Burns (Cornelius) Exam 1 Flashcards

Question 1

Q

The types of burns include heat, electrical, friction, chemical, and ________.

A) Frostbite
B) Radiation
C) Fever
D) Hotsauce

Answer

A

B) Radiation

Cornelius - “a lot of times we think of the heat as being the devastating part of it an injury but in reality it’s usually the toxic exposures to things that aren’t supposed to burn, so keep that in the back of your mind”

Slide 2

Question 2

Q

Which of the following is NOT a factor related to the depth of thermal injury?

A) Contact temperature
B) Duration of contact
C) Thickness of skin
D) Amount of burned tissue

Answer

A

D) Amount of burned tissue

Cornelius “thermal injury depth is in reference to the temperature, things that are very hot or very cold ultimately will result in more thermal injury.”

Slide 3

Question 3

Q

True or False

The longer contact with heat is generally better than short contact with heat for severity of injury

Answer

A

False

Cornelius - How long they were in contact with it… shorter contact is generally better than longer contact

…except in electrical injuries, can be thrown from impact or fall

Slide 3

Question 4

Q

Heat burns usually involve which layers of the skin?

A) Epidermis and dermis
B) Epidermis and subcutaneous tissue
C) Dermis and muscle
D) Epidermis and hypodermis

Answer

A

A) Epidermis and dermis

Cornelius - Remember..on the surface, they may not have any sort of burns, but because of that toxic exposure, they may actually be in cardiac arrest or already dead. ☠️

Slide 3

Question 5

Q

Which of the following areas are more likely to experience severe burn injuries due to thinner skin?

A) Face, genitals, joints, hands
B) Back, chest, abdomen, hands
C) Joints, upper arms, calves, face
D) Scalp, elbows, heels, genitals

Answer

A

A) Face, genitals, joints, hands

Cornelius -critical areas where the skin tends to be a little bit thinner. So think about the face…genitals..,joints…hands. …they have higher incidence of severity as far as burn injury

Slide 3

Question 6

Q

Which of the following are common examples of causes of heat burns? (Select 4)
A) Hot liquid
B) Lightening
C) Steam
D) Cold air
E) Hot solid
F) Sunburns
G) Flame

Answer

A

A) Hot liquid
C) Steam
E) Hot solid
G) Flame

Slide 3

Question 7

Q

Energy transformed to heat when current passes through body tissue is classified as what type of burn?
A) Friction
B) Thermal
C) Electrical
D) Chemical

Answer

A

C) Electrical Burn

Cornelius - *this is one of the more devastating injuries we see…you’ve turned your body into a conduction pathway for the electricity. *

Slide 4

Question 8

Q

What are the most common ways we see electrical burns? Select 2
A) Lightening strikes
B) Forks in outlets
C) Fingers in outlets
D) Power lines

Answer

A

A) Lightening strikes
D) Power lines

Cornelius - *more either lightning or high tension power lines. Linemen, the guys that go out and put up power lines, have seen multiple significant injuries from them. *

Slide 4

Question 9

Q

Electrical burns can disrupt ___________ potential in the body’s cells, leading to significant cellular damage.

A) Membrane
B) Action
C) Electrical
D) Resting

Answer

A

A) Membrane

Slide 4

Question 10

Q

The magnitude of an electrical burn injury is dependent on the pathway, resistance, ___________ and the ___________ of current flow.

A) Voltage; duration
B) Strength; duration
C) Duration; frequency
D) Type; frequency

Answer

A

B) Strength; duration

Slide 4

Question 11

Q

Electrical injuries are particularly dangerous due to the potential for ___________.

A) Myocardial infarction
B) Ventricular fibrillation
C) Atrial fibrillation
D) Cardiac tamponade

Answer

A

B) Ventricular fibrillation

Cornelius - …it’s really important for them to get defibrillated very quickly

Slide 4

Question 12

Q

True or False

Electrical burns travel from the point of contact to the point of ground, so from the arms/head all the way down to the feet.

Answer

A

True

Slide 4

Question 13

Q

Why might DC (Direct Current) injuries result in more severe burns compared to AC (Alternating Current) injuries?

A) DC injuries involve higher voltages
B) DC injuries involve longer contact time
C) DC injuries involve shorter contact time
D) DC current is more common in households

Answer

A

B) DC injuries typically involve longer contact time with the source

Cornelius - DC injuries are generally a little bit worse than AC injuries.

Most of our houses just have AC that we have access to. DC injuries, they tend to stay in contact with the source longer.

Slide 4

Question 14

Q

Friction burns occur as a result of ___________ and the heat generated by the friction.

A) Chemical reactions
B) Mechanical disruption
C) Electrical conduction
D) Radiant energy

Answer

A

B) Mechanical disruption

Cornelius-ropes being wrapped around arms, legs or like I said if you go back to when you were a kid and you went and like rubbed your sibling’s arm

Slide 5

Question 15

Q

Which of the following mechanisms is NOT typically involved in the injury pattern of chemical burns?

A) pH alteration
B) Disruption of cell membranes
C) Radiation damage
D) Direct toxic effect on metabolic processes

Answer

A

C) Radiation damage

Cornelius - Widespread burn from liquids/powders primarily… sometimes aersol. Weird injury patterns from splash

Slide 6

Question 16

Q

The magnitude of a chemical burn injury is influenced by both the duration of exposure and the ___________ of the chemical agent.

