Exam 1 - Burns (Andy's)

Question 1

What are the 5 types of burns?

Answer 1

• Heat
• Electrical
• Friction
• Chemical
• Radiation

Question 2

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

Answer 2

A. Contact temperature
B. Duration of contact
D. Thickness of skin

Question 3

Heat burns usually involve which layers of tissue? select 2.
A. subcutaneous tissue
B. dermis
C. blood vessels
D. epidermis

Answer 3

B. dermis
D. epidermis

Question 4

The most common examples of heat burns include:
A. flame
B. hot liquid
C. hot solid
D. steam
E. lightning
F. all except E

Answer 4

F. all except E so:
* Flame
* Hot liquid
* Hot solid
* Steam

Question 5

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

Answer 5

C. electrical burn

Question 6

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

Answer 6

B. disrupts cell membrane potential

Question 7

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

Answer 7

C. Strength and duration of current flow
D. Resistance to current flow
also: Pathway of current

Question 8

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).

Answer 8

B. electrical burns involve cardiac injury

lightning strikes cause vfib!!

Question 9

Friction burns are a combination of what two things generated by friction?
A. mechanical disruption
B. radiation
C. electricity
D. heat

Answer 9

A. mechanical disruption
D. heat

Question 10

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

Answer 10

B. PH alteration
D. Direct toxic effect on metabolic process - probably from the Disruption of cell membranes

Question 11

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

Answer 11

A. nature of agent

so whether chemical agent is an acid or alkili

Question 12

Acid causes tissue necrosis by ____, while alkali causes tissue necrosis by ____.
A. liquefaction; coagulation
B. coagulation; liquefaction

Answer 12

B. acid = Coagulation
alkali = Liquefaction

Question 13

Radiation burns cause what type of damage?
A. mechanical
B. membrane disruption
C. ionization
D. thermal injury

Answer 13

C. ionization

Question 14

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

Answer 14

A. Dose and time of exposure
B. Types of particles

Question 15

Most common examples of radiation burns?

Answer 15

• Sunburns
• Therapeutic radiation
• Diagnostic procedures
• Nuclear industry workers

Question 16

Burns take about ____ hours to fully declare themselves
A. 6-12
B. 12-24
C. 24-48
D. 48-96

Answer 16

C. 24-48 hours

Question 17

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

Answer 17

C. Adults >55
D. Kids <5

Question 18

Superficial 1st Degree Burns heal in approximately how many days?

Answer 18

3-6 days

Question 19

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

Answer 19

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

Question 20

What burn category is not counted in the TBSA (Total Burn Surface Area)?

Answer 20

1st degree (superficial) burns

think mild sunburns

Question 21

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

Answer 21

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

Question 22

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

Answer 22

B. Deep partial thickness burns

and obviously so on into full thickness

Question 23

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

Answer 23

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.

Question 24

Compare and Contrast the various degrees of burn injuries.

Answer 24

Question 25

What is the most painful burn? A. Superficial partial thickness burns B. Deep partial thickness burns C. 1st degree burns D. Full Thickness burns

Answer 25

A. Superficial Partial Thickness (2nd Degree Burn)

Question 26

What is the Rule of nines in adults?

Answer 26

* Head 9% * Each arm 9% * Each leg 18% * Anterior/Posterior trunk each 18% * Perineum 1% ## Footnote *only about 60-70% accurate tho*

Question 27

What is the **pediatric** version of the rule of nines?

Answer 27

* Head 21% * Each arm 10% * Back 13% * Abdomen 13% * Each leg 13.5% * Buttocks 5% * Genital area 1% ## Footnote *so head and abdomen larger in infants > adults*

Question 28

What is the Palmer method?

Answer 28

TBSA used for patient's palm with fingers together = 1%

Question 29

T/F: Larger burn surface areas are often overestimated.

Answer 29

False. They are underestimated!

