Burns

Question 1

What are the burn statistics?	
Gender
Ethnicity	
Cause	
Place of occurence

Answer 1

Male
Caucasian 20-60 y/o
Fire/flame >scald>contact >electrical > chemical
Home > occupational > street/hwy

Question 2

Name the types of burns (7)

Answer 2

Fire/flame	
Scald	
Steam	
Gas	
Electrical	Flash	
Chemical

Question 3

The more viscous the scald type burn, the more significant the damage. True or false?

Answer 3

true

Question 4

What is the significance of a burn caused by steam?

Answer 4

Can cause thermal injury to the distal airways of the lung.

Question 5

What is the risk related to a gas type burn?

Answer 5

Theupper airway is at risk for thermal injury and subsequent occlusion due to edema. Distal airway injury is more likely to be due to the direct effects of the products of combustion on the mucosa and alveoli.

Question 6

What is the voltage needed to create a deep tissue electrical burn? How does the injury appear? What is the voltage needed to burn children?

Answer 6

1000 Volts The injury is normally deep to the skin. Children can have significant injury between 200-1000V.

Question 7

What type of burn involves only the epidermis causing erythema?

Answer 7

First degree burn

Question 8

<p> Alkaline substances and acidic substances can burn the skin and can be associated with systemic toxicity describes this type of burn.</p>

Answer 8

Chemical burn

Question 9

What type of burn? partial/superficial or deep blistering painful heal well on own

Answer 9

Second degree burn

Question 10

How is a third degree burn defined?

Answer 10

full thickness burn with loss of epidermal/dermal elements

Question 11

How do we determine the extent of burn injury? (3)

Answer 11

Rule of Nines
Palm
Lund Browder

Question 12

How are the 9’s distributed when assessing burn area?

Answer 12

Head, chest, abdomen = 9%	
Each leg = 9%	
Each arm = 4.5%	
Pubic = 1%	
Posteriorly, do not add the head again.

Question 13

What criteria does the palm method for assessing burn area use?

Answer 13

Pt’s own palm = 1%

Question 14

When is the Lund Browder method for assessing burns most often used?

Answer 14

children

Question 15

What is rapidly assessed for when there is a burn injury?

Answer 15

Is there smoke inhalational injury??? Edema can form RAPIDLY preventing successful intubation.

Question 16

What can inhalational injuries be caused by? (2)

Answer 16

thermal lesions

exposure to toxic fumes

Question 17

EXAM What are signs/symptoms correlating to inhalational injury? (8)

Answer 17

Stridor
Hoarseness
Use of accessory muscles , increased WOB Facial burns
Singing of eyebrows
Soot or redness of mucosa in mouth/pharynx
Carbonaceous sputum
Accident occurred in confined space

Question 18

What is the function of skin? (5)

Answer 18

Protection
Regulate body temperature
Eliminates some wastes Make Vit D
Detect touch, pain, warmth, cold

Question 19

What are important points to remember regarding pathophysiology of capillaries? (5)

Answer 19

Capillaries are normally impermeable to proteins.
Lymphatic fluid increased in burn pts.
Body releases histamines, cytokines, and inflammatory agents increasing capillary permeability.
Endothelial cells slide apart.
Fluid accumulation occurs in unburned tissues.

Question 20

What is escharotomy?

Answer 20

Surgical cuts are made to prevent compartmental syndrome–buildup of fluid.

Question 21

What other pathophysiological changes may result from burn trauma? (4)

Answer 21

Decreased surfactant
Decreased macrophages to rid of wastes. Increased neutrophils to prevent infection. Edema may develop within minutes to 24 hours!

Question 22

Sloughing of mucosal surface, decreased ciliary function result in decreased airflow and gas exchange. True or false?

Answer 22

true A picture of distal bronchus.

Question 23

How is carbon monoxide formed?

Answer 23

combustion of flammable materials

Question 24

Carboxyhemoglobin will look like regular Hb so looking at O2 saturation in burn pt will be skewed. True or false?

Answer 24

true

Question 25

Carboxyhemoglobin hinders the delivery of oxygen to body cells which leads to hypoxia. True or false? 

Answer 25

true

Question 26

What kills most people at the site of a fire?

Answer 26

CN toxicity!!! (Cyanide)

Question 27

You must order a special blood gas for carboxyhgb called HbCO. True or false?

Answer 27

true

Question 28

What is the Baux score a function of and when is it used?

Answer 28

function of age + BSA Used for large BSA burns.

Question 29

death in 50% of cases.  True or false?

Answer 29

False, 110

Question 30

Inhalational injuries increases the Baux score ____-fold to that of a comparably sized thermal injury or adds ___ years to a Baux score.

Answer 30

10 17

Question 31

What other factors increase the Baux score? (2)

Answer 31

preexisting comorbidities | concurrent trauma

Question 32

EXAM What is the treatment for burn patients? (6)

Answer 32

Aggressive fluid resuscitation Monitor urine output O2 therapy, +/- intubation Escharotomy (preventing restriction of breathing/compartment syndrome) Antibiotic treatment Debridement within a few days to prevent sepsis

Question 33

What is the most popular fluid resuscitation formula used?

Answer 33

Parkland formula says give crystalloid in 1st 24 hrs.

Question 34

EXAM | What information do you need to obtain in pre-op? (5)

Answer 34

Preexisting issues Labs Respiratory status/vent requirements Drips/drugs Current hemodynamics

Question 35

EXAM What must be available in the OR prior to patient arrival?

Answer 35

Blood needs to be in the OR prior to the case. Room MUST be warm! Use underbody warmers.

Question 36

What are anesthetic considerations during the perioperative period? (5)

Answer 36

Tailored to your situation, are you worried about difficult a/w Profound hypovolemia/sepsis NO SUX 8 hours - 2 years post burn NMBs wear off fast due to decreased sensitivity Increased narcotic requirement!  

Question 37

Why do we prohibit the use of Sux 8 hrs to 2 YEARS post-burn?

Answer 37

Increased ACh density which continues to be abnormally elevated for a while.

Question 38

What are questions to ask yourself during the perioperative period? (7)

Answer 38

``` Adequate IV and arterial access? Are you staying on top of blood loss? You will quickly be behind. Need FFP? Pt. warm? Epi-soaked laps being used? They're cold! What will the narcotic need to be? Will you be able to extubate? ```

Question 39

Estimates say __% of blood volume may be lost for each % of BSA excised.

Answer 39

2% per 1% BSA excised.

Question 40

``` What multi-organ system issues do we need to consider?  CV Hematologic Renal GI ```

Answer 40

Increased metabolism increases cardiac demand. Coagulopathy/hypercoagulable state may be present. Inadequate fluid resuscitation may cause renal issues. GI --Curling's Ulcers (spont. ulceration of stomach lining, more rare now, but NO NSAIDs in these pts.)