A) Temperature
B) Nature
C) Volume
D) Color

Answer

A

B) Nature - Acid vs. Alkali

Cornelius - the magnitude of the injury is really related to the duration of the exposure, so think to think about how quickly you can decontaminate people.

Slide 6

Question 17

Q

The nature of the chemical burn caused by alkali substances typically result in ___________ necrosis.

A) Coagulation
B) Liquefaction
C) Fat
D) Caseous

Answer

A

B) Liquefaction

Slide 6

Question 18

Q

The nature of the chemical burn caused by acid substances typically result in ___________ necrosis.

A) Coagulation
B) Liquefaction
C) Fat
D) Caseous

Answer

A

A) Coagulation

Slide 6

Question 19

Q

True or False

Dilution of the chemical toxin with water is probably your best approach to decontamination.

Answer

A

True

Cornelius - …you can decontaminate people…by removing clothing, and then commonly we’ll use water to irrigate. Dilution of the toxin is probably your best approach to decontamination, getting them out of the environment as well, especially if it’s something that could be caustic and prolonging the exposure

Slide 6

Question 20

Q

What is the primary cause of tissue damage in radiation burns?

A) Mechanical disruption
B) Chemical reactions
C) Ionization
D) Thermal conduction

Answer

A

C) Ionization

Slide 7

Question 21

Q

The magnitude of radiation burns is most dependent on which of the following factors? Select 2

A) The amount of particles
B) The types of electric charge
C) The hydration level of the skin
D) The types of particles
E) The dose and time of exposure

Answer

A

D) The types of particles
E) The dose and time of exposure

Slide 7

Question 22

Q

Which of the following is a common long-term effect of radiation exposure in healthcare workers?

A) Skin cancer
B) Cataracts
C) Hypertension
D) Diabetes

Answer

A

B) Cataracts

Cornelius - an increased incidence of cataracts, some degree of neuropathy in fingers and toes especially like people that work in interventional radiology, cath lab, those sorts of things do lots of orthopedic procedures.

Slide 7

Question 23

Q

Which of the following are common examples of situations that can lead to radiation burns? (Select 4)

A) Sunburns
B) Exposure to therapeutic radiation
C) Diagnostic medical procedures
D) Wearing lead gloves
E) Working in the nuclear industry
F) Exposure to battery fluid

Answer

A

A) Sunburns
B) Exposure to therapeutic radiation
C) Diagnostic medical procedures
E) Working in the nuclear industry

Slide 7

Question 24

Q

Why is the classification of burn depth important in the treatment of burn injuries?

A) It determines the risk of infection
B) Helps with assessing the need for surgical grafting
C) Influences the choice of antibiotics
D) It decides the type of pain management required

Answer

A

B) It helps in assessing the need for surgical grafting

and determining healing potential

Slide 8

Question 25

Q

What is the typical time frame for burns, such as sunburns, to fully declare themselves?

A) 6 to 12 hours
B) 12 to 24 hours
C) 24 to 72 hours
D) Immediately

Answer

A

C) 24 to 72 hours

Cornelius - Burn injuries, they’re not going to magically get better over a day or two. They’re only going to get worse

Slide 8

Question 26

Q

In burn injuries, where are the higher degree burns typically located?

A) On the fringes of the burn area
B) In the center of the burn area
C) Evenly distributed throughout the burn area
D) Only on the surface layer of the skin

Answer

A

B) In the center of the burn area

Cornelius - *we don’t have uniformity as burns are applied, whether it’s a chemical burn or an electrical burn or thermal. It’s not just a magic chunk of tissue that is all going to be third degree. *

Slide 8

Question 27

Q

True or False

We include superficial or first degree burns in our total burn surface area (TBSA).

Answer

A

False

Cornelius - We don’t include superficial or first degree burns in our total burn surface area.
We really only talk about second degree or third degree burns

Slide 8

Question 28

Q

Which population is more likely to experience deeper burns due to thinner skin? (select 2)

A) Adults <55
B) Adults >55
C) Children <5
D) Children >5

Answer

A

B) Adults >55
C) Children <5

Cornelius - You may also notice that older people… patients or kids have deeper burns because they also have a little bit thinner skin. The good news for the kids is they generally have a little bit more adipose tissue underlying the skin.

Slide 8

Question 29

Q

Which layer of the skin is affected by a superficial (1st-degree) burn?

A) Dermis
B) Subcutaneous tissue
C) Epidermis
D) Muscle

Answer

A

C) Epidermis

Slide 9

Question 30

Q

What is a common characteristic of a superficial (1st-degree) burn?

A) Presence of blisters
B) Skin is intact and red in color
C) Deep tissue damage
D) Loss of sensation

Answer

A

B) Skin is intact and red in color

Slide 9

Question 31

Q

How long does it typically take for a superficial (1st-degree) burn to heal?

A) 1-2 days
B) 3-6 days
C) 7-10 days
D) Over 2 weeks

Answer

A

B) 3-6 days

Slide 9

Question 32

Q

Which of the following are true characteristics of a superficial (1st-degree) burn? (Select 2)

A) Involves only the dermis
B) Skin is broken and red in color
C) Surface is dry with no blisters
D) Extremely painful

Answer

A

C) Surface is dry with no blisters
D) Extremely painful and hypersensitive

Cornelius - If you touch a first -degree burn, it’s very painful. If they get in the shower, especially if there’s an exposure to kind of extremes of temperature, either very hot water or very cold, it’s very sensitive to them

Slide 9

Question 33

Q

Which layers of the skin are affected by a superficial partial thickness (2nd-degree) burn?

