deck_1548001 Flashcards by Brandon Taylor

Burns: Burns are acute wounds caused by a single, non-reoccuring insult to the skin or other organic tissue that is primarily caused by acute exposure to ____, _____, ____, ____, or _____

heat cold chemicals electricity radiation

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what are the funtions of the skin

protection form infection injury Prevention of loss of body fluids Regulation of bdy temp Sensory with enviroment

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Burns: what are the 6 types of burns

Thermal Cold exposure Chemical electrical Inhalation Radiation

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Burns: Thermal are associated with what?

Steam flames hot liquids hot solid objects

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Burns: Thermal Depth of thermal burn is related to what?

Temperature duration thickness of skin involved

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Burns: Cold also called what

frost bite

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Burns: Cold occurs when intracellular fluids freeze and the resulting ____ ____ puncture celss or when extracellular fluids freeze and create a hypotonic enviroment

ice crystals

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Burns: Cold result in tissue hypoxia through the interruption of ____ ____, ____, and ______ _____

blood flow hemoconcentration intravascular thrombosis

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Burns: Chemical tissue disruption results form a wide range of chemical reations such as what 3 main causes

Alteraion in PH
Disruption of cellular membranes
Direct toxic effects on metabolic processes

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Burns: Electrical electrical current passes through the body and is transformed into _____ energy as it passes through the poorly conductive tissues of the body

thermal

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Burns: Electrical electropration occurs!!! what the fuck is that?

damage to cell membranes that disrupt membrane potential and function

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Burns: Electrical Severity of burn depends on the pathway of _______, the ____ of tissues to electrical current flow, and the ____ and ____ of the electrical flow

electrical current resistance strength and duration

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Burns: Inhalation toxic chemicals produced in fires can injure the lower airways and cause a ______ burn

chemical

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Burns: Inhalation how smoke usually only burns the what

pharynx

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Burns: Inhalation stream can cause injury where?

below the glottis

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Burns: Inhalation carbon monoxide produced from combustion can inpair cellular what?

	respiration

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Burns: Radiation ____ frequency and ______ energy can disrupt and destroy tissues

Radio ionizing

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Burns: Radiation what is the most common type of radiation burn?

	sunburn

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Burns: Radiation depending on the photon, radiation burns can cause very deep ____ burns

internal

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Burns: Radiation radiation burns are associated w/ what b/c of their ability to interact w/ and damage DNA

Cancer

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Burns: Radiation _______is dependent on dose, _____ of exposure, and ____ of particle

Severity time type

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Burns: Assessment what are the 5 things you want to assess with burns?

Depth Extent Location Pt’s age Pt’s comorbidities

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Skin: Anatomy what are the layers of the skin (top down )

Epidermis Dermis Sub Q fat Muscle

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Skin: Anatomy what are the 5 layers of the epidermis( top down)

Stratum corneum Stratum lucidum Stratum granulosum Stratum spinosum Stratum Basale ( cute latin girls suck balls)

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Skin: Anatomy what is contained in the dermis

Hair follicle Sweat glands

Skin: Anatomy what is contained in the Sub Q

Sub q artery Sub Q Vein

Burns: Degrees Define 1st degree

superficial burn limited to epidermis (AKA sunburn Basic)

Burns: Degrees what is a superficial 2nd degree burn

Involves epidermis and superficial layers of dermis (usually a blister)

Burns: Degrees what is a DEEP 2nd degree burn

Involves epidermis and most of dermis

Burns: Degrees what is a third degree burn?

