Obesity & Thermal Injury - Quiz 1 Flashcards
How is BMI calculated?
Wt (kg) ÷ Ht (m2)
or
Wt (lbs) ÷ Ht (in2) x 703
What BMI is considered “Overweight”
25 - 29.9
What BMI is Class III Obese or Extreme Obese?
40 - 44.9
A BMI of 30 - 34.9 is considered ________
A BMI of 30 - 34.9 is considered Class I Obese
What BMI is Obese Class II?
35 - 39.9
At what BMI is a person considered Severly Obese or Class IV Obese?
BMI > 45
How is Ideal Body Weight calculated for Males using Broca’s Index?
Height (cm) - 100
How is Ideal Body Weight calculated for Females using Broca’s Index?
Height (cm) - 105
How is Lean Body Weight Calculated?
Ideal Body Weight (IBW) x 1.3
What are the functions of Adipose Tissue?
Protein Secretion
Energy
Insulation
Triglyceride & Lipid Synthesis
Android Adipose distribution is _____, whereas Gyencoid Adipose distribution is ______
Android Adipose distribution is APPLE-SHAPED, whereas Gyencoid Adipose distribution is PEAR-SHAPED
Which type of Adipose Distribution is associated with more Comorbidities?
Android: Heart Disease, DM, HTN, HLD, Death
How much Cardiac Demand is needed for each Kg of Fat?
0.1 L/min
What does Obesity do to the Heart?
Cardiomegaly
Atrial/Ventricle Dilatation
Hypertrophy
CAD
How does Obesity double the risk for HTN?
↑Blood Viscosity
↑Mineralocoticoids
Hyper-Insulin
Sodium Reabsorption
Kidney Compression
RAA Activation
How does Obesity affect the Lungs?
Restrictive Flow Volume –> Inhibited Lung Inflation –> Hypoventilation & Hypercarbia
With Restrictive Lung Disease, what is Decreased?
FRC
ERV
VC
TLC
How is Obstructive Sleep Apnea defined?
5 Apneic Episodes of 10 seconds per Hour or 30 Episodes per Night
What is the Gold Standard for Diagnosing OSA?
Polysomnography (PSG)
What are the signs of Obese Hypoventilation or Pickwickian Syndrome?
Sudden Somnolence
OSA
Right Heart Failure
Pulm. HTN
Polycythemia
How does Obese Hypoventilation or Pickwickian cause Right Heart Failure?
Hypoxic Pulmonary Vasoconstriction
or
Pulmonary HTN
or
Cor Pulmonale
Which anesthetic drug doses are based on Total Body Weight?
Maintenance Propofol
Induction Succinylcholine
Fentanyl Loading
All doses of Rocuronium, Vecuronium, and Cisatrcurium are based on what kind of weight?
Ideal Body Weight
How much is FRC reduced in the Obese Patient vs Non-Obese under General Anesthesia?
50% Reduced in Obese
vs
20% in Non Obese
What can Improve FRC, but also Reduce Cardiac Output & O2 Delivery?
PEEP
How does Obesity affect Volume Replacement?
↑Total Body Volume
&
↓EBV
What does a 1st Degree Burn affect?
Epidermis - no treatment needed
What does a 2nd Degree Burn affect?
Dermis - Deep, Superficial Partial Thickness
May need grafting
What does a 3rd Degree Burn affect?
Subcutaneous - Full Thickness
Grafting NEEDED
What does a 4th Degree Burn affect?
Muscle
Fascia
Bone
Requires Extensive Treatment
What is classified as a Major Burn?
2nd or 3rd Degree Burn > 10% for Adults & 20% for Age Extremes
How does the Rule of Nines work for Adults?
Head = 9%
Front Torso = 18%
Back Torso = 18%
Each Arm = 9%
Each Leg = 18%
How does the Rule of Nines work for Pediatrics?
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.
What is the Initial Treatment for Chemical Burns?
Lots of Water/Saline
What types of burns can cause Myoglobinuria & Renal Failure?
Electrical Burns
When is it ok to give Succinylcholine from the Time of Burn Injury?
Before 24 hours after Injury
How do Burn Injuries affect NDNMB dosing?
Increases Dosage requirement 2-3x
How does Carbon Monoxide poisoning kill 50-60% of Fire Victims?
Carbon Monixde has 200x more affinity to Hemoglobin & impaires O2 Delivery to tissues.
How is Carbon Monoxide Poisoning treated?
100% O2 - decreases CO half-life from 4 hours to 40 min.
When is Hypovolemic Shock the greatest after a Burn Injury?
First 12 Hours, then stabilizes after 24 hours
How should Fluids be given to an Adult for burn-related Hypovolemic Shock?
LR 2-4 mL / kg x %BSA Burned
How should Fluids be given to Children for burn-related Hypovolemic Shock?
LR 3-4 mL / kg x % BSA Burned
How fast should Fluid Resuscitation happen for Burn Victims?
Half in First 8 hours & Second Half in 16 hours
What are the signs of the Hypermetabolic / Hyperdanamic Phase 48 hours after a Burn Injury?
Hyperthermia
Tachypnea
Tachycardia
↑Catecholamines
↑O2 Consumption
↑Catabolism
↑BMR
What is the Hallmark of Burn Shock?
Decreased Cardiac Output
How do Burn Injuries affect the Lungs?
↓FRC & Function
↑Ventilation up to 40 L/min
Pulm Edema
