Multiple Interacting Systems

Question 1

is defined as a traumatic injury to the skin, primarily caused by thermal or other acute exposures such as extreme cold, electricity, radiation or chemicals.

Answer 1

a burn

Question 2

Almost _% of the burn injury patients die

Answer 2

6%

Question 3

what is the most common type of burn injury?

Answer 3

a thermal injury

Question 4

___ are dead and act as protection and forms water tight seal

Answer 4

outer cells in epidermis

Question 5

____ divide to produce stratum corneum and also contains pigment to protect against UV radiation.

Answer 5

deeper layers of epidermis

Question 6

Tough, elastic connective tissue which contains specialized structures including: nerve endings, blood vessels, sweat glands, oil glands, and hair follicles.

Answer 6

dermis

Question 7

• epidermal layer
• no blister
• pain, dry, red and blanch with pressure

Answer 7

superficial

Question 8

• blisters between epidermis and dermis
• painful, red or pink, moist and has a shiny appearance
• blanch with pressure

Answer 8

superficial partial-thickness

Question 9

• blister deep into dermis
• damage to hair follicle and glandular tissue
• can have variable mottled colour from pale ivory to red
• does NOT blanch with pressure

Answer 9

deep partial-thickness

Question 10

• all layers of dermis and often subcutaneous tissue
• eschar
• scarring
• hospitalization

Answer 10

full-thickness

Question 11

Is the most accurate method for estimating TBSA for both adults and children

Answer 11

Lund-Browder Chart

Question 12

is the area where tissue necrosis is irreversibly lost due to coagulation of the skin proteins and is evidenced by clotted blood and thrombosed blood vessels.

Answer 12

The zone of coagulation or necrosis

Question 13

• is deep and peripheral to the necrosis zone
• at risk due to the decrease blood flow but it is potentially salvageable if perfusion is maintained and infection or edema is prevented

Answer 13

the zone of stasis or injury

Question 14

characterized by minimal cellular injury with increased blood flow and should recover unless an invasive infection or profound tissue inflammation occurs

Answer 14

zone of hyperemia

Question 15

Children have a proportionately ____ body surface area in relation to their height or weight

Answer 15

larger

Question 16

This maintains a patent airway and is attached to a breathing machine or ventilator.

Answer 16

endotracheal tube

Question 17

Removal of ___, of deep dermal and full-thickness burns, should occur within 48 hours of injury

Answer 17

eschar, devitalized tissue

Question 18

It often requires a procedure called an escharotomy to release the constriction and this can be required early in the resuscitation.

Answer 18

a circumferential full-thickness burn

Question 19

___ is the most prevalent plasma protein and this is decreased in burns

Answer 19

Albumin

Question 20

Initially, with a major burn there will be a fluid shift phase lasting - hours with a peak around - hours

Answer 20

18-24 hours

6-8 hours

Question 21

The greatest loss of intravascular fluid occurs in the first ___ hours

Answer 21

8-12 hours

Question 22

often used to indicate the end of burn shock.

Answer 22

the capillary seal

Question 23

With burns, there are 2 different mechanisms occurring simultaneously…

Answer 23

the loss of skin integrity and the systemic pathological response to the burn.

Question 24

characterized by a hyperdynamic circulatory, physiologic, and immunologic response, that leads to a persistent and increased metabolic state that can least for days to weeks and even up to one year for a major burn.

Answer 24

hypermetabolic response

Question 25

___ can actually inhibit the healing process so should not be used

Answer 25

Disinfectants

Question 26

For deep partial-thickness and full-thickness burns, ____ should be removed early, usually within __ hours of injury.

Answer 26

eschar

48 hours

Question 27

have potent antimicrobial properties, but do not penetrate eschar well.

Answer 27

silver-based agents

Question 28

rapidly diffuses through eschar, and therefore a good agent for deep wounds when infection is suspected.

Answer 28

Mafenide acetate

Question 29

When the pressure inside the burned area increases due to edema/fluid overload, it can lead to a

Answer 29

compartment syndrome

Question 30

is an incision through the eschar (the dead dermis layer) only

Answer 30

escharotomy

Question 31

is an incision through all involved fascial layers

Answer 31

fasciotomy

Question 32

___ is a constant feature in severely burned patients, reflecting both increased glomerular permeability and decreased tubular absorption of filtered proteins

Answer 32

proteinuria

Question 33

is associated acute tubular necrosis due to volume alterations, electrolyte disturbances, hormones, inflammatory mediators and toxic breakdown products such as myoglobin and hemoglobin.

Answer 33

early ARF

Question 34

usually is secondary to hemodynamic changes associated with other burn complications such as sepsis or MODS.

Answer 34

late ARF

Question 35

uses a pressure gradient, with dialysate fluid that facilitates the removal of toxic waste products.

Answer 35

hemodialysis (HD)

Question 36

is the waste removal due to concentration gradients and ultra-filtration or convection is when fluid is removed based on pressure gradients namely the hydrostatic pressure of the blood in the dialyzer

Answer 36

diffusion

Question 37

• contains thousands of hollow capillary membranes (tubes)

- allows for well controlled and predictable diffusion and ultrafiltration

Answer 37

hollow fibre dialyzer

Question 38

is the progressive dysfunction of two or more organ systems resulting from an uncontrolled inflammatory response to a severe illness or injury

Answer 38

MODs

Question 39

is the immediate local or mild systemic response to the triggering event or illness

Answer 39

primary MODs

Question 40

is the excessive systemic inflammatory response particularly to TNF, IL-1, nitric oxide and the influx of macrophages and neutrophils, which develops after a latent period and results in organ dysfunction.

Answer 40

secondary MODs

Question 41

What does the onset of MODs begin with?

Answer 41

low-grade fever
tachycardia
dyspnea
altered mental status

Question 42

what is the therapeutic management of MODs?

Answer 42

prevention and support