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6903 > Trauma Burn > Flashcards

Trauma Burn Flashcards

1
Q

Preferred method of management for burn pts now?

A

early excision and grafting

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2
Q

AT 12-15% of O2 in the air, what toxicity symptoms does one exhibit?

A

muscular coordination for skilled movements lost

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3
Q

At 10-14% of O2 in the air, what toxicity symptoms does one exhibit?

A

judgement is faulty and and muscular effort leads to rapid fatigue

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4
Q

At 6-8 % O2 in the air, what symptoms are seen?

A

collapse, rapid treatment would prevent fatal outcome

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5
Q

Death occurs in 6-8 at what percent of oxygen?

A

6 or below

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6
Q

4 etiologies of burns?

A

chemical, thermal, electrical, inhalation

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7
Q

This degree burn involves the top layer of the epidermis only?

A

1st degree

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8
Q

Characteristics of 2nd degree burn?

A

blisters, epidermis and dermis- may involve all of dermis

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9
Q

Characteristics of 3rd degree burn?

A

deeper tissues past nerve endings, SQ

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10
Q

Can you have blisters with 1st degree burn?

A

yes

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11
Q

Characteristics of 1st degree burn?

A

red, painful, blisters, epidermis destroyed, superficial, heals spontaneously-no scarring

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12
Q

What type of burn is a 2nd degree burn?

A

partial thickness

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13
Q

What are the 2 types of 2nd degree burns?

A

superficial dermal and deep dermal

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14
Q

Characteristics of a superficial dermal burn?

A

epidermis and upper part of dermis. heals spontaneously. red or pale ivory, moist shiny surface, painful, immediate blistering, minimal scarring

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15
Q

Characteristics of deep dermal burn?

A

deep dermis, often involves incision and grafting for repair, mottled w white waxy dry surface, may or may not have blisters, significant scarring

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16
Q

Characteristics of third degree burn?

A

full thickness- epidermis and dermis, white, cherry red, or black, dry, tissue paper skin, needs grafting, decreased scarring w early excision

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17
Q

Characteristics of 4th degree burn?

A

muscle, fascia, bone, complete excision required, limited function

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18
Q

Characteristics of electrical burns?

A

total BSA % difficult to estimate, tissue damage is often more than it looks, renal problems electrical current may cause neuro probs, cardiac damage- arrythmias that persist for months

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19
Q

3 renal complications seen w electrical burns?

A

myoglobinuria, hemoglobinuria, renal failure

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20
Q

3 ways to manage the renal complications seen with electrical burns?

A

UO 1-1.5mL/kg/hr, mannitol and lasix, bicarb to alkalinize urine

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21
Q

Think of an electrical injury as what type of injury?

A

crush

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22
Q

Ferning is associated with what type of burn injury?

A

lightning strike

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23
Q

Why is eschar bad?

A

it is great for infection, it is hard and traps pressure, won’t ever heal

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24
Q

How can a 2nd degree burn turn in to a 3rd degree burn?

A

infection and cellulitis

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25
Q

What is considered a major burn in a normal adult?

A

2nd degree >10% TBSA

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26
Q

What is considered a major burn in age extremes?

A

2nd degree >20% TBSA

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27
Q

2 other types of burns that are major burns?

A

any electrical burn, burns complicated by smoke inhalation

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28
Q

The mortality is >80% w what formula?

A

age + TBSA% >115

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29
Q

Morality is doubled in a burn if what other type of injury also occurs?

A

inhalation injury

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30
Q

In rule of 9s, which body surfaces are 9% front and back?

A

upper and lower torso, and both legs (4)

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31
Q

3 most common causes of demise in burn pts?

A

septic complications, burn shock, MI >45 years

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32
Q

What is the normal water loss per m2/hr in a healthy human?

A

15-21 mL/m2/h

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33
Q

What is the water loss in m2/hr in a burn patient?

A

200 mL/m2/h

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34
Q

What is the latent heat of evaporation of water?

A

585 cal/H20

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35
Q

2 reasons why excessive evaporation is bad?

