Test #2 burns PPt- Josh Flashcards
this PPt is fucking ridiculous!!!! fuck ton of slides and small as font!!! I am going to pull the important shit only hopefully
1
Q
Burns:
Burns are acute wounds caused by a single, non-reoccuring insult to the skin or other organic tissue that is primarily caused by acute exposure to ____, _____, ____, ____, or _____
A
- heat
- cold
- chemicals
- electricity
- radiation
2
Q
what are the funtions of the skin
A
- protection form infection injury
- Prevention of loss of body fluids
- Regulation of bdy temp
- Sensory with enviroment
3
Q
Burns:
what are the 6 types of burns
A
- Thermal
- Cold exposure
- Chemical
- electrical
- Inhalation
- Radiation
4
Q
Burns: Thermal
are associated with what?
A
- Steam
- flames
- hot liquids
- hot solid objects
5
Q
Burns: Thermal
Depth of thermal burn is related to what?
A
Temperature
duration
thickness of skin involved
6
Q
Burns: Cold
also called what
A
frost bite
7
Q
Burns: Cold
occurs when intracellular fluids freeze and the resulting ____ ____ puncture celss or when extracellular fluids freeze and create a hypotonic enviroment
A
ice crystals
8
Q
Burns: Cold
result in tissue hypoxia through the interruption of ____ ____, ____, and ______ _____
A
- blood flow
- hemoconcentration
- intravascular thrombosis
9
Q
Burns: Chemical
tissue disruption results form a wide range of chemical reations such as what 3 main causes
A
- Alteraion in PH
- Disruption of cellular membranes
- Direct toxic effects on metabolic processes
10
Q
Burns: Electrical
electrical current passes through the body and is transformed into _____ energy as it passes through the poorly conductive tissues of the body
A
thermal
11
Q
Burns: Electrical
electropration occurs!!! what the fuck is that?
A
- damage to cell membranes that disrupt membrane potential and function
12
Q
Burns: Electrical
Severity of burn depends on the pathway of _______, the ____ of tissues to electrical current flow, and the ____ and ____ of the electrical flow
A
- electrical current
- resistance
- strength and duration
13
Q
Burns: Inhalation
toxic chemicals produced in fires can injure the lower airways and cause a ______ burn
A
chemical
14
Q
Burns: Inhalation
how smoke usually only burns the what
A
pharynx
15
Q
Burns: Inhalation
stream can cause injury where?
A
below the glottis
16
Q
Burns: Inhalation
carbon monoxide produced from combustion can inpair cellular what?
A
respiration
17
Q
Burns: Radiation
____ frequency and ______ energy can disrupt and destroy tissues
A
- Radio
- ionizing
18
Q
Burns: Radiation
what is the most common type of radiation burn?
A
sunburn
19
Q
Burns: Radiation
depending on the photon, radiation burns can cause very deep ____ burns
A
internal
20
Q
Burns: Radiation
radiation burns are associated w/ what b/c of their ability to interact w/ and damage DNA
A
Cancer
21
Q
Burns: Radiation
_______is dependent on dose, _____ of exposure, and ____ of particle
A
- Severity
- time
- type
22
Q
Burns: Assessment
what are the 5 things you want to assess with burns?
A
- Depth
- Extent
- Location
- Pt’s age
- Pt’s comorbidities
23
Q
Skin: Anatomy
what are the layers of the skin (top down )
A
- Epidermis
- Dermis
- Sub Q fat
- Muscle
24
Q
Skin: Anatomy
what are the 5 layers of the epidermis( top down)
A
- Stratum corneum
- Stratum lucidum
- Stratum granulosum
- Stratum spinosum
- Stratum Basale
( cute latin girls suck balls)
25
Skin: Anatomy
what is contained in the dermis
* Hair follicle
* Sweat glands
26
Skin: Anatomy
what is contained in the Sub Q
* Sub q artery
* Sub Q Vein
27
Burns: Degrees
Define 1st degree
* superficial burn limited to epidermis
* (AKA sunburn Basic)
28
Burns: Degrees
what is a **_superficial_** 2nd degree burn
* Involves epidermis and superficial layers of dermis
* (usually a blister)
29
Burns: Degrees
what is a **_DEEP_** 2nd degree burn
* Involves epidermis and most of dermis
30
Burns: Degrees
what is a third degree burn?
