Shock/Trauma Anesthesia Flashcards
What is (LD)50
lethal dose
the burn size lethal to 50% of the population
Why do third degree burns require grafting, but not second?
In third degree, the basement membrane of the epithelium AND the dermis appendages are destroyed
According to the ABA, what qualifies as a major burn?
- 2D with > 10% TBSA
- 3D with more than 10% TBSA
- Any electrical burn
- burn complicated by smoke inhalation
What is the ABA mortality estimate tool?
Patient Age + %TBSA
If > 150, mortality is 80%
How does smoke inhalation impact mortality of a burn injury?
doubles it
What are the four types of burns
Chemical
Electrical
Thermal
Inhalation
What is the most damaging type of burn?
Electrical
Why are patients with electrical burns at high risk for renal failure?
Myoglobinemia
What is the most common burn in kids < 4?
Kids > 5?
Scald
Flame
What are the three types of inhalation injury?
- upper airway
- lower airway injuries caused by chemical and particulate constituents of smoke
- metabolic asphyxiation from CO or Hydrogen Cyanide
What are the three phases of burn treatment?
- resuscitative
- debridement and grafting
- reconstructive
What usually causes inhalation damage below the cords: heat or particles?
Particles
Heat really only damages the upper airways because it gets dissipated
In a pediatric burn patient, what size tube should be used?
One size smaller than is recommended for that child’s height and weight
Cuffed if < 8 yrs old
When is it unsafe to do an RSI with Succ for a burn victim?
Why?
Generally if they’re greater than 24 hours out
The body up-regulates acetylcholine receptors, increasing the amount of potassium released
What kind of nebs can aid in burn healing?
Heparin and N-Acetylcysteine
What percent of fire deaths are due to CO?
50-60%
What is the half life of CO in a patient that’s been put on 100% O2?
30 min to 2.5 hours
How does hydroxycobolamin aid in CO?
Converts CO to CO2
Why does cyanide poisoning cause hypoxia?
blocks intracellular use of oxygen:
binds to the terminal cytochrome in the ETC
How does hydroxycobalamin neutralize Hydrogen cyanide?
binds with cyanide, forming cyanocobalamin, which can be easily excreted by the kidneys
When are fluid losses highest after a burn?
When do they start to stabilize?
12 hours
24 hours
Pretty much all burn resuscitation formulas are based on two things:
weight
%TBSA
Why are colloid solutions not recommended in the first 24 hours?
Capillary permeability is too high. Those proteins will seep right out and take the fluid with it