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Advance principles I, Exam 2 > Burns > Flashcards

Burns Flashcards

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0
Q

ABA grading system
Moderate burn

What type of burn?

A
  1. 10-20% adults
  2. 5-10% young or old
  3. 2-5% full thickness burn

High voltage injury, suspect inhalation injury, circumferential burn, medical problems DM, sickle cell
Admit to hospital

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1
Q

ABA grading system

Minor burn

A
  1. <2% full thickness

Outpatient

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2
Q

ABA grading system

  • Major burn numbers
  • injuries
A
  1. > 20% adults
  2. > 10% young or old
  3. > 5% fu thickness burn
    High voltage, known inhalation, significant burn to face, etc plus significant injury, fracture etc
    BURN CENTER
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3
Q

Can u use sux?

A

If <24 hrs

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4
Q 
Fiberoptic findings in inhalation injury
0
B
1
2
3
A

Grade. Findings. Mortality
0. N. 0
B. + on biopsy. 0
1. Hyperemia. 2
2. Severe edema/hypercapnia 15
3. Severe inj:ulcer/necrosis. 62

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5
Q

CO poisoning

A
  • Closed space
  • 200x greater affinity for Hgb than O2
  • CO=metabolic acidosis at cellular level
  • Shifts oxyHg curve to LEFT/incre O2 tissue
  • pulse Ox cannot detect CO Hgb
  • need CO-oximeter to detect COHgb
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6
Q

CO t1/2 & tx

A
  • 100% O2: CO t1/2=26-148 minutes
  • Rx until CO Hgb levels 25%

Normal CO 0-10 smokers 10%

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7
Q

Hydrogen cyanide poisoning

  • What happens
  • S/S
  • Rx
A
  • plastic stuff, foam, paints, wool, silk
  • produces hypoxia: blocks intercellular O2
  • t1/2 = 1 hr
  • s/s: decrease: LOC, B/P, RR - apnea, seizures
  • Rx: hydroxicobalamin ( Vit B12a) 50mg/kg
  • rapid Onset, good safety profile
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8
Q

What is t 1/2 for HCP and for CO?

A

HCN t1/2=1hr

CO t1/2. = 26-148 min

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9
Q

Fluid resuscitation

A

Adults:
LR 2-4ml x kg x %TBSA burned

Children:
LR 3-4ml x kg x %TBSA

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10
Q

Minimal URINE output for burn patients

A

Adults:
0.5-1.0 ml/kg/hr
Children <30kg
1ml/kg/hr

Patients w/high-voltage electrical injuries: 1-1.5ml/kg/hr

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11
Q

What fluids to use during for resuscitation for burn patients?

First 24 hrs and after

A

LR first 24 hrs, 1/2 in first 8 hrs and 1/2 in next 16 hrs
D5W second 24 hrs
Colloid 0.5 ml/% burn per kg

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12
Q

What r the consequences of fluid creep?

A
  • tissue edema & hypoproteinemia
  • abd compartment syndrome
  • pleural effusion/pul edema
  • fasciotomies
  • conversion of partial to full thickness lesions
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13
Q

Criteria for adequate fluid resuscitation

A
  • B/P WNL
  • UO 1-2ml/kg/hr
  • blood lactate 7.32
  • CVP
  • CI 4.5L/min/m2
  • O2 delivery index 600ml/min/m2
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14
Q

Rx for hyper metabolic phase

A

Early wound excision/grafting & prevention of sepsis

Remember: Lasts 24 hrs

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15
Q

Hyper metabolic phase

Effects/s&s

A
  • TBSA >40% phase will last 1-2 yrs
  • multi organ dysfxn
  • decrease muscle protein
  • 10-15 inc in catecholamines/corticosteroids - 9 months post burn
  • incre: cardiac work, MvO2, HR
  • lipolysis, liver dysfxn, muscle catabolism
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16
Q

What is metabolic phase

A

After 48 hrs & involves increased blood flow to organs & tissues

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17
Q

When is hyper dynamic state

A

After 24-36 hrs

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18
Q

Main CV points

A
  1. Increased vascular permeability
  2. Decrease reduced plasma volume
  3. Decrease of CO initially
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19
Q

When does burn shock happens?

S/S of burn shock

A

0-48 hrs

  • Hypovolemia is a major concern
  • Fluid resuscitation is mandatory
  • Impaired cardiac contractility
  • Initial myocardial depression
  • Decreased cardiac output
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20
Q

First 24-48 hrs CV effects

A
  • vascular permeability
  • plasma volume is reduced
  • CO initially decreases
  • fluid resuscitation
  • decreased RBC survival time
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21
Q

Why u give fluids

A
  • Flush blood stream
  • Maintain intravascular volume & CO
  • Maintain perfusion to vital organs
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22
Q

What % leads to loss of micro vascular integrity?

