Burns (Cornelius) Exam 1 Flashcards
The types of burns include heat, electrical, friction, chemical, and ________.
A) Frostbite
B) Radiation
C) Fever
D) Hotsauce
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
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
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
True or False
The longer contact with heat is generally better than short contact with heat for severity of injury
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
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
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
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
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
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
A) Hot liquid
C) Steam
E) Hot solid
G) Flame
Slide 3
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
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
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
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
Electrical burns can disrupt ___________ potential in the body’s cells, leading to significant cellular damage.
A) Membrane
B) Action
C) Electrical
D) Resting
A) Membrane
Slide 4
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
B) Strength; duration
Slide 4
Electrical injuries are particularly dangerous due to the potential for ___________.
A) Myocardial infarction
B) Ventricular fibrillation
C) Atrial fibrillation
D) Cardiac tamponade
B) Ventricular fibrillation
Cornelius - …it’s really important for them to get defibrillated very quickly
Slide 4
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.
True
Slide 4
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 injurties involve shorter contact time
D) DC current is more common in households
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
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
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 arm *
Slide 5
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
C) Radiation damage
Cornelius - Widespread burn from liquids/powders primarily… sometimes aersol. Weird injury patterns from splash
Slide 6
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
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
The nature of the chemical burn caused by alkali substances typically result in ___________ necrosis.
A) Coagulation
B) Liquefaction
C) Fat
D) Caseous
B) Liquefaction
Slide 6
The nature of the chemical burn caused by acid substances typically result in ___________ necrosis.
A) Coagulation
B) Liquefaction
C) Fat
D) Caseous
A) Coagulation
Slide 6
True or False
Dilution of the chemical toxin with water is probably your best approach to decontamination.
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
What is the primary cause of tissue damage in radiation burns?
A) Mechanical disruption
B) Chemical reactions
C) Ionization
D) Thermal conduction
C) Ionization
Slide 7
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
D) The types of particles
E) The dose and time of exposure
Slide 7
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
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
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) Using tanning beds frequently
A) Sunburns
B) Exposure to therapeutic radiation
C) Diagnostic medical procedures
E) Working in the nuclear industry
Slide 7
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
B) It helps in assessing the need for surgical grafting
Slide 8
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
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
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
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
True or False
We include superficial or first degree burns in our total burn surface area (TBSA).
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
Which population is more likely to experience deeper burns due to thinner skin?
A) Adults >65
B) Adults >55
C) Children <5
D) Children >5
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
Which layer of the skin is affected by a superficial (1st-degree) burn?
A) Dermis
B) Subcutaneous tissue
C) Epidermis
D) Muscle
C) Epidermis
Slide 9
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
B) Skin is intact and red in color
Slide 9
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
B) 3-6 days
Slide 9
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
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
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
B) Epidermis and part of the dermis
Cornelius - a very painful burn with exposed nerve endings.
Slide 10
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
B) Mottled red color with blisters or weeping
Slide 10
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
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
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
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
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
B) Pale in color with decreased moisture (due to damaged sweat glands)
E) Decreased moisture
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
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
C) Requires skin grafting for healing,
D) Blanching is absent or prolonged
Slide 12
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
C) 21-28
Slide 12
At what point is skin grafting typically required?
Deep partial thickness burns
What are the characteristics of a Full Thickness (3rd Degree) Burn?
- Dermis and epidermis are destroyed
- Translucent, dry, painless, charred
- Non-blanching
- Requires grafting
- No bleeding when you do an escharotomy
Differences in deep partial and full thickness is subtle and often hard to tell the exact transition areas in early hours.
Compare and Contrast the various degrees of burn injuries.
What is the most painful burn?
Superficial Partial Thickness (2nd Degree Burn)
What is the Rule of nines in adults?
- Head 9%
- Each arm 9%
- Each leg 18%
- Ant/Post trunk each 18%
- Perineum 1%
The rule of nines is approximately ________ accurate
60-70%
What is the pediatric version of the rule of nines?
