The Burn Injured Patient

Question 1

what is the Parkland formula?

Answer 1

4 mL per %TBSA burn per kilogram over the first 24 hours

Question 2

when should succinylcholine not be given to burn patients?

Answer 2

after 24 hours post-injury

Question 3

what is the CO, SVR and PVR in the early burn period?

Answer 3

reduced CO

increased SVR and PVR

Question 4

what happens to CO 3 to 5 days after major burn injury?

Answer 4

a supranormal CO is seen, due to the onset of a hypermetabolic state

Question 5

what is myoglobinurea?

Answer 5

myoglobin is released from muscle destruction, and is passed through the nephron which damages the kidneys

Question 6

why is it recommended to secure an airway right away in a burn patient?

Answer 6

it is safer to intubate the patient early rather than risk a difficult intubation after airway edema has occurred.

Question 7

what are 3 physical signs of an inhalational burn injury?

Answer 7

singed nasal hair, soot around mouth or nose, loss of consciousness

Question 8

why is direct heat injury to the airway usually restricted to the area above the carina?

Answer 8

due to efficient dissipation of heat by the upper airway, and reflex closure of the glottis

Question 9

what is the affinity of CO to hemoglobin vs O2?

Answer 9

CO is 200x more readily binding to hemoglobin than O2

Question 10

does CO poisoning shift the oxyhemoglobin dissociation curve to the right or left?

Answer 10

to the left, increasing the Hgb affinity for O2 and decreasing O2 delivery to tissues

Question 11

what is the half-life of carboxyhemoglobin in a patient breathing room air, and a patient breathing 100% O2?

Answer 11

4 hours breathing RA

1 hour breathing 100% O2

Question 12

how are SaO2 and PaO2 affected by carboxyhemoglobin?

Answer 12

neither are effected, the oximeter reads it the same as O2 and the PaO2 measures the amount of O2 dissolved in the blood, not the amount bound to Hb

Question 13

how is CO poisoning diagnosed?

Answer 13

by measuring the carboxyhemoglobin level in arterial blood

Question 14

what does cyanide toxicity do to the cells?

Answer 14

cyanide binds to mitochondrial cytochrome oxidase, preventing the use of oxygen by mitochondria

Question 15

what levels of cyanide toxicity are dangerous, and deadly?

Answer 15

20 ppm is dangerous

100 ppm leads to seizures, coma and death

Question 16

for patients with < 15% TBSA burned, how is fluid management handled?

Answer 16

they are not associated with extensive capillary leak, and can be managed with IV fluid administered at 1.5 times maintenance rate

Question 17

when are crystalloids and colloids given in a burn patient?

Answer 17

LR is given until capillary integrity returns, normally in 24-48 hours, then colloid is given

Question 18

what is the difference between first, second and third degree burns?

Answer 18

first degree is a sunburn

second degree has blistering

third degree burns through he skin and nerve fibers

Question 19

what are the three greatest predictors of death after burns?

Answer 19

age > 60
TBSA > 40% burned
inhalation injury

Question 20

what type of injury is most associated with cardiac arrhythmias?

Answer 20

electrical injury

Question 21

what is the goal for urine output in a patient with myoglobinurea?

Answer 21

2 mL/kg/hr

Question 22

what are toxic epidermal necrolysis syndrome (TENS) and Sevens-Johnson syndrome (SJS)?

Answer 22

severe exfoliative diseases of the skin caused by immunologic reactions

Question 23

what is the procedure to remove burned tissue?

Answer 23

escharotomy

Question 24

why is it hard to maintain normothermia in burn patients?

Answer 24

considerable evaporative heat loss can occur through the burn wounds

Question 25

do you use cuffed, or uncuffed ETTs in pediatric burn patients?

Answer 25

cuffed

Question 26

what are the ventilator settings for a patient with acute lung injury?

Answer 26

6 ml/kg

PAP below 30 cm H2O

Question 27

why do burn patients become hyperkalemic?

Answer 27

they have an increase in the number of extrajunctional acetylcholine receptors

Question 28

what are 3 reasons that ketamine is the drug of choice for burn patients?

Answer 28

maintains hemodynamic stability

maintains hypoxic response

decreases airway resistance

Question 29

why are burn patients hypermetabolic?

Answer 29

they become hypermetabolic through muscle catabolism

it is worsened by the body’s effort to generate heat to offset the inevitable temperature loss

Question 30

what should be done for glucose control in burn patients?

Answer 30

hyperglycemia is a common response after a burn, the perioperative goal is to keep it < 150 mg/dl

Question 31

what is expected blood loss for an escharectomy?

Answer 31

it is deceptively large

3.5-5% of blood volume for every 1% TBSA excised

Question 32

what are the consequences of hypothermia in burn patients?

Answer 32

decreased CO and arrhythmias

Question 33

what is the leading cause of morbidity and mortality in the burn patient?

Answer 33

infection

Question 34

what level of CO poisoning causes dizziness and headache?

Answer 34

< 15%

Question 35

what level of CO poisoning causes N/V?

Answer 35

20-40%

Question 36

what level of CO poisoning causes hallucinations and agitation?

Answer 36

40-60%

Question 37

what level of CO poisoning causes death?

Answer 37

> 60%

Question 38

what is your heart rate goal for burn patients?

Answer 38

110-120 bpm