Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Advance principles I, Exam 2 > Burns > Flashcards

Burns Flashcards

0
Q

ABA grading system
Moderate burn

What type of burn?

A
  1. 10-20% adults
  2. 5-10% young or old
  3. 2-5% full thickness burn

High voltage injury, suspect inhalation injury, circumferential burn, medical problems DM, sickle cell
Admit to hospital

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
1
Q

ABA grading system

Minor burn

A
  1. <2% full thickness

Outpatient

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

ABA grading system

  • Major burn numbers
  • injuries
A
  1. > 20% adults
  2. > 10% young or old
  3. > 5% fu thickness burn
    High voltage, known inhalation, significant burn to face, etc plus significant injury, fracture etc
    BURN CENTER
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Can u use sux?

A

If <24 hrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q 
Fiberoptic findings in inhalation injury
0
B
1
2
3
A

Grade. Findings. Mortality
0. N. 0
B. + on biopsy. 0
1. Hyperemia. 2
2. Severe edema/hypercapnia 15
3. Severe inj:ulcer/necrosis. 62

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

CO poisoning

A
  • Closed space
  • 200x greater affinity for Hgb than O2
  • CO=metabolic acidosis at cellular level
  • Shifts oxyHg curve to LEFT/incre O2 tissue
  • pulse Ox cannot detect CO Hgb
  • need CO-oximeter to detect COHgb
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

CO t1/2 & tx

A
  • 100% O2: CO t1/2=26-148 minutes
  • Rx until CO Hgb levels 25%

Normal CO 0-10 smokers 10%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Hydrogen cyanide poisoning

  • What happens
  • S/S
  • Rx
A
  • plastic stuff, foam, paints, wool, silk
  • produces hypoxia: blocks intercellular O2
  • t1/2 = 1 hr
  • s/s: decrease: LOC, B/P, RR - apnea, seizures
  • Rx: hydroxicobalamin ( Vit B12a) 50mg/kg
  • rapid Onset, good safety profile
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is t 1/2 for HCP and for CO?

A

HCN t1/2=1hr

CO t1/2. = 26-148 min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Fluid resuscitation

A

Adults:
LR 2-4ml x kg x %TBSA burned

Children:
LR 3-4ml x kg x %TBSA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Minimal URINE output for burn patients

A

Adults:
0.5-1.0 ml/kg/hr
Children <30kg
1ml/kg/hr

Patients w/high-voltage electrical injuries: 1-1.5ml/kg/hr

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What fluids to use during for resuscitation for burn patients?

First 24 hrs and after

A

LR first 24 hrs, 1/2 in first 8 hrs and 1/2 in next 16 hrs
D5W second 24 hrs
Colloid 0.5 ml/% burn per kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What r the consequences of fluid creep?

A
  • tissue edema & hypoproteinemia
  • abd compartment syndrome
  • pleural effusion/pul edema
  • fasciotomies
  • conversion of partial to full thickness lesions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Criteria for adequate fluid resuscitation

A
  • B/P WNL
  • UO 1-2ml/kg/hr
  • blood lactate 7.32
  • CVP
  • CI 4.5L/min/m2
  • O2 delivery index 600ml/min/m2
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Rx for hyper metabolic phase

A

Early wound excision/grafting & prevention of sepsis

Remember: Lasts 24 hrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Hyper metabolic phase

Effects/s&s

A
  • TBSA >40% phase will last 1-2 yrs
  • multi organ dysfxn
  • decrease muscle protein
  • 10-15 inc in catecholamines/corticosteroids - 9 months post burn
  • incre: cardiac work, MvO2, HR
  • lipolysis, liver dysfxn, muscle catabolism
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is metabolic phase

A

After 48 hrs & involves increased blood flow to organs & tissues

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

When is hyper dynamic state

A

After 24-36 hrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Main CV points

A
  1. Increased vascular permeability
  2. Decrease reduced plasma volume
  3. Decrease of CO initially
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

When does burn shock happens?

