Burns (Cornelius) Exam 1 Flashcards
1
Q
The types of burns include heat, electrical, friction, chemical, and ________.
A) Frostbite
B) Radiation
C) Fever
D) Hotsauce
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
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
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
3
Q
True or False
The longer contact with heat is generally better than short contact with heat for severity of injury
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
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
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
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
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
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
A
A) Hot liquid
C) Steam
E) Hot solid
G) Flame
Slide 3
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
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
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
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
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
A
A) Membrane
Slide 4
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
A
B) Strength; duration
Slide 4
11
Q
Electrical injuries are particularly dangerous due to the potential for ___________.
A) Myocardial infarction
B) Ventricular fibrillation
C) Atrial fibrillation
D) Cardiac tamponade
A
B) Ventricular fibrillation
Cornelius - …it’s really important for them to get defibrillated very quickly
Slide 4
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.
A
True
Slide 4
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 injurties involve shorter contact time
D) DC current is more common in households
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
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
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 arm *
Slide 5
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
A
C) Radiation damage
Cornelius - Widespread burn from liquids/powders primarily… sometimes aersol. Weird injury patterns from splash
Slide 6
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
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
17
Q
The nature of the chemical burn caused by alkali substances typically result in ___________ necrosis.
A) Coagulation
B) Liquefaction
C) Fat
D) Caseous
A
B) Liquefaction
Slide 6
18
Q
The nature of the chemical burn caused by acid substances typically result in ___________ necrosis.
A) Coagulation
B) Liquefaction
C) Fat
D) Caseous
A
A) Coagulation
Slide 6
19
Q
True or False
Dilution of the chemical toxin with water is probably your best approach to decontamination.
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
20
Q
What is the primary cause of tissue damage in radiation burns?
A) Mechanical disruption
B) Chemical reactions
C) Ionization
D) Thermal conduction
A
C) Ionization
Slide 7
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
A
D) The types of particles
E) The dose and time of exposure
Slide 7
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
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
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) Using tanning beds frequently
A
A) Sunburns
B) Exposure to therapeutic radiation
C) Diagnostic medical procedures
E) Working in the nuclear industry
Slide 7
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
A
B) It helps in assessing the need for surgical grafting
and determining healing potential
Slide 8
25
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*
## Footnote
Slide 8
26
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. *
## Footnote
Slide 8
27
# 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*
## Footnote
Slide 8
28
Which population is more likely to experience deeper burns due to thinner skin? (select all that apply)
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.
*
## Footnote
Slide 8
29
Which layer of the skin is affected by a superficial (1st-degree) burn?
A) Dermis
B) Subcutaneous tissue
C) Epidermis
D) Muscle
C) Epidermis
## Footnote
Slide 9
30
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
## Footnote
Slide 9
31
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
## Footnote
Slide 9
32
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*
## Footnote
Slide 9
33
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.*
## Footnote
Slide 10
34
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*
## Footnote
Slide 10
35
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 *
## Footnote
Slide 10
36
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. *
## Footnote
Slide 12
37
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
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.*
## Footnote
Slide 12
38
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
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*
## Footnote
Slide 12
39
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
## Footnote
Slide 12
40
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
C) Extends through the entire dermis
*Dermis has been destroyed*
## Footnote
Slide 14
41
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
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*
## Footnote
Slide 14
42
# 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.
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*
## Footnote
Slide 14
43
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.
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*
## Footnote
Slide 15
44
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
A) Red appearance
C) Dry or very small blisters on the surface
E) Painful sensation
*Not calculated in
TBSA*
## Footnote
Slide 16
45
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
A) Pink or mottled red appearance, may be white
C) Bullae or moist, weeping surface
## Footnote
Slide 16
46
# True or False
Partial Thickness (2nd Degree Burn) burns are very painful in sensation.
True
## Footnote
Slide 16
47
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
B) Pearly white, charred, translucent, or *parchment-like appearance*
C) Dry and inelastic surface
E) Insensate surface
*Any significant burn will require skin grafting*
## Footnote
Slide 16
48
According to the Rule of Nines, what percentage of Total Body Surface Area (TBSA) is assigned to each leg?
A) 9%
B) 18%
C) 36%
D) 1%
B) 18%
*Each leg is 18 percent, nine front, nine back. *
## Footnote
Slide 17
49
Which area is assigned 1% of TBSA according to the Rule of Nines?
A) Head
B) Each arm
C) Perineum
D) Each leg
C) Perineum
*The critical one percent*
## Footnote
Slide 17
50
The Rule of Nines assigns ___________ of TBSA to each arm.
A) 18%
B) 9%
C) 1%
D) 4.5%
B) 9%
## Footnote
Slide 17
51
The anterior and posterior trunk each account for ___________ of TBSA according to the Rule of Nines.
A) 9%
B) 18%
C) 36%
D) 1%
B) 18%
## Footnote
Slide 17
52
The head accounts for ___________ of TBSA according to the Rule of Nines.
A) 9%
B) 18%
C) 36%
D) 1%
A) 9%
## Footnote
Slide 17
53
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: 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*
## Footnote
Select 18
54
What percentage of TBSA is assigned to each leg in an infant?
A) 18%
B) 21%
C) 13.5%
D) 10%
C) 13.5%
## Footnote
Slide 18
55
The combined TBSA percentage for the abdomen and back in an infant is ___________.
A) 13%
B) 18%
C) 26%
D) 36%
C) 26%
13% for abdomen and 13% for back
## Footnote
Slide 18
56
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
B) Genital area 1%
## Footnote
Slide 18
57
The TBSA percentage for each arm in an infant is ___________.
A) 21%
B) 10%
C) 13%
D) 13.5%
B) 10%
## Footnote
Slide 18
58
The TBSA percentage for the buttocks in an infant is ___________.
