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NUNA 692 Principles III > burns > Flashcards

burns Flashcards

1
Q

pediatric burn injuries most often d/t

A

scalding

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2
Q

up to 20% of peds burns d/t _______ or _______

A

abuse or neglect

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3
Q

main cause of early death r/t burns (<48 hours):

A

shock and/or inhalation injury

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4
Q

after 48 hours, main cause of death is:

A

multi-organ failure and sepsis

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5
Q

first degree/superficial thickness burn

A

epidermis involvement
erythema, minor pain, no blisters

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6
Q

second degree/partial thickness - superficial

A

superficial (papillary) dermis
blisters, clear fluid, and pain

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7
Q

second degree/partial thickness - deep

A

deep (reticular) dermis
whiter appearance, with decreased pain, difficult to distinguish from full thickness

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8
Q

third or fourth degree/full thickness

A

dermis and underlying tissue and possibly fascia, bone, or muscle
hard, leather-like eschar, purple fluid, no senstation

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9
Q

ABA severity grading system
major burn =

A

2nd or 3rd degree burn
> 10% TBSA
electrical burns
inhalation injury (regardless of degree)

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10
Q

patient ______ + ________ > ________ means > 80% mortality

A

patient age + % TBSA is > 115 means > 80% mortality

ex: 70 yr old with 50% TBSA burn = 120

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11
Q

mortality __________ with inhalation injury

A

doubles

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12
Q

4 types of burn injuries

A
  1. chemical
  2. electrical
  3. thermal
  4. inhalation
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13
Q

electrical injury

A
  • damage concentrated at entry & exit wounds
  • major internal tissue damage seen
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14
Q

significant electrical burn leads to increased _________ leading to risk of _____________

A

myoglobin
renal failure

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15
Q

thermal injury

A

heat, flame, scald

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16
Q

suspect ____________ until ruled out

A

inhalation injury

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17
Q

inhalation injury classifications

A

upper airway, lower airway, or metabolic asphyxiation (carbon monoxide or cyanide)

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18
Q

brief exposure to hot dry air or steam leads to:

A

rapid airway destruction and edema

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19
Q

interesting phenomenon - heat in upper airway is dissipated but ______ _________ can occur so ________ _______ damage is uncommon

A

reflex laryngospasm
lower airway

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20
Q

most airway damage is d/t

A

toxins

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21
Q

inhalation injury warning signs

A

hoarseness
sore throat
dysphagia
hemoptysis
tachypnea
respiratory distress
elevated carbon monoxide levels

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22
Q

airway burn exam

A

direct visualization via laryngoscopy or fiberoptic bronchoscopy

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23
Q

gold standard airway exam

A

fiberoptic

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24
Q

if upper airway damage is present:

A

early intubation is indicated even when asymptomatic

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25
Q

avoid __________ if > __________ hours post injury

A

succinylcholine
24 hours

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26
Q

burns lead to _______________ which leads to _______________ which leads to cardiac arrest

A

receptor up-regulation (increased ACh receptors)
massive hyperkalemia

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27
Q

significant up-regulation occurs AFTER

A

first 24 hours

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28
Q

if airway swelling/obstruction is present, _________________ is best choice

A

awake intubation

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29
Q

awake intubation medications

A

topicals
ketamine
dex
no relaxants
spontaneous ventilation
avoid heavy sedation

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30
Q

awake intubation instruments

A

VL
FO
LMA assisted
blind nasal
retrograde wiring
light wand
surgical tracheostomy

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31
Q

progressive airway leak around ETT indicates

A

airway swelling is subsiding

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32
Q

suspect __________ if victim is rescued from an enclosed space

A

carbon monoxide poisoning

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33
Q

CO binds to _____ with _____ the affinity of O2 leading to decreased SaO2 and ___________________

A

Hgb
200x
metabolic acidosis

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34
Q

pulse oximetry does

A

NOT detect CoHgb which results in falsely high O2 saturation levels

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35
Q

______________ must be analyzed to obtain accurate measurement

A

arterial CoHgb

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36
Q

CO toxicity treatment

A

100% O2

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37
Q

burned plastic, paint, and some fabrics can cause

A

hydrogen cyanide (HCN)