A) Epidermis only
B) Epidermis and part of the dermis
C) Dermis and subcutaneous tissue
D) Subcutaneous tissue and muscle

Answer

A

B) Epidermis and part of the dermis

Cornelius - a very painful burn with exposed nerve endings.

Slide 10

Question 34

Q

What is a common appearance of a superficial partial thickness (2nd-degree) burn?

A) Dry and red
B) Mottled red color with blisters
C) White and leathery
D) Charred and blackened

Answer

A

B) Mottled red color with blisters or weeping

Slide 10

Question 35

Q

How long does it typically take for a superficial partial thickness (2nd-degree) burn to heal?

A) 3-6 days
B) 7-9 days
C) 10-14 days
D) 15-20 days

Answer

A

C) 10-14 days
* Minimal scarring*

Cornelius -*But it also depends on how severe and how much of an area you have if you have widespread partial superficial partial thickness burns *

Slide 10

Question 36

Q

Which layer of the skin is primarily affected by a deep partial thickness (2nd-degree) burn?

A) Epidermis only
B) Epidermis and superficial dermis
C) Extends more deeply into the dermis
D) Subcutaneous tissue

Answer

A

C) Extends more deeply into the dermis

Cornelius - good news is these tend to be a little bit less painful because the nerve endings may have already been damaged.

Slide 12

Question 37

Q

What is a characteristic appearance of a deep partial thickness (2nd-degree) burn? Select 2

A) Mottled red color with blisters
B) Pale in color
C) Charred and blackened
D) Dry and intact
E) Decreased moisture

Answer

A

B) Pale in color with decreased moisture
E) Decreased moisture (due to damaged sweat glands)

Cornelius - There’s decreased perfusion to the superficial area, so you may notice that they have no blanching or kind of an absent capillary refill there.

Slide 12

Question 38

Q

Which of the following are true characteristics of deep partial thickness (2nd-degree) burns? (Select 2)

A) Extends deeply into the fat
B) Mottled in color
C) Requires skin grafting
D) Blanching is absent or prolonged
E) Heals in 10-14 days

Answer

A

C) Requires skin grafting for healing,
D) Blanching is absent or prolonged

Cornelius called the pic on the left “non -accidental trauma.” Sticking the hand intentionally in a hot substance. The picture on the right is irregular pattern and likely from a fry cook splashing hot oil on his hands

Slide 12

Question 39

Q

Healing time for a deep partial thickness (2nd-degree) burn is generally ___________ days, and it may require skin grafting.

A) 10-14
B) 15-20
C) 21-28
D) 30-40

Answer

A

C) 21-28

Slide 12

Question 40

Q

Which layers of the skin are affected by a full thickness (3rd-degree) burn?

A) Epidermis only
B) Epidermis and part of the dermis
C) Extends through the entire dermis
D) Subcutaneous tissue and muscle only

Answer

A

C) Extends through the entire dermis

Dermis has been destroyed

Slide 14

Question 41

Q

What is a characteristic appearance of a full thickness (3rd-degree) burn?

A) Mottled red color, dry with blisters
B) Translucent, dry, painless, charred
C) Red, dry, and inflamed with pain
D) Moist, red with oozing fluid

Answer

A

B) Translucent, dry, painless, charred

Cornelius - even though the primary wound itself is not very painful, as you get a little bit further out, they’re still going to have pain there

Slide 14

Question 42

Q

True or False

At the center of a Full Thickness (3rd Degree Burn), there will be no cap-refill, they require grafting and sometimes amputation.

Answer

A

True - non-blanching

Cornelius - There’s no cap refill there. It’s kind of hard to tell whether it’s a second degree or a third degree. But if it’s second degree, it’s only going to get worse over time

Slide 14

Question 43

Q

Which of the following are true statements about the process of escharotomy in patients with thermal injuries? (Select 2)

A) There is minimal bleeding due to the coagulation of blood vessels by the burn.
B) Fluid loss does not occur during an escharotomy
C) Bleeding is a sign of reaching non-viable tissue
D) Significant blood loss is expected throughout the whole procedure.
E) Fluid loss may still occur even if there is minimal active bleeding.

Answer

A

A) There is minimal bleeding due to the coagulation of blood vessels by the burn

E) Fluid loss may still occur even if there is minimal active bleeding.

Cornelius - when we start getting to healthy tissue that’s bleeding and viable, that’s kind of a sign for us to stop

Slide 15

Question 44

Q

Which of the following characteristics describe a superficial (1st-degree) burn? (Select 3)

A) Red appearance
B) Pearly white, charred appearance
C) Dry or very small blisters on the surface
D) Very painful
E) Painful sensation
F) Involves the entire dermis

Answer

A

A) Red appearance
C) Dry or very small blisters on the surface
E) Painful sensation

Not calculated in
TBSA

Slide 16

Question 45

Q

Which of the following characteristics describe a partial thickness (2nd-degree) burn? (Select 2)

A) Pink or mottled red appearance, may be white
B) Pearly white, charred appearance
C) Bullae or moist, weeping surface
D) Insensate surface
F) Dry and inelastic

Answer

A

A) Pink or mottled red appearance, may be white
C) Bullae or moist, weeping surface

Slide 16

Question 46

Q

True or False

Partial Thickness (2nd Degree Burn) burns are very painful in sensation.

