Exam 1 - Burns (Andy's) Flashcards
his cards but i will slowly turn them into practice questions :)
What are the 5 types of burns?
- Heat
- Electrical
- Friction
- Chemical
- Radiation
In heat burns, the depth of thermal injury is related to: select 3.
A. contact temperature
B. duration of contact
C. pathway of current
D. thickness of skin
E. resistance to current flow
F. presence or lack of hair
A. Contact temperature
B. Duration of contact
D. Thickness of skin
Heat burns usually involve which layers of tissue? select 2.
A. subcutaneous tissue
B. dermis
C. blood vessels
D. epidermis
B. dermis
D. epidermis
The most common examples of heat burns include:
A. flame
B. hot liquid
C. hot solid
D. steam
E. lightning
F. all except E
F. all except E so:
* Flame
* Hot liquid
* Hot solid
* Steam
Electrical energy transformed to heat when current passes through body tissue is classified as what type of burn?
A. heat burn
B. radiation burn
C. electrical burn
D. chemical burn
C. electrical burn
What is special about electrical burns?
A. has caustic reactions
B. disrupts cell membrane potential
C. damage caused by ionization
D. sunburns are the most common example
B. disrupts cell membrane potential
The magnitude of electrical burn damage is dependent on: select 2.
A. nature of agent
B. contact temperature
C. strength and duration of current flow
D. resistance to current flow
C. Strength and duration of current flow
D. Resistance to current flow
also: Pathway of current
What is the major difference between electrical and heat burns?
A. heat burns involve cardiac injury
B. electrical burns involve cardiac injury
C. heat burns disrupt membrane potential
D. electrical burns involve the 4 T’s (testosterone, tequila, etc).
B. electrical burns involve cardiac injury
lightning strikes cause vfib!!
Friction burns are a combination of what two things generated by friction?
A. mechanical disruption
B. radiation
C. electricity
D. heat
A. mechanical disruption
D. heat
The caustic reactions of chemical burns include: select 2.
A. direct cardiac injury
B. pH alteration
C. mechanical disruption
D. direct toxic effect on metabolic processes
B. PH alteration
D. Direct toxic effect on metabolic process - probably from the Disruption of cell membranes
The magnitude of chemical burns are related to duration of exposure and:
A. nature of agent
B. contact temperature
C. thickness of skin
D. strength of current flow
A. nature of agent
so whether chemical agent is an acid or alkili
Acid causes tissue necrosis by ____, while alkali causes tissue necrosis by ____.
A. liquefaction; coagulation
B. coagulation; liquefaction
B. acid = Coagulation
alkali = Liquefaction
Radiation burns cause what type of damage?
A. mechanical
B. membrane disruption
C. ionization
D. thermal injury
C. ionization
Magnitude of radiation depends on: select 2.
A. dose and time of exposure
B. types of particles
C. nature of agent
D. thickness of skin
A. Dose and time of exposure
B. Types of particles
Most common examples of radiation burns?
- Sunburns
- Therapeutic radiation
- Diagnostic procedures
- Nuclear industry workers
Burns take about ____ hours to fully declare themselves
A. 6-12
B. 12-24
C. 24-48
D. 48-96
C. 24-48 hours
What age groups have deeper burns from less exposure and less intensity due to the thin skin? Select 2.
A. kids > 5
B. adults 40-55
C. adults > 55
D. kids < 5
E. adults > 75
C. Adults >55
D. Kids <5
Superficial 1st Degree Burns heal in approximately how many days?
3-6 days
A superficial partial thickness (2nd Degree) burn involves the epidermis and part of the dermis. Other characteristics include: Select 3.
A. no blisters
B. very painful / nerve endings exposed
C. blisters or weeping
D. painless
E. mottled red color
F. pale in color
B. Very painful / nerve endings exposed
C. blisters or weeping
E. Mottled red color
also:
* Small burns usually heal in 10 – 14 days
* Minimal scarring
What burn category is not counted in the TBSA (Total Burn Surface Area)?
