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Principles > Burns > Flashcards

Burns Flashcards

1
Q

Heat Burns depth is related to_____(3)

A

Contact temperature
Duration of contact
Thickness of skin

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2
Q

Heat burns usually involves what skin layers?

A

Usually involve epidermis and dermis

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3
Q

How are friction burns created?

A

Combo of mechanical disruption and heat generated by friction

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4
Q

How are electrical burns created? And what does it cause?

A

Electrical energy transformed to heat when current passes through body tissue

Disrupts membrane potential

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5
Q

Things that affect the severity of the electrical burns? (3)

A

Pathway of current
Resistance to current flow
Strength and duration of current flow

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6
Q

Electrical burns are more likely to cause______ issues than thermal burns

A

Cardiac

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7
Q

What can chemical burns cause?

A

alterations of the pH and cause the salt membranes to lose integrity and because of that destruction = metabolic processes are impeded.

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8
Q

What is the severity of the chemical burn related to?

A

Duration of exposure
Nature of agent

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9
Q

Acidic agents can cause what?

A

necrosis by coagulation

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10
Q

Basic agents can cause what?

A

necrosis by liquefacation

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11
Q

How is the severity of radiation burns influenced? (3)

A

dose and time of exposure
types of particles

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12
Q

Sunburns are what type of burn

A

radiation burns

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13
Q

How long does it take for burns to fully declare themselves?

A

24-48 hrs

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14
Q

What patient population are burns detrimental to?

A

Areas of thin skin and adults > 55 or kids < 5

Have deeper burns with less exposure/ intensity because of the thin skin

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15
Q

How are superficial burns manifested and what skin layers are involved?

A

Involving only the epidermis
Skin intact, red in color
Dry surface, no blisters
Painful, hypersensitive

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16
Q

How long does it take 1st degree burns to heal?

A

Heals in approximately
3–6 days

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17
Q

What burn is not counted in TBSA?

A

1st degree (superficial burns)

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18
Q

How are superficial partial Thickness burns manifested and what skin layers are involved?

A

Involves the epidermis and part of dermis
Mottled red color
Blisters or weeping
Very painful / nerve endings exposed

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19
Q

How long does it take of superficial partial thickness burns to heal?

A

Usually heals in 10 – 14 days
Minimal scarring

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20
Q

Deep partial thickness burns manifestation and skin layers involved?

A

Extends more deeply into the dermis
Decreased moisture
Pale in color
Absent or prolong blanching

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21
Q

How long does it take for Deep partial-thickness burns to heal? and what is usually required?

A

Healing in 21-28 days
Requires skin grafting

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22
Q

Why is there less moisture with deep partial thickness burns than superficial partial thickness burns?

A

Less pain is usually present in the deeper burn. Since the sweat glands have been destroyed, there is decreased moisture. This can also have consequences of temperature control when a graft is placed (i.e. the skin becomes hot but cannot sweat)

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23
Q

How are full thickness burns manifested and what skin layers are involved?

A

Full thickness (dermis is destroyed)
Translucent, dry, painless, charred
Non-blanching

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24
Q

What burns are included in burn surface calculations?

A

All 2nd and 3rd degree burns

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25
Q

escharotomy

A

done through escar/ burned tissue
cutting down through the escar

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26
Q

Fasciotomy

A

dont through tissue that has an injury but not a surface injury, cutting down through the fascia

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27
Q

Rule of 9s burn injuries adults

A

Adult;
Head 9%
Each arm 9%
Each leg 18%
Ant/Post trunk each 18%
Perineum 1%

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28
Q

Rule of 9s burn injuries peds

A

head and heck 21%
arms; 10%
back: 13%
abdomen; 13%
each leg; 13.5%
buttocks; 5%
genitals; 1%

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29
Q

Palmer method

A

PATIENTS palm Fingers together = 1%

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30
Q

What are the two conflicting properties that burns can cause

A

Hypovolemic shock and decreased perfusion
Loss of plasma from microvasculature into interstitium -> increased permeability

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31
Q

Patients with ________ TBSA develop burn shock and need IV resuscitation in an ICU

A

> 20%

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32
Q

Fluid losses are a function of _____ and _____

A

Fluid losses are a function of burn size and patient weight

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33
Q

Concerns for under resuscitating burns

A

↓ perfusion, burn shock, end organ failure

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34
Q

Concerns for over resuscitation burns

A

Abdominal compartment syndrome, pulmonary edema/ARDS

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35
Q

General metabolic response to trauma (burns)

A

Auto-cannibalism;
Loss of fat
Loss of lean body mass
Proteolysis
Gluconeogenesis
Lipolysis
Hypermetabolism;because of volume loss/ because of the pain
Insulin resistance

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36
Q

BSA ______ causes metabolic rate to double and can lead to________ (3)

A

40%

Cannibalism for months;

Immunodepression, recurrent infections, poor wound healing

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37
Q

How does Carbohydrate metabolism changes with burns?