- Head 21%
- Arms 10%
- Back 13%
- Chest 13%
- Legs 13.5%
- Butt 5%
- Perineum 1%
What is the Palmer method?
TBSA used for patient’s palm with fingers together = 1%
Larger burn surface areas are often overestimated. T/F?
False. They are underestimated
Women with large breasts have a _____
larger surface area than what was accounted for
Fluid losses secondary to burns are a function of ____ and ____.
- Burn size
- Patient weight
Patients with ____ TBSA will develop burn shock and need IV resuscitation in an ICU.
> 20%
An under fluid resuscitated patient is at risk for what?
↓ perfusion, burn shock, end organ failure
An overly fluid resuscitated patient is at risk for what?
- Abdominal compartment syndrome
- Pulmonary edema/ARDS
List the 6 effects of auto-cannibalism.
- Loss of fat
- Loss of lean body mass
- Gluconeogenesis
- Lipolysis
- Hypermetabolism
- Insulin resistance
The Intensity and duration of auto-cannibalism depends on which two factors?
- Magnitude of injury
- Degree of pain (leads to tachycardia and HTN, thus ↑ metabolism)
What happens to the metabolic rate in a >40% BSA burn?
Metabolic rate doubles.
The effects of auto-cannibalism lasts how long?
Months
Immunodepression, recurrent infections, poor wound healing will also be seen
What three “hormones” will increase with the excessive carbohydrate metabolism of burn injuries?
Increases in cortisol, catecholamines, and glucagon
Changes in carbohydrate metabolism for the burn patient results in what consequences?
- Accelerated hepatic gluconeogenesis
- Peripheral insulin resistance (50-70%)
- Impaired intracellular glucose transport
Accelerated lipolysis in burns is due to what three factors?
- B2 and B3 adrenergic stimulation (↑cAMP)
- ↑ glucagon, TNF, IL
- ↑ FFA (which produces ATP)
What treatment is indicated for excessive lipolysis?
β-blockers
Beta blockers decrease ____ and ____ in order to combat accelerated lipolysis.
- Lipid oxidation
- Metabolic rate
The degree of protein loss is proportional to the ____ and is doubled in _____
- Degree of stress
- Severe burns
What are the initial steps to the stabilization of a burn injury?
- Respiratory support
- Fluid resuscitation
- Cardiovascular stabilization
- Pain control
- Local care of burn wounds
What are the secondary steps to the stabilization of a burn injury?
- Pain control – (Long term pain control)
- Thromboprophylaxis
- Wound closure
- Nutritional support
- Control of hypermetabolism
- Prevention of infection
With spinal injury there is an increased risk of what?
Hypovolemia secondary to massive vasodilation
Open fractures will increase ______ _______ and may require ________.
Tissue edema and may require a fasciotomy
To achieve pain control, analgesics should be ________.
scheduled
Medications used to treat pain in burn patients include
- Methadone (long acting)
- NSAIDs (Acetaminophen)
- PCA infusions (Morphine)
- IV Ketamine
- Supplemental anxiolytics
Pharmacokinetics and ________ can be altered in burns.
Pharmacodynamics
May need to deviate from normal doses to avoid toxicity or decreased efficacy (Start low then give more)
The use of a large bore endotracheal tube (ETT) primarily decreases the risk of:
A) Hypoventilation
B) Airway occlusion
C) Bronchospasm
D) Pulmonary embolism
B) Airway occlusion
due to casts comprised of blood, mucous, and debris.
Slide 39
Burns cause damage to the endothelial layer leading to which two consequences?
- Increased capillary permeability
- Loss of intravascular oncotic pressure
Loss of intravascular fluid causes systemic inflammatory reactions which leads to the release of _____, _______, and _______.
- Histamine
- Prostaglandin
- Cytokines
Causes vasodilation of already impaired vessels
IV Fluids are needed generally for ____ TBSA or greater.
15%
The following burns/situations: ____, ____, ____ need higher volumes of fluid resuscitation than what would be indicated via their TBSA calculation.
- Inhaled burns
- Electrical burns
- Delayed resuscitation
Advocate for titrating formula down when adequate _______ ______ is achieved.