1st degree (superficial) burns
think mild sunburns
Characteristics of a Deep Partial Thickness (2nd Degree that extends more deeply into the dermis) burn include: select 2.
A. decreased moisture
B. minimal scarring
C. absent of prolonged cap refill
D. heal in 10-14 days
A. Decreased moisture
C. Absent or prolong blanching/cap refill
Also:
* Destroyed sweat glands + Impaired tissue integrity
* Difficulty regulating body temperature
* Pale in color – Usually a white/pinkish color
* Healing in 21-28 days
At what point is skin grafting typically required?
A. Superficial partial thickness burns
B. Deep partial thickness burns
C. 1st degree burns
D. Full Thickness burns
B. Deep partial thickness burns
and obviously so on into full thickness
What are the characteristics of a Full Thickness (3rd Degree) Burn? Select 2.
A. blisters and weeping
B. non-blanching
C. painless and dry
D. mottled red color
B. Non-blanching
C. Translucent, dry, painless, charred
Also:
* Dermis and epidermis are destroyed
* Requires grafting
* No bleeding when you do an escharotomy
Differences in deep partial and full thickness is subtle and often hard to tell the exact transition areas in early hours.
Compare and Contrast the various degrees of burn injuries.
What is the most painful burn?
A. Superficial partial thickness burns
B. Deep partial thickness burns
C. 1st degree burns
D. Full Thickness burns
A. Superficial Partial Thickness (2nd Degree Burn)
What is the Rule of nines in adults?
- Head 9%
- Each arm 9%
- Each leg 18%
- Anterior/Posterior trunk each 18%
- Perineum 1%
only about 60-70% accurate tho
What is the pediatric version of the rule of nines?
- Head 21%
- Each arm 10%
- Back 13%
- Abdomen 13%
- Each leg 13.5%
- Buttocks 5%
- Genital area 1%
so head and abdomen larger in infants > adults
What is the Palmer method?
TBSA used for patient’s palm with fingers together = 1%
T/F: Larger burn surface areas are often overestimated.
False. They are underestimated!
Fluid losses are a function of what 2 measurements?
A. burn size
B. patient height
C. kidney function
D. patient weight
A. burn size
D. pt weight
What is important to note when calculating TBSA for obese patients?
A. we overestimate torso burns
B. android vs gynoid shape
C. we underestimate extremity burns
D. unable to use palmer method
B. android vs gynoid shape is important
and one may underestimate torso burns and overestimate extremity burns
a google pic
Patients with > ____ TBSA will develop burn shock and need IV resuscitation in an ICU.
A. 15%
B. 20%
C. 25%
D. 30%
B. 20%
probz just need to go ahead and get transferred to a burn center tbh
An under-resuscitated patient is at risk for: select 2.
A. burn shock
B. ARDS
C. decreased perfusion
D. abd compartment syndrome
A. burn shock
C. ↓ perfusion
and ultimately end organ failure
An over-resuscitated patient is at risk for developing: select 2.
A. pulmonary edema
B. burn shock
C. bladder pressures > 20 mmHg
D. renal failure
A. Pulmonary edema/ARDS
C. Abdominal compartment syndrome (c/w bladder pressures > 20 mmHg)
Auto-cannibalism is a general metabolic response to trauma, specifically burns. Effects of auto-cannibalism include: select 2.
A. decreased cortisol
B. hypometabolism
C. peripheral insulin resistance
D. accelerated lipolysis
C. peripheral insulin resistance (from accelerated hepatic gluconeogenesis)
D. accelerated lipolysis d/t beta stimulation (treat w/ beta blockade)
Also:
* Loss of fat
* Loss of lean body mass
The Intensity and duration of auto-cannibalism depends on magnitude of injury and the degree of pain. Greater than what % TBSA will metabolic rate double?
A. 15
B. 20
C. 30
D. 40
D. > 40% TBSA - cannibalism for months
Knowing that auto-cannibalism will cause immunosuppression, recurrent infections, and poor wound healing, what is an intervention to consider when taking this pt back for surgery?