Answer

A

True

Slide 16

Question 47

Q

Which of the following characteristics describe a full thickness (3rd-degree) burn? (Select 3)

A) Red appearance
B) Pearly white, charred, translucent
C) Dry and inelastic surface
D) Very painful
E) Insensate surface
F) Involves only the epidermis

Answer

A

B) Pearly white, charred, translucent, or parchment-like appearance
C) Dry and inelastic surface
E) Insensate surface

Any significant burn will require skin grafting

Slide 16

Question 48

Q

According to the Rule of Nines, what percentage of Total Body Surface Area (TBSA) is assigned to each leg?

A) 19%
B) 18%
C) 13%
D) 13.5%

Answer

A

B) 18%

Each leg is 18 percent, nine front, nine back.

Slide 17

Question 49

Q

Which area is assigned 1% of TBSA according to the Rule of Nines?

A) Buttocks
B) Anus
C) Groin
D) Perineum
E) Penis
F) Pannus

Answer

A

D) Perineum

The critical one percent

Slide 17

Question 50

Q

The Rule of Nines assigns a total ___________ of TBSA to each adult arm.

A) 18%
B) 9%
C) 1%
D) 4.5%

Answer

A

B) 9%

4.5% front of arm + 4.5% back of arm

Slide 17

Question 51

Q

The anterior and posterior trunk each account for ___________ of TBSA according to the Rule of Nines.

A) 19%
B) 18%
C) 21%
D) 18.5%

Answer

A

B) 18%

Slide 17

Question 52

Q

The adult head accounts for ___________ of TBSA according to the Rule of Nines.

A) 9%
B) 18%
C) 13.5%
D) 21%

Answer

A

A) 9%

Slide 17

Question 53

Q

According to the TBSA percentages for an infant, what percentage is assigned to the head and neck?

A) 13.5%
B) 10%
C) 21%
D) 18%

Answer

A

Answer: C) 21%

Cornelius - going from the adult patient to the pediatric patient, the head tends to be disproportionately larger, so they tend to get a little bit more credit for that

Select 18

Question 54

Q

What percentage of TBSA is assigned to each leg in an infant?

A) 18%
B) 21%
C) 13.5%
D) 13%

Answer

A

C) 13.5%

Slide 18

Question 55

Q

The combined TBSA percentage for the abdomen and back in an infant is ___________.

A) 13%
B) 18%
C) 26%
D) 36%

Answer

A

C) 26%

13% for abdomen and 13% for back

Slide 18

Question 56

Q

Which body part has the smallest TBSA percentage in an infant according to the image?

A) Buttocks
B) Genital area
C) Each arm
D) Back

Answer

A

B) Genital area 1%

Slide 18

Question 57

Q

The TBSA percentage for each arm in an infant is ___________.

A) 21%
B) 10%
C) 13%
D) 13.5%

Answer

A

B) 10%

Slide 18

Question 58

Q

The TBSA percentage for the buttocks in an infant is ___________.
A) 5%
B) 8%
C) 10%
D) 13%

Answer

A

A) 5%

Slide 18

Question 59

Q

According to the Palmer Method, the area of the patient’s palm with fingers together represents what percentage of Total Body Surface Area (TBSA)?

A) 5%
B) 10%
C) 1%
D) 15%

Answer

A

C) 1%

Cornelius - it’s just kind of an estimate when you’re trying to figure out the burned area, but this is a little more specific, especially if you have irregular areas and you’re trying to be a little bit more detailed

Slide 19

Question 60

Q

True or False

Larger burn surface areas are often overestimated when calculating TBSA.

Answer

A

False. They are underestimated

Cornelius - we tend to underestimate larger burned surface areas. Part of that we are not really sure how badly burned they are for a couple of days…if you think you’ve got somebody that’s approaching burn center criteria, go ahead and round it up.

Slide 20

Question 61

Q

In obese individuals, burn estimation may ___________ torso burns while ___________ extremity burns.

A) Overestimate, underestimate
B) Accurately assess, underestimate
C) Ignore, overestimate
D) Underestimate, overestimate

Answer

A

D) Underestimate, overestimate

Slide 20

Question 62

Q

In women with large breasts (cup size D or larger), the ___________ surface area is larger, affecting burn estimation.

A) Abdominal
B) Chest
C) Extremity
D) Back

Answer

A

B) Chest
Cornelius - someone with large breasts, they may have a larger surface area in the chest because they have more involved tissue there.

Slide 20

Question 63

Q

The shape of the body, specifically ___________ versus ___________, is important in estimating burn areas in obese patients.

A) Android, gynecoid
B) Ectomorph, endomorph
C) Pear, pineapple
D) Android, ectomorph

Answer

A

A) Android, gynecoid

Slide 20

Question 64

Q

What are the two conflicting priorities that need to be managed in the pathophysiology of burn injuries?

A) Hypothermia and infection
B) Pain and mobility
C) Shock and edema
D) Nutrition and hydration

Answer

A

C) Shock and edema

Cornelius - you will have a relative hypovolemia, but at the same time you tend to see that they become very edematous

Slide 21

Answer 65

A

A) Intravascular

Cornelius - In one sense they’re fluid overloaded because they’re edematous, but they’re also volume depleted because they’ve lost that intravascular volume.

Slide 21

Answer 66

A

B) Permeability

Slide 21

Answer 67

A

D) Burn size and patient weight

Slide 22

Answer 68

A

C) 20%

Cornelius - .. if you have somebody that’s got an inhalation burn, essentially the size of a tennis court..imagine how much potential for fluid loss and injury there without being able to see a single thing.

