Burns pt3 Exam 1

Question 1

What lab is commonly elevated with inhalation injuries?

Answer 1

• Carboxyhemoglobin levels > 10%

Question 2

How are Inhalation injuries diagnosed/confirmed?

Answer 2

Bronchoscopy

Question 3

For facial burns:

• Apply bacitracin ointment to___
• Apply erythromycin ointment in the ___
• Avoid using what cream on the face?

Answer 3

• Eye lids
• Eyes

do not use silvadene on the face

Question 4

Carbon Monoxide inhalation is confirmed by what lab?

Answer 4

↑ COHb

Question 5

At what various levels of carboxyhemoglobin are differing signs and symptoms seen?

Answer 5

Question 6

After burns, patients will have elevated ____, ____, and energy needs.

Answer 6

• protein
• vitamin

Question 7

Nutrition within 16 hours of admission is thought to

Answer 7

reduce magnitude of stress response

Question 8

_____ resistance occurs after burn injuries (in regards to nutrition).

Answer 8

Insulin

Question 9

How are burn patients force-fed?

Answer 9

High calorie, high protein feeds into the jejunum

May not be D/C for OR if already intubated

Question 10

What factors can change the pharmacodynamics/kinetics of our drugs? (3)

Answer 10

• Loss of plasma protein concentration
• Alterations in drug receptor (nAChR)
• Cardiac output changes

Lots of medication floating around free because they aren’t bound to anything like albumin…
Increases free fractions and volume of distributon

Question 11

Burns result in up regulation of

Answer 11

nACH receptors

Takes Months to years (1-2) to recover

Question 12

What drug needs to be avoided in the >24hrs after a burn?
Why?

Answer 12

Succinylcholine

Due to upregulation of nACh receptors → may have exaggerated ↑K⁺

Question 13

What paralytic agent is resistant 24hrs after a burn injury?

Answer 13

Non-depolarizing NMBs

Due to upregulation of nACH receptors

Question 14

Resistance to non-depolarizers happens when BSA is over ____%.

Answer 14

25%

Question 15

What signs/symptoms are indicative of airway burn or inhalational injury? (6)

Answer 15

• Hoarseness, wheezing, SOB
• Carbonaceous sputum
• Singed nasal & facial hairs
• Deep facial burns
• Comatose patient
• > 40% TBSA

Question 16

Difficult laryngoscopy can be due to what four factors?

Answer 16

• Edema
• Pain
• Eschar
• Contractures

Question 17

What are some options for securing the ETT vs tracheostomy (2)

Answer 17

• Cotton umbilical tape
• Wire to teeth

Question 18

____ should not be used as an airway management for burn patients

Answer 18

LMA
* doesn’t help with airway edema

Question 19

What are some of the induction drugs for burns (4)

Answer 19

• Propofol
• Etomidate
• Ketamine(Simulates SNS vs depressant effect)
• Opioids

Question 20

An important adverse side effect noted with Etomidate is ______ _______.

Answer 20

Adrenal Insufficiency

• may need steroid supplement

Question 21

What drug is often useful as an adjunct in burn dressing changes?

Answer 21

Ketamine

Question 22

2.6% total blood volume is lost for every __% of burn excised or autograft harvested.

Answer 22

1%

Question 23

Hgb should be maintained around ____ g/dL.

Answer 23

7-8 g/dL

Question 24

____ is a off label drug for burns to prevent blood loss during burn excision.

Answer 24

rFVII

pts are at increased risk of thrombosis

Question 25

List the vasopressors used in shock when MAP is <55 mmHg.

Answer 25

* Vasopressin * Norepinephrine

Question 26

What is the CVP goal with burn patients?

Answer 26

* Goal 6-8 mm Hg * If not at goal, increase IVF rate by 20-25% ## Footnote If UO remains low, give fluids. If you have enough UO and your BP is still low, start vasopressors.

Question 27

What technique is utilized to infiltrate large volumes of local anesthetic subcutaneously?

Answer 27

Tumescent LA w/ epi

Question 28

What is the typical dose of tumescent local anesthetic?

Answer 28

Lidocaine 1G + epi + 10meq NaHCO₃⁻/1000cc NaCL ## Footnote 55mg/kg max

Question 29

What are the goals of tumescent technique? (4)

Answer 29

* Decreased blood loss * Easy excision of granulation tissue * Shorter surgical times * No hematoma or bruising postop

Question 30

When mechanically ventilating a burn patient, target pCO2 to ____ mm Hg or pH >_____.

Answer 30

* 30-35 mmHg * 7.20

Question 31

During mechanical ventilation patients should be nebulized with what drug?

Answer 31

Albuterol w/ 5000 units Heparin Q4H ## Footnote Ensure albuterol is given with heparin since heparin can induce bronchospasm (i.e. wheezing)

Question 32

Abdominal Compartment Syndrome is diagnosed via what?

Answer 32

Bladder pressures . ## Footnote This is the condition which is to be avoided given the high mortality rate if the abdomen is opened (90%). This is why we have such strict rules in terms of fluid management.

Question 33

Bladder Pressure for ACS should be measured every

Answer 33

* Measure Q4H with >20% TBSA

Question 34

Bladder pressures greater than ____ mmHg indicate early intra-abdominal hypertension.

Answer 34

* >12 mmHg

Question 35

____ mmHg is diagnostic for abdominal compartment syndrome.

Answer 35

>20 mmHg

Question 36

Additional burn pain treatment options include

Answer 36

* Additives PRN * Nitrous oxide 50/50 – in addition to Ketamine * Peripheral nerve blocks for extremity injuries

Question 37

Extremities should be elevated ____ degrees.

Answer 37

30-45 degrees (pillows first, then slings)

Question 38

Assess pulses every ____ hour(s).

Answer 38

Hour – Doppler (High risk for losing perfusion and sensation due to compartment syndrome)

Question 39

List the adjuncts to burn Resuscitation management

Answer 39

* **GI Prophylaxis** – High risk for stress ulcers * **Suture** and/or staple all venous and arterial catheters in place * Genitalia/Perineum- Insert **Foley** immediately to maintain urethral patency * **Tetanus** status o Burns are tetanus prone wounds o Booster if > 5 yrs since last booster o Booster plus TIG if no previous immunization * IV antibiotics NOT indicated * Steroids are NOT indicated

Question 40

What topical antibiotics are used in burn dressing changes?

Answer 40

Silvadene and Sulfamylon ## Footnote No Silvadene to the face

Question 41

List the types of commonly used burn dressings.

Answer 41

* Silver dressings * Silverton water or saline every 8 hours * Silver nitrate * Temporary skin substitutes such as Biobrane

Question 42

Why might you see cyanide poisoning with a burn trauma patient? What is the treatment?

Answer 42

* Burning of plastics breathed in * Treated with hydroxocobalamin