A. free water flushes thru their feeding tubes
B. minimize NPO times
C. give short acting insulin before procedure
D. d/c TPN before going to OR
B. minimize NPO times
- could even keep TFs on or continue TPN if possible, maybe allow carbs up to 2 hrs prior (cornelius’ words)
What results in accelerated hepatic gluconeogenesis and ultimately peripheral insulin resistance?
A. decreased cortisol, catecholamines, and glucagon
B. increases in intracellular glucose transport
C. decreased beta adrenergic stimulation
D. Increases in cortisol, catecholamines, and glucagon
D. increases in cortisol, catecholamines, and glucagon
causes impaired intracellular glucose transport
Accelerated lipolysis in burns is due to: select 3.
A. decreased beta stimulation
B. increased cAMP
C. increased free fatty acids
D. decreased glucagon
E. increased TNF and IL
F. decreased cAMP
B. B2 and B3 adrenergic stimulation (↑cAMP)
C. ↑ FFA(free fatty acids which produce ATP)
E. ↑ glucagon, TNF (tumor necrosis factor), IL (interleukin)
TREAT WITH BETA BLOCKADE
What treatment is indicated for excessive lipolysis?
A. cardizem
B. nicardipine
C. beta blockers
D. alpha blockers
C. β-blockers
decreases lipid oxidation and decreases metabolic rate
The degree of protein loss is proportional to the degree of stress. What mediators worsen this protein loss? select 2.
A. cortisol
B. TNF
C. IL-1 and IL-6
D. glucagon
B. TNF
C. IL-1 and IL-6
cortisol improves protein loss
What are the initial steps to the stabilization of a burn injury?
- Respiratory support (ABCs)
- Fluid resuscitation
- Cardiovascular stabilization
- Short term pain control
- Local care of burn wounds
What are the secondary steps to the stabilization of a burn injury?
- Long term pain control
- Thromboprophylaxis
- Wound closure
- Nutritional support
- Control of hypermetabolism
- Prevention of infection
To achieve constant levels of pain control, analgesics should be:
A. scheduled
B. IM route
C. short-acting opioids
D. only NSAIDs
A. scheduled
Some medications used to treat pain in burn patients include: select 3.
A. fentanyl
B. methadone
C. iV ketamine
D. gabapentin
E. morphine PCA
F. IM hydromorphone
B. Methadone (long acting)
C. IV Ketamine
E. PCA infusions (Morphine)
also:
* NSAIDs (Acetaminophen)
* Supplemental anxiolytics
NO IM opioids since absorption is uncertain
What is important to note about PK/PD in burns?
A. burns absorb more medication in the IM route
B. may need to deviate from normal doses to avoid toxicity or decreased efficacy
C. short-acting opioids will be more efficient
D. does not change in burn patients
B. may need to deviate from normal doses to avoid toxicity or decreased efficacy
What causes copious loss of intravascular fluid in burns? select 2.
A. decreased capillary permeability
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
Loss of intravascular fluid causes systemic inflammatory reactions which leads to the release of ____, ____, and ____.
A. histamine
B. prostaglandin
C. cortisol
D. FFA
E. cytokines
F. insulin
A. Histamine
B. Prostaglandin
E. Cytokines
Causes vasodilation of already impaired vessels
IV Fluids are needed for ____ % TBSA or greater.
15%
Which 3 burns/situations need higher volumes of fluid resuscitation than what would be indicated via their TBSA calculation?
A. facial burns
B. inhaled burns
C. chemical burns
D. electrical burns
E. delayed resuscitation
F. thermal burns
B. Inhaled burns
D. Electrical burns
E. Delayed resuscitation
When should we advocate for titrating formula down?
A. when BUN/creat is adequate
B. when UOP is adequate
C. when electrolyte replacement is complete
D. when Na+ is > 155 meQ/L
B. when Urine output is adequate
consider small amount of colloids on day 2!!!
What is the parkland burn formula?
4ml x kg x %BSA
- half in 1st 8 hours
- other half in the next 16 hours
What is US Army ISR Rule of 10 for adults?
10ml/hr x TBSA
> 80kg, add 100 mL/10kg
What is US Army ISR Rule of 10 for Pediatrics?
