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UPR- RCM Advanced Anesthesia I > Burn Patient Surgery > Flashcards

Burn Patient Surgery Flashcards

1
Q

How many individuals in the U.S. visit emergency departments annually due to burn injuries?

A
  • Approximately 486,000 individuals a year visit emergency departments in the U.S. for burn injuries (2011-2015 data).
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2
Q

What are the main causes of early death (<48 hours) in burn injury cases?

A
  • Shock and inhalation injury.
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3
Q

What are the most frequent causes of death after sustaining a burn injury?

A
  1. Multi-organ failure
  2. sepsis

These two conditions are the leading causes of death post-burn injury.

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4
Q

Why do burn injuries lead to death, beyond the damage to the skin?

A
  • Is often due to shock
  • metabolic and infectious consequences of large open wounds
  • Sepsis
  • Inhalation injury
  • Extensive malnutrition
  • Culminating in bacterial sepsis.
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5
Q

How are burn injuries classified?

A
  • Based on the depth
  • Extent of skin and tissue destruction,
  • As well as the total body surface area (TBSA) involved.
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6
Q

What characterizes a first-degree burn?

A
  • First-degree (superficial) burns affect only the epidermis
  • Usually heal spontaneously
  • Seldom require medical intervention
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7
Q

Describe second-degree burns.

A
  • Second-degree burns, or partial-thickness burns
  • Extend to the dermis, which is vascular and contains nerves.
  • If the epithelial basement membrane is intact, skin regeneration is possible without grafting.
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8
Q

What are third-degree burns?

A
  • Third-degree, or full-thickness burns
  • Extend to the subcutaneous tissue
  • Destroying the entire skin thickness.
  • These burns require skin grafting as the epithelium and dermal appendages are destroyed.
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9
Q

What is a fourth-degree burn?

A

Fourth-degree burns involve structures below:

  1. The Dermis
  2. Muscle
  3. Fascia
  4. Bone

This classification is used by some to describe more severe injuries.

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10
Q

Why is it important to determine the cause of a burn injury upon admission to a burn center?

A
  • Is crucial for anticipating specific pathophysiologic sequelae based on the mechanism of injury.
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11
Q

What characterizes chemical burns and where do they commonly occur?

A
  • Chemical burns typically occur in laboratories or industrial environments
  • result from noxious chemicals reacting with skin proteins and cells.
  • Damage continues until the irritant is removed or neutralized.
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12
Q

What determines the extent of electrical burns?

A
  • Depends on the thermal energy conducted through the skin
  • Influenced by voltage and contact duration.
  • Damage is concentrated at entry and exit points
  • Two wounds may not always be visible.
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13
Q

What are the common patterns for thermal burns based on age?

A
  • In children up to 4 years old, approximately 70% of burns are scald injuries.
  • In children aged 5 years and older, flame burns are more common.

Scald: Cause by heat

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14
Q

What are the four types of inhalation injury?

A
  1. Upper airway injury from thermal injury to the mouth, oropharynx, and larynx
  2. Lower airway injury to the trachea, bronchioles, and alveoli from chemical and particulate smokes
  3. Pulmonary parenchymal injury
  4. Metabolic asphyxiation or systemic toxicity from smoke constituents like carbon monoxide or hydrogen cyanide.
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15
Q

Can different types of inhalation injuries coexist in a burn patient?

A
  • Yes, all four types of inhalation injuries may coexist in a burn patient, complicating the clinical presentation and treatment.
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16
Q

What is the primary role of the burn team in assessing a burn injury?

A
  • Assesses the extent of the burn injury
  • Plans initial resuscitation efforts,
  • Though burn size estimation remains subjective.
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17
Q

What is the rule of nines in burn assessment?

A
  • The rule of nines divides the body into regions representing 9% or multiples of 9% of TBSA for quickly estimating burn size.
  • It has specific modifications for children due to different body proportions.
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18
Q

Are there any limitations to using the rule of nines for estimating burn size?

A
  • Yes, the rule of nines, while a quick visual estimation method,
  • May not be all-inclusive in assessing the full extent of burn injuries.
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19
Q

What is the duration of the resuscitative phase in burn treatment?

A
  • The resuscitative phase encompasses the first 24 to 48 hours post-burn.
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20
Q

What is burn shock and its consequences in severe burn injuries?

A
  • Burn shock, occurring in burns affecting more than 20% TBSA
  • leads to decreased blood volume and cardiac output, affecting perfusion to vital organs.
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21
Q

Why is fluid resuscitation crucial in the resuscitative phase?