Question 30

Fluid losses are a function of what 2 measurements? A. burn size B. patient height C. kidney function D. patient weight

Answer 30

A. burn size D. pt weight

Question 31

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

Answer 31

B. android vs gynoid shape is important and one may *underestimate* torso burns and *overestimate* extremity burns ## Footnote *a google pic*

Question 32

Patients with > ____ TBSA will develop burn shock and **need IV resuscitation** in an ICU. A. 15% B. 20% C. 25% D. 30%

Answer 32

B. 20% ## Footnote *probz just need to go ahead and get transferred to a burn center tbh*

Question 33

An under-resuscitated patient is at risk for: select 2. A. burn shock B. ARDS C. decreased perfusion D. abd compartment syndrome

Answer 33

A. burn shock C. ↓ perfusion *and ultimately end organ failure*

Question 34

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

Answer 34

A. Pulmonary edema/ARDS C. Abdominal compartment syndrome (c/w **bladder pressures > 20 mmHg)**

Question 35

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

Answer 35

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

Question 36

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

Answer 36

D. > 40% TBSA - *cannibalism for months*

Question 37

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

Answer 37

B. minimize NPO times - *could even keep TFs on or continue TPN if possible, maybe allow carbs up to 2 hrs prior (cornelius' words)*

Question 38

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

Answer 38

D. increases in cortisol, catecholamines, and glucagon ## Footnote causes *impaired* intracellular glucose transport

Question 39

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

Answer 39

B. B2 and B3 adrenergic stimulation (**↑cAMP**) C. **↑ FFA**(free fatty acids which produce ATP) E. ↑ glucagon, **TNF** (tumor necrosis factor), **IL** (interleukin) ## Footnote *TREAT WITH BETA BLOCKADE*

Question 40

What treatment is indicated for excessive lipolysis? A. cardizem B. nicardipine C. beta blockers D. alpha blockers

Answer 40

C. β-blockers ## Footnote *decreases lipid oxidation and decreases metabolic rate*

Question 41

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

Answer 41

B. TNF C. IL-1 and IL-6 ## Footnote *cortisol improves protein loss*

Question 42

What are the initial steps to the stabilization of a burn injury?

Answer 42

* Respiratory support (ABCs) * Fluid resuscitation * Cardiovascular stabilization * Short term pain control * Local care of burn wounds

Question 43

What are the secondary steps to the stabilization of a burn injury?

Answer 43

* Long term pain control * Thromboprophylaxis * Wound closure * Nutritional support * Control of hypermetabolism * Prevention of infection

Question 44

To achieve constant levels of pain control, analgesics should be: A. scheduled B. IM route C. short-acting opioids D. only NSAIDs

Answer 44

A. scheduled

Question 45

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

Answer 45

B. Methadone (long acting) C. IV Ketamine E. PCA infusions (Morphine) *also*: * NSAIDs (Acetaminophen) * Supplemental anxiolytics ## Footnote *NO IM opioids since absorption is uncertain*

Question 46

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

Answer 46

B. may need to deviate from normal doses to avoid toxicity or decreased efficacy

Question 47

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

Answer 47

B. Increased capillary permeability D. loss of intravascular oncotic pressure

Question 48

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

Answer 48

A. Histamine B. Prostaglandin E. Cytokines ## Footnote *Causes vasodilation of already impaired vessels*

Question 49

IV Fluids are needed for ____ % TBSA or greater.

Answer 49

15%

Question 50

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

Answer 50

B. Inhaled burns D. Electrical burns E. Delayed resuscitation

Question 51

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

Answer 51

B. when Urine output is adequate ## Footnote *consider small amount of colloids on day 2!!!*

Question 52

What is the parkland burn formula?

Answer 52

4ml x kg x %BSA * half in 1st 8 hours * other half in the next 16 hours

Question 53

What is US Army ISR Rule of 10 for adults?

Answer 53

10ml/hr x TBSA > 80kg, add 100 mL/10kg

Question 54

What is US Army ISR Rule of 10 for Pediatrics?

Answer 54

* 3 x TBSA x kg = vol for first 24 hrs * give HALF the total volume over 1st 8 hrs

Question 55

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

Answer 55

C. 1 mL/Kg/hr

Question 56

Which crystalloid is typically the best choice for burns? A. albumin B. NS C. LR D. D5W

Answer 56

C. Lactated Ringer’s

Question 57

What are the factors that would indicate that a transfer to a certified burn center is necessary?

Answer 57

- 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

Question 58

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

Answer 58

D. Hypernatremic hyperchloremic acidosis (**non-gap** metabolic acidosis!)

Question 59

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

Answer 59

C. 30-50 mL/hr ## Footnote increase/decrease by 20-25% if urine output goals are not being met.

Question 60

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

Answer 60

D. size 8 ETT = Large bore!! ## Footnote facilitates subsequent bronchoscopy and pulmonary toilet, and **decreases the risk of later airway occlusion** d/t casts comprised of blood, mucous and debris

Question 61

If a pediatric patient is heavier than ____ kg then use the adult formulas. A. 40 B. 50 C. 60 D. 70

Answer 61

A. 40 kg

Question 62

What is the fluid management for Pediatric patients < 14 yrs old and < 40 kg?