Slide 22

Answer 69

A

C) Decreased perfusion leading to burn shock and end organ failure

Slide 23

Answer 70

A

C) Kidneys

Cornelius - decreased intravascular volume = decreased perfusion shock, and end-organ damage, kidneys being the most susceptible

we’re better off focusing on treatment of the kidneys through CRRT than continuing to fluid overload them

Slide 23

Answer 71

A

B) Abdominal compartment syndrome

Cornelius - we generally use crystalloid for resuscitation, it’s going to leak out and can cause mesenteric edema.

slide 23

Answer 72

A

B) Pulmonary edema
F) ARDS

Corndog - good news is we were saving the kidneys with all that fluid. The downside is that we were causing kind of a secondary injury..better off to not take out the lungs, the abdominal organs

Slide 23

Answer 73

A

A) Loss of fat
B) Loss of lean body mass
D) Gluconeogenesis

Hypermetabolic state

Slide 24

Answer 74

A

C) Proteolysis

Slide 24

Answer 75

A

A) Lipolysis - loss of fat
C) Insulin resistance

Slide 24

Answer 76

A

B) Magnitude of the injury and degree of pain

Magnitude of injury
Degree of pain (leads to tachycardia and HTN, thus ↑ metabolism)

Slide 25

Answer 77

A

C) It doubles.

Slide 25

Answer 78

A

C) Auto-cannibalism

Slide 25

Answer 79

A

Immunosupression
D) Recurrent infections
E) Poor wound healing

Cornelius - increased metabolic rate for three to six months and sometimes even longer…make sure that they’re meeting all the nutritional demands. Continue TPN or clear carbohydrates

Slide 25

Answer 80

A

B) Cortisol, catecholamines, and glucagon

Slide 26

Answer 81

A

B) Hepatic Gluconeogenesis

Slide 26

Answer 82

A

C) 3 years!!

Cornelius - 36 months is kind of an accepted value, but we’ve seen case studies where it’s continued even longer than that. Burn patients tend to come back multiple times. So this may be somebody that’s coming back for grafts a year later, two years later. Be very mindful of their carbohydrates data at that point.

Slide 26

Answer 83

A

A) It is related to the extent of the burn
C) It results from a post-receptor defect

Keep an eye on carbohydrates, check the glucose levels

Slide 26

Answer 84

A

A) Elevated Interleukin
B) B2 adrenergic stimulation
E) B3 adrenergic stimulation
F) Elevated Tissue Necrosis Factor

d/t B2 and B3 adrenergic stimulation…⬆️ cAMP
d/t elevated glucagon, TNF, IL

Slide 27

Answer 85

A

A) Increased ATP production

Slide 27

Answer 86

A

B) Lipid oxidation and metabolic rate

Slide 27

Answer 87

A

C) Proteolysis

Cornelius - we try and encourage early PT. The other thing you’ll see is that very quickly, either due to decreased activity or the burn injuries themselves, they tend to have contractures

Slide 28

Answer 88

A

B) Hepatic gluconeogenesis

Slide 28

Answer 89

A

C) Stress

DOUBLES in severe burns

Slide 28

Answer 90

A

A) TNF, IL-1, and IL-6

Cortisol partially improves the loss of protein!

Slide 28

Answer 91

A

B) Respiratory

Cornelius -Edema gets worse overtime – intubation may need to happen early on – prophylactically

Initially large amounts of fluid resusitation but more judicious down the line.

Slide 29

Answer 92

A

A) Increased catecholamine surge
D) Existing cardiovascular comorbidities

Cornelius - From a CV standpoint the catecholamine surge will increase the heart rate and will increase metabolic demand…Older patients tend to do very poorly, not only because of the burns, but also because of their comorbidities.

Slide 29

Answer 93

A

C) Pain

Cornelius - this can be a quandary sometimes when you’ve got somebody that needs hemodynamic support and also needs pain management

Initially IV pain management

Slide 29

Answer 94

A

B) Pain control

Cornelius -initial pain management is generally going to be through IV medications. Long term management we may shift to something that’s longer lasting… oxycodone, methadone, whereas later on down the line we may consider putting in peripheral nerve catheters

Slide 30

Answer 95

A

A) Thromboprophylaxis
C) Wound closure

Cornelius - increased incidence of venous emboli. They need thromboprophylaxis. The good news is they’re not going to clot. The bad news is that they are in addition to the fluid they’re leaking out may start to leak out blood as well.

Slide 30

Answer 96

A

A) Control of hypermetabolism - nutritional support very important
B) Prevention of infection

Cornelius - Initially, there’s very little indication for antibiotics and burns, but later on down the line, especially with the exposure to secondary stuff, you may have to put them on antibiotic

Slide 30

Answer 97

A

A) Infection

Slide 30

Answer 98

A

C) Associated injuries
CHI, spinal injury, open fractures, chest/abd trauma

Cornelius - somebody with a head injury, the head injury is probably gonna kill them before the burns will. Will need to be cautious on aggressive resuscitation.

Same thing with spinal injuries, it may be beneficial in those patients to give large amounts of fluids because they’re perfectly vasodilated.

Slide 30

Answer 99

A

C) Methadone

Cornelius- ..long acting opioids, methadone, oxycodone, really thinking about sustained release formulas

Slide 31

Answer 100

A

B) Tylenol
C) PCA infusions (morphine)

Cornelius - In PCAs, you’re gonna find either morphine or hydromorphone because they are a little bit longer lasting. Helps the patient move around and give them autonomy

Slide 31

Answer 101

A

B) IV Ketamine

Cornelius - Ketamine is used especially from a procedural standpoint. They may get IV ketamine or sublingual ketamine for dressing changes. They could have achieved steady state as far as their analgesic level, but then for a procedure, they need something else

Slide 31

Answer 102

A

B) Diazepam - Valium
D) Alprazolam - Xanax

Cornelius - a lot of times we will supplement the analgesics with the anti -anxiety drugs and get kind of a synergistic effect.