A) 5%
B) 13%
C) 13.5%
D) 10%
A) 5%
## Footnote
Slide 18
59
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%
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*
## Footnote
Slide 19
60
# False
Larger burn surface areas are often overestimated.
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**. *
## Footnote
Slide 20
61
In **obese** individuals, burn estimation may ___________ torso burns while ___________ extremity burns.
A) Overestimate, underestimate
B) Accurately assess, miscalculate
C) Ignore, focus on
D) Underestimate, overestimate
D) Underestimate, overestimate
## Footnote
Slide 20
62
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
B) Chest
Cornelius - *someone with large breasts, they may have a larger surface area in the chest because they have more involved tissue there. *
## Footnote
Slide 20
63
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
A) Android, gynecoid
## Footnote
Slide 20
64
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
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*
## Footnote
Slide 21
65
Edema in burn patients is caused by fluid leaving the ___________ space and accumulating in the interstitium.
A) Intravascular
B) Intracellular
C) Intrathecal
D) Subcutaneous
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. *
## Footnote
Slide 21
66
The loss of plasma from the microvasculature into the interstitium is a result of increased ___________.
A) Blood pressure
B) Permeability
C) Heart rate
D) Oxygenation
B) Permeability
## Footnote
Slide 21
67
What factors determine the extent of fluid loss in burn patients?
A) Patient’s age and gender
B) Burn depth and patient temperature
C) Burn location and patient height
D) Burn size and patient weight
D) Burn size and patient weight
## Footnote
Slide 22
68
At what percentage of Total Body Surface Area (TBSA) does burn shock typically develop, necessitating IV resuscitation in an ICU?
A) 10%
B) 15%
C) 20%
D) 30%
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. *
## Footnote
Slide 22
69
What is a potential consequence of **under-resuscitation** in burn patients?
A) Abdominal compartment syndrome
B) Pulmonary edema
C) Decreased perfusion
D) ARDS
C) Decreased perfusion *leading to burn shock and end organ failure*
## Footnote
Slide 23
70
Which organ is most susceptible to damage due to under-resuscitation in burn patients?
A) Heart
B) Liver
C) Kidneys
D) Lungs
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*
## Footnote
Slide 23
71
What complication can occur due to **over-resuscitation** in burn patients?
A) Dehydration
B) Abdominal compartment syndrome
C) Hyperthermia
D) Hypotension
B) Abdominal compartment syndrome
Cornelius - *we generally use crystalloid for resuscitation, it's going to leak out and can cause mesenteric edema.*
## Footnote
slide 23
72
Which *complications *can arise from over-resuscitation in burn patients? (Select 2)
A) Chest compartment syndrome
B) Pulmonary edema
C) Improved kidney function
D) Hypovolemic shock
E) Dehydration
F) ARDS
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*
## Footnote
Slide 23
73
Which of the following are components of the auto-cannbalism that occurs after burn trauma? (Select 3)
A) Loss of fat
B) Loss of lean body mass
C) Decreased metabolic rate
D) Gluconeogenesis
E) Insulin sensitivity
A) Loss of fat
B) Loss of lean body mass
D) Gluconeogenesis
*Hypermetabolic state*
## Footnote
Slide 24
74
Which process is primarily responsible for the loss of *lean body mass* in burn patients?
A) Lipolysis
B) Gluconeogenesis
C) Proteolysis
D) Glycogenolysis
C) Proteolysis
## Footnote
Slide 24
75
Which of the following are metabolic responses observed in burn patients? (Select 2)
A) Lipolysis
B) Glycolysis
C) Insulin resistance
D) Gaining of lean body mass
E) Hypometabolism
A) Lipolysis - loss of fat
C) Insulin resistance
## Footnote
Slide 24
76
What factors determine the intensity and duration of the metabolic response to trauma in burn patients?
A) Age of the patient and body mass
B) Magnitude of injury and degree of pain
C) Degree of pain and type of burn
D) Magnitude of injurty and type of burn
B) Magnitude of the injury and degree of pain
Magnitude of injury
Degree of pain (leads to tachycardia and HTN, thus ↑ metabolism)
## Footnote
Slide 25
77
When a patient has burns covering more than 40% of their body surface area (BSA), what happens to their metabolic rate?
A) It decreases by half
B) It stays the same
C) It doubles
D) It triples
C) It doubles.
## Footnote
Slide 25
78
Burn patients with extensive injuries (over 40% BSA) may experience ___________ for months due to a hypermetabolic state.
A) Muscle growth
B) Fat accumulation
C) Auto-cannibalism
D) Increased energy
C) Auto-cannibalism
## Footnote
Slide 25
79
Which of the following are likely consequences in burn patients with more than 40% BSA affected? (Select 2)
A) Metabolic rate is cut in half
B) Auto-cannibalism lasting for days
C) Enhanced immune response
D) Recurrent infections
E) Poor wound healing
**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*
## Footnote
Slide 25
80
What hormones are increased in burn patients that affect carbohydrate metabolism?
A) Insulin, growth hormone, and glucagon
B) Cortisol, catecholamines, and glucagon
C) Catecholamines, progesterone, and glucagon
D) Cortisol, calcitonin, and catecholamines
B) Cortisol, catecholamines, and glucagon
## Footnote
Slide 26
81
What is the primary carbohydrate metabolic process accelerated in the liver as a result of burn injuries?
A) Glycolysis
B) Gluconeogenesis
C) Glycogenesis
D) Lipogenesis
B) *Hepatic* Gluconeogenesis
## Footnote
Slide 26
82
Peripheral insulin resistance in burn patients can last up to how many years?
