Thermal Injury

Question 1

1st degree burns are limited to ___ (what skin layer?); heal ___; ___ (do/do not) require medical treatment

Answer 1

1st degree burns are limited to epidermis; heal spontaneously; do not require medical treatment

Question 2

2nd degree burns–extend to ___; may need ___; aka ___ thickness burns

Answer 2

2nd degree burns–extend to dermis; may need grafting; aka deep, superficial partial thickness burns

Question 3

3rd degree burns–extend to ___; ___ required; aka ___ thickness burns

Answer 3

3rd degree burns–extend to subcutaneous; skin grafting required; aka full thickness

Question 4

4th degree burns–extend to ___, ___, ___

Answer 4

muscle, fascia, bone

Question 5

Mortality estimate for burns = ___ + ___

Answer 5

Mortality estimate for burns = age + TBSA%

> 115 mortality is > 80%
Doubled if inhalation injury

Question 6

What are (4) etiologies of burns?

Answer 6

• Chemical
• Electrical
• Thermal
• Inhalation

Question 7

Initial treatment for chemical burns = ___

Answer 7

copious water or saline

Question 8

Electrical burns can lead to ___ and ___ failure

Answer 8

Electrical burns can lead to myoglobinuria and renal failure

Question 9

What is the most common type of burn in children?

Answer 9

Thermal burns–2nd leading cause of death for 1-4 year olds

Question 10

Inhalation burns–UPPER airway can be ___ or ___ burn; LOWER airway usually from ___ or ___ particles

Answer 10

UPPER airway can be thermal (air, steam, smoke) or chemical; LOWER airway usually from chemical or soot particles

Question 11

What is the first priority of anesthetic management in a burn patient?

Answer 11

Diagnose and treat airway injury

EARLY intubation if necessary–may be extremely difficult, consider awake/fiberoptic, surgical airway, succs?

Question 12

What is the denervation-like phenomenon that occurs during the resuscitative phase of burn patients?–proliferation of ___ receptors, ___ release

Answer 12

Proliferation of acetylcholine receptors, K+ release

Question 13

Do NOT give succs to a burn patient after ___ hours

Answer 13

Do NOT give succs to a burn patient after 24 hours

Question 14

When is it okay to give succs to a burn patient?

Answer 14

When the wound is closed and the patient is gaining weight

Question 15

If you are using a NDNMB in a burn patient, you have to give ___-___x the ED95 dose for proper intubating conditions

Answer 15

2-3x the ED95 dose

Question 16

CO has ___x affinity for hemoglobin than O2

Answer 16

CO has 200x affinity for hemoglobin than O2

Question 17

CO poisoning–tissues are unable to extract ___, leads to metabolic ___osis

Answer 17

CO poisoning–tissues are unable to extract O2, leads to metabolic acidosis

Question 18

Labs for CO poisoning–SaO2 is ___; ABG has ___ total oxygen

Answer 18

SaO2 is normal; ABG has decreased total oxygen

Question 19

What device is needed to show true oxygen saturation in a patient with CO poisoning?

Answer 19

Co-oximeter

Question 20

Treatment of CO poisoning = ___

Answer 20

100% O2–decreases CO half-life from 4 hours to 40 mins

Question 21

Fluid loss/shifts are greatest in the first ___ hours in burn patients; begin to stabilize after ___ hours

Answer 21

fluid loss/shifts are greatest in the first 12 hours in burn patients; begin to stabilize after 24 hours

Question 22

Fluid shifts from ___ to ___

Answer 22

Fluid shifts from intravascular to interstitial

Question 23

Result of fluid shifts in burn patients–severe depletion of ___; marked increase in ___ volume

Answer 23

severe depletion of plasma (hypovolemia); marked increase in extracellular volume (edema)

Question 24

Parkland formula for burn patients–in the first 24 hours, give ___ ml LR/% burn/kg; give 1/2 in the first ___ hours, give 1/2 in the next ___ hours; ___ (yes/no) colloid

Answer 24

In the first 24 hours, give 4 ml LR/% burn/kg; give 1/2 in the first 8 hours, give 1/2 in the next 16 hours; no colloid

Question 25

Parkland formula for burn patients–in the second 24 hours, ___ maintenance fluid

Answer 25

In the second 24 hours, D5W maintenance fluid

Question 26

The hypermetabolic/hyperdynamic phase usually occurs after ___ hours

Answer 26

after 48 hours

Increased CO, tachycardia, lower SVR

Question 27

CV changes in burn patients–immediate IV fluid loss can occur for up to ___ hours; after ___ hours, get hypermetabolic

Answer 27

Immediate IV fluid loss can occur for up to 36 hours (most in first 12 hours, usually stabilize after 24 hours); after 48 hours, get hyper metabolic

Question 28

What is the hallmark of burn shock?

Answer 28

Decreased cardiac output–occurs within minutes of burn

Question 29

Pulmonary function is decreased in burn patients, even without inhalation burns–T/F?

Answer 29

True

Question 30

What (3) pulmonary things are reduced in burn patients?

Answer 30

• FRC

- Lung and chest wall compliance

Question 31

Ventilation can increase from ___ L/min to ___ L/min in burn patients

Answer 31

Ventilation can increase from 6 L/min to 40 L/min in burn patients

Question 32

What is the leading cause of death in burn patients?

Answer 32

SEPSIS

Adults–75%
Peds–near 100%

Question 33

Burn patients have ___ (increased/decreased) caloric requirement

Answer 33

INCREASED caloric requirement

For 40% burn = 132% higher energy expenditure