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Advanced Anesthesia > Burns > Flashcards

Burns Flashcards

1
Q

classifications of burns

A

depth
TBSA
presence of inhalation injury

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2
Q

First degree

A

epidermis
no blisters

example: sunburn

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3
Q

superficial second degree

A

epidermis and upper dermis
red
no grafting

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4
Q

deep second degree

A

loss of epidermis and deep dermis
+ grafting
raw blistered weepy skin
blanches
painful

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5
Q

third degree

A

complete destruction of epidermis and deep dermis
+excision and grafting
white, waxy
not painful - nerve damage

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6
Q

fourth

A

complete dermal loss
tendon bone involved
muscle necrosis
limb loss

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7
Q

Major burn definition

A

2nd degree = >25% or >20% TBSA in age extremes

3rd degree= >10% TBSA

Face, Hands, Feet or Perineum

Inhalation, chemical or electrical burns

Burn victim with pre-existing medical disorders

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8
Q

thermal injury <4 y/o

A

scald injury

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9
Q

thermal injury >5

A

flame injury

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10
Q

chemical burn

A

uncommon in children.
tissue destruction until chemical is neutralized.

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11
Q

electrical burn

A

arch / flash

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12
Q

effect of electrical burn on kidneys

A

ATN from myoglobin release form muscle damage

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13
Q

myoglobinuria

A

dark pink urine
IVF 2mg/kg/hr
mannitol
lasix
bicarbonate

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14
Q

Lichtenberg

A

Lightning injury
Extravasation of blood in subcutaneous tissue fades rapidly

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15
Q

Inhalation injury

A

often with thermal burns.
doubles the mortality rate.

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16
Q

carbon monoxide causes what shift in O2 curve

A

left

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17
Q

how to diagnose CO poisioining

A

COhb oximetry

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18
Q

CV symptoms of CO poisioning

A

tachycardia
hypotension

increased CO

dysrthymia
MI

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19
Q

Treatment for CO

A

100% –> 4 hr to 60-90m
hypercarbic o2

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20
Q

classic cherry red color of blood is absent in what patients with COhb unless they have levels above

A

40%.

not a reliable indicator

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21
Q

Cyanide is made from

A

Nitrogenous : wool, silk, cotton, nylon, paper, plastic, polymers

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22
Q

CO is made from

A

carbon containing materials

wood, coal, gas, paper, cotton

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23
Q

colorless, almond smell

A

cyanide

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24
Q

colorless, odorless

A

CO

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25
Q

Why is cyanide lethal

A

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.

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26
Q

presentation of cyanide

A

metabolic acidosis
CV depression
dysrhythmias
increased MvO2

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27
Q

diagnosis of cyanide

A

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

28
Q

treatment of cyanide

A

100% fio2
B12 Hydroxocobalamin
Amyl Nitrite
Sodium Nitrite
Sodium thiosulfate

29
Q

Parkland formula

A

LR 4 mL x kg x TBSA % burn

First half over 8 hours
Second half over 16 hours

30
Q

modified brookes

A

2mg x kg x tbsa x % burn of LR

First half over 8 hours
Second half over 16 hours

31
Q

how quickly to resusitate

A

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

32
Q

criteria for good resus

A

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

33
Q

bad fluid resus

A

increase in hematocrit on 1st day of thermal injury

34
Q

Burn shock patho

A

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.

35
Q

How to protiens move during burn shock?

A

albumin decrease
A1AG increases

36
Q

decreases albumin increases what medications?

A

Benzos
Phenytoin
Salicylic acid

37
Q

a1ag decreases what meds?

A

lidocaine
meperidine
propanolol
muscle relaxants

38
Q

Hyperdynamic/hypermetabolic phase pathophysiology

A

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

39
Q

induction in hyperdynamic burn patients

KOP rocks

A

+ 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.
40
Q

most heat loss in burn patients occurs due to

A

evaporation

41
Q

Effects of hypothermia

A
  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
42
Q

MAC BAR

A

BLOCK ADRENERGIC RESPONSE

43
Q

warmed topical

A

90 mg of Epinephrine in 1000 cc NSS Achieves Stasis

Tachycardia w/ epi:
Avoid this through MAC BAR

44
Q

How Much Epinephrine is in One Bulb Syringe?

A

5mg ???

90mg per 1000cc
bulb syring is 60 cc

45
Q

Blood replacement

A

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

46
Q

What are the rule of 9s?

A

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

different in children

47
Q

What is the pathophysiology of carbon monoxide poisoning?

A

CO + Hgb = carboxyhemoglobin
→ Left shift

200x greater affinity for hemoglobin than O2

48
Q

how is CO poisioning treated?

A

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

49
Q

What fluid should be used for fluid resuscitation of a burn patient?

A

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

50
Q

what are the possible complications of fluid resuscitation?

A

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

51
Q

What is smoke inhalation injury?

A

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

52
Q

what are the implications of inhalation injury

A

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.

53
Q

What complications are associated with electrical burns?

A

myocardial damage
muscle damage
myoglobin release –> renal failure

54
Q

myoglobinuria

A

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

55
Q

What pathophysiologic changes accompany major thermal injury?

A
56
Q

Name some of the known mediators released with thermal injury. What are the responses to those mediators?

A

histamine: cap permeability–> edema fluid loss

Prostaglandins: inflammation, pain, fever.

cytokines aka interleukins and TNF: inflammation, SIRS.

57
Q

what is cyanide poisioning?

A

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

58
Q

How is cyanide poisoning treated?

A

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

59
Q

What is normothermia for a burned patient?

A

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.

60
Q

How is temperature best maintained?

A

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

61
Q

What derangements occur with hypothermia?

A

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.

62
Q

why are we concerned about hypothermia in burn patients?

A

deleterious effects of vasoconstriction occur

63
Q

what is the definition of major burn?

A

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.

64
Q

What are Curling ulcers? How can they be prevented?

A

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

65
Q

What techniques may be used to secure the airway for airway management of burn patients?

A

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

66
Q

Is succinylcholine acceptable for a rapid-sequence intubation?

A

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.

Advanced Anesthesia (8 decks)

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