A) 1 year
B) 2 years
C) 3 years
D) 5 years
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.*
## Footnote
Slide 26
83
What are the characteristics of peripheral insulin resistance (50-70%) in burn patients? (Select 2)
A) It is related to the extent of the burn
B) It results from a pre-receptor defect
C) It results from a post-receptor defect
D) It lasts for a few weeks
E) It can last up to 8 years
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*
## Footnote
Slide 26
84
Which factors contribute to the accelerated lipolysis observed in burn patients? (Select 4)
A) Elevated Interleukin
B) B2 adrenergic stimulation
C) Decreased glucagon levels
D) A1 non-adrenergic stimulation
E) B3 adrenergic stimulation
F) Elevated Tissue Necrosis Factor
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
## Footnote
Slide 27
85
In the context of burn injuries and accelerated lypolsis, what are the outcomes of elevated free fatty acids (FFA) levels?
A) Increased ATP production
B) Reduced energy expenditure
C) Enhanced lipid storage
E) Decreased lipolysis
A) Increased ATP production
## Footnote
Slide 27
86
Beta blockers decrease __ and __ in order to combat accelerated lipolysis.
A) Lipid storage and metabolic rate
B) Lipid oxidation and metabolic rate
C) Protein synthesis and ATP production
D) Insulin sensitivity and lipid oxydation
B) Lipid oxidation and metabolic rate
## Footnote
Slide 27
87
What is the primary process that accelerates in burn patients, contributing to the breakdown of skeletal muscle?
A) Lipolysis
B) Glycolysis
C) Proteolysis
D) Gluconeogenesis
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***
## Footnote
Slide 28
88
Accelerated proteolysis in burn patients provides substrate for hepatic __________.
A) Lipogenesis
B) Gluconeogenesis
C) Glycogenesis
D) Ketogenesis
B) Hepatic gluconeogenesis
## Footnote
Slide 28
89
The degree of protein loss in burn patients is proportional to the degree of __________.
A) Hydration
B) Caloric intake
C) Stress
D) Physical activity
C) Stress
***DOUBLES** in severe burns*
## Footnote
Slide 28
90
The worsening of protein loss in burn patients is mediated by __, while *cortisol can partially improve* the condition.
A) TNF, IL-1, and IL-6
B) TNF, IL-1, and IL-7
C) TNF, IL-3, and IL-6
D) TNP, IL-1, and IL-6
A) TNF, IL-1, and IL-6
*Cortisol partially improves the loss of protein!*
## Footnote
Slide 28
91
Initial stabilization of burn patients includes __________ support, fluid resuscitation, and cardiovascular stabilization.
A) Nutritional
B) Respiratory
C) Neurological
D) Psychological
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.*
## Footnote
Slide 29
92
Which of the following are concerns in managing cardiovascular health in burn patients? (Select 2)
A) Increased catecholamine surge
B) Decreased heart rate
C) Decreased metabolic demand
D) Existing cardiovascular comorbidities
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. *
## Footnote
Slide 29
93
An essential part of the **initial stabilization** process for burn patients is __________ control, which needs to be balanced with hemodynamic support.
A) Infection
B) Wound
C) Pain
D) Nutritional
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
## Footnote
Slide 29
94
Which of the following is a **secondary priority** in the care of burn patients?
A) Respiratory support
B) Pain control
C) Initial wound cleaning
D) Fluid resuscitation
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*
## Footnote
Slide 30
95
Which of the following are considered **secondary priorities** in the care of burn patients? (Select 2)
A) Thromboprophylaxis
B) Local care of wounds
C) Wound closure
D) Fluid resuscitation
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.
*
## Footnote
Slide 30
96
Which of the following interventions are part of the **secondary priorities** for burn patients? (Select 2)
A) Control of hypermetabolism
B) Prevention of infection
C) Cardiovascular stabilization
D) Respiratory support
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*
## Footnote
Slide 30
97
The prevention of _________ becomes a critical secondary priority **later** in the burn recovery process.
A) Infection
B) Hypothermia
C) Malnutrition
D) Dehydration
A) Infection
## Footnote
Slide 30
98
What dictates the **secondary priorities** in burn management?
A) Patient's age
B) Severity of burns
C) Associated injuries
D) Time since injury
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.*
## Footnote
Slide 30
99
Which of the following is a commonly used long-acting opioid for pain control in burn patients?
A) Ketorolac
B) Tylenol
C) Methadone
D) Ketamine
C) Methadone
Cornelius- *..long acting opioids, methadone, oxycodone, really thinking about sustained release formulas*
## Footnote
Slide 31
100
# **need to check about NSAIDs with Corn
Which of the following are part of the pain control regimen for burn patients? (Select 2)
A) Short-acting opioids
B) NSAIDs
C) PCA infusions
D) IM opioids
B) NSAIDs (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*
## Footnote
Slide 31
101
__________ is often used for pain management during procedural interventions such as dressing changes in burn patients.
A) Acetaminophen
B) IV Ketamine
C) Methadone
D) NSAIDs
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*
## Footnote
Slide 31
102
Which of the following medications or methods are used to supplement anxiety in burn patients? (Select 2)
A) Diazepam
B) Oxycodone
C) Morphine
D) Alprazolam
A) 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.*
## Footnote
Slide 31
103
Pharmacokinetics and pharmacodynamics can be altered in burn patients, often requiring __________ of doses of medications to avoid toxicity or decreased efficacy.
A) Increased
B) Deviation
C) Standard
D) Decreased
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.*
## Footnote
Slide 31
104
Why are intramuscular (IM) opioids not recommended for burn patients?
A) They are too expensive.
B) Absorption is uncertain.
C) They cause too much pain.
D) They are ineffective for severe pain.
B) Absorption is uncertain.
