Thermal Injury Flashcards
what does myoglobinemia lead to?
renal failure
first degree burns are limited to the ____
epidermis
second degree burns are also called ___ , ____
deep, superficial partial thickness
T/F Second degree burns may need grafting, but for third degree burns, grafting is required
TRUE
Third degree burns extend to the ___ layer
subcutaneous
Fourth degree burns affect the ___, ___, ___
muscle, fascia, bone
A second degree burn affects >__% for adults, >___% for extremes of age
10, 20
a third degree burn affects >__%
10
how do you estimate mortality with a burn pt
Age + TBSA%
if >115, mortality is >80%
inhalation injury ___ the chance of mortality
doubles
rule of 9’s — legs are worth __%
18
rule of 9’s — front chest to waist is worth
18
rule of 9’s — back is worth
18%
rule of 9’s — arms are worth
9% each
rule of 9’s — baby head is worth
18
rule of 9’s — baby leg is worth
14 each
rule of 9’s - for a baby subtract __ from head for each year of age over 1
1%
what is the most common type of burn in children?
thermal
skin damage to tissues may continue over ___hrs
48-72
what are the 3 zones of burn?
zone of coagulation, zone of hyperemia, zone of stasis
T/F Succinylcholine is contraindicated after 24h of burn injury.
TRUE
when is succs ok in a burn patient?
after the wound is closed and the pt is gaining weight again.
T/F Burn patients may have a decreased requirement for NDNMB.
FALSE - may have increased requirement 2-3fold.
CO affinity for hemoglobin is ___x that of oxygen.
200
CO poising causes what acid base imbalance?
metabolic acidosis at cellular level.
if patient has CO poisoning, what will these labs show?
SAO2
ABG
Co-oximetry
SAO2 normal ------- ABG decreased total oxygen ---------- co-ox true o2 sat
T/F Treating CO Poisoning with 100% 02 decreases CO half life from 4h to 40min.
TRUE
Massive fluid loss from burns is greatest when?
first 12 hours.
begins to stabilize after 24h
what is the formula for fluid resuscitation in an adult
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.
what is the formula for fluid resuscitation in a child
LR 3-4ml x kg x percent BSA burned.
T/F infants and young children should receive fluid with 5% Dextrose at maintenance rate in addition to the resuscitation fluid.
TRUE
what is the minimum urinary output for an adult
0.5ml/kg/hr
what is the minimum urinary output for a child weighing <30kg
1ml/kg/hr
what is the min urinary output in patients with high voltage electrical injuries
1-1.5ml/kg/hr
The hypermetabolic/ hyperhemodynamic phase can persist for up to ____
2 years
The hypermetabolic/ hyperhemodynamic phase usually starts after ____h
48-72
how is the hypermetabolic/ hyperhemodynamic phase manifested?
hyperthermia, tachypnea, tachycardia, increased serum cats, increased O2 consumption, increased catabolism, increased BMR
what is the hallmark of burn shock and how is it initially preserved?
decreased CO.
initially preserved by catecholamine release - inc HR and vasoconstriction
The immediate intravascular fluid loss happens for about ___h
36
ventilation can increase from 6L/min to ___L/min
40
what is the leading cause of death in burn pt’s
sepsis
how should you tx myogloinemia
sodium bicarb
what is renal failure r/t?
hypovolemia, decreased CO, increased cat
for ___% burn, ___% higher energy expenditure
40, 132
stop tube feeds _h for non-intubated
4
__ - __ EBL for each 1% debridement
200-400
in the resuscitative phase, the patient experiences hypovolemic shock due to a severe depletion of ____ , and a marked increase in ____
plasma, extracellular volume
after 48 hours, burn patients get _____
hypermetabolic
you see: increased CO, tachycardia, lower SVR
how does decreased alumni affect pharmacokinetics?
altered VOD, protein binding. highly protein-bound drugs have a higher free fraction and thus a larger VOD
what happens if you give succs to a burn patient after 24h?
lethal hyperkalemia