A

Increases in cortisol, catecholamines, and glucagon resulting in;

Accelerated hepatic gluconeogenesis
Peripheral insulin resistance (50-70%increase )
Impaired intracellular glucose transport

38
Q

How long can the increased gluconeogenesis and the insulin resistance last in burn pts?

A

last up to 3 years

39
Q

What changes do burns cuase to lipid metabolism?

A

Accelerated lipolysis
d/t B2 and B3 adrenergic stimulation…⬆️ cAMP
d/t elevated glucagon, TNF, IL
… elevated levels of FFA…produce ATP

40
Q

Treatment for accelerated lipolysis from Burns? and how does it work?

A

Treatment with beta-blockade
Decreases lipid oxidation and decrease metabolic rate

41
Q

How is protein metabolism changed with burns?

A

Accelerated proteolysis of skeletal muscle
Provides substrate for hepatic gluconeogenesis

burns and bed ridden -> tissue strictures/ contractures

42
Q

Degree of loss skletal muscle loss is proportional to degree of______

A

stress

43
Q

Initial Stabilization of burn pts (5)

A

Respiratory support- airway
Fluid resuscitation
Cardiovascular stabilization
Pain control
Local care of burn wounds

44
Q

Secondary stabilization in burn pts (6)

A

Pain control
Thromboprophylaxis
Wound closure
Nutritional support
Control of hypermetabolism
Prevention of infection

consider associated injuries

45
Q

Pain control meds for burn pts

A

Long-acting opioids (methadone)
NSAIDs (acetaminophen)
PCA infusions (morphine)
IV Ketamine
Supplemented with anti-anxiety drugs

46
Q

What can be altered in burns to cause changes to the dose of medications?

A

PK/PD can be altered in burns
May need to deviate from normal doses to avoid toxicity or decreased efficacy, and relative shrinkage of the vascular system

also consider lack of plasma proteins = more free drug.

change of volume of distribution

changes in receptor

47
Q

Burns cause what changes cellularly resulting in large fluid loss? (3)

A

Impaired endothelial barrier
Increased capillary permeability
Loss of intravascular oncotic pressure
Therefore….copious loss of intravascular fluid

48
Q

Release of systemic inflammatory reactions of histamine, prostaglandin and cytokines from burns Cause:

A

vasodilation of vessels

49
Q

Aggressive IVF resuscitation at what BSA?

A

Generally for 15% BSA or >

50
Q

Parkland Formula

A

4ml/kg x %BSA;
2ml/kg/%BSA in 1st 8 hours (LRS)
2ml/kg/%BSA in next 16 hours (LRS)

51
Q

titrate IVF formula down when ______ and consider small amount of________ on day ____

A

Advocate titrating formula down when U/O adequate
Consider small amount of colloids on day 2

52
Q

US Army ISR Rule of 10 for adult

A

Adult;
10mL/hr x TBSA
>80kg, add 100 mL/10kg

53
Q

US Army ISR Rule of 10 for peds

A

Pediatric;
3 x TBSA x kg = vol for first 24 hrs
½ total volume over 8 hrs

54
Q

Anesthesia Management: Preop Assessment

A

Determine estimated BSA% burn

Determine severity of burn

Assess need for transfer to a certified burn center

55
Q

Burns to take to burn center

A

Full thickness > 10% BSA
High voltage electrical burns
Chemical burns
Associated inhalation injury
Face, hands, feet, perineum, major joints

56
Q

Goal for UOP and titration if outside that goal

A

Goal targeted to U/O of 1cc/kg

Titrated every hour according to UOP goal 30-50 ml/hr, 20- 25% up or down if outside the parameters

57
Q

What is the risk of ns for burn pts

A

Risk of hypernatremic hyperchloremic acidosis (non-gap acidosis)

58
Q

Max mls to give

A

1500 mL/hr or 250 mL/kg in 24 hours
No fluid boluses as volume increases edema

59
Q

fluid resuscitation for peds with crystalloids

A

> 40 kg - Use adult formula
< 14 yrs old and <40 kg:
2-4 ml (LR)/kg x %TBSA (2nd and 3rd degree)

Children <20 kg add maintenance rate of D5LR at 421 rule

60
Q

Goal for peds UOP

A

Titrate IVF to maintain urine output 0.5-1mL/kg/hr

61
Q

At _________hours post-burn, if the hourly IV fluid rate exceeds________ mL/hr or if the projected 24 hr total fluid volume approaches _________ mL/kg, initiate 5%_______

A

At 8-12 hours post-burn, if the hourly IV fluid rate exceeds 1500 mL/hr or if the projected 24 hr total fluid volume approaches 250 mL/kg, initiate 5% albumin

62
Q

Colloids for peds burn pts and what titrations should be made with the isotonic cystalloid?