## Footnote
Slide 31
105
Which of the following is a consequence of burns that contributes to the copious loss of intravascular fluid?
A) Decreased capillary permeability
B) Increased intravascular oncotic pressure
C) Impaired endothelial barrier
D) Systemic vasoconstriction
C) Impaired endothelial barrier
## Footnote
Slide 32
106
Which of the following are effects of burns that lead to the loss of intravascular fluid? (Select 2)
A) Increased endothelial barrier
B) Increased capillary permeability
C) Increased intravascular oncotic pressure
D) Loss of intravascular oncotic pressure
B) Increased capillary permeability
D) Loss of intravascular oncotic pressure
## Footnote
Slide 32
107
What causes the vasodilation of vessels in burn patients?
A) Release of histamine, prostaglandins, and epinephrine
B) Release of histamine, prostaglandins, and macrophages
C) Release of histamine, prostaglandins, and cytokines
D) Release of histamine, prostaglandins, and leukocytes
C) Release of histamine, prostaglandins, and cytokines
*Increased systemic inflammatory reactions*
## Footnote
Slide 32
108
IV fluid needs are generally required for burn patients with what percentage of Body Surface Area (BSA) involvement?
A) 10%
B) 15%
C) 20%
D) 25%
**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*
## Footnote
Slide 33
109
Concern arises when formulas are not followed, as it can lead to __________, which may cause pulmonary edema and compartment syndrome.
A) Hypohydration
B) Dehydration
C) Overhydration
D) Hypotension
C) Overhydration
Patients overhydrated (6ml/kg/% vs 4ml/kg/%)
## Footnote
Slide 33
110
The Parkland Formula is most commonly used as a starting point for fluid resuscitation in burn patients. Which of the following types of burns may require higher volumes of fluid?
A) Superficial burns
B) Chemical burns
C) Electrical burns
D) Inhaled burns
C) Electrical burns
D) Inhaled burns
Cornelius - ***delayed resuscitation**- if you 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*
## Footnote
Slide 34
111
According to the Parkland Formula, how much Lactated Ringer's solution should be administered in the first 8 hours for a patient?
A) 2ml/kg/%BSA
B) 4ml/kg/%BSA
C) 3ml/kg/%BSA
D) 1ml/kg/%BSA
**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.*
## Footnote
Slide 34
112
In cases of adequate urine output (U/O), it is recommended to __________ the fluid formula.
A) Increase
B) Decrease
C) Maintain
D) Double
B) Decrease
## Footnote
Slide 34
113
Which of the following is the correct Parkland Burn Formula?
A) 4 mL x kg x % TBSA burned
B) 3 mL x kg x % TBSA burned
C) 5 mL x kg x % TBSA burned
D) 2 mL x kg x % TBSA burned
**A) 4 mL x kg x % TBSA burned**
* 2 ml/kg/%BSA in 1st 8 hours
* 2 ml/kg/%BSA in next 16 hours
## Footnote
Slide 34
114
What is the basic fluid resuscitation rate according to the US Army ISR Rule of 10 for adults?
A) 5 mL/hr x TBSA (%)
B) 10 mL/hr x TBSA (%)
C) 15 mL/hr x TBSA (%)
D) 20 mL/hr x TBSA (%)
B) 10 mL/hr x TBSA (%)
## Footnote
Slide 35
115
According to the US Army ISR Rule of 10, what adjustment should be made for patients weighing more than 80 kg?
A) Subtract 50 mL/hr for every 10 kg over 80 kg
B) Add 100 mL/hr for every 10 kg over 80 kg
C) No adjustment is needed for weight
D) Reduce the rate by 10 mL/hr for every 10 kg over 80 kg
B) Add 100 mL/hr for every 10 kg over 80 kg
## Footnote
Slide 35
116
Which of the following correctly represents the volume of fluid to be administered in the first 24 hours for pediatric burn patients according to the US Army ISR Rule of 10?
A) 4 mL x TBSA (%) x kg
B) 3 mL x TBSA (%) x kg
C) 2 mL x TBSA (%) x kg
D) 1 mL x TBSA (%) x kg
B) 3 mL x TBSA (%) x kg
*½ total volume over 1st 8 hrs*
## Footnote
Slide 35
117
A pediatric patient weighing 20 kg has sustained burns covering 25% of their total body surface area (TBSA). Using the US Army ISR Rule of 10, how much fluid should be administered in the **first 24 hours**?
A) 1000 mL
B) 1500 mL
C) 2000 mL
D) 2500 mL
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
## Footnote
Slide 35
118
When performing a preoperative assessment for a burn patient, which of the following should be determined? (Select all that apply-3)
A) Estimated BSA% burn
B) Severity of burn
C) Duration of the burn
D) Need for transfer to a certified burn center
A) Estimated BSA% burn
B) Severity of burn
D) Need for transfer to a certified burn center
## Footnote
Slide 37
119
Which of the following criteria indicate the need for transfer to a certified burn center? (Select all that apply-4)
A) Full thickness burns > 10% BSA
B) Presence of chemical burns
C) Burns located on the torso only
D) Burn on face, hands, feet, perineum, major joints
E) High voltage electrical burns
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
## Footnote
Slide 37
120
High voltage electrical burns and associated ___ injuries are indications for transfer to a specialized burn center.
A) inhalation
B) cardiovascular
C) neurological
D) gastrointestinal
A) inhalation
## Footnote
Slide 37
121
The goal for urine output during fluid resuscitation in burn patients is:
A) 0.5 cc/kg/hr
B) 1 cc/kg/hr
C) 2 cc/kg/hr
D) 1.5 cc/kg/hr
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.