- 3 x TBSA x kg = vol for first 24 hrs
- give HALF the total volume over 1st 8 hrs
The goal of the ISR formula is to have UOP of:
A. 3 mL/kg/hr
B. 5 mL/kg/hr
C. 1 mL/kg/hr
D. 10 mL/kg/hr
C. 1 mL/Kg/hr
Which crystalloid is typically the best choice for burns?
A. albumin
B. NS
C. LR
D. D5W
C. Lactated Ringer’s
What are the factors that would indicate that a transfer to a certified burn center is necessary?
- full thickness (3rd deg) burns > 10% BSA
- High voltate electrical burns
- Chemical burns
- Concurrent inhalational injury
- Burns on the face, hands, feet, perineum, major joints
Isotonic solutions (NS) have a risk of what kind of acidosis?
A. respiratory acidosis
B. metabolic acidosis with an anion gap
C. mixed metabolic + resp acidosis
D. hypernatremic hyperchloremic acidosis
D. Hypernatremic hyperchloremic acidosis (non-gap metabolic acidosis!)
Crystalloids are titrated every hour according to a UOP goal of:
A. 10-15 mL/hr
B. 20-25 mL/hr
C. 30-50 mL/hr
D. 10-30 mL/hr
C. 30-50 mL/hr
increase/decrease by 20-25% if urine output goals are not being met.
When the determination is made to intubate the burn patient, especially if inhalation injury is suspected or noted on bronchoscopy, what size ETT is preferred?
A. 6 ETT
B. 7 ETT
C. 7.5 ETT
D. 8 ETT
D. size 8 ETT = Large bore!!
facilitates subsequent bronchoscopy and pulmonary toilet, and decreases the risk of later airway occlusion d/t casts comprised of blood, mucous and debris
If a pediatric patient is heavier than ____ kg then use the adult formulas.
A. 40
B. 50
C. 60
D. 70
A. 40 kg
What is the fluid management for Pediatric patients < 14 yrs old and < 40 kg?
2-4 ml (of LR)/kg x kg x %TBSA (2nd and 3rd degree)
For children less 20kg, what maintanence fluid should be added to support their basal metabolic rate?
A. D5LR
B. NS
C. D5W
D. LR
A. D5LR
Titrate IVF to maintain urine output 0.5-1ml/kg/hr!!!
When is it appropriate to initiate colloid infusion? Select 3.
A. 12-24 hours post-burn
B. 8-12 hours post-burn
C. if the hourly IV fluid rate exceeds 1000 mL/hr
D. if the hourly IV fluid rate exceeds 1500 mL/hr
E. if the projected 24 hr total fluid volume approaches 250 mL/kg
F. if the projected 24 hr total fluid volume approaches 300 mL/kg
B. 8-12 hours post-burn
D. if the hourly IV fluid rate exceeds 1500 mL/hr
E. if the projected 24 hr total fluid volume approaches 250 mL/kg
USE 5% albumin - not 25%!!
What is the dose for pediatric colloids?
A. 5-8 mL/kg at a rate of 0.5 mL/min
B. 4-7 mL/kg at a rate of 1 mL/min
C. 4-7 mL/kg at a rate of 0.5 mL/min
D. 5-8 mL/kg at a rate of 1 mL/min
C. 4-7 mL/kg at a rate of 0.5 mL/min
Reduce maintenance isotonic crystalloid by an equal volume per hour
In resuscitative “ebb” phase, cardiac output is reduced by as much as ____%.
60%
What happens to cardiac status in the resuscitative “ebb” phase? select 2.
A. hyperdynamic with tachycardia
B. Increased SVR d/t increased vasopressin levels
C. increased myocardial consumption
D. Hypovolemia d/t permeability
B. Increased SVR d/t increased vasopressin levels
D. Hypovolemia d/t permeability
also:
* Reduced response to catecholamines
* Myocardial ischemia d/t decreased coronary flow
Ensure appropriate fluid resuscitation!!
At 72-96 hours post-burn, the “flow” phase begins. What is the pt presentation at this time? Select 2.
