Burn Part 2. Nasa Kabila Yung Part 1 Flashcards Preview

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Flashcards in Burn Part 2. Nasa Kabila Yung Part 1 Deck (79):
1

Carbon monoxide poisoning

Mechanism of interfering O2 delivery

Prevents reversible displacement of O2
O2 Hg curves to the left
CO binds to reduced cytochrome a3
CO bind to cardiac and skeletal muscle direct toxicity
CO cause CNS demyelination

2

Carbon monoxide poisoning

Signs and symptoms

60% - usually fatal

3

Carbon monoxide poisoning

Treatment

Should be placed on 100% oxygen via a non rebreather face mask while waiting for measurement of CHOb levels

4

CO is reversibly bound to the heme molecules of Hb

Laws of mass action

5

Half life of COHb when breathing room air

4hours

6

Half life of COHb when breathing 100% O2

45-60 minutes

7

Half life of COHb when breathing in hyperbaric oxygen chamber

2atm

3atm

30 minutes

15-20 minutes

8

Heat in burning room is dissipated in the

Oropharynx
Nasopharynx
Proximal tracheobronchial tree

9

Sudden exposure of hot air typically triggers

Reflex closure of the vocal cords

10

Thermal airway injury

Greatest risk

Explosion
Burn of face and upper thorax
Unconscious in a fire

11

Thermal airway injury

Presence of intra oral and pharyngeal burns indication of

Endo tracheal intubation

12

Thermal airway injury

Has no role in the treatment upper airway edema in. Urns

Steroids

13

Thermal airway injury

Diagnosis

Lahat ng na sunod sa enclosed space

14

Thermal airway injury

SS

Hepoarseness
Sturdier
Edema
Wheezing or ronchi
Decrease level of consciousness

15

Treatment of airway injury in lower airway

Commonly seen with inhalation injury, produces wheezing, coughing, and retained secretions

Tracheobronchitis

16

Treatment of airway injury in lower airway

Should be administered routinely, increased airway resistance is more often the result of edema and retained secretions than true bronchospasm

Supplemental oxygen

17

Treatment of airway injury in lower airway

Indicated in those patients with per morbid broncho spastic disease

Bronchodilators

18

Treatment of airway injury in lower airway

Airway resistance and minimized with

Chest physiotherapy and bronchodilators

19

Treatment of airway injury in lower airway

If intubation is unsuccessful

Cricothyroidotomy
Tracheostomy

20

Treatment of airway injury in lower airway

Prophylactic antibiotics are not indicated with inhalation injury which is

Chemical pneumonitis

21

Treatment of airway injury in lower airway

Contraindicated with inhalation injury

Antibiotics
Steroids

22

Early incision and grafting

For deep partial and full thickness burns

Eschar is remove and then wound closed via grafting technique or immediate flap

23

Early incision and grafting

Done within

3-7 days and 10 days

24

Early incision and grafting

Can be performed to include the burn and subcutaneous fat to the level of the investing fascia

Fascial excision

25

Early incision and grafting

Tangentially removing thin slices of burned tissue until viable bed remains

Tangential excision

26

Early incision and grafting

Decrease hospital days
Decrease painful deridement
Fewer infections

27

Tangential excision

Burn can be removed with a variety of instruments usually

Hand dermatomes

28

Fascial excision

Reserved for patients with

Deep full thickness burns
Life treathening full thickness burns

29

Advantages of fascial excision

Reliable bed
Tourniquets routinely be used
Less blood loss
Less experience is required

30

Infection risk factors

Children
More than 20% of TBSA
Inhalation injury
Premorbid diabetes

31

Suggest the possibility that the patient is becoming unstable

Hyperglycemic
Hypotension
Anuria

32

Patient is developing sepsis

Hypothermia
Feeding intolerance
Falling platelet count

33

Silver nitrate active component

0.5 % aqueous solution

34

Silver nitrate spectrum of antimicrobial activity

Good for both

Negative
Positive
Yeast

35

Silver nitrate method of care

Occlusive dressing

36

Mafenide acetate

Active component

11.1% in water miscible base

37

Mafenide acetate

Spectrum of antimicrobial activity

Good for

Negative
Positive.

