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Advanced Anesthesia 2 > Thermal Injuries > Flashcards

Thermal Injuries Flashcards

1
Q

This burn extends to the dermis and could be deep or superficial partial thickness and may need grafting

A

2nd degree burn

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2
Q

This burn extends to the subcutaneous tissue and is considered full thickness involvement and skin grafting is required

A

3rd degree burn

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3
Q

This burn involves muscle, fascia and bone and requires extensive medical treatment

A

4th degree burn

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4
Q

TBSA can be calculated using what two methods

A

rule of nines, Lund and Bower chart

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5
Q

Mortality estimate

A

Age + TBSA% = (>115 mortaility is >80%) + double if inhalation injury involved

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6
Q

Electrocution is always a ______ burn

A

major

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7
Q

Major burn classification

A

2nd degree burn >10% for adults, >20% extremes of age. 3rd degree burn > 10%, electrical burn, one complicated with inhalation injury

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8
Q

Review rule of nines chart on slide

A

7

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9
Q

With chemical burns the burn continues until neutralized or removed. Initial treatment should be with copius ____ or _____

A

water or saline

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10
Q

Electrical burns may be much worse than appearance and also cause _____ and _____ failure

A

myoglobinuria and renal

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11
Q

Most common type of burn injury in children and is leading cause of death for age 1-4 yrs

A

thermal

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12
Q

1st step in resuscitative phase of burn injury is to what?

A

diagnose and treat the airway injury

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13
Q

Succinylcholine and burns can cause a denervation like phenomenom which will cause a proliferation of acetylcholine receptors and increase ____ release. So, No succs after ____ hrs and usually okay after ____ year

A

K+ / 24 hrs / 1 year

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14
Q

May have _______ requirement of NDNMB

A

increased

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15
Q

50-60% of fire victims die from ___ poisioning

A

CO

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16
Q

CO binds to hemoglobin with an affinity _____ times that of 02

A

200

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17
Q

When CO is bound, tissues are unable to extract 02 which disrupts oxidative phosphorylation and causes metabolic ______ at the cellular level

A

acidosis

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18
Q

If someone has CO poisoning what will Sa02 result be?

A

normal

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19
Q

If someone has CO poisoning what will ABG result be?

A

decreased total oxygen

20
Q

If someone has CP poisoning what is the method to test true oxygen saturation?

A

Co-Oximetry

21
Q

What is the treatment for CO poisoning?

A

100% oxygen which decreases the half life of CO from 4 hrs to 40 min

22
Q

With massive fluid loss and shifts related to burns the greatest is in the first _____ hrs and begin to stabilize after ____ hrs

A

12 hrs / 24 hrs

23
Q

What is the MOA for hypovolemic shock related to burns (3)

A

direct transudation of plasma from wound, plasma loss from diffuse capillary leakage, fluid shift from intravascular to interstitium

24
Q

What is the result of hypovolemic shock related to burns

A

severe depletion of plasma (hypovolemia) and marked increase in EXTRACELLULAR volume (edema)

25
Q

4ml x % burn x wt in kg

A

parkland formula (admin 1/2 in first 8 hrs and other 1/2 over next 16 hr)

26
Q

2ml x %burn x wt in kg

A

brooke formula (admin 1/2 in first 8hrs and other 1/2 over next 16 hr)

27
Q

Minimum UOP for adult burn patients

A

0.5 ml/kg/hr

28
Q

Minimum UOP for children weighing less than 30 kg

A

1 ml/kg/hr

29
Q

Minimum UOP for patients with high voltage injuries

A

1-1.5 ml/kg/hr

30
Q

Describe the hypermetabolic / hyperhemodynamic phase that usually happens 48 hrs after injury

A

Hyperthermia, tachypnea, tachycardia, increased serum catecholamines, increased 02 consumption, increased catabolism, increased basal metabolic rate

31
Q

Hallmark of burn shock and occurs within minutes

A

decreased cardiac output

32
Q

With the cardiovascular system following burn: Immediated intravascular fluid loss up to ____ hrs. Hypovolemia with hypotension and circulatory compromise. Decreases in cardiac output are initiallly preserved by __________ release that causes increaed HR and vascoconstriction. Loss overcomes this and there is a downward spiral. Also myocardial depressants thought to be released from ______ tissue. After 48 hrs, they get ___________ manifesting as increased CO, tachycardia, low SVR

A

36 / catecholamine / burn / hypermetabolic

33
Q

Hypermetabolic state characterized by what?

A

increased CO, decreased SVR, tachycardia

34
Q

What are the net effects of a burn on the pulmonary system?

A

function is decreased even without inhalation. FRC, lung and chest wall compliance decreased. Ventilation can increase from 6L/min to 40L/min. Pulmonary edema and require long-term ventilation

35
Q

What is a prime area for bacterial growth?

A

eschar

36
Q

What is the leading cause of death in burn patients

A

sepsis

37
Q

What element is added to skin protective barriers to provide bacteriostatic protection

A

silver

38
Q

What would you consider treating myoglobinemia with

A

sodium bicarb

39
Q

When would you stop feedings for a non-intubated patient for surgery?

A

4 hours

40
Q

When would you stop feedings for an intubated patient

A

never

41
Q

T/F An ileus is common if burn is 20% or greater

A

TRUE

42
Q

____ to ____ ml blood loss for each 1% of debridement is possible

A

200-400

43
Q

Anesthetic agents have a profound __________ effects secondary to ________

A

depressant / hypovolemia

44
Q

What is best method for pain meds

A

IV

45
Q

Would you want to use NSAIDS for pain on a burn patient?

A

NO, can inhibit platelet aggregation

46
Q

Which site is more painful, donor or grafting?

A

donor

Advanced Anesthesia 2 (4 decks)

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