A. increased myocardial o2 consumption
B. low cardiac output
C. decreased SVR
D. increased SVR
E. bradycardia
A. ↑ myocardial O₂ consumption
C. ↓ SVR
rmbr: this is a Hyperdynamic state! = increased CO, Tachycardia = administer beta blockers!
and make sure they are appropriately managed for pain
What are some of the pulmonary systemic inflammatory processes that begin immediately after burn? select 2.
A. pneumothoraces
B. pneumococcal pneumonia
C. pulmonary capillary alv membrane disruption
D. decreased plasma oncotic pressure
E. increased plasma oncotic pressure
C. Pulmonary capillary alveolar membrane disruption
D. Decreased plasma oncotic pressure
also:
* Pulmonary hypertension
* Increased extravascular lung water (b/c of the dec plasma oncotic pressure) = leads to impaired gas exchange
What pulm therapy should be initiated for a burn patient to treat the systemic inflammatory response?
A. lasix IV
B. ET intubation
C. scheduled bronchodilators
D. 100% O2
C. scheduled bronchodilators
because bronchospasm is common!
Describe the restrictive lung defect seen in burns: select 2.
A. hypoventilation d/t decreased elasticity
B. hyperventilation d/t anxiety
C. impaired oxygenation from increased extravascular lung water
D. impaired ventilation from circumferential burns/scar
A. Hypoventilation d/t decreased elasticity
D. Impaired ventilation from circumferential burns/scar
What treatment is potentially necessary for restrictive lung defect from circumferential burns?
A. exploratory laparotomy
B. fasciotomy
C. chest tube
D. escharotomy
D. escharotomy
What is the sign of possible restrictive lung defect?
left from last years class..
↑ airway pressures
What lab is elevated with inhalation burn injuries?
A. BUN/creat
B. COHb
C. lactic acid
D. CO2
B. Carboxyhemoglobin levels (> 10%!!)
Inhalation injuries should be suspected if pt present with singeing of face or nasal hair, oropharyngeal carbon, and/or wheezing. What diagnostic exam confirms an inhalation injury?
A. ultrasound
B. CXR
C. bronchoscopy
D. TEE
C. Bronchoscopy
think of intubating these patients early!
For facial burns,
Apply bacitracin ointment to____. Apply erythromycin ointment in the ____.
A. eye lids; eyes
B. eyes; nares
C. eyes; eye lids
D. eye lids; nares
A. Apply bacitracin ointment to eye lids. Apply erythromycin ointment in the eyes.
A patient presents with extreme facial burns; what are necessary interventions to prevent further complications? select 2.
A. place an NGT
B. secure ETT b/c extensive edema is common
C. remove contact lenses
D. rinse eyes with saline before applying erythromycin ointment
B. secure ETT b/c extensive edema is common
C. remove contact lenses to protect the eyes from corneal ulcers/abrasions
contact ophtho for corneal/globe injury!!
At what levels of carboxyhemoglobin are overt signs and symptoms of toxicity seen?
15-20% = HA, N/V
Nutrition within 16 hours of admission is thought to:
A. increase insulin resistance
B. cause elevated blood glucose
C. reduce magnitude of stress response
D. decrease protein, vitamin and energy needs
C. reduce magnitude of stress response
but poor evidence
What is the best way to ensure burn patients get their high calorie, high protein diet?
A. use TPN exclusively
B. place NGT and feed continuously
C. place OGT to feed into the duodenum
D. use nasoenteric tube to feed into the jejunum
D. nasoenteric tube and feed into the jejunum
May not be D/C for OR if already intubated
What factors r/t burns can cause pharmacology changes? select 2.
A. decreased free fraction of drugs
B. decreased Vd
C. loss of plasma proteins especially albumin
D. upregulation of nACh-Rs
C. Loss of plasma proteins (albumin) resulting in increased free fraction of drugs and Vd!!
D. upregulation of nACh-Rs
and:
* Cardiac output changes during the ebb/flow phases
The upregulation of nACh-Rs result in: select 2.