S/S of burn shock

A

0-48 hrs

  • Hypovolemia is a major concern
  • Fluid resuscitation is mandatory
  • Impaired cardiac contractility
  • Initial myocardial depression
  • Decreased cardiac output
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

First 24-48 hrs CV effects

A
  • vascular permeability
  • plasma volume is reduced
  • CO initially decreases
  • fluid resuscitation
  • decreased RBC survival time
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Why u give fluids

A
  • Flush blood stream
  • Maintain intravascular volume & CO
  • Maintain perfusion to vital organs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What % leads to loss of micro vascular integrity?

Increased vascular permeability

A

> 30% TBSA

  • Protein rich fluids leaks from capillary beds to interstitial spaces= peripheral edema
  • colloids also leak out NO albumin
  • altered cell membrane — swelling tongue, lips= airway edema/obstruction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Increase viscosity from:

A

Increase:

  • Hct
  • myoglobin release damaged tissue
  • de-natured RBCs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Why CO is decreased initially?

A
  • decreased blood volume

- decreased contractility from myocardial depressing factor ( released due to tissue damage)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Pulmonary

Early 0-24 hrs S/S

A

CO poisoning/inhalation can lead to airway obstruction & pul edema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Pulmonary

2-5 days

A

ARDS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Pulmonary LATE

Days and weeks

A

Pneumonia, atelectasis, pul emboli

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What r the 2 most common complications?

A

Pneumonia and respiratory failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What r the vent settings?

A

Vt = <31 cmH2O

30
Q

What is the gold standard in diagnosing inhalation injury?

31
Q

Immunologic complications

A

–Infection mortality/morbidity
100% children 75% adults
– gram + organisms responsible

32
Q

Glucose level r increased & pts are susceptible to ……

A

Non-ketotic hyperosmolar coma

33
Q

What happens when ADH is released?

A

Na & H2O retention

Loss of Ca, K, Mg

34
Q

What % ARF & what is the mortality rate?

A

ARF = 0.5-38%

Mortality rate = 77% - 100%

35
Q

Gold standard for assessing UofD replacement

A

Hourly Urine output

36
Q

Rx of myoglobinuria

A
  • –vigorous fluids till UO=2ml/kg/hr
  • –NaHCO3 alkinize urine, may reduce pigment ass renal failure
  • –osmotic diuretics mannitol rare
37
Q

Why hepatic hypoperfusion?

A
  • —Decrease CO
  • —Increase blood viscosity
  • —Splanchnic vasoconstriction (circulating and going to gut)
38
Q

What can Ketamine do?

Hepatic relation

A

Hypotension due to

  • habituation (tolerance)
  • hypercatabolism (excessive breakdown of body tissue)
  • hypovolemia
  • depleted catecholamines
39
Q

What meds can cause hypotension

A 
All in acute phase due to hypovolemia 
Propofol, 
Etomidate,
Thiopental,
VA
40
Q

Hematologic comications

A
  • -anemia, erythrocytes damaged
  • -infection- activation of coagulation cascade
  • -Coagulopathy: consumption of procoagulents
  • -decrease platelet fxn both quant/qualitative
  • -anti thrombin deficiency can be seen
41
Q

What happens after 48hrs to albumin bound drugs?

A

Cause of decrease of albumin, albumin bound drugs (bdz & anti seizure) have a greater free fraction & thus s prolonged effect

Opioids requirements will increase due to habituation & hypercatabolism

42
Q

What are the goals of early excision?

A
  • Rapidly restore skin integrity
  • Early removal/excision w/rapid closure
  • Protection from bacteria, trauma, H2O loss
  • multiple procedures
43
Q

Surgical endpoints

A

20% excision
2-3 hrs
10 units PRBC

44
Q

Decompression procedures

A

Escharotomy

Fasciotomy

45
Q

What r supportive surgical procedures?