A

causes tremendous loss of heat, contributes to increased metabolic demands

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36
Q

How long does revascularization take in full thickness and partial thickness burns?

A

full thickness: 3-4 weeks, partial thickness: 24-48 hours

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37
Q

Capillary permeability is altered how in a burn patient?

A

biphasic pattern

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38
Q

why is there a reduction in circulating volume in burn patients?

A

severe translocation of fluid from intravascular space to the interstitial compartment

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39
Q

The major portion of increased capillary permeability occurs when with a burn pt?

A

first 12 hours and persists 2-3 weeks

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40
Q

Whats the cause of increased cap permeability in burn pts?

A

heat damage releases vasoactive chemicals

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41
Q

When a burn exceeds what % of TBSA does 2x the loss of albumin occur not only in the area of the injury but the whole body?

A

30

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42
Q

What 2 things does losing albumin to the extravascular space do?

A

severe hemoconcentration and red cell destruction

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43
Q

When does hemolysis occur in burn pts?

A

first 24 hours

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44
Q

Generally hemolysis does not exceed >8% of pre burn red cell mass unless…..?

A

exposure to prolonged heat such as in scalding

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45
Q

Burn patients have a remarkably reduced red cell survival time? What % of normal is it?

A

30

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46
Q

Protein leaking in to the extravascular space can persist up to how many hours?

A

36

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47
Q

Initial microbial invasion in burn pts is usually what type?

A

gram positive like staph

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48
Q

Day 5 of burn, what microbial infections persist?

A

gram negative like pseudomonas

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49
Q

What happens to CO in burn pt?

A

decrease. really decreased in severe burns, CO can drop 50%. myocardial depression due to increased proteins

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50
Q

When does burn shock occur?

A

24-36 hours after burn

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51
Q

When does CO drop after a burn?

A

immediately after

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52
Q

In large burns, CO drops 50% in the first 30 minutes and that is thought to be due to what 3 things?

A

release of myocardial depressant factor, increased blood viscosity, and release of vasoactive substances

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53
Q

CO slowly returns to baseline around how many hours after the burn and why?

A

36 hours, hypermetabolic state

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54
Q

What happens to PVR after a burn?

A

it increases in the first 3 hours then starts to decrease until 12 hours when it goes up again until 30 hours and then decreases

55
Q

The three distinct syndromes of pulmonary injury in burn pts?

A

early complications, delayed injury, late complications

56
Q

When do early pulmonary complications occur? What is an example?

A

0-24 hours post burn; carbon monoxide poisoning, direct inhalation injury can lead to airway obstruction and pulmonary edema

57
Q

Delayed pulmonary injury occurs when? What is an example?

A

2-5 days after burn; ARDS

58
Q

Late pulmonary injury occurs when and what are some examples?

A

days to weeks after injury, pneumonia, atelectasis, PE

59
Q

What are some of the pulmonary complications from burn injury?

A

decreased FRC, decreased lung and chest wall compliance, increased alveolar-arterial gradient resulting in decreased capillary function, increased MV d/t increased O2 requirements and VQ abnormalities

60
Q

What’s the patho leading to pulmonary edema

A

decreased CO + impaired vascular permeability + large IVF

61
Q

This type of injury occurs when hot gasses, smoke particles, toxic substances reach the tracheobronchial tree

A

inhalation injury

62
Q

4 complications from inhalation injury?

A

wheezing, bronchospasm, corrosion, airway edema

63
Q

9 indications of inhalational injury?

A

closed space injury, facial burn, singed nose hairs, perioral burn, pharyngeal edema, hoarseness, carbonaceous sputum, bronchorrhea, wheezing

64
Q

This burn injury is often associated w a person under the influence of drugs or alcohol?

A

inhalation

65
Q

Signs of respiratory tract injury?

A

singed nasal hairs, burned nasal mucosa, lips or mouth, hoarseness, wheezing, soot in oro/nasopharynx, brassy cough with soot in sputum

66
Q

4 ways to diagnose inhalational injury?

