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apex review > Miscellaneous topics 2 > Flashcards

Miscellaneous topics 2 Flashcards

1
Q

Patients with extensive burn injuries require

A

aggressive fluid resuscitation as well as surgery for debridement and skin grafting to prevent bacterial sepsis

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2
Q

What are the four classes of burn injury?

A

superficial
partial-thickness
full-thickness 3rd degree
full-thickness 4th degree

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3
Q

Describe a superficial burn

A

epidermis only

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4
Q

Describe a partial-thickness burn.

A

extends to the dermis

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5
Q

Describe a full thickness 3rd degree burn.

A

complete destruction of the epidermis and dermis

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6
Q

Describe a full thickness 4th degree burn

A

Extends to muscle and bone

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7
Q

We can use _________________ to assist with fluid replacement calculations

A

“rule of nines”

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8
Q

Complications of burns include

A

hypovolemic shock
inhalation injury
sepsis
contractures
scarring

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9
Q

What is the patient experience with a 1st degree burn?

A

stinging, tender and sore

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10
Q

What does the patient experience with a 2nd degree burn?

A

very painful

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11
Q

What does the patient experience with a 3rd degree full thickness burn?

A

no sensation

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12
Q

What does the patient experience with a 4th degree burn?

A

no sensation

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13
Q

For children 1-4, the rule of nine’s looks a little different in that

A

more percentage is given to the child’s head (19%) and slightly less to the legs (15%) and torso (16%)

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14
Q

What is the BEST IV fluid to administer in the initial 24 hours after a major burn?
a. D5W
b. 3% NaCl
c. 5% albumin
d. Lactated ringers

A

d. Lactated ringer’s

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15
Q

Immediately after a burn, microvascular permeability

A

increases and this creates a capillary leak

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16
Q

Capillary leak leads to

A

edema formation
hypovolemia
shock

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17
Q

Fluid shifts and edema formation are greatest in the first ______________ and begin to stabilize by _____________

A

12 hours; 24 hours

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18
Q

________________- should be avoided during the first 24 hours because it’s lost to the interstitial space

A

Albumin

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19
Q

What are the two commonly used fluid resuscitation formulas used for the acutely burned patient?

A

Parkland and Modified Brooke
-both use LR in the 1st 24 hrs. and then use D5W

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20
Q

Additional considerations for burn injuries include

A

abdominal compartment syndrome
carbon monoxide poisoning
airway complications
up-regulation of extrajunctional receptors after 24 hours
impaired temperature regulation
increased oxygen consumption

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21
Q

A rising hemoglobin in the first few days following a burn suggests

A

inadequate volume resuscitation

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22
Q

Describe the Parkland fluid resuscitation goals.

A

4 mL LR x %TBSA burned x kg
1/2 in first 8 hours
1/2 in next 16 hours

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23
Q

Describe the Modified Brooke resuscitation goals.

A

2 mL LR x %TBSA burned X kg
1/2 in first 8 hours
1/2 in next 16 hours

24
Q

What are the clinical end points of burn resuscitation for adults?

A

UO: >0.5 mL/kg/hr
MAP> 60 mmHg
HR: 80-100
Base deficit <2
Oxygen delivery index: 600 mL O2/min/m2
Mixed venous oxygen tension: 35-40 mmHg

25
Q

What are the clinical end points for children and infants?

A

UO child <30 kg: >1 mL/kg/hr
SBP 70-90 + (2x age in years)
SBP for infants >60 mmHg

26
Q

What are considerations with electrical burns

A

dysrhythmias are common
myoglobinemia is caused by extensive muscle damage and is nephrotoxic so needs to be flushed out of the body

27
Q

Abdominal compartment syndrome may result from

A

aggressive fluid resuscitation

28
Q

Abdominal compartment syndrome is defined as

A

intraabdominal pressure >20 mmHg (transduction of bladder pressure) AND evidence of organ dysfunction (hemodynamic instability, oliguria, increased PIP)

29
Q

Treatment of abdominal compartment syndrome includes

A

neuromuscular blockade
sedation
diuresis
abdominal decompression via laparotomy

30
Q

With carbon monoxide poisoning, blood takes on

A

a cherry red appearance

31
Q

The SpO2 with carbon monoxide poisoning

A

may give a falsely elevated result

32
Q

Treatment of carbon monoxide poisoning is

A

100% FiO2 or hyperbaric oxygen

33
Q

The first priority in all burn patients is to

A

administer a high FiO2

34
Q

The gold standard for diagnosing the extent of airway injury is

A

fiberoptic bronchoscopy

35
Q

A surgical airway with the patient with a burn injury increases the risk of

A

pulmonary sepsis and late pulmonary complications
- it should only be used as a last resort

36
Q

When can succinylcholine be used with burns?

A

only within 24 hours; after that it can cause lethal hyperkalemia

37
Q

The dose of nondepolarizing NMBs with burns should be

A

increased 2-3 fold b/c there are more receptors

38
Q

Patients become ________________ after a burn

A

hypermetabolic

39
Q

Hypermetabolism leads to increased

A

catabolism, oxygen consumption, heart rate, and respiratory rate

40
Q

Choose the statement that BEST describes the anesthetic considerations for the patient undergoing electroconvulsive therapy.
a. there is an initial increase in sympathetic tone followed by an increased in parasympathetic tone
b. hypocarbia increases the seizure duration
c. pregnancy is an absolute contraindication
d. lithium shortens the duration of action of succinylcholine

A

b. hypocarbia increases the seizure duration

41
Q

Electroconvulsive therapy is a treatment for

A

medication resistant depression as well as mania, catatonia, suicidal ideation, and some types of schizophrenia

42
Q

________ is the gold standard induction agent for ECT

A

Methohexital

43
Q

The efficacy of ECT is primarily dependent on

A

the seizure duration

44
Q

The best response is obtained when the seizure lasts

A

> 25 seconds

45
Q

__________ during induction can produce a better quality seizure

A

hyperventilation

46
Q

Select absolute contraindications to ECT include

A

pheochromocytoma
unstable C-spine
brain tumor
MI within the past 4-6 months
recent intracranial surgery (<3 months)
recent stroke (<3 months)

47
Q

Key relative contraindications to ECT include

A

pregnancy
CHF
glaucoma
presence of a pacemaker/ICD
retinal detachment
severe pulmonary disease

48
Q

The physiologic response to ECT includes

A

initial response: increased PNS activity during the tonic phase
secondary response: increased SNS activity during the clonic phase

49
Q

What drugs are avoided because they decease seizure duration?

A

propofol
midazolam
lorazepam
fentanyl
lidocaine

50
Q

What actions are avoided because they decrease seizure duration?

A

hypoventilation
hypercarbia
hypoxia

51
Q

What drugs increase seizure duration?

A

etomidate
ketamine
alfentanil with propofol
aminophylline
caffeine

52
Q

____________ may be given during ECT to blunt the SNS response

A

Esmolol

53
Q

___________________________ is used as an antisialogogue and reduces the risk of bradycardia and asystole

A

Glycopyrrolate

54
Q

This drug prolongs the duration of action of succinylcholine AND nondepolarizing neuromuscular blockers

A

lithium

55
Q

Patients on MAOIs who receive indirect acting sympathomimetics can experience

A

hypertensive crisis

apex review (224 decks)

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