A

Children - infuse 4-7 mL/kg at the rate of 0.5 mL per minute.
Reduce maintenance isotonic crystalloid by an equal volume per hour

63
Q

resuscitative cardiac state

A

low co from hypovolemia decreased coronary flow (MI)
decreased response to catecholamines
increase SVR

64
Q

At cardiac status 72-96 post-burn and what to give

A

Hyperdynamic/ increased O2 consumption and decreased SVR

administer Beta-blockers

65
Q

Pulmonary status post burn and treatment

A

inflammation -> pulm htn -> impaired gas exchange -> broncho spasms (give bronchodilators)

66
Q

Restrictive lung defect post burn

A

Impaired ventilation from circumferential burns/scar
Hypoventilation d/t decreased elasticity
…escharotomies potentially necessary

67
Q

normal carboxy hb and symptoms with changes

A

1-3%

smokers; 4-9%

20% = symptoms (HA, N/V)

long term injury = 20-25%

> 25% = unconsiousness and death

68
Q

What is the goal for getting the burn pts nutrition and how will we get it to them>

A

Within 16 hours of admission; Thought to reduce magnitude of stress response

Nasoenteric feeds into the jejunum
Ensures high calorie, high protein

69
Q

Treatment for CN toxicity

A

cyanocobalamin

70
Q

When do we avoid succ in burn pts?

A

avoid after first 24 hrs of burns. Peaks at 48-72 hrs.

71
Q

upregulation of NACR can last for how long?

A

Months to years (1-2) to recover

72
Q

What happens as a result of the depolarizing agents on the upregulated nachrs?

A

Markedly increased serum K+
Begins approx. 24 hrs post burn
Significant after 48-72 hours
Does not correlate with severity of burn

73
Q

Burn pts cause lose up to ______ degree _____ q ______min

A

Can lose up to 1 degree C q 15 min

74
Q

airway burn s/s

A

Hoarseness, wheezing, SOB,
Stridor, dysphagia
Carbonaceous sputum
Singed nasal & facial hairs
Deep facial burns
Comatose patient
>40% TBSA

75
Q

induction meds and concerns for burn pts

A

Prop and opioids; consider the cardiac state

Etomidate; adrenal insufficiency concern

Ketamine; SNS reserve

76
Q

Resistance to non depolarizer occurs at what BSA?

A

25% BSA and >

77
Q

Paramaters to give blood to burn pts

A

2.6% total blood volume lost for every
1% burn excised or autograft harvest
PRBCs to 7-8 g/dL hemoglobin
(10g/dL acute coronary syndrome)

78
Q

things to give to reduce the risk of hemorrhage (3)

A

Use of topical thrombin, staged procedures, subq vasoconstrictors

79
Q

Shock treatment and goal CVP and whta to do if not in goal

A

Shock MAP <55 mmHg ; Vasopressin and Norepinephrine

CVP;
Goal 6-8 mm Hg
If not at goal, increase IVF rate by 20-25%

80
Q

Technique to infiltrate large volumes of LA subq

A

Tumescent LA

81
Q

Tumescent LA dose

A

Lidocaine 1G + epi + 10meq NaHCO3/1000cc NaCL
55mg/kg max?

82
Q

Effects of tumescent

A

Decreased blood loss
Easy excision of granulation tissue
Shorter surgical times
No hematoma or bruising postop

83
Q

target abgs for burn pts

A

Target pCO2 30-35 mm Hg or pH >7.20

84
Q

Meds to give for break up blood clots/ mobilize secretions

A

Nebulized 5000 units Heparin with Albuterol Q4H

85
Q

Abdominal Compartment Syndrome

A

Abdominal pressure displaces diaphragm up by bowel (high airway pressures)

ACS are best diagnosed by bladder pressures

A burn patient has a 90% mortality with an open abdomen

86
Q

S/s for abd compartment syndrome

A

Measure Q4H with >20% TBSA

Bladder pressures >12 mm Hg indicate early intra-abdominal hypertension

> 20 mm Hg is c/w abdominal compartment syndrome

87
Q

Post op burn pts

A

Postop mechanical ventilation
Inhalation burns
At risk for ongoing bleeding
Additional surgery plans
Need to minimize movement/graft disruption

DVT prophylaxis, Beta blocker admin, Nutritional support, Temp control

88
Q

Where is silvadene cream not applied?

A

face

89
Q

What are Txa and Factor 7 at risk of

A

thrombosis

90
Q

What eye ointment is applied and where

A

bacitracin = outside
erythromycin = inside

91
Q

421 rule

A

4 ml/kg/hr for first 10 kg
2 ml/kg/hr for next 10Kg
1 ml/kg/hr for each kg >20 kg

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