Burn

Question 1

what are the 4 functions of the skin? (S, PI, F/E B, TR)

Answer 1

sensation, prevents infection, fluid/electrolyte balance, thermal regulation

Question 2

why is the Lund & Browder burn chart preferred over Rule of Nines?

Answer 2

because it takes into account the proportional difference in adults and children

Question 3

what enzyme does cyanide inhibit?

Answer 3

cytochrome oxidase

Question 4

cyanide concentration of > 100 ppm causes what 3 s/s? (L, S, RF)

Answer 4

lethargy, seizures, resp failure

Question 5

for cyanide toxicity, what 2 meds do you give?

Answer 5

sodium nitrate, sodium thiosulfate

Question 6

how many mg of sodium nitrate do you give?

Answer 6

300 mg

Question 7

how many grams of sodium thiosulfate do you give?

Answer 7

12.5 grams

Question 8

repeat what percent of the sodium nitrate and sodium thiosulfate doses if s/s reoccur within 2 hours?

Answer 8

50%

Question 9

what carbon monoxide s/s are seen at these % levels?

1. 15-20% (H,T,C)
2. 20-40% (N,F,D)
3. 40-60% (H,C,CI)
4. > 60% (D)

Answer 9

1. HA, tinnitus, confusion
2. nausea, fatigue, disorientation
3. hallucination, combativeness, C/V instability
4. death

Question 10

immediately after a major burn, are these increased or decreased:

1. CO and arterial BP
2. SVR and PVR
3. contractility
4. capillary permeability
5. response to catecholamines

Answer 10

1. decreased
2. increased
3. decreased
4. increased
5. decreased

Question 11

what factors cause decrease contractility and increase capillary permeability? (HMF)

Answer 11

humor mediated factors

Question 12

2-5 days after a burn, O2 consumption and cardiac output are increased how many times for weeks to months? (range)

Answer 12

2-3 times

Question 13

what are 3 vascular s/s the first 24 hours after injury? (V,H,H)

Answer 13

vasoconstricted, hypercoagulable, hemoconcentrated

Question 14

what is a potential SE of silver nitrate 0.5%? (M)

Answer 14

methemoglobinemia

Question 15

what are the 2 fluid resuscitation formulas? (PMH, BAH)

Answer 15

parkland memorial hospital, brooke army hospital

Question 16

what is the formula for first 24 hours?

Answer 16

4mL x kg x % burn

4 x 100kg x 80% = 32,000 mL

Question 17

what % of fluid do you give in the first 8 hours?

Answer 17

50%

Question 18

what % of fluid do you give in the next 16 hours?

Answer 18

50%

Question 19

after first 24 hours, maintenance rate of D5W with colloids is what? (mL/kg/%TBSA)

Answer 19

0.5 mL/kg/%TBSA

Question 20

what is the drug of choice for burn procedures?

Answer 20

ketamine

Question 21

what degree range do you keep the OR?

Answer 21

98-100 degrees

Question 22

initial burns are considered what and require what?

Answer 22

full stomachs, RSI

Question 23

Succs may be used up to how many hours?

Answer 23

24 hours

Question 24

burn pts may require how many times more non-depolarizing muscle relaxants d/t increased Vd and plasma protein binding? (range)

Answer 24

2-3 times

Question 25

are narcotic requirements increased or decreased in burns?

Answer 25

increased

Question 26

what is max epi dose with these agents? (mcg/kg) 1. sevoflurane 2. isoflurane 3. desflurane

Answer 26

1. 5 mcg/kg 2. 6.7 mcg/kg 3. 7 mcg/kg

Question 27

Criteria for adequate fluid resuscitation: 1. UO how many ml/kg/hr? (range) 2. blood lactate less than how many mmol/L 3. base deficit less than what? 4. gastric intramucosal pH greater than what? 5. cardiac index of what? (L/min/m^2) 6. oxygen delivery index (mL/min/m^2)

Answer 27

1. 1-2 mL/kg/hr 2. 2 mmol/L 3. -5 4. 7.32 5. 4.5 L/min/m^2 6. 600 mL/min/m^2

Question 28

do burn pts require more or less NMBs?

Answer 28

more

Question 29

what is the major cause of inhalation injury in burn pts?

Answer 29

carbon monoxide

Question 30

what type of metabolic state are burn pts in: 1. first 24 hours post burn 2. 2-5 days post burn

Answer 30

1. hypodynamic | 2. hyperdynamic

Question 31

cyanide concentration > how many ppm cause seizures, lethargy and respiratory failure?

Answer 31

> 100 ppm

Question 32

are induction agents (ketamine, propofol, etomidate) stand doses for burns?

Answer 32

yes

Question 33

during debridement, pts may lose what range of mLs per 1% TBSA excised?

Answer 33

200-400 mL

Question 34

after ABCs, what is the #1 priority?

Answer 34

temperature

Question 35

for burns, maintain UO greater than what mL?kg/hr?

Answer 35

> 0.5 mL/kg/hr

Question 36

reasons why burn pts need more NDMRs: 1. reason related to Vd 2. reason related to plasma protein 3. what are the 2 reasons related to NMJ receptors?

Answer 36

1. increased Vd 2. increased plasma protein 3. increased # of NMJ receptors and decreased affinity

Question 37

avoid what two muscle relaxants in burn pts? (T, A)

Answer 37

tubocurarine (DTC), atracurium

Question 38

why avoid tubocurarine (DTC) and atracurium in burn pts? (HR)

Answer 38

histamine release