Thermal injury and obesity Flashcards
1
Q
1st degree burn skin involvement
A
- epidermis
- appears red and slightly edematous
- sunburn
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
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
4
Q
4th degree burn skin involvement
A
- muscle, facia, bone
- electrical injuries
- limb loss is common
5
Q
mortality estimate for burns
A
age + TBSA%
> 115 = 80% mortality
doubled if inhalational injury
6
Q
major burn classification
A
2nd or 3rd degree burn > 10 %
electrical burn
one complicated with inhalation
7
Q
rule of nines for adult
A
- head and each arm = 9% each
- torso 18% front and 18 % back
- each leg 18%
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
9
Q
thermal burns
A
- most common type in children
- 2nd leading cause of death in children 1-4 yrs
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)
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
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
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)
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
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
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
android body shape
- central or abdominal visceral
- apple shaped
- correlates with higher risk of comorbidities (heart disease, DM, HTN, dyslipidemia, death)
26
gynecoid body shape
- gluteal femoral or peripheral
- pear shaped
- varicose vein and joint disease
27
obesity effects on CO
- CO increased 0.1 L/min for each kg of fat
28
cardiovascular effects due to obesity
- increased CO
- increased vessels and volume
- increased volume + RAA activation = HTN
- increased CO, O2 consumption, CO2 production, cardiomegaly, hypertrophy, CAD
29
respiratory effects due to obesity
- decreased compliance
- restrictive flow volume loop
- decreased FRC, ERV, VC, TLC
- increased dead space
- FRC < CC
30
respiratory volumes that do not change
- RV
- CC
- FVC
- FEV1
31
OSA diagnosis and definition
- directly proportional to BMI
- BMI > 35 OSA 75%
- definition = episodes of apnea > 10 seconds, > 5 episodes / hour or 30 / night
32
gold standard diagnostic test for OSA
- polysomnography (PSG)
33
Pickwickian syndrome
- 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
drugs and weight based dosing
- SCh (b/c of increased fluid compartment and increased pseudocholinesterase) based on TBW
- sugammadex TBW
- Vec, Roc, cis based on IBW
35
GA resp effects with obesity
- decreases FRC by 50% compared to usual 20%
- PEEP < 15 improves FRC and arterial O2 tension but may decrease CO and O2 delivery
36
BMI formula
BMI = weight (kg) / height (m2)
37
conversion of inches to cm
inches x 2.54