A
  • Fluid resuscitation addresses ongoing burn shock
  • Involves balancing over and under resuscitation to ensure adequate organ perfusion.
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22
Q

What are the primary focuses in the initial treatment of burn patients?

A

Initial treatment involves:

  • Attention to airway
  • Breathing
  • circulation
  • Coexisting trauma
  • The patient’s health history
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23
Q

Why must all burn patients be considered at risk for pulmonary compromise?

A
  • All burn patients, especially those with significant TBSA involvement and signs of inhalation injury,
  • At risk for pulmonary compromise.
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24
Q

What is the recommended method for examining the airway in burn patients?

A
  • Direct visualization of the airway using a laryngoscope or flexible intubation scope is the best method for airway examination in burn patients.
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25
Q

What is the gold standard for diagnosing the severity of inhalation injury in burn patients?

A
  • Flexible scope bronchoscopy is the gold standard for diagnosing the severity of inhalation injury in burn patients.
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26
Q

What is the recommended intubation technique for burn patients without an airway abnormality?

A
  • Early tracheal intubation can typically be achieved using a routine technique with an intravenous induction agent and a rapid-acting muscle relaxant.
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27
Q

When is it unsafe to use succinylcholine in burn patients?

A
  • Is generally considered unsafe for patients more than 24 hours after a burn injury
  • Due to the risk of hyperkalemia and cardiac arrest.
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28
Q

What happens to acetylcholine receptors after a burn injury?

A
  • Post-burn injury, there is an up-regulation of acetylcholine receptors throughout the muscle membrane
  • Leading to increased potassium release from the entire muscle membrane.
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29
Q

What are safe intubation techniques for burn patients with airway injury?

A
  • Intubation using a nondepolarizing relaxant or without a relaxant is safe for airway control in burn patients.
  • Awake intubation is safest for those with abnormal airways or upper airway obstructions.
30
Q

Who should be considered at high risk for carbon monoxide poisoning?

A
  • Burn victims rescued from enclosed-space fires should be considered at high risk for carbon monoxide poisoning.
31
Q

What determines the toxicity of carbon monoxide in burn victims?

A
  • Depends on tissue carbon monoxide levels
  • With symptoms varying based on carboxyhemoglobin (COHgb) levels.
32
Q

How does carbon monoxide affect oxygen transport in the blood?

A
  • Carbon monoxide binds to hemoglobin with 200 times the affinity of oxygen
  • Reducing oxyhemoglobin saturation and impairing oxygen extraction by tissues.
33
Q

What is the effect of carbon monoxide on cellular mitochondrial function?

A
  • Carbon monoxide disrupts mitochondrial oxidative phosphorylation,
  • Leading to metabolic acidosis at the cellular level.
34
Q

Why are pulse oximeters limited in detecting carbon monoxide poisoning?

A
  • Pulse oximeters cannot detect COHgb and provide falsely elevated readings of oxygen saturation in the presence of carbon monoxide.
35
Q

When is hydrogen cyanide (HCN) poisoning a risk for burn victims?

A
  • HCN poisoning can occur in burn injuries
  • Especially from the combustion of materials like plastics, foam, paints, wool, and silk.
36
Q

How does cyanide poisoning lead to tissue hypoxia?

A
  • Cyanide produces tissue hypoxia by blocking the intracellular use of oxygen, impairing cellular respiration.
37
Q

What are the symptoms of cyanide poisoning?

A

Symptoms include:

  • Loss of consciousness
  • Dilated pupils
  • Seizures
  • Hypotension
  • Tachypnea followed by apnea, and high lactate levels.
38
Q

What is the main antidote for cyanide poisoning?

A
  • Hydroxocobalamin (vitamin B12) is the primary antidote,

which actively binds cyanide to form:

  • cyanocobalamin, subsequently excreted by the kidneys.
39
Q

What are the benefits of using hydroxocobalamin for cyanide poisoning?

A
  • Hydroxocobalamin has a rapid onset,
  • Neutralizes cyanide without affecting cellular oxygen use
  • Has a good safety profile, making it the preferred antidote for smoke-inhalation victims.
40
Q

What are the immediate concerns following an acute burn injury?

A
  • The primary concerns are massive fluid shifts
  • airway management, which should be addressed immediately by first-response emergency medical providers.
41
Q

What are the common formulas for calculating fluid resuscitation in burn patients?

A
  1. The Parkland
  2. Modified Brooke formulas

Are widely accepted for calculating initial fluid resuscitation requirements in severely burned patients.

42
Q

Is blood transfusion a major concern during initial resuscitation in burn patients?

A
  • Is usually not a major concern during the immediate resuscitation phase in acutely burned patients, unless there is coexisting trauma.
43
Q

Why is it important for anesthetists to understand pathophysiologic changes after an acute burn injury?

