Miscellaneous topics 2

Question 1

Patients with extensive burn injuries require

Answer 1

aggressive fluid resuscitation as well as surgery for debridement and skin grafting to prevent bacterial sepsis

Question 2

What are the four classes of burn injury?

Answer 2

superficial
partial-thickness
full-thickness 3rd degree
full-thickness 4th degree

Question 3

Describe a superficial burn

Answer 3

epidermis only

Question 4

Describe a partial-thickness burn.

Answer 4

extends to the dermis

Question 5

Describe a full thickness 3rd degree burn.

Answer 5

complete destruction of the epidermis and dermis

Question 6

Describe a full thickness 4th degree burn

Answer 6

Extends to muscle and bone

Question 7

We can use _________________ to assist with fluid replacement calculations

Answer 7

“rule of nines”

Question 8

Complications of burns include

Answer 8

hypovolemic shock
inhalation injury
sepsis
contractures
scarring

Question 9

What is the patient experience with a 1st degree burn?

Answer 9

stinging, tender and sore

Question 10

What does the patient experience with a 2nd degree burn?

Answer 10

very painful

Question 11

What does the patient experience with a 3rd degree full thickness burn?

Answer 11

no sensation

Question 12

What does the patient experience with a 4th degree burn?

Answer 12

no sensation

Question 13

For children 1-4, the rule of nine’s looks a little different in that

Answer 13

more percentage is given to the child’s head (19%) and slightly less to the legs (15%) and torso (16%)

Question 14

What is the BEST IV fluid to administer in the initial 24 hours after a major burn?
a. D5W
b. 3% NaCl
c. 5% albumin
d. Lactated ringers

Answer 14

d. Lactated ringer’s

Question 15

Immediately after a burn, microvascular permeability

Answer 15

increases and this creates a capillary leak

Question 16

Capillary leak leads to

Answer 16

edema formation
hypovolemia
shock

Question 17

Fluid shifts and edema formation are greatest in the first ______________ and begin to stabilize by _____________

Answer 17

12 hours; 24 hours

Question 18

________________- should be avoided during the first 24 hours because it’s lost to the interstitial space

Answer 18

Albumin

Question 19

What are the two commonly used fluid resuscitation formulas used for the acutely burned patient?

Answer 19

Parkland and Modified Brooke
-both use LR in the 1st 24 hrs. and then use D5W

Question 20

Additional considerations for burn injuries include

Answer 20

abdominal compartment syndrome
carbon monoxide poisoning
airway complications
up-regulation of extrajunctional receptors after 24 hours
impaired temperature regulation
increased oxygen consumption

Question 21

A rising hemoglobin in the first few days following a burn suggests

Answer 21

inadequate volume resuscitation

Question 22

Describe the Parkland fluid resuscitation goals.

Answer 22

4 mL LR x %TBSA burned x kg
1/2 in first 8 hours
1/2 in next 16 hours

Question 23

Describe the Modified Brooke resuscitation goals.

Answer 23

2 mL LR x %TBSA burned X kg
1/2 in first 8 hours
1/2 in next 16 hours

Question 24

What are the clinical end points of burn resuscitation for adults?

Answer 24

UO: >0.5 mL/kg/hr
MAP> 60 mmHg
HR: 80-100
Base deficit <2
Oxygen delivery index: 600 mL O2/min/m2
Mixed venous oxygen tension: 35-40 mmHg

Question 25

What are the clinical end points for children and infants?

Answer 25

UO child <30 kg: >1 mL/kg/hr SBP 70-90 + (2x age in years) SBP for infants >60 mmHg

Question 26

What are considerations with electrical burns

Answer 26

dysrhythmias are common myoglobinemia is caused by extensive muscle damage and is nephrotoxic so needs to be flushed out of the body

Question 27

Abdominal compartment syndrome may result from

Answer 27

aggressive fluid resuscitation

Question 28

Abdominal compartment syndrome is defined as

Answer 28

intraabdominal pressure >20 mmHg (transduction of bladder pressure) AND evidence of organ dysfunction (hemodynamic instability, oliguria, increased PIP)

Question 29

Treatment of abdominal compartment syndrome includes

Answer 29

neuromuscular blockade sedation diuresis abdominal decompression via laparotomy

Question 30

With carbon monoxide poisoning, blood takes on

Answer 30

a cherry red appearance

Question 31

The SpO2 with carbon monoxide poisoning

Answer 31

may give a falsely elevated result

Question 32

Treatment of carbon monoxide poisoning is

Answer 32

100% FiO2 or hyperbaric oxygen

Question 33

The first priority in all burn patients is to

Answer 33

administer a high FiO2

Question 34

The gold standard for diagnosing the extent of airway injury is

Answer 34

fiberoptic bronchoscopy

Question 35

A surgical airway with the patient with a burn injury increases the risk of

Answer 35

pulmonary sepsis and late pulmonary complications - it should only be used as a last resort

Question 36

When can succinylcholine be used with burns?

Answer 36

only within 24 hours; after that it can cause lethal hyperkalemia

Question 37

The dose of nondepolarizing NMBs with burns should be

Answer 37

increased 2-3 fold b/c there are more receptors

Question 38

Patients become ________________ after a burn

Answer 38

hypermetabolic

Question 39

Hypermetabolism leads to increased

Answer 39

catabolism, oxygen consumption, heart rate, and respiratory rate

Question 40

Choose the statement that BEST describes the anesthetic considerations for the patient undergoing electroconvulsive therapy. a. there is an initial increase in sympathetic tone followed by an increased in parasympathetic tone b. hypocarbia increases the seizure duration c. pregnancy is an absolute contraindication d. lithium shortens the duration of action of succinylcholine

Answer 40

b. hypocarbia increases the seizure duration

Question 41

Electroconvulsive therapy is a treatment for

Answer 41

medication resistant depression as well as mania, catatonia, suicidal ideation, and some types of schizophrenia

Question 42

________ is the gold standard induction agent for ECT

Answer 42

Methohexital

Question 43

The efficacy of ECT is primarily dependent on

Answer 43

the seizure duration

Question 44

The best response is obtained when the seizure lasts

Answer 44

>25 seconds

Question 45

__________ during induction can produce a better quality seizure

Answer 45

hyperventilation

Question 46

Select absolute contraindications to ECT include

Answer 46

pheochromocytoma unstable C-spine brain tumor MI within the past 4-6 months recent intracranial surgery (<3 months) recent stroke (<3 months)

Question 47

Key relative contraindications to ECT include

Answer 47

pregnancy CHF glaucoma presence of a pacemaker/ICD retinal detachment severe pulmonary disease

Question 48

The physiologic response to ECT includes

Answer 48

initial response: increased PNS activity during the tonic phase secondary response: increased SNS activity during the clonic phase

Question 49

What drugs are avoided because they decease seizure duration?

Answer 49

propofol midazolam lorazepam fentanyl lidocaine

Question 50

What actions are avoided because they decrease seizure duration?

Answer 50

hypoventilation hypercarbia hypoxia

Question 51

What drugs increase seizure duration?

Answer 51

etomidate ketamine alfentanil with propofol aminophylline caffeine

Question 52

____________ may be given during ECT to blunt the SNS response

Answer 52

Esmolol

Question 53

___________________________ is used as an antisialogogue and reduces the risk of bradycardia and asystole

Answer 53

Glycopyrrolate

Question 54

This drug prolongs the duration of action of succinylcholine AND nondepolarizing neuromuscular blockers

Answer 54

lithium

Question 55

Patients on MAOIs who receive indirect acting sympathomimetics can experience

Answer 55

hypertensive crisis