A
  • Trach,
  • gastrostomy,
  • chole,
  • bronch,
  • vascular access
46
Q

Pre op anesthesia planning

A
  • OR room 95% not more
  • blood
  • IV access/warmers
  • narcotic/muscle relaxants
47
Q

What is the MUST monitor in OR?

A

Temp: foley or esophageal

48
Q

Anesthetic management

What to use/not

A
  • NO SUX after 24 hrs
  • propofol OK if stable
  • Ketamine OK if unstable
  • etomidate, opioids, VA= OK

Resistant to NDMR – cholinergic receptor damage

49
Q

Pulmonary

Early 0-24 hrs S/S

A

CO poisoning/inhalation can lead to airway obstruction & pul edema

50
Q

Pulmonary

2-5 days

51
Q

Pulmonary LATE

Days and weeks

A

Pneumonia, atelectasis, pul emboli

52
Q

What r the 2 most common complications?

A

Pneumonia and respiratory failure

53
Q

What r the vent settings?

A

Vt = <31 cmH2O

54
Q

What is the gold standard in diagnosing inhalation injury?

55
Q

Immunologic complications

A

–Infection mortality/morbidity
100% children 75% adults
– gram + organisms responsible

56
Q

Glucose level r increased & pts are susceptible to ……

A

Non-ketotic hyperosmolar coma

57
Q

What happens when ADH is released?

A

Na & H2O retention

Loss of Ca, K, Mg

58
Q

What % ARF & what is the mortality rate?

A

ARF = 0.5-38%

Mortality rate = 77% - 100%

59
Q

Gold standard for assessing UofD replacement

A

Hourly Urine output

60
Q

Rx of myoglobinuria

A
  • –vigorous fluids till UO=2ml/kg/hr
  • –NaHCO3 alkinize urine, may reduce pigment ass renal failure
  • –osmotic diuretics mannitol rare
61
Q

Why hepatic hypoperfusion?

A
  • —Decrease CO
  • —Increase blood viscosity
  • —Splanchnic vasoconstriction (circulating and going to gut)
62
Q

What can Ketamine do?

Hepatic relation

A

Hypotension due to

  • habituation (tolerance)
  • hypercatabolism (excessive breakdown of body tissue)
  • hypovolemia
  • depleted catecholamines
63
Q

What meds can cause hypotension

A 
All in acute phase due to hypovolemia 
Propofol, 
Etomidate,
Thiopental,
VA
64
Q

Hematologic comications

A
  • -anemia, erythrocytes damaged
  • -infection- activation of coagulation cascade
  • -Coagulopathy: consumption of procoagulents
  • -decrease platelet fxn both quant/qualitative
  • -anti thrombin deficiency can be seen
65
Q

What happens after 48hrs to albumin bound drugs?

A

Cause of decrease of albumin, albumin bound drugs (bdz & anti seizure) have a greater free fraction & thus s prolonged effect

Opioids requirements will increase due to habituation & hypercatabolism

66
Q

What are the goals of early excision?

A
  • Rapidly restore skin integrity
  • Early removal/excision w/rapid closure
  • Protection from bacteria, trauma, H2O loss
  • multiple procedures
67
Q

Surgical endpoints

A

20% excision
2-3 hrs
10 units PRBC

68
Q

Decompression procedures

A

Escharotomy

Fasciotomy

69
Q

What r supportive surgical procedures?

A
  • Trach,
  • gastrostomy,
  • chole,
  • bronch,
  • vascular access
70
Q

Pre op anesthesia planning

A
  • OR room 95% not more
  • blood
  • IV access/warmers
  • narcotic/muscle relaxants
71
Q

What is the MUST monitor in OR?

A

Temp: foley or esophageal

72
Q

Anesthetic management

What to use/not

A
  • NO SUX after 24 hrs
  • propofol OK if stable
  • Ketamine OK if unstable
  • etomidate, opioids, VA= OK

Resistant to NDMR – cholinergic receptor damage

Advance principles I, Exam 2 (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions