Multiple Interacting Systems

Question 1

What is the most common type of burns?

Answer 1

Thermal

Question 2

What is peripheral IV extravasation?

Answer 2

Chemical burns due to chemicals in IV exiting a blood vessel and cause burns

Question 3

In which classification of burns are blisters visible?

Answer 3

2nd degree

Superficial and deep partial thickness

Question 4

Describe the appearance of a superficial burn

Answer 4

No visible blisters

Dry, red, blanching lesion

Question 5

Describe the appearance of a superficial partial thickness burn?

Answer 5

Red/pink, blanching lesion, moist with shiny appearance

Visible blisters

Question 6

Describe the appearance of a deep partial thickness burn

Answer 6

Mottled red/white, dry non-blanching lesion, possible visible blisters

Question 7

Describe the appearance of a full thickness burn

Answer 7

No blisters

Charred dry leathery skin

Question 8

Why is blanching not observed in a deep partial and full thickness burn?

Answer 8

No perfusion to site

Question 9

What layer of skin is involved with each burn?

Answer 9

Superficial: Epidermis
Superficial partial thickness and deep partial thickness: Dermis
Full Thickness: Subcut fat

Question 10

True or False. It is important to include all types of burns when calculating the total body surface area

Answer 10

False

Never include superficial burns

Question 11

Are pediatric patients more susceptible to sepsis? Why or why not?

Answer 11

Yes

This is due to their immature immune systems

Question 12

What is the role of thromboxane-A2 in burn management?

Answer 12

It is a pro-inflammatory mediator which reduces blood flow
Body wrongfully thinks injury = loss of blood so it tries to stop blood flow
However this is harmful because it reduces perfusion and inhibits ability to heal

Question 13

How does compartment syndrome occur?

Answer 13

Tissue inflammation, edema or hemorrhage causes a local increase in pressure that damages tissue

Question 14

What is the zone of coagulation?

Answer 14

Area of necrosis

Its the epicentre with the point of maximum, irreversible damage due to coagulation of proteins

Question 15

What is the zone of stasis/injury?

Answer 15

Zone of injury with decreased tissue perfusion however if adequate perfusion the tissue will heal

Question 16

What is the zone of hyperaemia?

Answer 16

Area of increased blood flow where the tissue is expected to recover

Question 17

When burn is more than 30% TBSA it will cause damage to different systems of the body. What systems are affected and give a brief explanation of how

Answer 17

Respiratory: Bronchoconstriction and acute resp distress syndrome
Metabolic: Increase basal metabolic rate and body rerouting blood flow from gut leading to loss of gut integrity
Immunological: Reduced immune response and hyperinflamm state
Cardiovascular: Burn shock, reduced contractility, inc cap perm and decreased perfusion

Question 18

When is fluid resuscitation required for (a) children and (b) adults in terms of TBSA

Answer 18

More than 10% TBSA burn in children

More than 15% TBSA burn in adults

Question 19

What is the fluid resuscitation calculation for a loading dose?

Answer 19

4 mL x kg x %TBSA

Question 20

Following a severe burn what is an early AND late kidney injury associated with?

Answer 20

Early: Perfusion issue
Late: MODS associated with sepsis

Question 21

What is the fluid maintenance calculation for a maintenance dose? For children

Answer 21

0-10 kg: 100 mL per kg
10-20: 1000 ml + 50 ml per kg above 10
20-70: 1500 ml + 20ml per kg above 20
70+: 2500 mL (Adult requirement)

Question 22

After calculating the fluid resuscitation dose, in what time frame do you give the first and second half of fluid?

Answer 22

First half run in the first 8 hours

Second half run in the next 16 hours

Question 23

In the rule of 9s how much does each body part cost?

Answer 23

Head: 9% 
Arms: 9% each
Front trunk: 18%
Back Trunk: 18%
Lower limbs: 18% each 
Perineum: 1%

Question 24

What special considerations are given to pediatric burns?

Answer 24

Pediatrics have thinner skin due have more severe burns
Larger body surface area in relation to height or weight leads to a greater risk for fluid and heat loss
Immature immune system

Question 25

What are special considerations given to geriatric patients?

Answer 25

Decreased myocardial func makes effective fluid resus difficult
More likely to have co-morbidities
Compromised immune system

Question 26

Initial management assessment for burn victims

Answer 26

Cardiovascular status
Circulation
Airway and breathing
Smoke inhalation injury

Question 27

Potential complications for a burn victim

Answer 27

Hypovolemia/Fluid and electrolyte loss as fluid shifts after initial injury
Hypothermia
Infection/Tetanus
Formation of eschar
Complication of circumferential burn: Constrict torso or limb leading to extensive tissue injury
Renal or Hepatic failure

Question 28

What is burn shock?

Answer 28

Shock: Condition brought about by a sudden drop in blood flow
Burn Shock: Distributive and hypovolemic shock
Causes intravascular volume depletion, low pulmonary artery occlusion pressure (PAOP), increased systemic vascular resistance and depressed cardiac output

Question 29

What kind of electrolyte imbalance do you see in burn shock after the first 1-2 days? Think sodium, potassium, calcium, magnesium and phosphorous

Answer 29

Electrolytes transition to cause potential hypernatremia, hypokalemia, Hypocalcemia, hypomagnesemia and hypophosphatemia

Question 30

Why is proteinuria a feature in severely burned patients?

Answer 30

Due to increased glomerular permeability and decreased tubular absorption of filtered proteins

Question 31

Describe the differences between early and late acute renal failure. When do they occur and what causes them?

Answer 31

Early: Few hours to a few days after injury. Associated acute tubular necrosis
Late: 1 or more weeks after injury. Secondary to hemodynamic changes associated with other burn complications

Question 32

How is blood glucose affected in the burn victim?

Answer 32

Stress hormones oppose anabolic actions of insulin
Hepatic glycogenolysis releases glucose
Body muscle and fat broken down to inc glucose production
Leads to hyperglycemia

Question 33

What are the two kinds of dialysis?

Answer 33

Hemodialysis: Acute situations

Peritoneal dialysis

Question 34

What is the difference between primary and secondary MODS?

Answer 34

Primary: Immediate local or mild systemic response to triggering event or illness
Secondary: Excessive systemic inflammatory response resulting in organ dysfunction

Question 35

What are the clinical manifestations for the onset of MODS?

Answer 35

Low-grade fever
Tachy and dyspnea
Altered mental status