Thermal Injury

Question 1

what does myoglobinemia lead to?

Answer 1

renal failure

Question 2

first degree burns are limited to the ____

Answer 2

epidermis

Question 3

second degree burns are also called ___ , ____

Answer 3

deep, superficial partial thickness

Question 4

T/F Second degree burns may need grafting, but for third degree burns, grafting is required

Answer 4

TRUE

Question 5

Third degree burns extend to the ___ layer

Answer 5

subcutaneous

Question 6

Fourth degree burns affect the ___, ___, ___

Answer 6

muscle, fascia, bone

Question 7

A second degree burn affects >__% for adults, >___% for extremes of age

Answer 7

10, 20

Question 8

a third degree burn affects >__%

Answer 8

10

Question 9

how do you estimate mortality with a burn pt

Answer 9

Age + TBSA%

if >115, mortality is >80%

Question 10

inhalation injury ___ the chance of mortality

Answer 10

doubles

Question 11

rule of 9’s — legs are worth __%

Answer 11

18

Question 12

rule of 9’s — front chest to waist is worth

Answer 12

18

Question 13

rule of 9’s — back is worth

Answer 13

18%

Question 14

rule of 9’s — arms are worth

Answer 14

9% each

Question 15

rule of 9’s — baby head is worth

Answer 15

18

Question 16

rule of 9’s — baby leg is worth

Answer 16

14 each

Question 17

rule of 9’s - for a baby subtract __ from head for each year of age over 1

Answer 17

1%

Question 18

what is the most common type of burn in children?

Answer 18

thermal

Question 19

skin damage to tissues may continue over ___hrs

Answer 19

48-72

Question 20

what are the 3 zones of burn?

Answer 20

zone of coagulation, zone of hyperemia, zone of stasis

Question 21

T/F Succinylcholine is contraindicated after 24h of burn injury.

Answer 21

TRUE

Question 22

when is succs ok in a burn patient?

Answer 22

after the wound is closed and the pt is gaining weight again.

Question 23

T/F Burn patients may have a decreased requirement for NDNMB.

Answer 23

FALSE - may have increased requirement 2-3fold.

Question 24

CO affinity for hemoglobin is ___x that of oxygen.

Answer 24

200

Question 25

CO poising causes what acid base imbalance?

Answer 25

metabolic acidosis at cellular level.

Question 26

if patient has CO poisoning, what will these labs show?

SAO2
ABG
Co-oximetry

Answer 26

SAO2 normal
-------
ABG decreased total oxygen 
----------
co-ox true o2 sat

Question 27

T/F Treating CO Poisoning with 100% 02 decreases CO half life from 4h to 40min.

Answer 27

TRUE

Question 28

Massive fluid loss from burns is greatest when?

Answer 28

first 12 hours.

begins to stabilize after 24h

Question 29

what is the formula for fluid resuscitation in an adult

Answer 29

LR 2-4ml x kg x percent BSA burned.

[one half of the estimated volume of fluid should be administered in the first 8h after the burn. the remaining half should be given over the subsequent 16h of the first post-burn day.

Question 30

what is the formula for fluid resuscitation in a child

Answer 30

LR 3-4ml x kg x percent BSA burned.

Question 31

T/F infants and young children should receive fluid with 5% Dextrose at maintenance rate in addition to the resuscitation fluid.

Answer 31

TRUE

Question 32

what is the minimum urinary output for an adult

Answer 32

0.5ml/kg/hr

Question 33

what is the minimum urinary output for a child weighing <30kg

Answer 33

1ml/kg/hr

Question 34

what is the min urinary output in patients with high voltage electrical injuries

Answer 34

1-1.5ml/kg/hr

Question 35

The hypermetabolic/ hyperhemodynamic phase can persist for up to ____

Answer 35

2 years

Question 36

The hypermetabolic/ hyperhemodynamic phase usually starts after ____h

Answer 36

48-72

Question 37

how is the hypermetabolic/ hyperhemodynamic phase manifested?

Answer 37

hyperthermia, tachypnea, tachycardia, increased serum cats, increased O2 consumption, increased catabolism, increased BMR

Question 38

what is the hallmark of burn shock and how is it initially preserved?

Answer 38

decreased CO.

initially preserved by catecholamine release - inc HR and vasoconstriction

Question 39

The immediate intravascular fluid loss happens for about ___h

Answer 39

36

Question 40

ventilation can increase from 6L/min to ___L/min

Answer 40

40

Question 41

what is the leading cause of death in burn pt’s

Answer 41

sepsis

Question 42

how should you tx myogloinemia

Answer 42

sodium bicarb

Question 43

what is renal failure r/t?

Answer 43

hypovolemia, decreased CO, increased cat

Question 44

for ___% burn, ___% higher energy expenditure

Answer 44

40, 132

Question 45

stop tube feeds _h for non-intubated

Answer 45

4

Question 46

__ - __ EBL for each 1% debridement

Answer 46

200-400

Question 47

in the resuscitative phase, the patient experiences hypovolemic shock due to a severe depletion of ____ , and a marked increase in ____

Answer 47

plasma, extracellular volume

Question 48

after 48 hours, burn patients get _____

Answer 48

hypermetabolic

you see: increased CO, tachycardia, lower SVR

Question 49

how does decreased alumni affect pharmacokinetics?

Answer 49

altered VOD, protein binding. highly protein-bound drugs have a higher free fraction and thus a larger VOD

Question 50

what happens if you give succs to a burn patient after 24h?

Answer 50

lethal hyperkalemia