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Big Blue Topics > Burns > Flashcards

Burns Flashcards

1
Q

Etomidate and burns

A
  • causes adrenocortical suppression (inhibits cholesterol conversion to cortisol)
  • occurs with repeated administrations
  • riskier in pts who are stressed: sepsis, hemorrhage, burn injury
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2
Q

succinylcholine and burns

A
  • causes massive hyperkalemia as denervated muscle membrane acts like a large receptor in its chemical sensitivity to succinylcholine
  • sensitivity will develop within days, and lasts for several months
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3
Q

First Degree Burn

A

epidermal injury (sunburn)

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4
Q

Second Degree Burn

A

Into the dermis

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5
Q

Third Degree Burn

A
  • full thickness burn involving destruction of the epidermis and dermis
  • spontaneous regeneration not possible
  • graft usually required
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6
Q

Rule of nines: Adult

A

9% head, each arm
18% each leg
36% trunk (18% anterior, 18% posterior)

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7
Q

1 year old

A

19% head
9.5% each arm
15% each leg
32% trunk

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8
Q

Pathophys: circulation

A
  • cardiac output falls (due to dec intravascular volume–>dec preload)
  • patients hyperdynamic by 2nd post-burn day, lasts 3-4 weeks
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9
Q

pathophys: respiratory

Upper airway obstruction

A
  • secondary to swelling
  • secure airway before intubation more difficult
  • except for steam inhalation injury, direct thermal injury to airways doesn’t occur below level of vocal cords b/c of efficiency of cooling in upper airways
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10
Q

pathophys: respiratory

chemical pneumonitis

A
  • due to smoke inhalation
  • increased pulmonary shunting and hypoxia
  • FRC and pulmonary compliance are decreased with increase in A-a gradient (FRC decreased below closing capacity)
  • minute ventilation increases dramatically
  • often no physical signs during first 24 hrs post-burn–singed nasal hair, burned nasal or oral mucosa
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11
Q

pathophys: intravascular volume deficits

A
  • vasculature permeable to plasma proteins, and these leave vascular space and exert osmotic pressure–>large fluid losses
  • colloids should not be given
  • Parkland formula: crystalloid 4 cc/kg/% burned in first 24 hrs, 1/2 first 8 hrs, 1/4 second 8 hrs, 1/4 thrid 8 hrs
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12
Q

pathopys: GI tract

A
  • adynamic ileus in burns >20% body surface area
  • curling’s ulcer: acute ulceration in stomach=GI hemorrhage
  • metabolic rate can more than double
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13
Q

pathophys: renal

A
  • dec in CO and intravascular fluid volume–>Dec in GFR
  • red cell destruction–>myoglobinuria and hemoglobinuria
  • need to maintain UOP, fluids, mannitol, lasix, PA cath
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14
Q

pathophys: sepsis

A
  • superficial infxn of burned area–delays wound healing, septic shock
  • beta-hemolytic strep/staph GN contaminate wound–rx w/ silver nitrate
  • silver nitrate can produce methemoglobinemia
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15
Q

pathophys: DIC

A

DIC, hypothermia

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16
Q

Ketamine

A
  • for dressing changes

- 2 mg/kg IV, 4 mg/kg IM

17
Q

ketamine: advantages

A
  • analgesia and dissociation
  • sympathetic stimulation
  • minimal respiratory depression
18
Q

ketamine: disadvantages

A
  • psychic effects

- excessive salivation–can cause laryngospasm

19
Q

nondepolarizers

A
  • more resistant to nondepolarizers
  • pseudocholinesterase levels are dec 5-6 days after burn injury and level can be depressed several months
  • inc number extrajunctional receptors
  • pts with >25% total body area burned require NM blocker 3-5 x greater than nl
20
Q

depolarizers

A
  • more sensitive to succs

- dec level pseudocholinesterase

21
Q

electrical burns

A
  • small areas of skin necrosis, large amt of muscle damage
  • huge fluid losses
  • kidney at risk–large amt of myoglobin released–give IVFs, mannitol, lasix
  • cardiac conduction abnormalities
22
Q

carboxyhemoglobin

A
  • binding of hemoglobin to CO–binds at the same point as O2 therefore competes with O2
  • CO 250 times stronger binding than oxygen
  • CO partial pressure 0.4 mmHg equivalent to PaO2 of 95-100 (binds 50% hemoglobin)
  • CO partial pressure of 0.7 mmHG will bind all available Hg
23
Q

amt of CO in people

A
  • nonsmokers: 1-3% from auto emissions
  • smokers: 4-8%
  • fire victims: 100%
  • carboxyhemoglobin levels depends on how
24
Q

PaO2

A
  • measure of dissolved O2 in blood
  • can be nl in setting of carboxyhemoglobinemia
  • chemoreceptors are not stimulated because PaO2 remains normal
25
Q

rx CO

A

-high partial pressures of O2, hyperbaric

26
Q

airway management in burns

A
  • cooling of upper airway protects subglottic structures
  • with thermal injury, this can be lost–edema of hypopharynx
  • intubate if: inhaled steam, smoke, toxic fumes, hoarseness/stridor, face burned
  • edema worsened by IVFs
  • emergent trach in burn pt has high mortality
27
Q

toxic fumes

A
  • fluorides, bromides, iodides can deminish cough reflex, have anesthetic properties
  • local tissues rxn–inflammation, retained secretions, bronchspasm

Big Blue Topics (25 decks)

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