Thermal Injuries

Question 1

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

Answer 1

2nd degree burn

Question 2

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

Answer 2

3rd degree burn

Question 3

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

Answer 3

4th degree burn

Question 4

TBSA can be calculated using what two methods

Answer 4

rule of nines, Lund and Bower chart

Question 5

Mortality estimate

Answer 5

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

Question 6

Electrocution is always a ______ burn

Answer 6

major

Question 7

Major burn classification

Answer 7

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

Question 8

Review rule of nines chart on slide

Answer 8

7

Question 9

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

Answer 9

water or saline

Question 10

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

Answer 10

myoglobinuria and renal

Question 11

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

Answer 11

thermal

Question 12

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

Answer 12

diagnose and treat the airway injury

Question 13

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

Answer 13

K+ / 24 hrs / 1 year

Question 14

May have _______ requirement of NDNMB

Answer 14

increased

Question 15

50-60% of fire victims die from ___ poisioning

Answer 15

CO

Question 16

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

Answer 16

200

Question 17

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

Answer 17

acidosis

Question 18

If someone has CO poisoning what will Sa02 result be?

Answer 18

normal

Question 19

If someone has CO poisoning what will ABG result be?

Answer 19

decreased total oxygen

Question 20

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

Answer 20

Co-Oximetry

Question 21

What is the treatment for CO poisoning?

Answer 21

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

Question 22

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

Answer 22

12 hrs / 24 hrs

Question 23

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

Answer 23

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

Question 24

What is the result of hypovolemic shock related to burns

Answer 24

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

Question 25

4ml x % burn x wt in kg

Answer 25

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

Question 26

2ml x %burn x wt in kg

Answer 26

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

Question 27

Minimum UOP for adult burn patients

Answer 27

0.5 ml/kg/hr

Question 28

Minimum UOP for children weighing less than 30 kg

Answer 28

1 ml/kg/hr

Question 29

Minimum UOP for patients with high voltage injuries

Answer 29

1-1.5 ml/kg/hr

Question 30

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

Answer 30

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

Question 31

Hallmark of burn shock and occurs within minutes

Answer 31

decreased cardiac output

Question 32

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

Answer 32

36 / catecholamine / burn / hypermetabolic

Question 33

Hypermetabolic state characterized by what?

Answer 33

increased CO, decreased SVR, tachycardia

Question 34

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

Answer 34

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

Question 35

What is a prime area for bacterial growth?

Answer 35

eschar

Question 36

What is the leading cause of death in burn patients

Answer 36

sepsis

Question 37

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

Answer 37

silver

Question 38

What would you consider treating myoglobinemia with

Answer 38

sodium bicarb

Question 39

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

Answer 39

4 hours

Question 40

When would you stop feedings for an intubated patient

Answer 40

never

Question 41

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

Answer 41

TRUE

Question 42

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

Answer 42

200-400

Question 43

Anesthetic agents have a profound __________ effects secondary to ________

Answer 43

depressant / hypovolemia

Question 44

What is best method for pain meds

Answer 44

IV

Question 45

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

Answer 45

NO, can inhibit platelet aggregation

Question 46

Which site is more painful, donor or grafting?

Answer 46

donor