A

fiberoptic, ABGs, carboxyhg concen, xenon scan

67
Q

Toxic components in smoke inhalation can cause what 4 things?

A

bronchospasm, impaired mucociliary ftn, ulceration of mucous mem, edema

68
Q

In inhalational injury, damage to the lungs is almost always what in nature?

A

chemical (chemical pneumonitis)

69
Q

Why does steam not affect the lungs?

A

rarely does enough steam get inhaled bc the specific heat of air is so low that it rarely reaches the carina w increased temps

70
Q

What happens to surfactant production w inhalational injury?

A

it’s impaired

71
Q

Why is O2 and CO2 exchange impaired w inhalational injury?

A

increased cap permeability damages alveoli and ciliary ftn is halted so secretions and bacteria accumulate

72
Q

What is important to know about smoke inhalational injury?

A

the smoke inhalation signs often lag behind other events and the patients may rapidly deteriorate. prophylactically intubate!

73
Q

How do you treat inhalational injury?

A

supportive, PEEP, O2 therapy and mech vent. typically gets worse for 1st 3 days after injury then improvement starts

74
Q

Carbon monoxide has affinity for hg how many times that of O2?

A

200

75
Q

What does ABG show in CO poisoning?

A

normal PaO2 but low O2 content, low SaO2

76
Q

Why does CO poisoning not result in tachypnea?

A

carotid bodies are sensitive to arterial PaO2 and not arterial oxygen content so pts may be hypoxic but not tachypneic

77
Q

20% carboxyhg level corresponds w what sx?

A

HA, mild dyspnea, visual changes, confusion

78
Q

20-40% carboxyhg levels correspond w what sx?

A

irritability, decreased judgement, dim vision, N, easy fatigueabilitiy

79
Q

40-60% carboxyhg levels correspond w what sx?

A

hallucinations, confusion, ataxia, collapse, coma

80
Q

What % of carboxyhg levels is fatal?

A

60

81
Q

Treatment for carboxyhg poisoning?

A

100% O2 NRB, intubate w decreased LOC, hyperbaric O2 treatment w high CO levels or symptomology

82
Q

What’s the half life of carboxyhg?

A

3-4 hours

83
Q

T/F: Fetal hg has higher affinity for carboxyhg than adults?

A

true

84
Q

When does the hypermetabolic phase occur in a burn pt?

A

first few hours of a burn into the convalescent phase

85
Q

6 characteristics of hypermetabolism?

A

catabolism and nitrogen wasting, hyperglycemia, hyperthermia, tachycardia, tachypnea, increased oxygen consumption, contributes to poor wound healing and immunosuppression

86
Q

Good results w what treatment for hypermetabolism?

A

human growth hormone

87
Q

What does a burn pt need during hypermetabolism phase?

A

increased oxygen, ventilation, nutrition

88
Q

What happens to RBF and GFR in the hypermetabolic state?

A

they diminish immediately and activate the RAAS

89
Q

ADH release causes retention of what and excretion of what?

A

retention of Na and H20; excretion of K, Ca, Mg

90
Q

Hemoglobinuria is secondary to what?

A

hemolysis

91
Q

Myoglobinuria is secondary to what?

A

muscle necrosis

92
Q

What can hemoglobinuria and myoglobinuria lead to?

A

ATN and ARF

93
Q

Oliguria is usually a sign of?

A

inadequate fluid replacement

94
Q

Initially you want to maintain a UO of?

A

0.5 mL/kg/hr

95
Q

In children

A

1mL/kg/hr

96
Q

What do you have to worry ab w electrical burns in r/t renal failure?

A

myoglobinemia d/t extensive areas of devitalized muscle

97
Q

How do you treat myoglobinuria and renal failure?

A

fluids and diuretics/mannitol

98
Q

How can you reduce pigment associated renal failure?

A

give bicarb

99
Q

5 ftns of burns on immune system?