Slide 31

Answer 103

A

B) Deviation

Cornelius -oftentimes we will wind up decreasing doses to avoid making our patients toxic…or you may see that because of that hypermetabolic state, you may actually have decreased efficacy… so you may have to give more.

Slide 31

Answer 104

A

B) Absorption is uncertain.

Slide 31

Answer 105

A

C) Impaired endothelial barrier

Slide 32

Answer 106

A

B) Increased capillary permeability
D) Loss of intravascular oncotic pressure

Slide 32

Answer 107

A

C) Release of histamine, prostaglandins, and cytokines

Increased systemic inflammatory reactions

Slide 32

Answer 108

A

B) 15% BSA or greater
Cornelius - we’re going to start using IV resuscitation for patients with a burn surface area are greater than about 15%. Remember, as I said before, greater than 20%, they probably need to go to burn centers

Slide 33

Answer 109

A

C) Overhydration

Patients overhydrated (6ml/kg/% vs 4ml/kg/%)

Slide 33

Answer 110

A

C) Electrical burns
D) Inhaled burns

Cornelius - delayed resuscitation- if you also have somebody that maybe didn’t receive initial treatment or initial appropriate treatment, you kind of have to play catch -up then, so you may have to give a little bit higher volume

Slide 34

Answer 111

A

A) 2ml/kg/%BSA
Cornelius - figure out your patient’s burn surface area (BSA), then over the first 8 hours you give 2mls/kilogram x BSA.

Then over the next 16 hours, you’re going to give another 2mls/kilogram x BSA.

Over the first 24 hours, they receive about 4mls/kilogram x BSA.

Half of fluid given in the first 8 hrs and the rest in the last 16hrs

Slide 34

Answer 112

A

B) Decrease

Slide 34

Answer 113

A

A) 4 mL x kg x % TBSA burned
* 2 ml/kg/%BSA in 1st 8 hours
* 2 ml/kg/%BSA in next 16 hours

Slide 34

Answer 114

A

B) 10 mL/hr x TBSA (%)

Slide 35

Answer 115

A

B) Add 100 mL/hr for every 10 kg over 80 kg

Slide 35

Answer 116

A

B) 3 mL x TBSA (%) x kg
½ total volume over 1st 8 hrs

Slide 35

Answer 117

A

C) 1500 mL

Formula:
3×TBSA×Weight(kg)= Volume for first 24 hours

Calculation:
3 × 25 (TBSA) × 20kg = 1500 mL

If you were to give half in the first 8 hrs, that would be 750ml

Slide 35

Answer 118

A

A) Estimated BSA% burn
B) Severity of burn
D) Need for transfer to a certified burn center

Slide 37

Answer 119

A

A) Full thickness burns > 10% BSA
B) Presence of chemical burns
D) Burn on face, hands, feet, perineum, major joints
E) High voltage electrical burns

Slide 37

Answer 120

A

A) inhalation

Slide 37

Answer 121

A

B) 1 cc/kg/hr

Avoid Fluid Creep - “Fluid creep” can result from overly aggressive fluid administration based on formulas, failure to adjust fluid rates appropriately, or lack of accurate monitoring of the patient’s response to fluid resuscitation.

Slide 38

Answer 122

A

C) Lactated Ringer’s

Slide 39

Answer 123

A

B) Airway occlusion

due to casts comprised of blood, mucous, and debris.

Slide 39

Answer 124

A

B) Hypernatremic hyperchloremic acidosis (non-anion gap acidosis)

Cornelius: you need to reevaluate what you’re doing every hour. Sometimes even more so than that, depending on what’s going on with the patient.

Slide 39

Answer 125

A

C) 30-50 mL/hr

Slide 39

Answer 126

A

B) 20-25%

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

Slide 39

Answer 127

A

C) Size 8 or larger

Slide 39

Answer 128

A

C) 40kg

Slide 40

Answer 129

A

C) 2-4 mL of Lactated Ringer’s/kg x %TBSA

Ex. 2mL 30kg and 10% TBSA

2mL x 30kg x 10% = 600 mL

Slide 40

Answer 130

A

C) D5LR (5% Dextrose in Lactated Ringer’s)

Slide 40

Answer 131

A

C) 0.5-1 mL/kg/hr

Burns greater than 20-25% are assoc w/ increased capillary permeability and intravascular volume deficits that are most severe in the first 24 hours post burn. Burn shock begins at the cellular level.

Slide 40

Answer 132

A

False.

The initiation of 5% albumin infusion should be considered if the hourly IV fluid rate exceeds 1500 mL/hr during the first 8-12 hours post-burn.

Slide 41

Answer 133

A

D) 250 mL/kg

Slide 41

Answer 134

A

B) 4-7 mL/kg at the rate of 0.5 mL per minute
* Reduce maintenance isotonic crystalloid by an equal volume per hour

Slide 42

Answer 135

A

C) 60%

Slide 43

Answer 136

A

A) Hypovolemia due to increased permeability
C) Increased systemic vascular resistance (SVR) due to increased vasopressin levels
E) Reduced response to catecholamines
F) Myocardial ischemia d/t decreased coronary flow

Ensure appropriate fluid resuscitation

Slide 43

Answer 137

A

A) Hyperdynamic state with increased cardiac output (CO), tachycardia
C) Increased myocardial oxygen consumption
D) Decreased systemic vascular resistance (SVR)

Slide 43

Answer 138

A

B) Administer beta-blockers

They don’t respond very well to catecholamines, so treatment with things like epinephrine may not be helpful.