Answer 62

2-4 ml (**of LR**)/kg x kg x %TBSA (2nd and 3rd degree)

Question 63

For children less 20kg, what maintanence fluid should be added to support their basal metabolic rate? A. D5LR B. NS C. D5W D. LR

Answer 63

A. D5LR ## Footnote Titrate IVF to maintain urine output **0.5-1ml/kg/hr**!!!

Question 64

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

Answer 64

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 ## Footnote USE 5% albumin - not 25%!!

Question 65

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

Answer 65

C. 4-7 mL/kg at a rate of 0.5 mL/min *Reduce maintenance isotonic crystalloid by an equal volume per hour*

Question 66

In resuscitative "ebb" phase, cardiac output is reduced by as much as ____%.

Answer 66

60%

Question 67

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

Answer 67

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 ## Footnote *Ensure appropriate fluid resuscitation!!*

Question 68

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

Answer 68

A. ↑ myocardial O₂ consumption C. ↓ SVR rmbr: this is a Hyperdynamic state! = **increased CO, Tachycardia = administer beta blockers!** ## Footnote *and make sure they are appropriately managed for pain*

Question 69

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

Answer 69

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

Question 70

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

Answer 70

C. scheduled bronchodilators ## Footnote *because bronchospasm is common!*

Question 71

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

Answer 71

A. Hypoventilation d/t decreased elasticity D. Impaired ventilation from circumferential burns/scar

Question 72

What treatment is potentially necessary for restrictive lung defect from circumferential burns? A. exploratory laparotomy B. fasciotomy C. chest tube D. escharotomy

Answer 72

D. escharotomy

Question 73

What is the sign of possible restrictive lung defect? ## Footnote *left from last years class..*

Answer 73

↑ airway pressures

Question 74

What lab is elevated with *inhalation* burn injuries? A. BUN/creat B. COHb C. lactic acid D. CO2

Answer 74

B. Carboxyhemoglobin levels (**> 10%!!**)

Question 75

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

Answer 75

C. Bronchoscopy ## Footnote *think of intubating these patients early!*

Question 76

# *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

Answer 76

A. Apply bacitracin ointment to **eye lids**. Apply erythromycin ointment in the **eyes**.

Question 77

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

Answer 77

B. secure ETT b/c extensive edema is common C. remove contact lenses *to protect the eyes from corneal ulcers/abrasions* ## Footnote *contact ophtho for corneal/globe injury!!*

Question 78

At what levels of carboxyhemoglobin are overt signs and symptoms of toxicity seen?

Answer 78

15-20% = HA, N/V

Question 79

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

Answer 79

C. reduce magnitude of stress response ## Footnote *but poor evidence*

Question 80

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

Answer 80

D. nasoenteric tube and feed into the jejunum ## Footnote *May not be D/C for OR if already intubated*

Question 81

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

Answer 81

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

Question 82

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

Answer 82

B. resistance to non-depolarizers (-curiums) C. sensitivity to depolarizers (sux)

Question 83

Resistance to non-depolarizers (-curiums) occurs when BSA is ____ % and higher. A. 25% B. 30% C. 35% D. 40%

Answer 83

A. 25% and > ## Footnote *so give higher dose of roc, vec, any -curium*

Question 84

A burn patient's sensitivity to succinylcholine *begins* approx how many hours post-burn? What timeframe does this sensitivity become *significant*?

Answer 84

begins: approx 24 hrs post-burn significant after: 48-72 hrs

Question 85

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

Answer 85

A. staple EKG patches B. get base deficit instead of lactate levels in OR D. suture art lines ## Footnote *ALSO USE A BAIR HUGGER!! they can lose up to 1 deg q 15 mins*

Question 86

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

Answer 86

B. may be inaccurate d/t COHb levels

Question 87

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

Answer 87

C. Comatose patient D. Hoarseness, wheezing, SOB E. Carbonaceous sputum and: * **Singed** nasal & facial hairs * **Deep** facial burns * **>40%** TBSA

Question 88

Difficult laryngoscopy is possible with any signs of inhalation injury, especially: A. cherry lips B. altered mental status C. edema D. singed eyebrows

Answer 88

C. Edema ## Footnote *also limited mobility d/t pain, contractures, eschar*

Question 89

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

Answer 89

A. use cotton umbilical tape C. Wire ETT to teeth ## Footnote and **NO LMAs!**

Question 90

What medication should we use for induction on a burn patient? A. lidocaine and fentanyl B. beta blocker C. ketamine D. dexmedetomidine