A

decreased neutrophil chemotaxis and phagocytosis, impaired macrophage activity, increased T suppressor cells, poor leukocyte ftn, low immunoglobulin levels

100
Q

Treatment for burn GI complications?

A

H2 blocker, antacids, NGT

101
Q

GI complications d/t burn?

A

ileus, under perfusion of splanchic circulation and bacterial translocation from the gut to the systemic circulating leading to sepsis, gastric and duodenal mucosal injury (Curling’s ulcer)

102
Q

Why is there a potential for abnormal liver ftn after burn?

A

shock

103
Q

Why is there HTN after a burn?

A

increased catecholamines

104
Q

Neurologic abnormalities are seen especially w what type of burn?

A

electric

105
Q

Erythrocytes are damaged or destroyed by heat and removed by the spleen when after burn?

A

w/in 72 hours

106
Q

What’s the Parkland formula?

A

4mL LR/ %TBSA burned/ kg. 1/2 given in 1st 8 hours and remaining over the next 16 hours

107
Q

What are your alternative fluid solutions for burn pts?

A

hypertonic saline to maintain UO 0.5-1 mL/kg/hr; colloids not recommended w/in first 24 hours

108
Q

3 factors which would increase volume of fluid needed to resuscitate?

A

delay in initiation, inhalation injury, high BAC at time of injury

109
Q

when does airway edema develop in relation to the injury?

A

several hours after, gets worse for 2-3 days then begins to recede

110
Q

When is airway edema the worst after a burn injury?

A

2-3 days after injury

111
Q

Prophylactic intubation w what 2 signs?

A

signs of smoke inhalation or upper airway burn

112
Q

Some considerations for intubating a burn pt?

A

tube size smaller than normal, topical, transtracheal or translaryngeal blocks, mild sedation, gentle

113
Q

Leading cause of death in burn pts?

A

sepsis/infection

114
Q

What is preferably used for sedation in burn pts?

A

narcs

115
Q

First burn surgical excision is usually how many hours after injury?

A

24-48 hours

116
Q

What do surgeons use to control the bleeding after harvesting grafts?

A

epi soaked sponges

117
Q

What does the anesthetist have to pay attention to during grafting?

A

blood loss! there can be a lot

118
Q

What do burns do to the muscle membrane?

A

denervation so proliferation of the extrajunctional receptors. unaltered for first 24 hours

119
Q

When what %TBSA is burned does the excessive K release from suxxs occur?

A

> 10%

120
Q

Which 2 types of injuries are immediately susceptible to the increased K from suxxs?

A

electrical burns and crush injuries

121
Q

With burns > what TBSA % is there sensitivity to NMDRs?

A

30

122
Q

Which NMDR are burn pts not sensitive to?

A

mivacurium

123
Q

When does NMDR sensitivity start and stop?

A

starts 1 week after burn and peaks 5-6 weeks after injury

124
Q

How do you adjust your NMDRs in sensitive pts?

A

larger and more frequent doses

125
Q

What about the burn pt increases ventilatory requirements?

A

hypermetabolic state and VQ mismatches

126
Q

Average adult MV at rest?

A

5L/min

127
Q

What is the estimated blood loss formula for burn pts?

A

2.8%(+/- 0.2%) of circulating volume per % TBSA excised + 1.8%(+/-0.2%) of circulating volume per % TBSA grafted

128
Q

What do you need to avoid with emergence in a burn pt?

A

shivering

129
Q

Drugs administered by a route other than IV in a burn pt have what type of absorption?

A

delayed

130
Q

When is the albumin concentration in a burn pt decreased?

A

after 48 hours

131
Q

What are 2 drugs affected by the decreased albumin? (increased free concen)

A

benzos and anticoagulants

132
Q

What is the change in the effect of drugs metabolized by the liver by oxidative metabolism (ie diazepam)?

A

prolonged

133
Q

What is the change in the effect of drugs conjugated by phase II reactions in the liver (ie lorazepam)?

A

not affected

134
Q

Why are opioid requirements increased in burn pts?

A

increased metabolism and habituation

6903 (12 decks)

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