Poor yeast

38

Mafenide acetate

Method of wound care

Exposure

39

Silver sulfadiazine

Active component

1.0% water miscible base

40

Silver sulfadiazine

Spectrum of antimicrobial activity

Good fro

Positive
Yeast

Poor negative

41

Silver sulfadiazine

Method of wound care

Exposure of single layer dressing

42

Pneumonia more related to

Endo tracheal intubation than inhalation injury

43

Diagnostic of pneumonia is confirmed by the presence of

Infiltrates on chest radiographs and positive sputum cultures

44

When pneumonia is clinically suspected

Broad spectrum antibiotics

45

Pneumonia

Single agent therapy is generally appropriate and efficacious regardless of the pathogen, including

Pseudomonas aeruginosa

46

Inversely related from the distance of burn wound

CRBSI

Catheter related blood stream infection

47

CRBSI

Catheter related blood stream infection

Treated by

Systemic antimicrobials and immediate removal of the catether.

48

Electrical injury and burns

Severity depends

Current
Pathway
Duration

49

Electrical injury and burns

Driving line of high or low voltage

1000 volts

50

Electrical injury and burns

Totally destroyed by high voltage injuries

Fingers
Hands
Forearms
Feet
Lower legs

51

Electrical injury and burns

Usually dissipate enough current to prevent extensive damage to viscera unless the contact point are abdomen and chest

Areas with larger volume like trunk

52

Electrical injury and burns

Disruption of muscle cells release cellular

Debris and myoglobin
Filtered by kidney that can lead to irreversible renal failure

53

Electrical injury and burns

Unnecessary

ECG monitoring
Cardiac enzymes
Within 24 hours

54

Electrical injury and burns

Most devastating injury in brain

Occurs in the head

Less if occurs in the spinal cord

55

Electrical injury and burns

Quite susceptible and delayed transverse myelitis can occur days or weeks after injury

Schwann cells

56

Electrical injury and burns

Well recognized sequela of high voltage electrical burns

Cataracts

57

Electrical injury and burns

Cataract

5-7 of patients
Bilateral
Within 1-2 years of injury (manifest)

58

Chemical burns

Cause most chemical burns

String acids or alkalia

59

Chemical burns

In contrast to thermal injury, chemical burns cause

Progressive damage and injury the chemicals are inactivated

60

Chemical burns

More self limiting than alkali

Acid burns

61

Chemical burns

Irrigating for at least how many minutes under a running water

15minutes

62

Chemical burns

Antidotes are contraindicated except with

Hydrofluoric acid burn

63

Chemical burns

Antidote of Hydrofluoric acid burn

Calcium gluconate

64

Chemical burns

Considered

Deep partial thickness
Full thickness

Best treated by EG

65

Pain control

The main stays of pharmacological pain control are

Analgesics (opioid)
NSAID

66

Pain control

Anesthetic agents namely, _______ and _______ are quite useful for extremely painful procedures such as dressing changes

Ketamine
Nitrous oxide

67

Classically develops in deeper partial thickness and full thickness injuries that are allowed to heal by primary intention

Burn scar hypertrophy

68

Hypertrophic scar

More likely to result in hypertrophic scarring, and pigmented individuals are at an increased risk

Delayed excision

69

Hypertrophic scar

Quickly reduce the mass of hypertrophic immature scars

Compression garments

70

Hypertrophic scar

Most successful approach to residual hypertrophic burn scars is

Initial pressure therapy

71

Hypertrophic scar

Most commonly used steroid, acts by decreasing collagen synthesis and increasing collagen degradation

Triamcinolone

72

Wound contractures prevented by

Excision and grafting
Used of splint
Triamconolone
z plasty

73

Chronic ulceration of old burn scars predispose to malignant degeneration

Marjorie's ulcer

74

Marjolins ulcer cancer related

Basal cell carcinoma
Squamous cell carcinoma

Malignant fibrous histiocytoma
Sarcoma
Melanoma

75

Marjolins ulcer

Burn scars carcinoma can metastasize, typically to

Regional nodal basins

76

Marjolins ulcers

Has not improved survival

Prophylactic regional lymph node resection

77

Marjolins ulcer

Promising modality to direct therapeutic node dissection and awaits validation in this population

Sentinel lymph node

78

Marjolins ulcer

On a selected basis, _______________ may be warranted. Generally, outcome is good with prompt diagnosis and resection.

Adjuvant radiation

79

Carbon monoxide

House fire deaths
Colorless, odorless, tasteless
Affinity to HgB 200 x than O2