Burns Flashcards

Question

Why is cyanide lethal

Answer 1

stops cellular oxygenation. binds to mitochondrial cytochrome oxidase blocking the last step in the oxidative phosphorylation, preventing the use of oxygen for conversion of pyruvate to adenosine triphosphate.

Answer 2

metabolic acidosis CV depression dysrhythmias increased MvO2

Answer 3

Blood cyanide >0.2mg/l lethal >1mg/L

Answer 4

100% fio2 B12 Hydroxocobalamin Amyl Nitrite Sodium Nitrite Sodium thiosulfate

Answer 5

**LR** 4 mL x kg x TBSA % burn First half over 8 hours Second half over 16 hours

Answer 6

2mg x kg x tbsa x % burn of LR First half over 8 hours Second half over 16 hours

Answer 7

1/2 over 8 hours 1/2 over 16 hours

Answer 8

Normal BP UO 1-2 m/k/h Lactate <2 Base deficit <5 CI 4.5 L/min

Answer 9

increase in hematocrit on 1st day of thermal injury

Answer 10

Decreased CO Increased SVR/PVR Decreased perfusion Hemoconcentration Reduced Drug Elimination RBC volume loss HCT rises Decreased UO Decreased CV function Loss of Plasma Generalized edema --> fluid shifts.

Answer 11

albumin decrease A1AG increases

Answer 12

Benzos Phenytoin Salicylic acid

Answer 13

lidocaine meperidine propanolol muscle relaxants

Answer 14

increased CO & CO2 increased O2 consumption decreased SVR/PVR tachycardia tachypnea drop in immune system function protein wasting increased blood flow to liver and kidneys catecholamine surge capillary integrity returns

Answer 15

+ Rocur 1.5mg/kg for RSI takes 90s + Ketamine (increased) + Propofol (increased) + opioids (increased) + volatiles - avoid succinylcholine after 24 hours because of increased exJunct receptors and upregulation.

Answer 16

evaporation

Answer 17

1. Cardiac arrhythmias and ischemia 2. Increased PVR 3. Left shift of hemoglobin oxygen saturation curve 4. Reversible coagulopathy 5. Increase protein catabolism and stress 6. Altered mental status 7. Delayed drug metabolism 8. Impaired wound healing 9. Increased risk of infection

Answer 18

BLOCK ADRENERGIC RESPONSE

Answer 19

90 mg of Epinephrine in 1000 cc NSS Achieves Stasis Tachycardia w/ epi: **Avoid this through MAC BAR**

Answer 20

5mg ??? 90mg per 1000cc bulb syring is 60 cc

Answer 21

Hct <15-20 Hct <25 healthy w/ extensive procedure Hct <30 preexisting condition 1:1 PRBC & FFP minimize cystalloid CaCl > phenylephrine Blood loss is continual

Answer 22

Head: 9% Each arm: 9% Anterior chest and abdomen: 18% Posterior chest and back: 18% Each leg: 18% Perineum: 1% = 100% different in children

Answer 23

CO + Hgb = carboxyhemoglobin → Left shift 200x greater affinity for hemoglobin than O2

Answer 24

100% FiO2 decreases COhb from 4 hours to 60-90min Hyperbaric O2 therapy

Answer 25

Crystalloids should be used in most cases of fluid resuscitation of a burn patient

Answer 26

Tissue edema Hypoprotienemia Compartment syndrome ACS Pleural and pericardial effusions Pulmonary edema Fasciotomies Conversion to partial to full thickness lesions.

Answer 27

singed nasal hairs facial burns dysphonia cough soot in the nose or mouth difficulty swallowing

Answer 28

causing swelling of the airway and obstruction. This is managed by a very low threshold for intubation in order to be proactive in protecting the airway before inflammation and edema set in from the treatment of burns.

Answer 29

myocardial damage muscle damage myoglobin release --> renal failure

Answer 30

Dark pink urine indicated muscles damage IV fluids 2ml/kg/hr + NaHCO3 + mannitol + lasix

Answer 31

histamine: cap permeability--> edema fluid loss Prostaglandins: inflammation, pain, fever. cytokines aka interleukins and TNF: inflammation, SIRS.

Answer 32

Cyanide binds to the terminal cytochrome on the electron transport chain, causing hypoxia, lactic acidosis, and elevated mixed venous oxygen saturation. loss of consciousness, dilated pupils, seizures, hypotension, tachypnea followed by apnea, and increased lactate levels

Answer 33

100% fio2 hydroxocobalamin (B12) amyl nitrite sodium nitrite sodium thiosulfate

Answer 34

International Society for Burn Injuries (ISBI) guidelines recommend maintaining a core temperature of at least 36°C at all times with some burn centers recommending a temperature as high is 38.5 +/- 1C.

Answer 35

keep the OR between 80-100F warmed fluid for IVF and skin preparations HME adapters low gas flows forced-air warming blankets over body heating lamps plastic bags covering burned areas

Answer 36

cardiac arrhythmias increased PVR left shift of hemoglobin-oxygen saturation curve reversible coagulopathy increased post op protein catabolism and stress response altered mental status delayed drug metabolism impaired wound healing increased risk for infection.

Answer 37

deleterious effects of vasoconstriction occur

Answer 38

1.) 2nd degree burn >20% TBSA 2.) 3rd degree burn involving more than 10% TBSA 3.) face, hands, feet, and perineum 4.) inhalation, chemical, or electrical burn 5.) pre-existing medical disorders.

Answer 39

ulcerations of the gastric or duodenal mucosa from gurns that can be prevented by the administration of H2 blockers, PPIs, and antacids.

Answer 40

If endotracheal intubation is not possible due to injury, then a surgical airway such as a tracheotomy is indicated.

Answer 41

To secure the airway a rapid sequence intubation is recommended with the use of succinylcholine in the first 24 hours or the use of a nondepolarizing muscle relaxant such as Rocuronium.