Slide 43

Answer 139

A

Begin immediately after burn

A) Pulmonary hypertension

B) Pulmonary capillary alveolar membrane disruption

D) Decreased plasma oncotic pressure

F) Increased extravascular lung water leading to impaired gas exchange

Slide 44

Answer 140

A

C) Bronchodilators

Patients should be placed in the prone position to reduce bronchospasm due to impaired gas exchange and tissue injury and have scheduled bronchodilator therapy.

Slide 44

Answer 141

A

A) Impaired ventilation from circumferential burns/scar
B) Hypoventilation due to decreased elasticity

Slide 44

Answer 142

A

B) Escharotomy

Slide 44

Answer 143

A

B) Increased airway pressures

You may have a hard time ventilating these patients

Slide 44

Answer 144

A

A) Singeing of face or nasal hair
B) Oropharyngeal carbon
C) Wheezing

Slide 45

Answer 145

A

B) Carboxyhemoglobin levels
> 10%

Slide 45

Answer 146

A

C) Bronchoscopy

Slide 45

Answer 147

A

Extensive edema is common - B) Secure endotracheal tube (ETT)
Protect the eyes - A) Remove contact lenses
Consult ophthalmology - C) For corneal/globe injury
Apply bacitracin ointment - E) To eyelids
Apply erythromycin ointment - D) In the eyes

Slide 46

Answer 148

A

A) Engine exhaust
B) Fire
C) Improperly vented gas/oil heaters

Slide 47

Answer 149

A

True

Slide 47

Answer 150

A

B) Fuels; plastics

Carbon monoxide (fuels) and CN poisoning (plastics)

Sliide 47

Answer 151

A

B) 100% oxygen; Vitamin B12 (Cobalamin)

Cornelius: Carbon monoxide we generally treat with 100% oxygen. Cyanide poisoning with B12

Slie 47

Answer 152

A

1-3% - D) Normal nonsmoker
4-9% - C) Smokers
15-20% - A) Overt signs of toxicity (headache, nausea, vomiting, etc.)
20-25% - E) Signs of severe toxicity (seizures, acute renal failure, myocardial ischemia)
> 25% - B) Unconsciousness and death

Slide 47

Answer 153

A

A) Elevated protein needs
B) Increased energy needs
C) Increased vitamin needs
D) Insulin resistance

Slide 48

Answer 154

A

B) Magnitude of the stress response

Slide 48

Answer 155

A

E) jejunum; high-calorie; high-protein

Nasoenteric feeds into the jejunum are particularly important for burn patients to ensure high-calorie and high-protein intake directly to the jejunum.

May not be D/C for OR if already intubated

Slide 48

Answer 156

A

A) Loss of plasma protein concentration
*Especially albumin
*Increases free fractions and volume of distribution

B) Alterations in drug receptor (nAChR)

C) Changes in cardiac output (ebb/flow))

Slide 49

Answer 157

A

B) nACh receptors

Takes Months to years (1-2) to recover

Slide 50

Answer 158

A

A) Resistance to non-depolarizing neuromuscular blockers

B) Sensitivity to depolarizing neuromuscular blockers

Slide 50

Answer 159

A

D) 25% BSA and greater

Slide 50

Answer 160

A

C) Succinylcholine
* Markedly increased serum K+
* Significant after 48-72 hours
* Does not correlate with severity of burn

Slide 50

Answer 161

A

A) EKG patches, potentially stapled for secure placement

B) Pulse oximetry probe accuracy, considering carboxyhemoglobin interference

C) Non-invasive BP cuffs or arterial lines for blood pressure monitoring

E) Arterial blood gases (ABGs) to monitor ventilation and acid-base balance

F) Stroke Volume Variation (SVV) for assessing fluid responsiveness

G) Body temperature, with the use of convection warming devices
Can lose up to 1 degree C q 15 min

H) Urine output to monitor renal function and fluid balance

Slide 51

Answer 162

A

A) Hoarseness, wheezing, shortness of breath (SOB)

B) Carbonaceous sputum

C) Singed nasal and facial hairs

D) Deep facial burns

E) Comatose patient

F) Greater than 40% total body surface area (TBSA) burned

Slide 52

Answer 163

A

A) Difficulty identifying the tracheal aperture

B) Early worsening of the airway condition

D) Significant tracheal edema

why we trying to intubate these patients early

Slide 53

Answer 164

A

A) Stridor
B) Hoarseness
C) Dysphagia

Slide 55

Answer 165

A

A) Edema- Signs of inhalation injury

Limited mobility
B) Pain
C) Eschar
D) Contractures

Slide 55

Answer 166

A

B) Burn dressings preventing an adequate seal

Slide 55

Answer 167

A

A) Facilitates intubation
B) Maintains gas exchange

Slide 55

Answer 168

A

A) Cotton umbilical tape
B) Wire to teeth

Slide 55

Answer 169

A

False: LMA should not be used as an airway management for burn patients

Slide 55

Answer 170

A

A) Propofol - Ebb vs flow phase

B) Etomidate - Adrenal insufficiency concern

C) Ketamine -Stimulates SNS vs depressant effect

D) Opioids - Ebb vs flow phase

Slide 56

Answer 171

A

B) Adrenal insufficiency

Cornelius: If they’re in that hyperdynamic state, something like Propofol may be good because you get a nice sympathetic blockade. If they’re in that early on state where their volume depleted, something like Ketamine may be a little bit better. One of the things we have to worry about for all these patients is using Etomidate just because the concern of adrenal insufficiency. But if this is that patient that’s very high risk for myocardial ischemia, you may want to avoid the tachycardia Ketamine or the hypotension from Propofol. In that case, Etomidate may be your best choice and probably consider supplementing them with steroids at that point.