full thicknness burn Involves epidermis all layers of dermis and sub q

Burns: Degrees what is a 4th degree burn

full thickness burn extends down to muscle and/ or bone

Burns: 1st degree depth

Epidermis

Burns: 1st degree appearance

dry red blanches

Burns: 1st degree sensations

painful

Burns: 1st degree outcome

heals spontaneously

Burns: partial thickness 2nd degree superficial depth

epidermis and superficial dermis

Burns: partial thickness 2nd degree superficial appearance

blisters moist red weeping blanches

Burns: partial thickness 2nd degree superficial sensation

painful to air and temp

Burns: partial thickness 2nd degree superficial outcomes

heals spont

Burns: partial thickness 2nd degree Deep depth

Epidermis deep dermis

Burns: partial thickness 2nd degree Deep appearance

blisters wet/waxy patchy to cheesy white to red DOES NOT BLANCH

Burns: partial thickness 2nd degree Deep sensation

pain to pressure only

Burns: partial thickness 2nd degree Deep outcomes

requires excision and usually grafting

Burns: Full thickness 3rd depth

destruction of epidermis and dermis

Burns: Full thickness 3rd appearance

waxy white leathery gray/ charred/ black dry inelastic DOES NOT BLANCH

Burns: Full thickness 3rd Sensation

deep pressure only

Burns: Full thickness 3rd outcome

complete excision limited function

Burns: Full thickness 4th Depth

muscle fascia bone

Burns: Full thickness 4th appearance

waxy white leathery gray/ charred/ black dry inelastic DOES NOT BLANC

Burns: Full thickness 4th sensation

deep pressure only

Burns: Full thickness 4th outcome

complete excision limited function

Burns: what burns are partial thickness?

2nd superficial 2nd deep

Burns: what burns are full thickness

3rd 4th

Burns: the extent of the burn s expressed in what?

TBSA (total body surface area)

Burns: the ___ ___ ___ is commonly used to estamiate the burn injury in adults

rule of nines

Burns: the ____-____ chart is reccomended for estimates in pediatric population

lund-Browder

Burns: what method may be used to assess irregular and patchy burn injuries

The palm method

Burns: name the rule of nines

head- 4.5 and 4.5 =9 chest and abd 18 Back 18 Right arm 4.5 and 4.5 =9 Left arm 4.5 and 4.5 = 9 right leg 9 and 9=18 left leg 9 and 9 =18 no no area = 1%

rule of nine pic

Lund-browder chart picture

Burns: what is the palm of hand estimation

the palm of the PATIENTS hand represents 0.5% of TBSA the palm of thr PATIENTS hand including the fingers is 1% of TBSA

Palm of hands estimation pic

Location of injury and complications: facial and chest burns may indicate possible damage to what?

respiratory system

Location of injury and complications: 3rd and 4th degree burns on neck, chest, and abd, could restrict what efforts

respiratory

Location of injury and complications: circumferential burns can restrict what and compress neurovascular bundles

blood flow

Location of injury and complications: burns on what can restrict range of motion

Joints

Burn Injury and age of Pt: children and elderly tend to have ____ skin

thinner

Burn Injury and age of Pt: higher motolity in what poopulation due to deeper and more severe burns

children and elderly

Burn injury grading system: what are the 3 classes

minor Moderate Major

Burn injury grading system: what is the criteria for MINOR burns in adult Peds Full thickness

Burn injury grading system: what is the criteria for Moderate burns in adults peds full thickness

10-20% 5-10% 2-5%

Burn injury grading system: what is the criteria for Major burns adult peds Fullthickness

>20% >10% >5%

Patho of burn injury: what is the patho of a burn?

Acute burn injury Inflammatory mediators released increased capillary permeability extravasation of fluids into burned tissue tissue edema

Mediators of burns: what are local mediators released

Histamine Prostaglandins Bradykinin Nitric oxide Seratonin Substance P

Mediators of burns: what are systemic mediators released

Cytokins Endotoxins Nitric oxide

Mediators of burns: what is the systemic response of the body from all the mediators released from a burn injurt

immune supression hypermetabolism Protein catabolism Sepsis Multiple organ system failure

what are the 2 main phases of a burn

burn shock Hypermetabolic phase

Hypermetabolic phase of a burn: CO and HR can increase up to how much?