## Footnote
Slide 38
122
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
## Footnote
Slide 39
123
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.*
## Footnote
Slide 39
124
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)
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.*
## Footnote
Slide 39
125
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
## Footnote
Slide 39
126
Fluids should increase/decrease by ___% if urine output outside the parameters.
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*
## Footnote
Slide 39
127
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
## Footnote
Slide 39
128
If a pediatric patient is heavier than __ then use the adult formulas.
A) 30 kg
B) 35 kg
C) 40 kg
D) 45 kg
C) 40kg
## Footnote
Slide 40
129
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 kg x %TBSA
D) 2-4 mL of 0.45% Saline/kg x %TBSA
C) **2-4 mL of Lactated Ringer’s/kg x kg x %TBSA**
Ex. 30kg and 10% TBSA
2/30 x 30 x 10 = 4500 mL
## Footnote
Slide 40
130
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)
## Footnote
Slide 40
131
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.*
## Footnote
Slide 40
132
# 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.
## Footnote
Slide 41
133
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
## Footnote
Slide 41
134
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
## Footnote
Slide 42
135
In the "ebb" state of the resuscitative phase, cardiac output is typically reduced by ____.
A) 30%
B) 50%
C) 60%
D) 70%
C) 60%
## Footnote
Slide 43
136
During the resuscitative phase, which of the following changes occur in cardiac status? (Select all that apply-4)
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) EMyocardial ischemia d/t decreased coronary flow
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*
## Footnote
Slide 43
137
At 72-96 hours post-burn during the "flow" phase, which of the following physiological changes are typically observed? (Select all that apply-3)
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)
## Footnote
Slide 43
138
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
B) Administer beta-blockers
*They don't respond very well to catecholamines, so treatment with things like epinephrine may not be helpful.*
## Footnote
Slide 43
139
Which of the following pulmonary complications are associated with systemic inflammatory responses in burn patients? (Select all that apply-4)
A) Pulmonary hypertension
B) Pulmonary capillary alveolar membrane disruption
C) Increased plasma oncotic pressure
D) Decreased plasma oncotic pressure
E) Decreased extravascular lung water
F) Increased extravascular lung water leading to impaired gas exchange
*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
## Footnote
Slide 44
140
Which of the following therapies is typically used to manage bronchospasm in burn patients?
A) Diuretics
B) Antibiotics
C) Bronchodilators
D) Anticoagulants
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.*
## Footnote
Slide 44
141
Which of the following factors contribute to Restrictive lung defect in burn patients? (Select all that apply-2)
A) Impaired ventilation from circumferential burns/scar
B) Hypoventilation due to decreased elasticity
C) Increased lung compliance
D) Hyperventilation from increased chest wall mobility
A) Impaired ventilation from circumferential burns/scar
B) Hypoventilation due to decreased elasticity
## Footnote
Slide 44
142
What is the primary treatment for lung restriction due to burn tissue damage?
A) Bronchodilator therapy
B) Escharotomy
C) Fluid resuscitation
D) Diuretic administration
B) Escharotomy
## Footnote
Slide 44
143
Which of the following is a sign of possible restrictive lung deficit in a patient?
A) Decreased airway pressures
B) Increased airway pressures
C) Hypoventilation
D) Hyperventilation
B) Increased airway pressures
*You may have a hard time ventilating these patients*
## Footnote
Slide 44
144
Which of the following signs is commonly associated with exposure to fire in a closed space? (Select all that apply-3)
A) Singeing of face or nasal hair
B) Oropharyngeal carbon
C) Wheezing
D) Clear breath sounds
E) Hypothermia
A) Singeing of face or nasal hair
B) Oropharyngeal carbon
C) Wheezing
## Footnote
Slide 45
145
Which lab value is typically elevated in patients with inhalation injuries?
A) Hemoglobin A1c
B) Carboxyhemoglobin levels
C) Serum lactate
D) Arterial blood pH
B) Carboxyhemoglobin levels
**> 10%**
## Footnote
Slide 45
146
What is the primary diagnostic tool used to confirm inhalation injuries?
C) Bronchoscopy
## Footnote
Slide 45
147
Match the treatment or intervention for Facial burns with the corresponding condition or action.
1. Extensive edema is common
2. Protect the eyes
3. Consult ophthalmology
4. Apply bacitracin ointment
5. Apply erythromycin ointment
Options:
A) Remove contact lenses
B) Secure endotracheal tube (ETT)
C) For corneal/globe injury
D) In the eyes
E) To eyelids
1. Extensive edema is common - B) Secure endotracheal tube (ETT)
2. Protect the eyes - A) Remove contact lenses
3. Consult ophthalmology - C) For corneal/globe injury
4. Apply bacitracin ointment - E) To eyelids
5. Apply erythromycin ointment - D) In the eyes
## Footnote
Slide 46
148
Which of the following are common sources of carbon monoxide exposure? (Select all that apply-3)
A) Engine exhaust
B) Fire
C) Improperly vented gas/oil heaters
D) Fresh air ventilation
E) Electric heaters
A) Engine exhaust
B) Fire
C) Improperly vented gas/oil heaters
## Footnote
Slide 47
149
# True or False
Carbon monoxide exposure can be confirmed by measuring elevated carboxyhemoglobin (COHb) levels.
True
## Footnote
Slide 47
150
Carbon monoxide poisoning is often associated with the burning of ___________, while cyanide poisoning is linked to the combustion of ___________.
A) Plastics; metals
B) Fuels; plastics
C) Wood; metals
D) Fresh air; water
B) Fuels; plastics
*Carbon monoxide (fuels) and CN poisoning (plastics)*
## Footnote
Sliide 47
151
Carbon monoxide poisoning is generally treated with __________, while cyanide poisoning is treated with __________.