sorry for the TMI

Slide 56

Answer 172

A

True

Slide 56

Answer 173

A

B) Hypovolemia

Decreased preload….decreased CO

Slide 57

Answer 174

A

C) Transesophageal Echocardiography (TEE)

Slide 57

Answer 175

A

A) Cardiogenic shock
B) Distributive shock
C) Myocardial infarction (MI)

Slide 57

Answer 176

A

A) 1% of burn; 2.6% total blood volume

2.6% total blood volume lost for every 1% burn excised or autograft harvest

Slide 58

Answer 177

A

B) 7-8 g/dL
(10g/dL acute coronary syndrome)

Cornelius: So with these patients don’t just supplement them with fluid. Also consider colloids and ultimately you may need to consider blood products as well. Use of topical thrombin, staged procedures, subq vasoconstrictors

Slide 58

Answer 178

A

B) rFVII

Slide 58

Answer 179

A

True

Slide 58

Answer 180

A

B) Vasopressin; Norepinephrine

Slide 59

Answer 181

A

C) 6-8 mm Hg

If not at goal, increase IVF rate by 20-25%

if you’re experiencing chalk in spite of giving the appropriate amount of IV fluids, you may want to consider using a vasopressor.

Slide 59

Answer 182

A

C) Tumescent anesthesia with epinephrine

Slide 60

Answer 183

A

B) 1G lidocaine, epinephrine, and 10 meq NaHCO₃⁻ in 1000cc NaCl

55mg/kg max

Slide 60

Answer 184

A

A) Decreased blood loss
B) Easy excision of granulation tissue
C) Shorter surgical times
E) Reduced bruising postoperatively or no hematoma

Slide 60

Answer 185

A

B) 30-35 mmHg; pH 7.2

Target pCO2 30-35 mm Hg or pH >7.20

Slide 61

Answer 186

A

B) Albuterol with 5000 units of Heparin
Q4H

Heparin is an anticoagulant and prevent clumping of the epithelial cells
Ensure albuterol is given with heparin since heparin can induce bronchospasm
if you’re having patients that are bleeding inside their Airways, we may administer TXA as opposed to Afrin

Elevate HOB to 30˚

Slide 62

Answer 187

A

A) Abdominal pressure displaces the diaphragm upwards by the bowel

B) ACS is best diagnosed by measuring bladder pressures

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

Slide 63

Answer 188

A

B) Bladder pressure should be measured every 4 hours

C) Bladder pressure should be monitored with >20% TBSA burns

Slide 64

Answer 189

A

C) 12

somebody with their pressure greater than 12, consider they may have early intraabdominal hypertension

Slide 64

Answer 190

A

C) 20

over 20 They probably have abdominal compartment syndrome and need to be lapped.

Slide 64

Answer 191

A

A) Inhalation burns
B) High risk for ongoing bleeding
D) To minimize movement and prevent graft disruption

Additional surgery plans
* DVT prophylaxis
* Beta blocker admin
* Nutritional support
* Temp control

Slide 65

Answer 192

A

C) The same pain scale should be used consistently

Cornelius: there’s not a specific burn scale.
Just make sure that things are being used consistently so we’re able to kind of get a good assessment of those patients.

Slide 66

Answer 193

A

A) Use of additives PRN
* Burn debridement
* Dressing changes

B) Nitrous oxide 50/50 in addition to ketamine
D) Peripheral nerve blocks for extremity injuries

Slide 67

Answer 194

A

A) HPMK/Blizzard Heat
B) Aircraft temperature control
C) Belmont Buddy Lite
D) Wool blanket

Slide 68

Answer 195

A

C) 30-45 degrees

pillows first, then slings

Slide 69

Answer 196

A

C) Every 1 hour

use a doppler

Slide 69

Answer 197

A

C) Escharotomy is performed on limbs primarily to monitor pulse checks, and on the chest to prevent ventilator compromise and decreased cardiac output

Slide 69

Answer 198

A

A) GI Prophylaxis

C) Sew and/or staple all venous and arterial catheters in place

D) Insert Foley immediately to maintain urethral patency
* Scrotal swelling may be impressive, but does not require specific treatment.

Slide 71

Answer 199

A

True

Tetanus status
* Burns are tetanus prone wounds
* Booster if > 5 yrs since last booster
* Booster plus TIG if no previous immunization

Slide 72

Answer 200

A

A) IV antibiotics
B) Steroids

Tetanus status
Burns are tetanus prone wounds
Booster if > 5 yrs since last booster
Booster plus TIG if no previous immunization

Slide 72

Answer 201

A

A) Silvadene
B) Sulfamylon

No Silvadene to the face

Slide 73

Answer 202

A

A) Silver dressings
C) Silver nitrate
D) Temporary skin substitutes such as Biobrane
E) Silverton water or saline every 8 hours

Slide 73

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Burns (Cornelius) Exam 1 Flashcards

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