150-300%

Effects of burns: Cardiac what are early effects

hypovolemia myocardial depression

Effects of burns: Cardiac late effects

systemic HTN tachycardia Increased CO

Effects of burns: PULMONARY early effects

Upper airway obstruction Airway damage (laryngospasms) Chemical pneumonitis Pulmonary edema

Effects of burns: PULMONARY late effects

restriction of chest wall Oxygen toxicity barotrauma Infections Laryngeal damage Tracheal strictures

Effects of burns: Electrolytes/ renal early efefcts

Decreased renal blood flow (hypovolemia) Myoglobinuria Hyperkalemia Oliguria/anuria

Effects of burns: Electrolytes/ renal late effects

Increased renal blood flow varible drug clearance Hypokalemia (diuresis)

Effects of burns: Endocrine and GI effects GI response

Adynamic ileus Stress ulcers Impaired GI barrier to bacteria Endotoxemia

Effects of burns: Endocrine and GI effects Endocrine response

Increased serum NE Hyperglycemia

Effects of burns:Hemotology early effects

Activation of thrombotic and fibrinolytic factors hemoconcentration hemolysis

Effects of burns:Hemotology late effects

Anemia Thrombocytopenia

Effects of burns: Thermoregulation Fxns of the skin such as what are diminished or obliterated

Vasoactivity Sweating piloerection insulation

Effects of burns: Thermoregulation hypermetabolic phase of burn injury results in what

| * increased skin and core temp

Effects of burns: Thermoregulation what does GA do to the hypermetabolic response

Depresses vasoconstriction and metabolism results in rapid decrease in body temp

Effects of burns: Immunologic what happens

Loss of protective barrier immune system impaired Burn eschar- ideal medium for bacterial growth Macrophage activity in alveoli is impaired

Fluid resuscitation: fluid resuscitation should be titrated to maintain a UOP if ___-__ ml/kg/hr in adults and ___-___ mL/kg/hr for peds

0.5-1 mL/kg/hr -adults 1.0-1.5 mL/kg/hr peds

Fluid resuscitation: what is the parkland formula for the 1st 24hrs

LR 4 mL/kg x % TBSA

Fluid resuscitation: what is teh parkland formula for 2nd 24 hrs

* crystalloids * 20-60% esamated plasma volume * Colloids * to OUP of 30 mL/hr

Fluid resuscitation: Capillary leak is a its greatest when

1st 24hrs post burn

Fluid resuscitation: why is use of colloids contraversial in 1st 24 hrs

increased capillary permeability leads to proteins leak into the interstitial space leading to an oncotic effect in extracellular compartment and corsen edema and intravasular hypovolemia

Inhalation Injury: patiens often exhibit no signs or symptoms for first ____ hours

24 hours

Inhalation Injury: CO poisoning shifts oxyhemoglobing curve where?

left

Inhalation Injury: CO poisoning does what to pulse ox readings

False high

Inhalation Injury: what is the best tx for CO poisoning?

100% fio2

Inhalation Injury: w/ CO poisoning the use of 100Fio2 decreases the half life of CO from 4-6 hours to what?

40-80 min

Inhalation Injury: S/S of CO poisoning

H/a Nausea Breathlessness Collapse Dizziness LOC (just like a hangover)

Debredment and Dressing procedures: sugical debredment is done by what 2 methods

Tangential excision Fascial Excision

Debredment and Dressing procedures: what is Tangential excision

thin slices of eschar are shaved

Debredment and Dressing procedures: what is Fascial Excision

involves removing the burn eschar and underlying fat to the level of the muscle

Debredment and Dressing procedures: massive blood loss of how much

10 PRBCs

Debredment and Dressing procedures: how to estimate blood loss

2-3% of blood loss for each 1% of TBSA

Anesthestic management: b/c the facemask may be uncomfortable what is a great way to intubate

AFOI

Anesthestic management: all fluids should be what?

warm

Anesthestic management: room temp should be what?

28 C 83 F

Anesthestic management: what is a great drug for burn pts b/c it wil increase SVR and drcrease heat loss, increase HR and BP

Keta-fucking-mine

Anesthestic management: what inhalation agaent may be best

N2O b/c least depressant effect of CV

Anesthestic management: do not use what NMBD

SCh

Anesthestic management: many burn pt's may need a __-___ increase in NDMBD

2-5%

that is i guess

boo that sucked