Exam 1 (Burns) Flashcards
What is the depth of thermal injury related to?
- Contact temp.
- Duration
- Thickness of skin
Heat burns usually involve the?
Epidermis & dermis
An electrical burn magnitude depends on what 3 things?
- Pathway of current.
- Resistance to current flow.
- Strength & duration of current flow.
Chemical burns cause what 3 caustic reactions?
- pH alteration,
- cell membrane disruption.
- Toxic effect on metabolism
An acid chemical burn causes what kind of necrosis?
Necrosis by coagulation
An alkali chemical burn causes what kind of necrosis?
Necrosis by liquefaction
Radiation burns magnitude depends on?
- Dose & time of exposure.
- Type of particles
How long does it take burns to show their extend?
12-48hrs
Who is at higher risk for deeper burns?
Adults >55 or kids <5yrs
Which burn does not calculate TBSA?
1st degree burns
How long does it take for superficial 2nd degree burns to heal?
10 - 14 days
Which burn has white patches?
Deep Partial 2nd degree burns
Which burn has decreased moisture as its hallmark sign?
Deep partial thickness (2nd degree burn)
How long does it take for deep partial 2nd degree burns to heal?
21-28 days
Which burns usually have no bleeding?
3rd degree
What areas of the body account for 18% each?
- Each leg.
- Anterior trunk.
- Posterior trunk.
In infants, the head & neck area account for how much BSA?
21%
What is the palmar method?
Pt’s hand w/ fingers together accounts for 1% of BSA
What burn % needs IV resuscitation?
> 20% TBSA
What are the consequences of fluid under resuscitation in burns?
- Decreased perfusion.
- Burn shock.
- End organ failure
What are the consequences of fluid over resuscitation in burns?
- Abd compartment syndrome.
- Pulm edema/ARDS
What is the body’s general response to burns & how long can it last?
- Auto-cannibalism.
- Can last months
Explain carbohydrate metabolism in burns?
- Increased cortisol, catecholamines & glucagon results in hepatic gluconeogenesis.
- peripheral insulin resistance
- impaired intracellular glucose transport.
Explain lipid metabolism in burns?
Accelerated lipolysis → elevated glucagon, TNF, Interlukens, FFA & ATP
Why treat burns with beta-blockers?
To decreases lipid oxidation, which leads to cytotoxic substances. Beta blockers decrease metabolic rate, therefore ↓ lipid oxidation
What mediators cause vasodilation in burns?
Histamines, prostaglandins & cytokines
What is the Parkland formula?
- 4mL x kg x %BSA
- 2mL x kg x %BSA in 1st 8hrs, then
- 2mL x kg x %BSA in next 16hrs
What is the US Army’s Rule of 10 for adults?
- 10mL/hr x TBSA.
- If >80kg, add 100mL per 10kg
What is the targeted U/O for burns?
1cc/kg/hr
LR or NS have the risk to cause ____ ___ ___ in burns?
Hypernatremic hyperchloremic acidosis (non-gap acidosis)
With what percentage of burns does capillary permeability increase in peds?
Burns > 20-25%
What is added to pediatric burns weighing <20 kg?
Add maintenance rate of D5LR
When is the adult crystalloid formula used in pediatrics?
When >40kg
When does the “flow” phase start in burn patients?
At 72-96hrs post burn
What is applied to eye lids in facial burns? What about the eyes?
- Bacitracin to the eyelids.
- Erythromycin to the eyes.
What is a normal COHb level for smokers?
4 – 9%
At what COHb levels could seizures & ARF occur?
20-25%
Burned plastics can lead to what kind of poisoning?
Cyanide
What kind of diet do burn victims need?
High calorie & high protein
When is Scc not used in burn victims?
After the First 24hrs
Does the sensitivity to depolarizers correlate to the severity of burn?
No
What happens to nAChR’s in burns?
They are upregulated for months to 2yrs
What kind of warming devices are used for burn patients?
Convection
What is the approximate TBSA of the lungs in %?
> 40%
What is the concern when inducing a burn Pt with etomidate?
Adrenal insufficiency
What is the concern when inducing burn Pt with ketamine?
SNS reserve.
What med is often used for dressing changes in burn Pts?
Ketamine
What can be used off-label for burns?
Factor 7 & TXA
What is the goal CVP for burn & what is done if not at goal?
- Goal: 6-8mmHg.
- Increased IVF rate by 20-25%
What is the target pCO2 for burns, what about pH?
- 30-35 mm Hg
- or pH>7.20
What is nebulized and given with albuterol for inhalation burns q4h? Why?
- 5,000 units heparin
- Nebulized heparin can cause bronchospams
Why is albuterol given with heparin?
Because heparin can cause bronchospasm
What is the max dose of Tumescent LA?
55mg/kg
What is the mortality rate for a burn patient with an open abdomen?
90%
What bladder pressure indicates early intra-abdominal HTN?
> 12 mmHg
What is the pressure for abdominal compartment syndrome?
> 20 mmHg
Which burn victims get a tetanus booster?
If it’s been >5yrs
Are steroids and IV Abx indicated for burns?
No
Where is Silvadene not applied to?
The face