A) Vitamin B12; 100% oxygen
B) 100% oxygen; Vitamin B12
C) Diuretics; bronchodilators
D) Anticoagulants; antiplatelets
B) 100% oxygen; Vitamin B12 (Cobalamin)
Cornelius: *Carbon monoxide we generally treat with 100% oxygen. Cyanide poisoning with B12
## Footnote
Slie 47
152
Match the carboxyhemoglobin (COHb) level with the appropriate symptoms.
1. 1-3%
2. 4-9%
3. 15-20%
4. 20-25%
5. >25%
Options:
A) Overt signs of toxicity (headache, nausea, vomiting, etc.)
B) Unconsciousness and death
C) Smokers
D) Normal nonsmoker
E) Signs of severe toxicity (seizures, acute renal failure, myocardial ischemia)
1. 1-3% - D) Normal nonsmoker
2. 4-9% - C) Smokers
3. 15-20% - A) Overt signs of toxicity (headache, nausea, vomiting, etc.)
4. 20-25% - E) Signs of severe toxicity (seizures, acute renal failure, myocardial ischemia)
5. >25% - B) Unconsciousness and death
## Footnote
Slide 47
153
After a burn injury, which of the following are commonly observed in patients? (Select all that apply-4)
A) Elevated protein needs
B) Increased energy needs
C) Increased vitamin needs
D) Insulin resistance
E) Decreased metabolic rate
A) Elevated protein needs
B) Increased energy needs
C) Increased vitamin needs
D) Insulin resistance
## Footnote
Slide 48
154
Early nutrition within 16 hours of admission in burn patients is believed to reduce the ____ and support overall recovery.
A) Risk of infection
B) Magnitude of the stress response
C) Metabolic rate
D) Requirement for surgery
B) Magnitude of the stress response
## Footnote
Slide 48
155
Nasoenteric feeds into the ___ are particularly important for burn patients to ensure ___ and ___ intake directly to the jejunum.
A) duodenum; high carbohydrate; low protein
B) ileum; high fiber; low fat
C) jejunum; high-calorie; high-protein
D) jejunum; high-calorie; low-protein
C) 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
## Footnote
Slide 48
156
Which of the following factors can alter the pharmacodynamics and pharmacokinetics of drugs in patients? (Select all that apply-3)
A) Loss of plasma protein concentration
B) Alterations in drug receptor
C) Changes in cardiac output
D) Increased hydration status
E) Decreased body temperature
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))
## Footnote
Slide 49
157
In burn patients, the upregulation of ___________ receptors can lead to an increased risk of adverse effects when using certain neuromuscular blocking agents.
A) GABA
B) nACh
C) Dopamine
D) Serotonin
B) nACh receptors
| Takes Months to years (1-2) to recover
## Footnote
Slide 50
158
What are the potential consequences of upregulation of nACh receptors in burn patients? (Select all that apply-2)
A) Resistance to non-depolarizing neuromuscular blockers
B) Sensitivity to depolarizing neuromuscular blockers
C) Decreased sensitivity to depolarizers
D) Enhanced effects of non-depolarizers
E) Resistance to depolarizers
A) Resistance to non-depolarizing neuromuscular blockers
B) Sensitivity to depolarizing neuromuscular blockers
## Footnote
Slide 50
159
Burn patients with what percentage of body surface area (BSA) affected may develop resistance to non-depolarizing neuromuscular blockers?
A) 10% BSA and greater
B) 15% BSA and less
C) 20% BSA and greater
D) 25% BSA and greater
D) 25% BSA and greater
## Footnote
Slide 50
160
Which drug should be avoided in burn patients after 24 hours post-injury?
A) Rocuronium
B) Vecuronium
C) Succinylcholine
D) Atracurium
**C) Succinylcholine**
* Markedly increased serum K+
* Significant after 48-72 hours
* Does not correlate with severity of burn
## Footnote
Slide 50
161
Which of the following should be closely monitored during the intraoperative period for burn patients? (Select all that apply-7)
A) EKG patches
B) Pulse oximetry probe accuracy
C) Blood pressure monitoring
D) Continuous capnography for measuring end-tidal CO₂
E) Arterial blood gases (ABGs)
F) Stroke Volume Variation (SVV)
G) Body temperature
H) Urine output
**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
## Footnote
Slide 51
162
Which of the following signs and symptoms are indicative of an airway burn or inhalational injury? (Select all that apply-6)
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
G) Hypotension with bradycardia
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
## Footnote
Slide 52
163
Which of the following challenges may be encountered when intubating a patient with an airway burn or inhalational injury? (Select all that apply-3)
A) Difficulty identifying the tracheal aperture
B) Early worsening of the airway condition
C) Ease of passing the endotracheal tube
D) Significant tracheal edema
E) Minimal airway obstruction
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
## Footnote
Slide 53
164
Which of the following are signs of impending airway obstruction that indicate the need for immediate intubation? (Select all that apply-3)
A) Stridor
B) Hoarseness
C) Dysphagia
D) Clear breath sounds
E) Wheezing
A) Stridor
B) Hoarseness
C) Dysphagia
## Footnote
Slide 55
165
Which of the following factors can contribute to difficult laryngoscopy in burn patients? (Select all that apply-4)
A) Edema
B) Pain
C) Eschar
D) Contractures
E) Increased lung compliance
A) Edema- *Signs of inhalation injury*
*Limited mobility*
B) Pain
C) Eschar
D) Contractures
## Footnote
Slide 55
166
Which of the following factors can contribute to difficult bag-valve mask ventilation in burn patients?