* full thicknness burn
* Involves epidermis
* all layers of dermis
* and sub q
31
Burns: Degrees
what is a 4th degree burn
* full thickness burn
* extends down to muscle and/ or bone
32
Burns: 1st degree
depth
Epidermis
33
## Footnote
Burns: 1st degree
appearance
## Footnote
dry
red
blanches
34
Burns: 1st degree
sensations
painful
35
Burns: 1st degree
outcome
heals spontaneously
36
Burns: partial thickness 2nd degree superficial
depth
epidermis and superficial dermis
37
Burns: partial thickness 2nd degree superficial
appearance
blisters
moist
red
weeping
blanches
38
Burns: partial thickness 2nd degree superficial
sensation
painful to air and temp
39
Burns: partial thickness 2nd degree superficial
outcomes
heals spont
40
Burns: partial thickness 2nd degree Deep
depth
Epidermis
deep dermis
41
Burns: partial thickness 2nd degree Deep
appearance
blisters
wet/waxy
patchy to cheesy
white to red
DOES NOT BLANCH
42
Burns: partial thickness 2nd degree Deep
sensation
pain to pressure only
43
Burns: partial thickness 2nd degree Deep
outcomes
requires excision and usually grafting
44
Burns: Full thickness 3rd
depth
destruction of epidermis and dermis
45
Burns: Full thickness 3rd
appearance
waxy white
leathery
gray/ charred/ black
dry
inelastic
DOES NOT BLANCH
46
Burns: Full thickness 3rd
Sensation
deep pressure only
47
Burns: Full thickness 3rd
outcome
complete excision
limited function
48
Burns: Full thickness 4th
Depth
muscle
fascia
bone
49
Burns: Full thickness 4th
appearance
waxy white
## Footnote
leathery
gray/ charred/ black
dry
inelastic
DOES NOT BLANC
50
Burns: Full thickness 4th
sensation
deep pressure only
51
Burns: Full thickness 4th
outcome
complete excision
limited function
52
Burns:
what burns are partial thickness?
* 2nd superficial
* 2nd deep
53
Burns:
what burns are full thickness
* 3rd
* 4th
54
Burns:
the extent of the burn s expressed in what?
TBSA
(total body surface area)
55
Burns:
the ___ \_\_\_ ___ is commonly used to estamiate the burn injury in adults
rule of nines
56
Burns:
the \_\_\_\_-\_\_\_\_ chart is reccomended for estimates in pediatric population
lund-Browder
57
Burns:
what method may be used to assess irregular and patchy burn injuries
The palm method
58
Burns:
name the rule of nines
* head- 4.5 and 4.5 =9
* chest and abd 18
* Back 18
* Right arm 4.5 and 4.5 =9
* Left arm 4.5 and 4.5 = 9
* right leg 9 and 9=18
* left leg 9 and 9 =18
* no no area = 1%
59
rule of nine pic
60
Lund-browder chart
picture
61
Burns:
what is the palm of hand estimation
the palm of the PATIENTS hand represents 0.5% of TBSA
the palm of thr PATIENTS hand including the fingers is 1% of TBSA
62
Palm of hands estimation
pic
63
Location of injury and complications:
facial and chest burns may indicate possible damage to what?
respiratory system
64
Location of injury and complications:
3rd and 4th degree burns on neck, chest, and abd, could restrict what efforts
respiratory
65
Location of injury and complications:
circumferential burns can restrict what and compress neurovascular bundles
blood flow
66
Location of injury and complications:
burns on what can restrict range of motion
Joints
67
Burn Injury and age of Pt:
children and elderly tend to have ____ skin
thinner
68
Burn Injury and age of Pt:
higher motolity in what poopulation due to deeper and more severe burns
children and elderly
69
Burn injury grading system:
what are the 3 classes
* minor
* Moderate
* Major
70
Burn injury grading system:
what is the criteria for MINOR burns in
1. adult
2. Peds
3. Full thickness
1. \<10%
2. \<5%
3. \<2%
71
Burn injury grading system:
what is the criteria for Moderate burns in
1. adults
2. peds
3. full thickness
1. 10-20%
2. 5-10%
3. 2-5%
72
Burn injury grading system:
what is the criteria for Major burns
1. adult
2. peds
3. Fullthickness
1. \>20%
2. \>10%
3. \>5%
73
Patho of burn injury:
what is the patho of a burn?
Acute burn injury
Inflammatory mediators released
increased capillary permeability
extravasation of fluids into burned tissue
tissue edema
74
Mediators of burns:
what are local mediators released
* Histamine
* Prostaglandins
* Bradykinin
* Nitric oxide
* Seratonin
* Substance P
75
Mediators of burns:
what are systemic mediators released
* Cytokins
* Endotoxins
* Nitric oxide
76
Mediators of burns:
what is the systemic response of the body from all the mediators released from a burn injurt
immune supression
hypermetabolism
Protein catabolism
Sepsis
Multiple organ system failure
77
what are the 2 main phases of a burn
burn shock
Hypermetabolic phase
78
Hypermetabolic phase of a burn:
CO and HR can increase up to how much?