A. resistance to depolarizers
B. resistance to non-depolarizers
C. sensitivity to depolarizers
D. sensitivity to non-depolarizers
B. resistance to non-depolarizers (-curiums)
C. sensitivity to depolarizers (sux)
Resistance to non-depolarizers (-curiums) occurs when BSA is ____ % and higher.
A. 25%
B. 30%
C. 35%
D. 40%
A. 25% and >
so give higher dose of roc, vec, any -curium
A burn patient’s sensitivity to succinylcholine begins approx how many hours post-burn?
What timeframe does this sensitivity become significant?
begins: approx 24 hrs post-burn
significant after: 48-72 hrs
What are some considerations to ensure we continue standard AANA monitoring with our burn patients? select 3.
A. staple EKG patches
B. get base deficit instead of lactate levels in OR
C. CVC on any burn patient with TBSA > 25%
D. suture art lines
E. place foley with temperature probe
F. pulse ox should go on toes, not fingers
A. staple EKG patches
B. get base deficit instead of lactate levels in OR
D. suture art lines
ALSO USE A BAIR HUGGER!! they can lose up to 1 deg q 15 mins
What should be considered regarding pulse ox probe for burn patients?
A. should place on toes instead of fingers
B. may be inaccurate d/t COHb levels
C. might need to be taped on instead of using the clip on
D. use ear lobe to get accurate reading
B. may be inaccurate d/t COHb levels
What signs/symptoms are indicative of airway burn or inhalational injury? Select 3.
A. > 25% TBSA
B. ginger/red facial hair
C. comatose patient
D. hoarseness
E. carbonaceous sputum
F. cherry lips
C. Comatose patient
D. Hoarseness, wheezing, SOB
E. Carbonaceous sputum
and:
* Singed nasal & facial hairs
* Deep facial burns
* >40% TBSA
Difficult laryngoscopy is possible with any signs of inhalation injury, especially:
A. cherry lips
B. altered mental status
C. edema
D. singed eyebrows
C. Edema
also limited mobility d/t pain, contractures, eschar
What is impt to consider when securing the burn patient’s airway? select 2.
A. use cotton umbilical tape
B. LMAs are preferred
C. wire the ETT to teeth
D. use hollister to hold ETT in place
A. use cotton umbilical tape
C. Wire ETT to teeth
and NO LMAs!
What medication should we use for induction on a burn patient?
A. lidocaine and fentanyl
B. beta blocker
C. ketamine
D. dexmedetomidine
C. Ketamine(Simulates SNS vs depressant effect)
propofol and opioids could be used but impt to consider ebb and flow phases….also etomidate has adrenal insufficiency concern….
What drug is often used for burn dressing changes?
A. dilaudid
B. ketamine
C. dexmedetomidine
D. fentanyl
B. Ketamine
What can you perform if a burn patient presents with hemodynamic instability (due to hypovolemia)?
A. diagnostic angiogram
B. CT
C. MRI
D. rescue TEE
D. rescue TEE
to rule out cardiogenic shock, distributive shock, or MI
How much total blood volume is lost for every 1% of burn excised or autograft harvested?
A. 7-8%
B. 1-2%
C. 2.6%
D. 5%
C. 2.6%
Hgb should maintained around ____ g/dL.
7-8 g/dL
10 g/dL for acute coronary syndrome
Options to prevent blood loss during burn excision include: select 2
A. heparin 5000 units
B. subq vasoconstrictors
C. protamine sulfate
D. topical thrombin
B. subq vasoconstrictors
D. topical thrombin
and staged procedures
Which of the following is an off-label drug to prevent blood loss during burn excision, but may have increased risk of thrombosis?
A. tPA
B. bivalirudin
C. recombinant factor 7
D. rivaroxaban
C. rFVII
TXA also has incr risk of thromboembolism!!!
What vasopressors should be used in shock when MAP is < 55 mmHg? select 2.
A. phenylephrine
B. epinephrine
C. dopamine
D. vasopressin
E. norepinephrine
D. Vasopressin
E. Norepinephrine
What is the CVP goal with burn patients?