Urine output
If the projected 24-hour total fluid volume in a burn patient approaches __________, 5% albumin infusion should be initiated.
A) 100 mL/kg
B) 150 mL/kg
C) 200 mL/kg
D) 250 mL/kg
D) 250 mL/kg
Slide 41
What is US Army ISR Rule of 10 for adults?
10ml/hr x TBSA
> 80kg, add 100 mL/10kg
What is US Army ISR Rule of 10 for Pediatrics?
- 3 x TBSA x kg = vol for first 24 hrs
- ½ total volume over 1st 8 hrs
The goal of the ISR is to have U/O at _____.
1cc/Kg
Slide 38
KRISTA’s START :P
Which of the following crystalloids is typically the best choice for initial fluid resuscitation in burn patients?
A) Normal Saline
B) 5% Dextrose
C) Lactated Ringer’s
D) 3% Hypertonic Saline
C) Lactated Ringer’s
Slide 39
What factors would indicate that a transfer to a certified burn center is necessary?
- > 10% BSA
- High voltate electrical burns
- Chemical burns
- Concurrent inhalational injury
- Burns on the face, hands, feet, perineum, major joints
Slide 37
Isotonic solutions (NS) have a risk of __?
A) Hyperkalemia
B) Hypernatremic hyperchloremic acidosis
C) Hypochloremic alkalosis
D) Hypoglycemia
B) Hypernatremic hyperchloremic acidosis (non-anion gap acidosis)
Slide 39
Crystalloids are often titrated to achieve a urine output goal of:
A) 10-20 mL/hr
B) 20-30 mL/hr
C) 30-50 mL/hr
D) 50-70 mL/hr
C) 30-50 mL/hr
Slide 39
Fluids should increase/decrease by ___% if urine output goals are not being met.
A) 10-15%
B) 20-25%
C) 30-35%
D) 40-45%
B) 20-25%
1500 mL/hr or 250 mL/kg in 24 hours.
No fluid boluses as volume increases edema
Slide 39
When the determination is made to intubate the burn patient, especially if inhalation injury is suspected or noted on bronchoscopy. Size __ is preferred as it facilitates subsequent bronchoscopy and pulmonary toilet
A) Size 6 or larger
B) Size 7 or smaller
C) Size 8 or larger
D) Size 5 or smaller
C) Size 8 or larger
Slide 39
If a pediatric patient is heavier than __ then use the adult formulas.
A) 30 kg
B) 35 kg
C) 40 kg
D) 45 kg
Slide 40
What is the recommended fluid resuscitation formula for a pediatric patient under 14 years old and weighing less than 40 kg with 2nd and 3rd degree burns?
A) 2-4 mL of Normal Saline/kg x %TBSA
B) 2-4 mL of D5W/kg x %TBSA
C) 2-4 mL of Lactated Ringer’s/kg x %TBSA
D) 2-4 mL of 0.45% Saline/kg x %TBSA
C) 2-4 mL of Lactated Ringer’s/kg x %TBSA
Ex. 30kg and 10% TBSA
2/30 x 30 x 10 = 4500 mL
Slide 40
What fluid is typically recommended to support the basal metabolic rate in children weighing less than 20 kg?
A) Normal Saline
B) D5W
C) D5LR (5% Dextrose in Lactated Ringer’s)
D) Ringer’s Lactate
C) D5LR (5% Dextrose in Lactated Ringer’s)
Slide 40
When managing IV fluids in a pediatric patient, the goal is to titrate the fluid rate to maintain a urine output of:
A) 0.1-0.3 mL/kg/hr
B) 0.3-0.5 mL/kg/hr
C) 0.5-1 mL/kg/hr
D) 1-2 mL/kg/hr
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
True or False
The initiation of 5% albumin infusion should be considered if the hourly IV fluid rate exceeds 1500 mL/hr during the first 5-12 hours post-burn.
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
The dose for pediatric colloids is _______, administered at a rate of _______ per minute.