Increased vascular permeability

A

> 30% TBSA

  • Protein rich fluids leaks from capillary beds to interstitial spaces= peripheral edema
  • colloids also leak out NO albumin
  • altered cell membrane — swelling tongue, lips= airway edema/obstruction
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23
Q

Increase viscosity from:

A

Increase:

  • Hct
  • myoglobin release damaged tissue
  • de-natured RBCs
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24
Why CO is decreased initially?
- decreased blood volume | - decreased contractility from myocardial depressing factor ( released due to tissue damage)
25
Pulmonary | Early 0-24 hrs S/S
CO poisoning/inhalation can lead to airway obstruction & pul edema
26
Pulmonary | 2-5 days
ARDS
27
Pulmonary LATE | Days and weeks
Pneumonia, atelectasis, pul emboli
28
What r the 2 most common complications?
Pneumonia and respiratory failure
29
What r the vent settings?
Vt = <31 cmH2O
30
What is the gold standard in diagnosing inhalation injury?
FOB
31
Immunologic complications
--Infection mortality/morbidity 100% children 75% adults -- gram + organisms responsible
32
Glucose level r increased & pts are susceptible to ......
Non-ketotic hyperosmolar coma
33
What happens when ADH is released?
Na & H2O retention | Loss of Ca, K, Mg
34
What % ARF & what is the mortality rate?
ARF = 0.5-38% | Mortality rate = 77% - 100%
35
Gold standard for assessing UofD replacement
Hourly Urine output
36
Rx of myoglobinuria
- --vigorous fluids till UO=2ml/kg/hr - --NaHCO3 alkinize urine, may reduce pigment ass renal failure - --osmotic diuretics mannitol rare
37
Why hepatic hypoperfusion?
- ---Decrease CO - ---Increase blood viscosity - ---Splanchnic vasoconstriction (circulating and going to gut)
38
What can Ketamine do? | Hepatic relation
Hypotension due to - habituation (tolerance) - hypercatabolism (excessive breakdown of body tissue) - hypovolemia - depleted catecholamines
39
What meds can cause hypotension
``` All in acute phase due to hypovolemia Propofol, Etomidate, Thiopental, VA ```
40
Hematologic comications
- -anemia, erythrocytes damaged - -infection- activation of coagulation cascade - -Coagulopathy: consumption of procoagulents - -decrease platelet fxn both quant/qualitative - -anti thrombin deficiency can be seen
41
What happens after 48hrs to albumin bound drugs?
Cause of decrease of albumin, albumin bound drugs (bdz & anti seizure) have a greater free fraction & thus s prolonged effect Opioids requirements will increase due to habituation & hypercatabolism
42
What are the goals of early excision?
- Rapidly restore skin integrity - Early removal/excision w/rapid closure - Protection from bacteria, trauma, H2O loss - multiple procedures
43
Surgical endpoints
20% excision 2-3 hrs 10 units PRBC
44
Decompression procedures
Escharotomy Fasciotomy
45
What r supportive surgical procedures?
- Trach, - gastrostomy, - chole, - bronch, - vascular access
46
Pre op anesthesia planning
- OR room 95% not more - blood - IV access/warmers - narcotic/muscle relaxants
47
What is the MUST monitor in OR?
Temp: foley or esophageal
48
Anesthetic management | What to use/not
- NO SUX after 24 hrs - propofol OK if stable - Ketamine OK if unstable - etomidate, opioids, VA= OK Resistant to NDMR -- cholinergic receptor damage
49
Pulmonary | Early 0-24 hrs S/S
CO poisoning/inhalation can lead to airway obstruction & pul edema
50
Pulmonary | 2-5 days
ARDS
51
Pulmonary LATE | Days and weeks
Pneumonia, atelectasis, pul emboli
52
What r the 2 most common complications?
Pneumonia and respiratory failure
53
What r the vent settings?
Vt = <31 cmH2O
54
What is the gold standard in diagnosing inhalation injury?
FOB
55
Immunologic complications
--Infection mortality/morbidity 100% children 75% adults -- gram + organisms responsible
56
Glucose level r increased & pts are susceptible to ......
Non-ketotic hyperosmolar coma
57
What happens when ADH is released?
Na & H2O retention | Loss of Ca, K, Mg
58
What % ARF & what is the mortality rate?
ARF = 0.5-38% | Mortality rate = 77% - 100%
59
Gold standard for assessing UofD replacement
Hourly Urine output
60
Rx of myoglobinuria
- --vigorous fluids till UO=2ml/kg/hr - --NaHCO3 alkinize urine, may reduce pigment ass renal failure - --osmotic diuretics mannitol rare
61
Why hepatic hypoperfusion?
- ---Decrease CO - ---Increase blood viscosity - ---Splanchnic vasoconstriction (circulating and going to gut)
62
What can Ketamine do? | Hepatic relation
Hypotension due to - habituation (tolerance) - hypercatabolism (excessive breakdown of body tissue) - hypovolemia - depleted catecholamines
63
What meds can cause hypotension
``` All in acute phase due to hypovolemia Propofol, Etomidate, Thiopental, VA ```
64
Hematologic comications
- -anemia, erythrocytes damaged - -infection- activation of coagulation cascade - -Coagulopathy: consumption of procoagulents - -decrease platelet fxn both quant/qualitative - -anti thrombin deficiency can be seen
65
What happens after 48hrs to albumin bound drugs?
Cause of decrease of albumin, albumin bound drugs (bdz & anti seizure) have a greater free fraction & thus s prolonged effect Opioids requirements will increase due to habituation & hypercatabolism
66
What are the goals of early excision?
- Rapidly restore skin integrity - Early removal/excision w/rapid closure - Protection from bacteria, trauma, H2O loss - multiple procedures
67
Surgical endpoints
20% excision 2-3 hrs 10 units PRBC
68
Decompression procedures
Escharotomy Fasciotomy
69
What r supportive surgical procedures?
- Trach, - gastrostomy, - chole, - bronch, - vascular access
70
Pre op anesthesia planning
- OR room 95% not more - blood - IV access/warmers - narcotic/muscle relaxants
71
What is the MUST monitor in OR?
Temp: foley or esophageal
72
Anesthetic management | What to use/not
- NO SUX after 24 hrs - propofol OK if stable - Ketamine OK if unstable - etomidate, opioids, VA= OK Resistant to NDMR -- cholinergic receptor damage

Advance principles I, Exam 2 (5 decks)

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