Obesity & Thermal Injury - Quiz 1

Question 1

How is BMI calculated?

Answer 1

Wt (kg) ÷ Ht (m²)

or

Wt (lbs) ÷ Ht (in²) x 703

Question 2

What BMI is considered “Overweight”

Answer 2

25 - 29.9

Question 3

What BMI is Class III Obese or Extreme Obese?

Answer 3

40 - 44.9

Question 4

A BMI of 30 - 34.9 is considered ________

Answer 4

A BMI of 30 - 34.9 is considered Class I Obese

Question 5

What BMI is Obese Class II?

Answer 5

35 - 39.9

Question 6

At what BMI is a person considered Severly Obese or Class IV Obese?

Answer 6

BMI > 45

Question 7

How is Ideal Body Weight calculated for Males using Broca’s Index?

Answer 7

Height (cm) - 100

Question 8

How is Ideal Body Weight calculated for Females using Broca’s Index?

Answer 8

Height (cm) - 105

Question 9

How is Lean Body Weight Calculated?

Answer 9

Ideal Body Weight (IBW) x 1.3

Question 10

What are the functions of Adipose Tissue?

Answer 10

Protein Secretion

Energy

Insulation

Triglyceride & Lipid Synthesis

Question 11

Android Adipose distribution is _____, whereas Gyencoid Adipose distribution is ______

Answer 11

Android Adipose distribution is APPLE-SHAPED, whereas Gyencoid Adipose distribution is PEAR-SHAPED

Question 12

Which type of Adipose Distribution is associated with more Comorbidities?

Answer 12

Android: Heart Disease, DM, HTN, HLD, Death

Question 13

How much Cardiac Demand is needed for each Kg of Fat?

Answer 13

0.1 L/min

Question 14

What does Obesity do to the Heart?

Answer 14

Cardiomegaly

Atrial/Ventricle Dilatation

Hypertrophy

CAD

Question 15

How does Obesity double the risk for HTN?

Answer 15

↑Blood Viscosity

↑Mineralocoticoids

Hyper-Insulin

Sodium Reabsorption

Kidney Compression

RAA Activation

Question 16

How does Obesity affect the Lungs?

Answer 16

Restrictive Flow Volume –> Inhibited Lung Inflation –> Hypoventilation & Hypercarbia

Question 17

With Restrictive Lung Disease, what is Decreased?

Answer 17

FRC

ERV

VC

TLC

Question 18

How is Obstructive Sleep Apnea defined?

Answer 18

5 Apneic Episodes of 10 seconds per Hour or 30 Episodes per Night

Question 19

What is the Gold Standard for Diagnosing OSA?

Answer 19

Polysomnography (PSG)

Question 20

What are the signs of Obese Hypoventilation or Pickwickian Syndrome?

Answer 20

Sudden Somnolence

OSA

Right Heart Failure

Pulm. HTN

Polycythemia

Question 21

How does Obese Hypoventilation or Pickwickian cause Right Heart Failure?

Answer 21

Hypoxic Pulmonary Vasoconstriction

or

Pulmonary HTN

or

Cor Pulmonale

Question 22

Which anesthetic drug doses are based on Total Body Weight?

Answer 22

Maintenance Propofol

Induction Succinylcholine

Fentanyl Loading

Question 23

All doses of Rocuronium, Vecuronium, and Cisatrcurium are based on what kind of weight?

Answer 23

Ideal Body Weight

Question 24

How much is FRC reduced in the Obese Patient vs Non-Obese under General Anesthesia?

Answer 24

50% Reduced in Obese

vs

20% in Non Obese

Question 25

What can Improve FRC, but also Reduce Cardiac Output & O₂ Delivery?

Answer 25

PEEP

Question 26

How does Obesity affect Volume Replacement?

Answer 26

↑Total Body Volume & ↓EBV

Question 27

What does a 1st Degree Burn affect?

Answer 27

Epidermis - no treatment needed

Question 28

What does a 2nd Degree Burn affect?

Answer 28

Dermis - Deep, Superficial Partial Thickness May need grafting

Question 29

What does a 3rd Degree Burn affect?

Answer 29

Subcutaneous - Full Thickness Grafting NEEDED

Question 30

What does a 4th Degree Burn affect?

Answer 30

Muscle Fascia Bone Requires Extensive Treatment

Question 31

What is classified as a Major Burn?

Answer 31

2nd or 3rd Degree Burn \> 10% for Adults & 20% for Age Extremes

Question 32

How does the Rule of Nines work for Adults?

Answer 32

Head = 9% Front Torso = 18% Back Torso = 18% Each Arm = 9% Each Leg = 18%

Question 33

How does the Rule of Nines work for Pediatrics?

Answer 33

**Head** = 18% - 1% for each year over 1 y.o **Front Torso** = 18% **Back Torso** = 18% **Each Arm** = 9% **Each Leg** = 14% + 0.5% for each year over 1 y.o.

Question 34

What is the Initial Treatment for Chemical Burns?

Answer 34

Lots of Water/Saline

Question 35

What types of burns can cause Myoglobinuria & Renal Failure?

Answer 35

Electrical Burns

Question 36

When is it ok to give Succinylcholine from the Time of Burn Injury?

Answer 36

Before 24 hours after Injury

Question 37

How do Burn Injuries affect NDNMB dosing?

Answer 37

Increases Dosage requirement 2-3x

Question 38

How does Carbon Monoxide poisoning kill 50-60% of Fire Victims?

Answer 38

Carbon Monixde has 200x more affinity to Hemoglobin & impaires O₂ Delivery to tissues.

Question 39

How is Carbon Monoxide Poisoning treated?

Answer 39

100% O₂ - decreases CO half-life from 4 hours to 40 min.

Question 40

When is Hypovolemic Shock the greatest after a Burn Injury?

Answer 40

First 12 Hours, then stabilizes after 24 hours

Question 41

How should Fluids be given to an Adult for burn-related Hypovolemic Shock?

Answer 41

LR 2-4 mL / kg x %BSA Burned

Question 42

How should Fluids be given to Children for burn-related Hypovolemic Shock?

Answer 42

LR 3-4 mL / kg x % BSA Burned

Question 43

How fast should Fluid Resuscitation happen for Burn Victims?

Answer 43

Half in First 8 hours & Second Half in 16 hours

Question 44

What are the signs of the Hypermetabolic / Hyperdanamic Phase 48 hours after a Burn Injury?

Answer 44

Hyperthermia Tachypnea Tachycardia ↑Catecholamines ↑O₂ Consumption ↑Catabolism ↑BMR

Question 45

What is the Hallmark of Burn Shock?

Answer 45

Decreased Cardiac Output

Question 46

How do Burn Injuries affect the Lungs?

Answer 46

↓FRC & Function ↑Ventilation up to 40 L/min Pulm Edema