Burns pt3 Exam 1 Flashcards
What lab is commonly elevated with inhalation injuries?
- Carboxyhemoglobin levels > 10%
How are Inhalation injuries diagnosed/confirmed?
Bronchoscopy
For facial burns:
- Apply bacitracin ointment to___
- Apply erythromycin ointment in the ___
- Avoid using what cream on the face?
- Eye lids
- Eyes
do not use silvadene on the face
Carbon Monoxide inhalation is confirmed by what lab?
↑ COHb
At what various levels of carboxyhemoglobin are differing signs and symptoms seen?
After burns, patients will have elevated ____, ____, and energy needs.
- protein
- vitamin
Nutrition within 16 hours of admission is thought to
reduce magnitude of stress response
_____ resistance occurs after burn injuries (in regards to nutrition).
Insulin
How are burn patients force-fed?
High calorie, high protein feeds into the jejunum
May not be D/C for OR if already intubated
What factors can change the pharmacodynamics/kinetics of our drugs? (3)
- Loss of plasma protein concentration
- Alterations in drug receptor (nAChR)
- Cardiac output changes
Lots of medication floating around free because they aren’t bound to anything like albumin…
Increases free fractions and volume of distributon
Burns result in up regulation of
nACH receptors
Takes Months to years (1-2) to recover
What drug needs to be avoided in the >24hrs after a burn?
Why?
Succinylcholine
Due to upregulation of nACh receptors → may have exaggerated ↑K⁺
What paralytic agent is resistant 24hrs after a burn injury?
Non-depolarizing NMBs
Due to upregulation of nACH receptors
Resistance to non-depolarizers happens when BSA is over ____%.
25%
What signs/symptoms are indicative of airway burn or inhalational injury? (6)
- Hoarseness, wheezing, SOB
- Carbonaceous sputum
- Singed nasal & facial hairs
- Deep facial burns
- Comatose patient
- > 40% TBSA
Difficult laryngoscopy can be due to what four factors?
- Edema
- Pain
- Eschar
- Contractures
What are some options for securing the ETT vs tracheostomy (2)
- Cotton umbilical tape
- Wire to teeth
____ should not be used as an airway management for burn patients
LMA
* doesn’t help with airway edema
What are some of the induction drugs for burns (4)
- Propofol
- Etomidate
- Ketamine(Simulates SNS vs depressant effect)
- Opioids
An important adverse side effect noted with Etomidate is ______ _______.
Adrenal Insufficiency
- may need steroid supplement
What drug is often useful as an adjunct in burn dressing changes?
Ketamine
2.6% total blood volume is lost for every __% of burn excised or autograft harvested.
1%
Hgb should be maintained around ____ g/dL.
7-8 g/dL
____ is a off label drug for burns to prevent blood loss during burn excision.
rFVII
pts are at increased risk of thrombosis
List the vasopressors used in shock when MAP is <55 mmHg.
- Vasopressin
- Norepinephrine
What is the CVP goal with burn patients?
- Goal 6-8 mm Hg
- If not at goal, increase IVF rate by 20-25%
If UO remains low, give fluids. If you have enough UO and your BP is still low, start vasopressors.
What technique is utilized to infiltrate large volumes of local anesthetic subcutaneously?
Tumescent LA w/ epi
What is the typical dose of tumescent local anesthetic?
Lidocaine 1G + epi + 10meq NaHCO₃⁻/1000cc NaCL
55mg/kg max
What are the goals of tumescent technique? (4)
- Decreased blood loss
- Easy excision of granulation tissue
- Shorter surgical times
- No hematoma or bruising postop
When mechanically ventilating a burn patient, target pCO2 to ____ mm Hg or pH >_____.
- 30-35 mmHg
- 7.20
During mechanical ventilation patients should be nebulized with what drug?
Albuterol w/ 5000 units Heparin Q4H
Ensure albuterol is given with heparin since heparin can induce bronchospasm (i.e. wheezing)
Abdominal Compartment Syndrome is diagnosed via what?
Bladder pressures
.
This is the condition which is to be avoided given the high mortality rate if the abdomen is opened (90%). This is why we have such strict rules in terms of fluid management.
Bladder Pressure for ACS should be measured every
- Measure Q4H with >20% TBSA
Bladder pressures greater than ____ mmHg indicate early intra-abdominal hypertension.
- > 12 mmHg
____ mmHg is diagnostic for abdominal compartment syndrome.
> 20 mmHg
Additional burn pain treatment options include
- Additives PRN
- Nitrous oxide 50/50 – in addition to Ketamine
- Peripheral nerve blocks for extremity injuries
Extremities should be elevated ____ degrees.
30-45 degrees (pillows first, then slings)
Assess pulses every ____ hour(s).
Hour – Doppler (High risk for losing perfusion and sensation due to compartment syndrome)
List the adjuncts to burn Resuscitation management
- GI Prophylaxis – High risk for stress ulcers
- Suture and/or staple all venous and arterial catheters in place
- Genitalia/Perineum- Insert Foley immediately to maintain urethral patency
-
Tetanus status
o Burns are tetanus prone wounds
o Booster if > 5 yrs since last booster
o Booster plus TIG if no previous immunization - IV antibiotics NOT indicated
- Steroids are NOT indicated
What topical antibiotics are used in burn dressing changes?
Silvadene and Sulfamylon
No Silvadene to the face
List the types of commonly used burn dressings.
- Silver dressings
- Silverton water or saline every 8 hours
- Silver nitrate
- Temporary skin substitutes such as Biobrane
Why might you see cyanide poisoning with a burn trauma patient? What is the treatment?
- Burning of plastics breathed in
- Treated with hydroxocobalamin