Answer 90

C. Ketamine (Simulates SNS vs depressant effect) ## Footnote *propofol and opioids could be used but impt to consider ebb and flow phases....also etomidate has adrenal insufficiency concern....*

Question 91

What drug is often used for burn dressing changes? A. dilaudid B. ketamine C. dexmedetomidine D. fentanyl

Answer 91

B. Ketamine

Question 92

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

Answer 92

D. rescue TEE ## Footnote *to rule out cardiogenic shock, distributive shock, or MI*

Question 93

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%

Answer 93

C. 2.6%

Question 94

Hgb should maintained around ____ g/dL.

Answer 94

7-8 g/dL ## Footnote *10 g/dL for acute coronary syndrome*

Question 95

Options to prevent blood loss during burn excision include: select 2 A. heparin 5000 units B. subq vasoconstrictors C. protamine sulfate D. topical thrombin

Answer 95

B. subq vasoconstrictors D. topical thrombin *and staged procedures*

Question 96

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

Answer 96

C. rFVII ## Footnote *TXA also has incr risk of thromboembolism!!!*

Question 97

What vasopressors should be used in shock when MAP is < 55 mmHg? select 2. A. phenylephrine B. epinephrine C. dopamine D. vasopressin E. norepinephrine

Answer 97

D. Vasopressin E. Norepinephrine

Question 98

What is the CVP goal with burn patients?

Answer 98

* 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%

Question 99

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

Answer 99

A. increase IVF rate by 20-25% ## Footnote *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*

Question 100

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

Answer 100

Tumescent LA w/ epi

Question 101

What is the typical dose of tumescent LA?

Answer 101

Lidocaine 1G + epi + 10 mEq bicarb / 1 liter of NS

Question 102

What is the max dose of tumescent LA?

Answer 102

55mg/kg

Question 103

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

Answer 103

E. all of the above * Decreased blood loss * Easy excision of granulation tissue * Shorter surgical times * No hematoma or bruising postop

Question 104

When mechanically ventilating a burn patient with inhalational injury, what is target pCO2? target pH?

Answer 104

target pCO2: 30-35 mmHg pH > 7.20

Question 105

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

Answer 105

B. nebulized Heparin (5000 units) with albuterol Q4H ## Footnote *since heparin can induce bronchospasm, ensure albuterol is given together w/ hep!!!!*

Question 106

Abdominal Compartment Syndrome is best diagnosed by: A. CVP B. abdominal pressures C. bladder pressures D. urine output

Answer 106

C. Bladder pressures ## Footnote *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.*

Question 107

For burns > 20% TBSA, how often should we measure bladder pressures? A. q2H B. q4H C. q6H D. q12H

Answer 107

B. Measure Q4H with >20% TBSA

Question 108

What bladder pressure indicate early intra-abdominal hypertension? A. > 8 mmHg B. > 10 mmHg C. > 12 mmHg D. > 20 mmHg

Answer 108

C. >12 mmHg

Question 109

What are the bladder pressures continuous with abdominal compartment syndrome?

Answer 109

Greater than 20 mmHg

Question 110

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

Answer 110

C. scheduled long-acting opioids E. scheduled anxiolytics ## Footnote *could be IV, enteral, transmucosal, po*

Question 111

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

Answer 111

D. ketamine for burn debridement E. peripheral nerve blocks and could use nitrous oxide **50/50**

Question 112

Extremities should be elevated ____ degrees.

Answer 112

30-45 degrees (pillows first, then slings)

Question 113

How often should we examine pulses? and using what?

Answer 113

every hour; using Doppler *(High risk for losing perfusion and sensation due to compartment syndrome!)*

Question 114

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

Answer 114

A. IV antibiotics E. steroids

Question 115

List the adjuncts to burn Resuscitation

Answer 115

* 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

Question 116

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

Answer 116

B. Booster if > 5 yrs since last booster C. Booster plus tetanus immune globulin (TIG) if no previous immuniza/on

Question 117

What topical antibiotics are used in burn dressing changes?

Answer 117

Silvadene and Sulfamylon ## Footnote *No Silvadene to the face!!!*

Question 118

List the types of commonly used burn dressings.

Answer 118

* Silver dressings * Silverton water or saline every 8 hours * Silver nitrate * Temporary skin substitutes such as Biobrane