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38
Q

HCN blocks intracellular O2 use leading to

A

metabolic acidosis

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39
Q

symptoms of HCN toxicity

A

changes in LOC
seizures
dilated pupils
hypotension
apnea
high lactate levels

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40
Q

treatment for HCN toxicity

A

hydroxocobalamin (vit B12a)

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41
Q

after securing airway, _____ _______ ______ begins

A

aggressive fluid resuscitation begins

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42
Q

burns cause loss of ______ _______, leading to ___________, _______ ________, decreased urine output, ______ depression, and collapse

A

circulating plasma
hemoconcentration
massive edema
decreased urine output
CV depression

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43
Q

fluid loss is greatest

A

during first 12 hours

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44
Q

fluid loss stabilizes after

A

24 hours

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45
Q

fluid resuscitation is required to prevent ______ ______ which leads to ________ ______ formation

A

hypovolemic shock
increased edema

also called the “fluid creep”

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46
Q

beware of ______ _______

A

compartment syndrome

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47
Q

2 commonly used guidelines for fluid resuscitation

A

Parkland and Brooke

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48
Q

heavy _______ _______ with no ________ or _______ (unless other traumatic injuries are present) during the resuscitation period

A

isotonic crystalloid
colloid
blood

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49
Q

parkland formula

A

4mL/kg/% TBSA burned

give first half over 8 hours and second half over the next 16 hours

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50
Q

caution with _________ - fluid management must be precise

A

children

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51
Q

children require maintenance ________ infusion along with __________ ______

A

glucose
resuscitation fluids

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52
Q

highest stress response

A

first 3 days of injury

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53
Q

plasma catecholamines ___ to ___ higher than usual

A

10-50x

54
Q

if not managed, physiologic exhaustion leads to

A

death

55
Q

around 48 hours post injury, pronounced

A

hypermetabolic phase sets in

56
Q

hyper metabolic phase can last ___________ after _________ burn

A

up to 2 years after 40% TBSA burn

57
Q

drugs/treatments for prevention of sepsis, temp maintenance, and hypermetabolism

A

antibiotics
warming devices
nutritional support
anabolic agents
beta blockers
anti-hyperglycemics

58
Q

loss of plasma protein leads to _________ and ________ “burn shock”

A

hypovolemia and hypotension

59
Q

decreased CO is initially

A

compensated by catecholamines (increase HR and vasoconstriction)

60
Q

in children, ______ persists for weeks after injury

A

HTN

61
Q

treating __________ ________ may improve long-term outcomes

A

hyperdynamic response

62
Q

decreased ______ ______ even with no inhalation injury

A

pulmonary function

63
Q

_____ _______ _______ common

A

acute lung injury

64
Q

decreased ______ and ________ d/t circumferential burns, edema, eschar

A

decreased FRC and compliance

may require escharotomy

65
Q

increased ______ _______ + ______ _______ = risk of pulm edema/ARDS

A

increased capillary permeability + fluid resuscitation = risk of pulm edema/ARDS

66
Q

current trend to minimize barotrauma

A

low Vt
low PiP ventilation to minimize barotrauma

67
Q

renal fxn decreased r/t

A

myo- and hemoglobinuria

68
Q

up to 40% develop

A

acute kidney injuries (AKI)

69
Q

“RIFLE” criteria used to categorize AKI

A

R - risk
I - injury
F - failure
L - loss
E - end-stage kidney disease

70
Q

high risk of _____ and ______

A

sepsis and pneumonia

71
Q

______ is leading cause of death in children (up to 100%) and adults (up to 75%)

A

sepsis

72
Q

metabolic rate

A

2x normal

73
Q

failure to meet nutritional requirements leads to (4)

A
  1. poor healing
  2. sepsis
  3. multi-organ dysfunction
  4. death
74
Q

burns lead to ________ resistance. _______/______ protocols common.

