What are the burn statistics?
Place of occurence
Caucasian 20-60 y/o
Fire/flame > scald> contact > electrical > chemical
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Name the types of burns (7)
The more viscous the scald type burn, the more significant the damage. True or false?
What is the significance of a burn caused by steam?
Can cause thermal injury to the distal airways of the lung.
What is the risk related to a gas type burn?
The upper 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.
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?
The injury is normally deep to the skin.
Children can have significant injury between 200-1000V.
What type of burn involves only the epidermis causing erythema?
First degree burn
Alkaline substances and acidic substances can burn the skin and can be associated with systemic toxicity describes this type of burn.
What type of burn?
partial/superficial or deep
heal well on own
Second degree burn
How is a third degree burn defined?
full thickness burn with loss of epidermal/dermal elements
How do we determine the extent of burn injury? (3)
Rule of Nines
How are the 9's distributed when assessing burn area?
Head, chest, abdomen = 9%
Each leg = 9%
Each arm = 4.5%
Pubic = 1%
Posteriorly, do not add the head again.
What criteria does the palm method for assessing burn area use?
Pt's own palm = 1%
When is the Lund Browder method for assessing burns most often used?
What is rapidly assessed for when there is a burn injury?
Is there smoke inhalational injury???
Edema can form RAPIDLY preventing successful intubation.
What can inhalational injuries be caused by? (2)
exposure to toxic fumes
What are signs/symptoms correlating to inhalational injury? (8)
Use of accessory muscles , increased WOB
Singing of eyebrows
Soot or redness of mucosa in mouth/pharynx
Accident occurred in confined space
What is the function of skin? (5)
Regulate body temperature
Eliminates some wastes
Make Vit D
Detect touch, pain, warmth, cold
What are important points to remember regarding pathophysiology of capillaries? (5)
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.
What is escharotomy?
Surgical cuts are made to prevent compartmental syndrome--buildup of fluid.
What other pathophysiological changes may result from burn trauma? (4)
Decreased macrophages to rid of wastes.
Increased neutrophils to prevent infection.
Edema may develop within minutes to 24 hours!
Sloughing of mucosal surface, decreased ciliary function result in decreased airflow and gas exchange. True or false?
A picture of distal bronchus.
How is carbon monoxide formed?
combustion of flammable materials
Carboxyhemoglobin will look like regular Hb so looking at O2 saturation in burn pt will be skewed. True or false?
Carboxyhemoglobin hinders the delivery of oxygen to body cells which leads to hypoxia. True or false?
What kills most people at the site of a fire?
You must order a special blood gas for carboxyhgb called HbCO. True or false?
What is the Baux score a function of and when is it used?
function of age + BSA
Used for large BSA burns.
A Baux score of 80 is associated with death in 50% of cases. True or false?
Inhalational injuries increases the Baux score ____-fold to that of a comparably sized thermal injury or adds ___ years to a Baux score.
What other factors increase the Baux score? (2)
What is the treatment for burn patients? (6)
- 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
What is the most popular fluid resuscitation formula used?
Parkland formula says give crystalloid in 1st 24 hrs.
What information do you need to obtain in pre-op? (5)
Respiratory status/vent requirements
What must be available in the OR prior to patient arrival?
Blood needs to be in the OR prior to the case.
Room MUST be warm!
Use underbody warmers.
What are anesthetic considerations during the perioperative period? (5)
Tailored to your situation, are you worried about difficult a/w
NO SUX 8 hours - 2 years post burn
NMBs wear off fast due to decreased sensitivity
Increased narcotic requirement!
Why do we prohibit the use of Sux 8 hrs to 2 YEARS post-burn?
Increased ACh density which continues to be abnormally elevated for a while.
What are questions to ask yourself during the perioperative period? (7)
Adequate IV and arterial access?
Are you staying on top of blood loss? You will quickly be behind.
Epi-soaked laps being used? They're cold!
What will the narcotic need to be?
Will you be able to extubate?
Estimates say __% of blood volume may be lost for each % of BSA excised.
2% per 1% BSA excised.
What multi-organ system issues do we need to consider?
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.)