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
and determining healing potential
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? (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.
*
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
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.
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
Cornelius called* the pic on the left “non -accidental trauma.” Sticking the hand intentionally in a hot substance. The picture on the right is irregular pattern and likely from a fry cook splashing hot oil on his hands*
Slide 12
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
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
Slide 14
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
Slide 14
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
Slide 14
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
Slide 15
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
Slide 16
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
Slide 16
True or False
Partial Thickness (2nd Degree Burn) burns are very painful in sensation.
True
Slide 16
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
Slide 16
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. *
Slide 17
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
Slide 17
The Rule of Nines assigns ___________ of TBSA to each arm.
A) 18%
B) 9%
C) 1%
D) 4.5%
B) 9%
Slide 17
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%
Slide 17
The head accounts for ___________ of TBSA according to the Rule of Nines.
A) 9%
B) 18%
C) 36%
D) 1%
A) 9%
Slide 17
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
Select 18
What percentage of TBSA is assigned to each leg in an infant?
A) 18%
B) 21%
C) 13.5%
D) 10%
C) 13.5%
Slide 18
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
Slide 18
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%
Slide 18
The TBSA percentage for each arm in an infant is ___________.
A) 21%
B) 10%
C) 13%
D) 13.5%
B) 10%
Slide 18
The TBSA percentage for the buttocks in an infant is ___________.
A) 5%
B) 13%
C) 13.5%
D) 10%
A) 5%
Slide 18
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
Slide 19
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. *
Slide 20
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
Slide 20
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. *
Slide 20
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
Slide 20
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
Slide 21
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. *
Slide 21
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
Slide 21
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
Slide 22
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. *
Slide 22
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
Slide 23
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
Slide 23
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.
slide 23
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
Slide 23
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
Slide 24
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
Slide 24
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
Slide 24
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)
Slide 25
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.
Slide 25
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
Slide 25
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
Slide 25
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
Slide 26
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
Slide 26
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.
Slide 26
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
Slide 26
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
Slide 27
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
Slide 27
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
Slide 27
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
Slide 28
Accelerated proteolysis in burn patients provides substrate for hepatic __________.
A) Lipogenesis
B) Gluconeogenesis
C) Glycogenesis
D) Ketogenesis
B) Hepatic gluconeogenesis
Slide 28
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
Slide 28
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!
Slide 28
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.
Slide 29
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. *
Slide 29
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
Slide 29
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*
Slide 30
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.
*
Slide 30
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
Slide 30
The prevention of _________ becomes a critical secondary priority later in the burn recovery process.
A) Infection
B) Hypothermia
C) Malnutrition
D) Dehydration
A) Infection
Slide 30
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.
Slide 30
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
Slide 31
**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
Slide 31
__________ 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
Slide 31
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.
Slide 31
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.*
Slide 31
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.
Slide 31
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
Slide 32
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
Slide 32
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
Slide 32
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
Slide 33
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/%)
Slide 33
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
Slide 34
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.
Slide 34
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
Slide 34
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
Slide 34
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 (%)
Slide 35
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
Slide 35
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
Slide 35
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)= Volumeforfirst24hours
Calculation:
3 × 25 (TBSA) × 20kg = 1500 mL
If you were to give half in the first 8 hrs, that would be 750ml
Slide 35
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
Slide 37
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
Slide 37
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
Slide 37
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.
Slide 38
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
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
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.
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 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
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
C) 40kg
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 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
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
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
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-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
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-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)
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
B) Administer beta-blockers
They don’t respond very well to catecholamines, so treatment with things like epinephrine may not be helpful.
Slide 43
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
Slide 44
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.
Slide 44
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
Slide 44
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
Slide 44
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
Slide 44
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
Slide 45
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%
Slide 45
What is the primary diagnostic tool used to confirm inhalation injuries?
C) Bronchoscopy
Slide 45
Match the treatment or intervention for Facial burns with the corresponding condition or action.
- Extensive edema is common
- Protect the eyes
- Consult ophthalmology
- Apply bacitracin ointment
- 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
- Extensive edema is common - B) Secure endotracheal tube (ETT)
- Protect the eyes - A) Remove contact lenses
- Consult ophthalmology - C) For corneal/globe injury
- Apply bacitracin ointment - E) To eyelids
- Apply erythromycin ointment - D) In the eyes
Slide 46
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
Slide 47
True or False
Carbon monoxide exposure can be confirmed by measuring elevated carboxyhemoglobin (COHb) levels.
True
Slide 47
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)
Sliide 47
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
Slie 47
Match the carboxyhemoglobin (COHb) level with the appropriate symptoms.
- 1-3%
- 4-9%
- 15-20%
- 20-25%
- > 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)
- 1-3% - D) Normal nonsmoker
- 4-9% - C) Smokers
- 15-20% - A) Overt signs of toxicity (headache, nausea, vomiting, etc.)
- 20-25% - E) Signs of severe toxicity (seizures, acute renal failure, myocardial ischemia)
- > 25% - B) Unconsciousness and death
Slide 47
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
Slide 48
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
Slide 48
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
Slide 48
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))
Slide 49
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
Slide 50
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
Slide 50
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
Slide 50
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
Slide 50
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
Slide 51
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
Slide 52
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
Slide 53
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
Slide 55
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
Slide 55
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
Slide 55
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
Slide 55
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
Slide 55
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
Slide 55
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
Slide 56
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
Slide 56
True or False
Ketamine is often used during burn dressing changes.
True
Slide 56
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
Slide 57
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)
Slide 57
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)
Slide 57
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
Slide 58
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
Slide 58
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
Slide 58
True or False
TXA (tranexamic acid) is associated with an increased risk of thromboembolism in burn patients.
True
Slide 58
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
Slide 59
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.
Slide 59
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
Slide 60
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
Slide 60
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
Slide 60
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
Slide 61
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˚
Slide 62
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
Slide 63
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
Slide 64
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
Slide 64
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.
Slide 64
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
Slide 65
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.
Slide 66
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
Slide 67
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
Slide 68
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
Slide 69
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
Slide 69
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
Slide 69
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.
Slide 71
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
Slide 72
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
Slide 72
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
Slide 73
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
Slide 73