A) Edema
B) Burn dressings preventing an adequate seal
C) Pain
D) Contractures
E) Increased lung compliance
B) Burn dressings preventing an adequate seal
## Footnote
Slide 55
167
Which of the following are benefits of preserving spontaneous ventilation in burn patients? (Select all that apply-2)
A) Facilitates intubation
B) Maintains gas exchange
C) Reduces the need for sedation
D) Decreases the risk of aspiration
E) Increases the likelihood of airway obstruction
A) Facilitates intubation
B) Maintains gas exchange
## Footnote
Slide 55
168
Which of the following methods can be used to secure an endotracheal tube (ETT) vs tracheostmy in burn patients? (Select all that apply-2)
A) Cotton umbilical tape
B) Wire to teeth
C) Silk sutures to the skin
D) Adhesive tape
A) Cotton umbilical tape
B) Wire to teeth
## Footnote
Slide 55
169
# True or False
A LMA (Laryngeal Mask Airway) is an appropriate airway management option for burn patients.
False: LMA should **not** be used as an airway management for burn patients
## Footnote
Slide 55
170
Which of the following drugs are commonly used for induction in burn patients? (Select all that apply-4)
A) Propofol
B) Etomidate
C) Ketamine
D) Opioids
E) Midazolam
**A) Propofol** - *Ebb vs flow phase*
**B) Etomidate** - *Adrenal insufficiency concern*
**C) Ketamine** -*Stimulates SNS vs depressant effect*
**D) Opioids** - *Ebb vs flow phase*
## Footnote
Slide 56
171
Which of the following is a significant adverse side effect of Etomidate?
A) Respiratory depression
B) Adrenal insufficiency
C) Renal failure
D) Hyperglycemia
**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
## Footnote
Slide 56
172
# True or False
Ketamine is often used during burn dressing changes.
True
## Footnote
Slide 56
173
Which of the following is a common cause of hemodynamic instability during anesthesia in burn patients?
A) Hypervolemia
B) Hypovolemia
C) Bradycardia
D) Hypertension
B) Hypovolemia
*Decreased preload….decreased CO*
## Footnote
Slide 57
174
What tool can be used as a rescue intervention to assess hypovolemia-related hemodynamic instability?
A) Electrocardiogram (ECG)
B) Pulmonary artery catheter
C) Transesophageal Echocardiography (TEE)
D) Capnography
C) Transesophageal Echocardiography (TEE)
## Footnote
Slide 57
175
Which differential diagnoses should be ruled out when assessing a patient for hemodynamic instability? (Select all that apply-3)
A) Cardiogenic shock
B) Distributive shock
C) Myocardial infarction (MI)
D) Hypertensive crisis
A) Cardiogenic shock
B) Distributive shock
C) Myocardial infarction (MI)
## Footnote
Slide 57
176
For every __ of burn excised or autograft harvested, ___ of total blood volume is lost.
A) 1% of burn; 2.6% total blood volume
B) 2% of burn; 1.5% total blood volume
C) 1% of burn; 3.2% total blood volume
D) 2% of burn; 4.0% total blood volume
A) 1% of burn; 2.6% total blood volume
*2.6% total blood volume lost for every 1% burn excised or autograft harvest*
## Footnote
Slide 58
177
What is the recommended range for maintaining hemoglobin (Hgb) in burn patients?
A) 9-10 g/dL
B) 7-8 g/dL
C) 11-12 g/dL
D) 5-6 g/dL.
**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*
## Footnote
Slide 58
178
Which of the following drugs is used off-label in burn patients and is known to increase the risk of thrombosis?
A) TXA
B) rFVII
C) Propofol
D) Ketamine
B) rFVII
## Footnote
Slide 58
179
# True or False
TXA (tranexamic acid) is associated with an increased risk of thromboembolism in burn patients.
True
## Footnote
Slide 58
180
In cases of shock with MAP less than 55 mmHg, vasopressors such as __ and __ are typically administered to restore adequate perfusion.
A) Epinephrine; Dopamine
B) Vasopressin; Norepinephrine
C) Phenylephrine; Dobutamine
D) Atropine; Amiodarone
B) Vasopressin; Norepinephrine
## Footnote
Slide 59
181
What is the recommended central venous pressure (CVP) goal in burn patients?
A) 2-4 mm Hg
B) 5-7 mm Hg
C) 6-8 mm Hg
D) 8-10 mm Hg
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.*
## Footnote
Slide 59
182
What is the primary technique used to infiltrate large volumes of local anesthetic subcutaneously?
A) Regional anesthesia
B) Epidural anesthesia
C) Tumescent anesthesia with epinephrine
D) Intravenous anesthesia
C) Tumescent anesthesia with epinephrine
## Footnote
Slide 60
183
Which of the following correctly describes the components of a typical tumescent local anesthetic solution?
A) 1G lidocaine, epinephrine, and 10 meq NaHCO₃⁻ in 500cc NaCl
B) 1G lidocaine, epinephrine, and 10 meq NaHCO₃⁻ in 1000cc NaCl
C) 500mg lidocaine, epinephrine, and 5 meq NaHCO₃⁻ in 1000cc NaCl
D) 2G lidocaine, epinephrine, and 20 meq NaHCO₃⁻ in 1000cc NaCl
B) 1G lidocaine, epinephrine, and 10 meq NaHCO₃⁻ in 1000cc NaCl
| 55mg/kg max
## Footnote
Slide 60
184
Which of the following are benefits associated with the tumescent technique? (Select all that apply-4)
A) Decreased blood loss
B) Easy excision of granulation tissue
C) Shorter surgical times
D) Postoperative hematoma formation
E) Reduced bruising postoperatively
A) Decreased blood loss
B) Easy excision of granulation tissue
C) Shorter surgical times
E) Reduced bruising postoperatively *or no hematoma*
## Footnote
Slide 60
185
When mechanically ventilating a burn patient, the pCO2 should be maintained between ___ mm Hg or a pH greater than ___.