150-300%
79
Effects of burns: Cardiac
what are early effects
hypovolemia
myocardial depression
80
Effects of burns: Cardiac
late effects
systemic HTN
tachycardia
Increased CO
81
Effects of burns: PULMONARY
early effects
* Upper airway obstruction
* Airway damage (laryngospasms)
* Chemical pneumonitis
* Pulmonary edema
82
Effects of burns: PULMONARY
late effects
* restriction of chest wall
* Oxygen toxicity
* barotrauma
* Infections
* Laryngeal damage
* Tracheal strictures
83
Effects of burns: Electrolytes/ renal
early efefcts
* Decreased renal blood flow (hypovolemia)
* Myoglobinuria
* Hyperkalemia
* Oliguria/anuria
84
Effects of burns: Electrolytes/ renal
late effects
* Increased renal blood flow
* varible drug clearance
* Hypokalemia (diuresis)
85
Effects of burns: Endocrine and GI effects
GI response
* Adynamic ileus
* Stress ulcers
* Impaired GI barrier to bacteria
* Endotoxemia
86
Effects of burns: Endocrine and GI effects
Endocrine response
* Increased serum NE
* Hyperglycemia
87
Effects of burns:Hemotology
early effects
* Activation of thrombotic and fibrinolytic factors
* hemoconcentration
* hemolysis
88
Effects of burns:Hemotology
late effects
* Anemia
* Thrombocytopenia
89
Effects of burns: Thermoregulation
Fxns of the skin such as what are diminished or obliterated
* Vasoactivity
* Sweating
* piloerection
* insulation
90
Effects of burns: Thermoregulation
hypermetabolic phase of burn injury results in what
* increased skin and core temp
91
Effects of burns: Thermoregulation
what does GA do to the hypermetabolic response
* Depresses vasoconstriction and metabolism
* results in rapid decrease in body temp
92
Effects of burns: Immunologic
what happens
* Loss of protective barrier
* immune system impaired
* Burn eschar- ideal medium for bacterial growth
* Macrophage activity in alveoli is impaired
93
Fluid resuscitation:
fluid resuscitation should be titrated to maintain a UOP if \_\_\_-\_\_ ml/kg/hr in adults and \_\_\_-\_\_\_ mL/kg/hr for peds
* 0.5-1 mL/kg/hr -adults
* 1.0-1.5 mL/kg/hr peds
94
Fluid resuscitation:
what is the parkland formula for the 1st 24hrs
* LR
* 4 mL/kg x % TBSA
95
Fluid resuscitation:
what is teh parkland formula for 2nd 24 hrs
* crystalloids
* 20-60% esamated plasma volume
* Colloids
* to OUP of 30 mL/hr
96
Fluid resuscitation:
Capillary leak is a its greatest when
* 1st 24hrs post burn
97
Fluid resuscitation:
why is use of colloids contraversial in 1st 24 hrs
* increased capillary permeability
* leads to proteins leak into the interstitial space
* leading to an oncotic effect in extracellular compartment and corsen edema and intravasular hypovolemia
98
Inhalation Injury:
patiens often exhibit no signs or symptoms for first ____ hours
## Footnote
24 hours
99
Inhalation Injury:
CO poisoning shifts oxyhemoglobing curve where?
left
100
Inhalation Injury:
CO poisoning does what to pulse ox readings
False high
101
Inhalation Injury:
what is the best tx for CO poisoning?
100% fio2
102
Inhalation Injury:
w/ CO poisoning the use of 100Fio2 decreases the half life of CO from 4-6 hours to what?
40-80 min
103
Inhalation Injury:
S/S of CO poisoning
* H/a
* Nausea
* Breathlessness
* Collapse
* Dizziness
* LOC
(just like a hangover)
104
Debredment and Dressing procedures:
sugical debredment is done by what 2 methods
1. Tangential excision
2. Fascial Excision
105
Debredment and Dressing procedures:
what is Tangential excision
* thin slices of eschar are shaved
106
Debredment and Dressing procedures:
what is Fascial Excision
* involves removing the burn eschar and underlying fat to the level of the muscle
107
Debredment and Dressing procedures:
massive blood loss of how much
10 PRBCs
108
Debredment and Dressing procedures:
how to estimate blood loss
2-3% of blood loss for each 1% of TBSA
109
Anesthestic management:
b/c the facemask may be uncomfortable what is a great way to intubate
AFOI
110
Anesthestic management:
all fluids should be what?
warm
111
Anesthestic management:
room temp should be what?
28 C
83 F
112
Anesthestic management:
what is a great drug for burn pts b/c it wil increase SVR and drcrease heat loss, increase HR and BP
Keta-fucking-mine
113
Anesthestic management:
what inhalation agaent may be best
N2O
b/c least depressant effect of CV
114
Anesthestic management:
do not use what NMBD
SCh
115
Anesthestic management:
many burn pt's may need a \_\_-\_\_\_ increase in NDMBD
2-5%
116
## Footnote
that is i guess
boo that sucked