A) 2-4 ml/kg ; 0.2 mL
B) 4-7 ml/kg; 0.5 mL
C) 8-10 ml/kg; 0.8 mL
D) 10-12 ml/kg; 1.0 mL
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
In the “ebb” state of the resuscitative phase, cardiac output is typically reduced by ____.
A) 30%
B) 50%
C) 60%
D) 70%
C) 60%
Slide 43
During the resuscitative phase, which of the following changes occur in cardiac status? (Select all that apply)
A) Hypovolemia due to increased permeability
B) Enhanced response to catecholamines
C) Increased systemic vascular resistance (SVR) due to increased vasopressin levels
D) Myocardial ischemia due to increased coronary blood flow
E) Reduced response to catecholamines
F) Ensure appropriate fluid resuscitation
A) Hypovolemia due to increased permeability
C) Increased systemic vascular resistance (SVR) due to increased vasopressin levels
E) Reduced response to catecholamines
F) Ensure appropriate fluid resuscitation
*and Myocardial ischemia d/t decreased coronary flow
Slide 43
At 72-96 hours post-burn during the “flow” phase, which of the following physiological changes are typically observed? (Select all that apply)
A) Hyperdynamic state with increased cardiac output (CO)
B) Bradycardia
C) Increased myocardial oxygen consumption
D) Decreased systemic vascular resistance (SVR)
E) Decreased myocardial oxygen consumption
F) Increased systemic vascular resistance (SVR)
A) Hyperdynamic state with increased cardiac output (CO), tachycardia
C) Increased myocardial oxygen consumption
D) Decreased systemic vascular resistance (SVR)
Slide 43
Which of the following treatments is typically used to manage the post-burn “flow state”?
A) Administer diuretics
B) Administer beta-blockers
C) Increase fluid resuscitation
D) Administer vasopressors
Answer:
B) Administer beta-blockers
B) Administer beta-blockers
They don’t respond very well to catecholamines, so treatment with things like epinephrine may not be helpful.
Slide 43
What are the pulmonary systemic inflammatory processes that happen with burns?
- Pulmonary hypertension
- Pulmonary capillary alveolar membrane disruption
- Decreased plasma oncotic pressure
- Increased extravascular lung water leads to impaired gas exchange
Patients should be placed in the ____ position to reduce bronchospasm due to impaired gas exchange and tissue injury and have scheduled ____ therapy.
- Prone
- Bronchodilator
Why is impaired ventilation seen in burns?
- Impaired ventilation from circumferential burns/scar
- Hypoventilation d/t decreased elasticity
What treatment is necessary for lung restriction necessary to burn tissue damage?
Escharatomy
What is the sign of possible restrictive lung deficit?
↑ airway pressures
What lab is elevated with inhalation injuries?
- Carboxyhemoglobin levels > 10%
How are Inhalation injuries diagnosed?
Bronchoscopy
Apply bacitracin ointment to___
Apply erythromycin ointment in the ___
- Eye lids
- Eyes
Carbon Monoxide inhalation is confirmed by what lab?
↑ COHb
At what various levels of carboxyhemoglobin are differing signs and symptoms seen?
After burns patients will have elevated ____, ____, and energy needs.
- protein
- vitamin
Nutrtion within 16 hours of admission is thought to
reduce magnitude of stress response
_____ resistance occurs after burn injuries (in regards to nutrition).
Insulin
How are burn patients force-fed?
High calorie, high protein feeds into the jejunum
May not be D/C for OR if already intubated
What factors can change the pharmacodynamics/kinetics of our drugs?
- Loss of plasma protein concentration
- Alterations in drug receptor (nAChR)
- CO changes
Lots of medication floating around free because they aren’t bound to anything like albumin…
Increases free fractions and volume of distributon
Burns result in up regulation of
nACH receptors
Takes Months to years (1-2) to recover
What drug needs to be avoided in the >24hrs after a burn?
Why?
Succinylcholine
Due to upregulation of nACh receptors → ↑K⁺
What paralytic agent is resisted 24hrs after a burn injury?
Non-depolarizing NMBs
Due to upregulation of nACH receptors
Resistance to non-depolarizers happens when BSA is over ____%.