- Goal: 6-8 mm Hg - but best to trend, as one single CVP value won’t necessarily be helpful
- If not at goal, increase IVF rate by 20-25%
If CVP is not at goal, what is your first intervention?
A. increase IVF rate by 20-25%
B. initiate colloids
C. start vasopressors
D. keep IVF rate as is to prevent fluid overload
A. increase IVF rate by 20-25%
If UO remains low, continue giving fluids and/or initiate colloids. If you have enough UO and your BP is still low, start vasopressors. - left from last yrs class
What technique is utilized to infiltrate large volumes of local anesthetic subcutaneously?
Tumescent LA w/ epi
What is the typical dose of tumescent LA?
Lidocaine 1G + epi + 10 mEq bicarb / 1 liter of NS
What is the max dose of tumescent LA?
55mg/kg
Positive effects of tumescent LA include:
A. easy excision of granulation tissue
B. shorter surgical times
C. decreased blood loss
D. no hematoma or bruising post-op
E. all of the above
E. all of the above
* Decreased blood loss
* Easy excision of granulation tissue
* Shorter surgical times
* No hematoma or bruising postop
When mechanically ventilating a burn patient with inhalational injury, what is target pCO2?
target pH?
target pCO2: 30-35 mmHg
pH > 7.20
What 2 medications should be given together for mechanically ventilated burn patients with inhalation injury thru their ETT?
A. nebulized epi with txa
B. nebulized heparin with albuterol
C. nebulized lidocaine and epi
D. nebulized heparin with ipatropium
B. nebulized Heparin (5000 units) with albuterol Q4H
since heparin can induce bronchospasm, ensure albuterol is given together w/ hep!!!!
Abdominal Compartment Syndrome is best diagnosed by:
A. CVP
B. abdominal pressures
C. bladder pressures
D. urine output
C. Bladder pressures
This condition is to be avoided given the high mortality rate if the abdomen is opened. This is why we have such strict rules in terms of fluid management.
For burns > 20% TBSA, how often should we measure bladder pressures?
A. q2H
B. q4H
C. q6H
D. q12H
B. Measure Q4H with >20% TBSA
What bladder pressure indicate early intra-abdominal hypertension?
A. > 8 mmHg
B. > 10 mmHg
C. > 12 mmHg
D. > 20 mmHg
C. >12 mmHg
What are the bladder pressures continuous with abdominal compartment syndrome?
Greater than 20 mmHg
What are treatment options for the “always present” background pain? select 2.
A. frequent short-acting
B. long-term SSRI’s
C. scheduled long-acting opioids
D. precedex gtt
E. scheduled anxiolytics
C. scheduled long-acting opioids
E. scheduled anxiolytics
could be IV, enteral, transmucosal, po
What are some other pain treatment options? select 2.
A. neuraxial approach
B. nitrous oxide 25/75
C. versed gtt
D. ketamine for burn debridement
E. peripheral nerve blocks
D. ketamine for burn debridement
E. peripheral nerve blocks
and could use nitrous oxide 50/50
Extremities should be elevated ____ degrees.
30-45 degrees (pillows first, then slings)
How often should we examine pulses? and using what?
every hour; using Doppler (High risk for losing perfusion and sensation due to compartment syndrome!)
What 2 drugs are NOT indicated for uncomplicated burns in initial phase?
A. iv antibiotics
B. anxiolytics
C. DVT prophylaxis
D. beta blockers
E. steroids
A. IV antibiotics
E. steroids
List the adjuncts to burn Resuscitation
- GI Prophylaxis – High risk for stress ulcers
- Sew and/or staple all venous and arterial catheters in place
- Genitalia/Perineum- Insert Foley immediately to maintain urethral patency
Since burns are tetanus prone wounds, which burn pt would require a tetanus booster shot? select 2.
A. if > 3 yrs since last booster
B. if > 5 yrs since last booster
C. booster plus tetanus immune globulin if no prev immunization
D. booster plus tetanus immune globulin on every patient
B. Booster if > 5 yrs since last booster
C. Booster plus tetanus immune globulin (TIG) if no previous immuniza/on
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
