Thermal Injury Flashcards
1st degree burns are limited to ___ (what skin layer?); heal ___; ___ (do/do not) require medical treatment
1st degree burns are limited to epidermis; heal spontaneously; do not require medical treatment
2nd degree burns–extend to ___; may need ___; aka ___ thickness burns
2nd degree burns–extend to dermis; may need grafting; aka deep, superficial partial thickness burns
3rd degree burns–extend to ___; ___ required; aka ___ thickness burns
3rd degree burns–extend to subcutaneous; skin grafting required; aka full thickness
4th degree burns–extend to ___, ___, ___
muscle, fascia, bone
Mortality estimate for burns = ___ + ___
Mortality estimate for burns = age + TBSA%
> 115 mortality is > 80%
Doubled if inhalation injury
What are (4) etiologies of burns?
- Chemical
- Electrical
- Thermal
- Inhalation
Initial treatment for chemical burns = ___
copious water or saline
Electrical burns can lead to ___ and ___ failure
Electrical burns can lead to myoglobinuria and renal failure
What is the most common type of burn in children?
Thermal burns–2nd leading cause of death for 1-4 year olds
Inhalation burns–UPPER airway can be ___ or ___ burn; LOWER airway usually from ___ or ___ particles
UPPER airway can be thermal (air, steam, smoke) or chemical; LOWER airway usually from chemical or soot particles
What is the first priority of anesthetic management in a burn patient?
Diagnose and treat airway injury
EARLY intubation if necessary–may be extremely difficult, consider awake/fiberoptic, surgical airway, succs?
What is the denervation-like phenomenon that occurs during the resuscitative phase of burn patients?–proliferation of ___ receptors, ___ release
Proliferation of acetylcholine receptors, K+ release
Do NOT give succs to a burn patient after ___ hours
Do NOT give succs to a burn patient after 24 hours
When is it okay to give succs to a burn patient?
When the wound is closed and the patient is gaining weight
If you are using a NDNMB in a burn patient, you have to give ___-___x the ED95 dose for proper intubating conditions
2-3x the ED95 dose
CO has ___x affinity for hemoglobin than O2
CO has 200x affinity for hemoglobin than O2
CO poisoning–tissues are unable to extract ___, leads to metabolic ___osis
CO poisoning–tissues are unable to extract O2, leads to metabolic acidosis
Labs for CO poisoning–SaO2 is ___; ABG has ___ total oxygen
SaO2 is normal; ABG has decreased total oxygen
What device is needed to show true oxygen saturation in a patient with CO poisoning?
Co-oximeter
Treatment of CO poisoning = ___
100% O2–decreases CO half-life from 4 hours to 40 mins
Fluid loss/shifts are greatest in the first ___ hours in burn patients; begin to stabilize after ___ hours
fluid loss/shifts are greatest in the first 12 hours in burn patients; begin to stabilize after 24 hours
Fluid shifts from ___ to ___
Fluid shifts from intravascular to interstitial
Result of fluid shifts in burn patients–severe depletion of ___; marked increase in ___ volume
severe depletion of plasma (hypovolemia); marked increase in extracellular volume (edema)
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
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
Parkland formula for burn patients–in the second 24 hours, ___ maintenance fluid
In the second 24 hours, D5W maintenance fluid
The hypermetabolic/hyperdynamic phase usually occurs after ___ hours
after 48 hours
Increased CO, tachycardia, lower SVR
CV changes in burn patients–immediate IV fluid loss can occur for up to ___ hours; after ___ hours, get hypermetabolic
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
What is the hallmark of burn shock?
Decreased cardiac output–occurs within minutes of burn
Pulmonary function is decreased in burn patients, even without inhalation burns–T/F?
True
What (3) pulmonary things are reduced in burn patients?
- FRC
- Lung and chest wall compliance
Ventilation can increase from ___ L/min to ___ L/min in burn patients
Ventilation can increase from 6 L/min to 40 L/min in burn patients
What is the leading cause of death in burn patients?
SEPSIS
Adults–75%
Peds–near 100%
Burn patients have ___ (increased/decreased) caloric requirement
INCREASED caloric requirement
For 40% burn = 132% higher energy expenditure
