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1Fall24 PoA II > Burns pt3 Exam 1 > Flashcards

Burns pt3 Exam 1 Flashcards

1
Q

What lab is commonly elevated with inhalation injuries?

A
  • Carboxyhemoglobin levels > 10%
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2
Q

How are Inhalation injuries diagnosed/confirmed?

A

Bronchoscopy

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3
Q

For facial burns:

  • Apply bacitracin ointment to___
  • Apply erythromycin ointment in the ___
  • Avoid using what cream on the face?
A
  • Eye lids
  • Eyes

do not use silvadene on the face

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4
Q

Carbon Monoxide inhalation is confirmed by what lab?

A

↑ COHb

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5
Q

At what various levels of carboxyhemoglobin are differing signs and symptoms seen?

A
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6
Q

After burns, patients will have elevated ____, ____, and energy needs.

A
  • protein
  • vitamin
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7
Q

Nutrition within 16 hours of admission is thought to

A

reduce magnitude of stress response

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8
Q

_____ resistance occurs after burn injuries (in regards to nutrition).

A

Insulin

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9
Q

How are burn patients force-fed?

A

High calorie, high protein feeds into the jejunum

May not be D/C for OR if already intubated

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10
Q

What factors can change the pharmacodynamics/kinetics of our drugs? (3)

A
  • 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

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11
Q

Burns result in up regulation of

A

nACH receptors

Takes Months to years (1-2) to recover

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12
Q

What drug needs to be avoided in the >24hrs after a burn?
Why?

A

Succinylcholine

Due to upregulation of nACh receptors → may have exaggerated ↑K⁺

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13
Q

What paralytic agent is resistant 24hrs after a burn injury?

A

Non-depolarizing NMBs

Due to upregulation of nACH receptors

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14
Q

Resistance to non-depolarizers happens when BSA is over ____%.

A

25%

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15
Q

What signs/symptoms are indicative of airway burn or inhalational injury? (6)

A
  • Hoarseness, wheezing, SOB
  • Carbonaceous sputum
  • Singed nasal & facial hairs
  • Deep facial burns
  • Comatose patient
  • > 40% TBSA
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16
Q

Difficult laryngoscopy can be due to what four factors?

A
  • Edema
  • Pain
  • Eschar
  • Contractures
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17
Q

What are some options for securing the ETT vs tracheostomy (2)

A
  • Cotton umbilical tape
  • Wire to teeth
18
Q

____ should not be used as an airway management for burn patients

A

LMA
* doesn’t help with airway edema

19
Q

What are some of the induction drugs for burns (4)

A
  • Propofol
  • Etomidate
  • Ketamine(Simulates SNS vs depressant effect)
  • Opioids
20
Q

An important adverse side effect noted with Etomidate is ______ _______.

A

Adrenal Insufficiency

  • may need steroid supplement
21
Q

What drug is often useful as an adjunct in burn dressing changes?

A

Ketamine

22
Q

2.6% total blood volume is lost for every __% of burn excised or autograft harvested.

A

1%

23
Q

Hgb should be maintained around ____ g/dL.

A

7-8 g/dL

24
Q

____ is a off label drug for burns to prevent blood loss during burn excision.

A

rFVII

pts are at increased risk of thrombosis

25
Q

List the vasopressors used in shock when MAP is <55 mmHg.

A
  • Vasopressin
  • Norepinephrine
26
Q

What is the CVP goal with burn patients?

A
  • 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.

27
Q

What technique is utilized to infiltrate large volumes of local anesthetic subcutaneously?

A

Tumescent LA w/ epi

28
Q

What is the typical dose of tumescent local anesthetic?

A

Lidocaine 1G + epi + 10meq NaHCO₃⁻/1000cc NaCL

55mg/kg max

29
Q

What are the goals of tumescent technique? (4)

A
  • Decreased blood loss
  • Easy excision of granulation tissue
  • Shorter surgical times
  • No hematoma or bruising postop
30
Q

When mechanically ventilating a burn patient, target pCO2 to ____ mm Hg or pH >_____.

A
  • 30-35 mmHg
  • 7.20
31
Q

During mechanical ventilation patients should be nebulized with what drug?

A

Albuterol w/ 5000 units Heparin Q4H

Ensure albuterol is given with heparin since heparin can induce bronchospasm (i.e. wheezing)

32
Q

Abdominal Compartment Syndrome is diagnosed via what?

A

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.

33
Q

Bladder Pressure for ACS should be measured every

A
  • Measure Q4H with >20% TBSA
34
Q

Bladder pressures greater than ____ mmHg indicate early intra-abdominal hypertension.

A
  • > 12 mmHg
35
Q

____ mmHg is diagnostic for abdominal compartment syndrome.

A

> 20 mmHg

36
Q

Additional burn pain treatment options include

A
  • Additives PRN
  • Nitrous oxide 50/50 – in addition to Ketamine
  • Peripheral nerve blocks for extremity injuries
37
Q

Extremities should be elevated ____ degrees.

A

30-45 degrees (pillows first, then slings)

38
Q

Assess pulses every ____ hour(s).

A

Hour – Doppler (High risk for losing perfusion and sensation due to compartment syndrome)

39
Q

List the adjuncts to burn Resuscitation management

A
  • 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
40
Q

What topical antibiotics are used in burn dressing changes?

A

Silvadene and Sulfamylon

No Silvadene to the face

41
Q

List the types of commonly used burn dressings.

A
  • Silver dressings
  • Silverton water or saline every 8 hours
  • Silver nitrate
  • Temporary skin substitutes such as Biobrane
42
Q

Why might you see cyanide poisoning with a burn trauma patient? What is the treatment?

A
  • Burning of plastics breathed in
  • Treated with hydroxocobalamin

1Fall24 PoA II (28 decks)

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