A) 20-25 mmHg; pH 7.0
B) 30-35 mmHg; pH 7.2
C) 40-45 mmHg; pH 7.4
D) 50-55; pH 7.6
B) 30-35 mmHg; pH 7.2
*Target pCO2 30-35 mm Hg or pH >7.20*
## Footnote
Slide 61
186
Which drug combination is recommended for nebulization during mechanical ventilation?
A) Salbutamol with 1000 units of Heparin
B) Albuterol with 5000 units of Heparin
C) Ipratropium with 2000 units of Heparin
D) Albuterol with 10000 units of Heparin
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˚
## Footnote
Slide 62
187
Which of the following are true regarding Abdominal Compartment Syndrome (ACS)? (Select all that apply-2)
A) Abdominal pressure displaces the diaphragm upwards by the bowel
B) ACS is best diagnosed by measuring bladder pressures
C) Abdominal pressure displaces the diaphragm downwards by the liver
D) ACS can be diagnosed by assessing skin turgor
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*
## Footnote
Slide 63
188
Which of the following statements are true regarding the measurement of bladder pressure for ACS? (Select all that apply-2)
A) Bladder pressure should be measured every 2 hours
B) Bladder pressure should be measured every 4 hours
C) Bladder pressure should be monitored with >20% TBSA burns
D) Bladder pressure measurement is unnecessary in patients with less than 10% TBSA burns
B) Bladder pressure should be measured every 4 hours
C) Bladder pressure should be monitored with >20% TBSA burns
## Footnote
Slide 64
189
Intra-abdominal hypertension is considered early when bladder pressures exceed __________ mm Hg.
A) 8
B) 10
C) 12
D) 14
C) 12
*somebody with their pressure greater than 12, consider they may have early intraabdominal hypertension*
## Footnote
Slide 64
190
Abdominal compartment syndrome is indicated by bladder pressures greater than __________ mm Hg.
A) 15
B) 18
C) 20
D) 25
C) 20
*over 20 They probably have abdominal compartment syndrome and need to be lapped.*
## Footnote
Slide 64
191
Which of the following is a reason to maintain postoperative mechanical ventilation in burn patients? (Select all that apply-3)
A) Inhalation burns
B) High risk for ongoing bleeding
C) To avoid additional surgery
D) To minimize movement and prevent graft disruption
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
## Footnote
Slide 65
192
What is a key consideration when using pain scales in burn patients?
A) There is abundant data specific to burn patients
B) Different scales should be used for each assessment
C) The same pain scale should be used consistently
D) Pain scales are not necessary for burn patients
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.*
## Footnote
Slide 66
193
Which of the following are treatment options for managing burn pain? (Select all that apply-3)
A) Use of additives PRN
B) Nitrous oxide 50/50 in addition to ketamine
C) Spinal anesthesia for all burn injuries
D) Peripheral nerve blocks for extremity injuries
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
## Footnote
Slide 67
194
Which of the following are methods used for thermoregulation in patients? (Select all that apply-4)
A) HPMK/Blizzard Heat
B) Aircraft temperature control
C) Belmont Buddy Lite
D) Wool blanket
E) Cooling packs
A) HPMK/Blizzard Heat
B) Aircraft temperature control
C) Belmont Buddy Lite
D) Wool blanket
## Footnote
Slide 68
195
What is the recommended angle for elevating extremities to prevent complications?
A) 10-15 degrees
B) 20-25 degrees
C) 30-45 degrees
D) 50-60 degrees
C) 30-45 degrees
| pillows first, then slings
## Footnote
Slide 69
196
How often should pulses be examined in patients with elevated extremities?
A) Every 4 hours
B) Every 2 hours
C) Every 1 hour
D) Every 6 hours
C) Every 1 hour
*use a doppler*
## Footnote
Slide 69
197
Escharotomy is performed on limbs primarily to monitor __________, and on the chest to prevent __________.
A) Pain; pressure sores
B) Blood pressure; fluid overload
C) Pulse checks; ventilator compromise and decreased cardiac output
D) Temperature; infection
C) Escharotomy is performed on limbs primarily to monitor **pulse checks**, and on the chest to prevent **ventilator compromise and decreased cardiac output**
## Footnote
Slide 69
198
Which of the following are appropriate adjuncts to burn resuscitation? (Select all that apply-3)
A) GI Prophylaxis
B) Applying cold compresses to scrotal swelling
C) Sew and/or staple all venous and arterial catheters in place
D) Insert Foley immediately to maintain urethral patency
E) Administer high-dose steroids for inflammation
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.
## Footnote
Slide 71
199
# True or False
Assessing tetanus status is a critical component of burn resuscitation.
True
Tetanus status
* Burns are tetanus prone wounds
* Booster if > 5 yrs since last booster
* Booster plus TIG if no previous immunization
## Footnote
Slide 72
200
Which of the following are NOT indicated in the routine management of burn patients? (Select all that apply-2)
A) IV antibiotics
B) Steroids
C) Tetanus prophylaxis
D) Fluid resuscitation
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
## Footnote
Slide 72
201
Which of the following topical antibiotics are commonly used in burn dressing changes? (Select all that apply-2)
A) Silvadene
B) Sulfamylon
C) Neosporin
D) Bacitracin
A) Silvadene
B) Sulfamylon
| No Silvadene to the face
## Footnote
Slide 73
202
Which of the following are types of commonly used burn dressings? (Select all that apply-4)
A) Silver dressings
B) Honey-based dressings
C) Silver nitrate
D) Temporary skin substitutes such as Biobrane
E) Silverton water or saline every 8 hours
A) Silver dressings
C) Silver nitrate
D) Temporary skin substitutes such as Biobrane
E) Silverton water or saline every 8 hours
## Footnote
Slide 73
