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Advanced anesthesia 2 > Thermal injury and obesity > Flashcards

Thermal injury and obesity Flashcards

1
Q

1st degree burn skin involvement

A
  • epidermis
  • appears red and slightly edematous
  • sunburn
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2
Q

2nd degree burn skin involvement

A
  • extends to the dermis
  • deep superficial partial thickness
  • appears wet, blisters, edematous
  • scars uncommon, heals 7-10 days
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3
Q

3rd degree burn skin involvement

A
  • extends the the sub q tissue
  • full thickness
  • needs skin grafting
  • waxy white leathery appearance
  • no pain due to nerve damage
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4
Q

4th degree burn skin involvement

A
  • muscle, facia, bone
  • electrical injuries
  • limb loss is common
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5
Q

mortality estimate for burns

A

age + TBSA%
> 115 = 80% mortality
doubled if inhalational injury

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6
Q

major burn classification

A

2nd or 3rd degree burn > 10 %
electrical burn
one complicated with inhalation

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7
Q

rule of nines for adult

A
  • head and each arm = 9% each
  • torso 18% front and 18 % back
  • each leg 18%
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8
Q

rule of nines for a child

A
  • head, front torso, back torso = 18% each
  • arms 9% each
  • legs 14% each
  • subtract 1% from head for each year over 1 and add .5% to each leg
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9
Q

thermal burns

A
  • most common type in children
  • 2nd leading cause of death in children 1-4 yrs
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10
Q

resuscitative phase interventions

A
  • early intubation
  • awake fiberoptic maybe
  • CXR
  • denervation like phenomenon
  • proliferation of acetylcholine receptors
  • k+ release
  • no succs after 24 hours
  • require high dose NDNMB (2-3 fold increase)
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11
Q

CO poisoning effects

A
  • 50-60% of fire victims die from CO poisoning
  • CO binds to Hbg (200 x greater affinity)
  • tissues are unable to extract O2, disrupts oxidative phosphorylation
  • metabolic acidosis at cellular level
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12
Q

CO poisoning labs

A
  • SaO2 normal
  • ABG decreased total O2
  • CO oximetry shows true total O2
  • treat with 100% O2, decreases CO half life from 4 hours to 40 min
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13
Q

burns and hypovolemic shock

A
  • fluid loss and shifts, greatest in the first 12 hours, stabilizes in 24
  • direct transudation of plasma from wound
  • plasma loss from diffuse capillary leakage
  • fluid shifts from intravascular to interstitium (edema)
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14
Q

adult fluid resuscitation formula

A

2-4 ml/ kg x % BSA burned of LR
first half should be given within 8 hours
second half given over the remaining 16 hours
second 24 hours D5W maintenance at 0.5 ml / % burn / kg

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15
Q

child fluid resuscitation formula

A
  • 3-4 ml / kg x % BSA burned
  • infants and children should receive 5% dextrose at a maintenance along with fluids
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16
Q

minimum UO for burns

A
  • adults 0.5 ml / kg
  • children < 30kg 1ml / kg / hour
  • high voltage electrical injuries 1-1.5 ml / kg/ hour
17
Q

hypermetabolic/ hyperhemodynamic phase manifestations

A
  • usually after 48 hours & can persist for 1-2 years
  • hyperthermia
  • tachypnea
  • tachycardia
  • increased catecholamines
  • increased O2 consumption
  • increased basal metabolic rate
18
Q

cardiovascular changes with burns

A
  • immediate intravascular fluid loss
  • hypotension
  • decreased CO within minutes (hallmark sign of burn shock)
  • after 48 hours pt gets hypermetabolic
19
Q

pulmonary changes with burns

A
  • function decreased even without inhalation injury
  • FRC, lung and chest wall compliance decreased
  • ventilation can increase from 6 to 40 l / min
  • pulmonary edema
20
Q

immune system and burns

A
  • altered immune response, strict asepsis
  • sepsis is the leading cause of death in burn pts
21
Q

myoglobinemia treatment

A
  • sodium bicarb
22
Q

GI/ nutrition for burns

A
  • increased caloric requirement
  • stop tube feeding 4 hours before surgery for non-intubated pts and do not stop for intubated pts
  • highly protein bound drugs have more free fraction = larger volume of distribution
23
Q

IDBW formula

A

Males = height in cm - 100
Females = height in cm - 105

24
Q

adipose tissue importance

A
  • considered an endocrine organ
  • secretes proteins
  • degrades into fatty acids
  • synthesis of triglycerides from carbs and proteins
  • synthesis of lipids from fatty acids
25
Q

android body shape

A
  • central or abdominal visceral
  • apple shaped
  • correlates with higher risk of comorbidities (heart disease, DM, HTN, dyslipidemia, death)
26
Q

gynecoid body shape

A
  • gluteal femoral or peripheral
  • pear shaped
  • varicose vein and joint disease
27
Q

obesity effects on CO

A
  • CO increased 0.1 L/min for each kg of fat
28
Q

cardiovascular effects due to obesity

A
  • increased CO
  • increased vessels and volume
  • increased volume + RAA activation = HTN
  • increased CO, O2 consumption, CO2 production, cardiomegaly, hypertrophy, CAD
29
Q

respiratory effects due to obesity

A
  • decreased compliance
  • restrictive flow volume loop
  • decreased FRC, ERV, VC, TLC
  • increased dead space
  • FRC < CC
30
Q

respiratory volumes that do not change

A
  • RV
  • CC
  • FVC
  • FEV1
31
Q

OSA diagnosis and definition

A
  • directly proportional to BMI
  • BMI > 35 OSA 75%
  • definition = episodes of apnea > 10 seconds, > 5 episodes / hour or 30 / night
32
Q

gold standard diagnostic test for OSA

A
  • polysomnography (PSG)
33
Q

Pickwickian syndrome

A
  • obese hypoventilation
  • sudden somnolence, cant function throughout the day d/t fatigue
  • develop right HF d/t HPV from constant hypoxia = pulmonary HTN (cor pulmonale)
34
Q

drugs and weight based dosing

A
  • SCh (b/c of increased fluid compartment and increased pseudocholinesterase) based on TBW
  • sugammadex TBW
  • Vec, Roc, cis based on IBW
35
Q

GA resp effects with obesity

A
  • decreases FRC by 50% compared to usual 20%
  • PEEP < 15 improves FRC and arterial O2 tension but may decrease CO and O2 delivery
36
Q

BMI formula

A

BMI = weight (kg) / height (m2)

37
Q

conversion of inches to cm

A

inches x 2.54

Advanced anesthesia 2 (10 decks)

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