaxis by normalizing gut pH
  • improved wound healing

Indication for TPN

  • ileus
  • electrical burn with GI involvement
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are complications of TPN

A
  • hyperglycemia
  • hyperosmolarity
  • hypoKalemia hypophosphetemia
  • FA deficiency
  • fluid imbalance
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are criteria for trasnfer to a burn unit

A
  • >10%TBSA partial thickness burn
  • any 3rd degree burn
  • burns involving face, hand/feet, genitalia, major joints
  • electrical burn
  • chemical burn
  • inhalational injury
  • burn w concomitant trauma where burn is sourc eo fmorbidity
  • preexistin comorbidity that could affect mortality
  • facility where personel/equipment not sufficient for kids
  • patients who will require social/emotional/psychological support
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How do you predict mortality

A

Modified Baux score

based on age, TBSA, presence of II

  • Age + TBSA% + II (17) >100 => 50% mortality
  • Age + TBSA% >110 => 50% mortality
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are indications for prophylactic intubation

A
  • Inhalational injury - or strong suspicion
  • facial/neck burns
  • large volume of fluid resus anticipated =>35TBSA
  • close range explosion
  • steam inhalation
  • long transport
  • respiratory failure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the parkland formula, when is it used and in what circusmtances is parkland inadequate

A
  • Formula is to guide fluid resusicitation in primary survery
  • RL 4cc/kg/%TBSA, with half volume igven in first 8 hr and second half in next 16hrs
  • Titrate to urine output for o.5cc/hr adult, 1cc/hr kids

Fluid resuscitationr equired when

  • >15%TBSA 2’ and 3’
  • >10%TBSA for kids <10 and adults >50

When parkland may be inadeqaute

  • Inhalational injury (50% increased needs)
  • children
  • high voltage electrical injury
  • delayed resuscitation
  • alcohol intoxication
  • polytrauma
  • deep burns 2’ vs 3’ because of increased zone of stasis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are principles for pediatric lfuid resuscitation

A
  • normal blood volume is 80cc/kg
  • higher requirements compared to adults
  • parkland for peds: Parkland (RL) + Maintenance fluid D5W
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are end points of fluid resuscitation

A
  • urine output 30-50cc/hr
  • base deficit normalization (<3mmol/L)
  • lactate clearance <2mmol/L)
  • MAP >65mmHg
  • HR normalized
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is fluid creep

A

Complications of edema secondary to fluid resuscitation

  • abdominal compartmen syndrome
  • pleural effusion, pulmonary edema
  • CHF
  • compartment syndrome of extremities
  • pericardial effusion
  • increased intra-ocular pressures
  • H&N edema leading to airway compromise
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are 4 clinical signs of abdominal compartmnet syndrome and RFs for ACS

ALso what is the differene b/w A HTN and ACS

A
  • oliguria
  • high airway pressure
  • hemodynamic instability
  • metabolic acidosis

Risk factors

  • circumferential abdominal/chest burn
  • TBSA>40%
  • large fluid resuscitation (>200cc/kg in last 24hr)
  • inhalation injury
  • burn sepsis
  • hemo/myoglobinuria

Diangosis:

  • Intrabdominal pressure determined with transduction catheter inside bladder
  • IAHTN: Pbladder >12mmHg
  • ACS: Pbladder >20mmHg + new organd failrue (eg. oliguria, hypotension, oxygentation/ventilation hypoxemia, high A/W, drop in Vt)

Diangosis: increased bladder pressure trasnduction: >20mmHg

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

What is the treatment for ACS

A

Conservative

  • reduce IV rate
  • pharmacologic paralysis,
  • neuromuscle relaxants + sedation
  • escharotomy
  • peritoneal dialysis
  • diuresis

Operative

  • decompressive laparotomy
17
Q

How does burn injury lead to immunosppression?

A

Burn leads to thermal/tissue damage =>

  • proinflammatory cytokine activation (TNFa, IL-1 IL-6)
  • AA cascade (PGE2, TXB2, TXA2)
  • neuroendocrine dysfunction
  • immune cell dysfunction (macrophage, IgG, APC)
18
Q

What are management strategies to improve immune function

A
  • early E&G
  • early enteral feeding
  • adequate resuscitation
19
Q

How do you define SIRS

A

2 or more of the following

  • Temp: <36, >38
  • HR >90
  • RR >20/min, PaCO<32mmHg
  • WBC <4 or >12
20
Q

What is the cytokine cascade and its role in immunosuppression in the burn patient

A
  • Tissue damage stimulates cytokine relase
  • IL-1, IL-6, TNFalpha
  • released by macropahges
21
Q

When do you consider using colloids and why?

A
  • TBSA>40%
  • to reduce amountof crystalloid given
  • start 8-12hr post-burn (reduced leak in non-burns areas)
  • 100cc/hr IV 5% albumin or 1/3 rate of crystalloid
22
Q

When do you consider hypertonic solution

A
  • to reduce overall fluid form taking from ISF to plasma
  • 3% HTS 200cc over 2hrs
  • risk hypernatremia, hyperchloremia, AKI
23
Q
A

Thermal Injury (6 decks)

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