A
  • Is crucial for anesthetists to effectively manage these changes intraoperatively
  • To tailor the anesthetic plan accordingly
44
Q

What is the primary goal of burn therapy?

A
  • To rapidly restore skin integrity,
  • Typically involving thorough cleansing and treatment with antimicrobial agents
  • To limit bacterial growth and prevent wound invasion.
45
Q

What is the standard practice in managing severe burns?

A
  • Early removal and excision of dead burn tissue
  • Followed by rapid closure of the burn wound is the standard in severe burn management.
46
Q

How often may a burn patient require surgical treatment?

A
  • Burn patients may require surgical treatment every 2 to 3 days
  • With staged burn wound excisions until full grafting is completed.
47
Q

What is a significant challenge during burn surgery and how can it be addressed?

A
  • Significant blood loss is a challenge in burn surgery.
  • Blood-conserving protocols, including the use of tumescent epinephrine, thrombin, fibrin, and
  • Other systemic hemostatic agents, can help reduce blood component requirements.
48
Q

How is wound coverage managed in patients with extensive burns and limited donor sites?

A
  • May require a combination of skin grafts
  • Cultured skin, and skin substitutes, including both temporary and permanent options.
49
Q

Why is there a high risk of hypothermia in burn patients during surgery?

A

Burn patients have a high risk of hypothermia due to:

  • evaporative heat loss
  • extensive body surface area exposure intraoperatively.
50
Q

What should be the temperature range in the operating room for burn patients?

A
  • Should be between 28°C and 33°C (80°F and 100°F),
  • with warmed intravenous solutions and skin preparations.
51
Q

What methods should be employed for heat conservation in the operating room?

A

All methods of heat conservation should be used, including:

  • inline circuit heat moisture
  • exchangers
  • lower gas flows to reduce respiratory tract heat loss
  • forced-air warming blankets (with limitations based on surgical exposure).
52
Q

How can over-body heating lamps be used safely during burn surgery?

A
  • Lamps must be positioned at a safe distance from the patient to prevent further burning.
53
Q

What is the preferred method for pain management early in burn care?

A
  • Intravenous patient-controlled analgesia is preferred early in burn care
  • Due to potential erratic or slow absorption from intramuscular sites.
54
Q

How are opioids used in the care of burn patients?

A
  • Opioids, such as morphine, fentanyl, and sufentanil, are crucial for intra- and postoperative analgesia in burn patients, especially for pain from skin harvest sites.
55
Q

What is the role of NSAIDs in managing pain in burn patients?

A
  • NSAIDs can be effective for smaller superficial burns
  • But their anticoagulant effects may pose hemostasis problems in larger burn injuries.
56
Q

What is the importance of planning for the postoperative period in burn patients?

A
  • Should be planned in advance, considering their critical condition and specific care requirements.
57
Q

What should be done with critically ill and intubated burn patients postoperatively?

A
  • Patients should remain intubated postoperatively
  • Be transported directly to the burn unit for continued care.
58
Q

What is the anesthetist’s responsibility during the postoperative phase?

A
  • The anesthetist should protect the airway
  • provide adequate sedation and analgesia during the terminal phase of the anesthetic for burn patients.
59
Q

How should opioids be managed if extubation of the trachea is anticipated?

A
  • Should be titrated according to the patient’s needs for effective pain management.
60
Q

What is a common issue that remains after skin grafting and surgical procedures in burn patients?

A
  • Scarring is a common issue that can persist after numerous skin grafting and surgical procedures, even when some degree of healing has occurred.
61
Q

What is the most important anesthetic concern during the reconstructive phase in burn patients?

A
  • Is the management of the airway
  • Especially if there are contractures of the face and neck.
62
Q

What are the airway management options during the reconstructive phase in burn patients?

A
  • Standard laryngoscopy
  • Videolaryngoscopy
  • Awake intubation using a flexible intubation scope.
63
Q

What challenge might arise with intravenous access in burn patients during the reconstructive phase?

A
  • Intravenous access can be problematic due to the contraction of extremities from burn scars.
  • Additionally, invisible scars may also be present in patients who have suffered a burn injury.
64
Q

Degree of burn injury table

A
65
Q

Identify the structures in the picture below.

A
66
Q

Burn Assessment chart with body proportions

A
67
Q

Biphasic organ system response to injury

A
68
Q

Carbon monoxide Monitoring

A
69
Q

Fluid resuscitation formula tables

A
70
Q

Pathophysiologic effects of burn injuries Table

A

UPR- RCM Advanced Anesthesia I (5 decks)

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