25%
What signs/symptoms are indicative of airway burn or inhalational injury?
- Hoarseness, wheezing, SOB
- Carbonaceous sputum
- Singed nasal & facial hairs
- Deep facial burns
- Comatose pa/ent
- > 40% TBSA
Difficult laryngoscopy can be due to what four factors?
- Edema
- Pain
- Eschar
- Contractures
Securing the ETT vs tracheostomy
- Cotton umbilical tape
- Wire to teeth
____ should not be used as an airway management for burn patients
LMA
What are the induction drugs for burns
- Propofol
- Etomidate
- Ketamine(Simulates SNS vs depressant effect)
- Opioids
An important adverse side effect noted with Etomidate is ______ _______.
Adrenal Insufficiency
What drug is often useful as an adjunct in burn dressing changes?
Ketamine
2.6% total blood volume is lost for every __% of burn excised or autograft harvested.
1%
Hgb should maintained around ____ g/dL.
7-8 g/dL
____ is a off label drug for burns to prevent blood loss during burn excision.
rFVII
pts are at increased risk of thrombosis
List the vasopressors used in shock when MAP is <55 mmHg.
- Vasopressin
- Norepinephrine
What is the CVP goal with burn patients?
- Goal 6-8 mm Hg
- If not at goal, increase IVF rate by 20-25%
If UO remains low, give fluids. If you have enough UO and your BP is still low, start vasopressors.
What technique is utilized to infiltrate large volumes of local anesthetic subcutaneously?
Tumescent LA w/ epi
Bladder pressures greater than ____ mmHg indicate early intra-abdominal hypertension.
- > 12
____ mmHg is diagnostic for abdominal compartment syndrome.
> 20 mmHg
Burn pain treatment options include
- Additives PRN
- Nitrous oxide 50/50 – in addition to Ketamine
- Peripheral nerve blocks for extremity injuries
Extremities should be elevated ____ degrees.
30-45 degrees (pillows first, then slings)
Assess pulses every ____ hour(s).
Hour – Doppler (High risk for losing perfusion and sensation due to compartment syndrome)
List the adjuncts to burn Resuscitation
- GI Prophylaxis – High risk for stress ulcers
- Sew and/or staple all venous and arterial catheters in place
- Genitalia/Perineum- Insert Foley immediately to maintain urethral patency
- Tetanus status
o Burns are tetanus prone wounds
o Booster if > 5 yrs since last booster
o Booster plus TIG if no previous immuniza/on - IV antibiotics NOT indicated
- Steroids are NOT indicated
What topical antibiotics are used in burn dressing changes?
Silvadene and Sulfamylon
No Silvadene to the face
List the types of commonly used burn dressings.
- Silver dressings
- Silverton water or saline every 8 hours
- Silver nitrate
- Temporary skin substitutes such as Biobrane
Bladder Pressure for ACS should be measured every
- Measure Q4H with >20% TBSA
Abdominal Compartment Syndrome is diagnosed via what?
Bladder pressures
This is the condition which is to be avoided given the high mortality rate if the abdomen is opened. This is why we have such strict rules in terms of fluid management.
During mechanical ventilation patients should be nebulized with what drug?
Albuterol w/ 5000 units Heparin Q4H
Ensure albuterol is given with heparin since heparin can induce bronchospasm (i.e. wheezing)
When mechanically ventilating a burn patient, target pCO2 to ____ mm Hg or pH >_____.
- 30-35 mmHg
- 7.20
What are the goals of tumescent technique?
- Decreased blood loss
- Easy excision of granulation tissue
- Shorter surgical times
- No hematoma or bruising postop
What is the typical dose of tumescent local anesthetic?
Lidocaine 1G + epi + 10meq NaHCO₃⁻/1000cc NaCL
55mg/kg max
What is the parkland burn formula?
4ml x kg x %BSA
- 2 ml/kg/%BSA in 1st 8 hours
- 2 ml/kg/%BSA in next 16 hours
Opioids should not be given via the ____ route due to abnormal ___.
- IM
- Absorption