A

insulin resistance
glucos/insulin

75
Q

if intubated, do not

A

stop enteral feedings preoperatively (controversial)

76
Q

continue _____ intraop

A

TPN

77
Q

monitor _____ perioperatively

A

glucose

78
Q

use _______ ______ for pediatrics

A

infusion pumps

79
Q

ileus common with >_____ TBSA burn

A

20%

80
Q

multiple procedures frequently required

A

debridement
grafting
amputation

81
Q

standard procedure

A

early debridement with rapid coverage

82
Q

debridement/grafting is done every ___-___ ____ until grafting is complete

A

2-3 days

83
Q

3 types grafts

A

autologous skin
cultured skin
skin substitutes (porcine)

84
Q

common guidelines (3)

A

no more than 20% of body surface at a time
stop surgery at core temp < 35 C
stop when 10 units (3500 mL) PRBCs given (EBV of 50 kg pt). less in children.

85
Q

pre op assessment, thorough airway _________, __________, and pulm assessment ____, _________. prepare for possible ________ ________ ________.

A

neck mobility, oral opening
PiPs, minute ventilation
difficult airway techniques

86
Q

minimally safe _____ ______

A

NPO orders

87
Q

evaluate ___ _____

A

IV access (2 large bore PIVs or CVLs)

88
Q

check ______ and ______ ______

A

labs
blood availability

89
Q

have ______ in the OR BEFORE ________ begins, especially geriatrics

A

blood
debridement

90
Q

_______ the OR, fluids, bed, surgeon

A

WARM

91
Q

plan for _______ _______ and __ ______

A

post-op ventilation and ICU bed

92
Q

may need ____ ______ for EKG

A

needle electrodes

93
Q

______ _______ if all extremities affected or are being used for donor grafts

A

arterial lines

94
Q

creative pulse oximetry

A

ear lobes
nose
toes
cheek

95
Q

_______ or ______ temp probe for accurate core temp

A

esophageal or bladder

96
Q

EXTREME CAUTION when

A

transporting and moving

97
Q

airway loss can be

A

LETHAL

98
Q

watch ______ ____, monitor ______ while transporting

A

invasive lines
monitor VS

99
Q

for non-intubated patients with no airway injury, induction and intubation done ___ ________ EXCEPT _____________________.

A

as usual
SUX MUST BE AVOIDED

100
Q

BIG problem

A

temp regulation

101
Q

heat everything to

A

a miserable level

102
Q

keep up and stay ahead, debridement causes ______, ______ _______ loss

A

heavy, rapid blood loss

103
Q

may be at transfusion trigger on

A

arrival

104
Q

start blood transfusion as soon as

A

blood loss begins

105
Q

_____ is difficult

A

EBL

106
Q

look for ______ blood loss

A

hidden

107
Q

transfuse based on

A

hemodynamics, urine output, labs

108
Q

____ _______ method preferred for induction and maintenance

A

no single

109
Q

______, _______, _______ okay to use

A

volatiles, opioids, TIVA okay to use

110
Q

anesthetic events may exaggerated if

A

hypovolemic

111
Q

_________ if stable, ________ if unstable

A

propofol
ketamine

112
Q

_______ for ICU patients on specialized ventilators

A

TIVAs (anesthesia machine will not be used)

113
Q

ABSOLUTELY NO

A

SUX

114
Q

receptor ___-________ requires increased amounts of MRs

A

up-regulation

115
Q

never _______ a ______ through burned skin

A

never pass a needle

116
Q

associated vasodilation with regional may lead to ________ ________

A

hemodynamic instability

117
Q

may have burn-related _________

A

coagulopathy

118
Q

regional is a _______ choice if areas of debridement/grafting can not be anesthetized

A

poor

119
Q

________ may be good choice for children with lower extremity burns

A

caudals

120
Q

caution with intraop _________ if extubation is planned, especially with possible airway compromise

A

narcotics

121
Q

vigilance during ________ of intubated patients

A

transport

122
Q

post op _____ _____

A

PCA pumps

123
Q

_________ graft sites more painful than _______ sites

A

donor
grafted

124
Q

opioids best when

A

hemodynamically stable

125
Q

CAUTION with __________ - can interfere with hemostasis

A

NSAIDs

126
Q

repeated painful procedures leads to

A

analgesic tolerance

127
Q

later on, scarring and neck contractures of mouth and neck lead to

A

difficult intubations

128
Q

consider pre-op sedation for children __________

A

needing repeated procedures

129
Q

child legs
adult legs

A

13.5%
18%

130
Q

child head
adult head

A

18%
9%

NUNA 692 Principles III (20 decks)

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