Test #2 burns PPt- Josh Flashcards Preview

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Flashcards in Test #2 burns PPt- Josh Deck (116):
1

Burns:

Burns are acute wounds caused by a single, non-reoccuring insult to the skin or other organic tissue that is primarily caused by acute exposure to ____, _____, ____, ____, or _____

 

 

  • heat
  • cold
  • chemicals
  • electricity
  • radiation

 

 

2

what are the funtions of the skin

 

  • protection form infection injury
  • Prevention of loss of body fluids
  • Regulation of bdy temp
  • Sensory with enviroment

 

3

Burns:

what are the 6 types of burns

  1. Thermal
  2. Cold exposure
  3. Chemical
  4. electrical
  5. Inhalation
  6. Radiation

4

Burns: Thermal

are associated with what?

  • Steam
  • flames
  • hot liquids
  • hot solid objects

5

Burns: Thermal

Depth of thermal burn is related to what?

Temperature

duration

thickness of skin involved

6

Burns: Cold

also called what

frost bite

7

Burns: Cold

occurs when intracellular fluids freeze and the resulting ____ ____ puncture celss or when extracellular fluids freeze and create a hypotonic enviroment

ice crystals

8

Burns: Cold

result in tissue hypoxia through the interruption of ____ ____, ____, and  ______ _____

  • blood flow
  • hemoconcentration
  • intravascular thrombosis

9

Burns: Chemical

tissue disruption results form a wide range of chemical reations such as what 3 main causes

 

  1. Alteraion in PH
  2. Disruption of cellular membranes
  3. Direct toxic effects on metabolic processes

10

Burns: Electrical
 

electrical current passes through the body and is transformed into _____ energy as it passes through the poorly conductive tissues of the body

thermal

11

Burns: Electrical

electropration occurs!!! what the fuck is that?

  • damage to cell membranes that disrupt membrane potential and function

12

Burns: Electrical

Severity of burn depends on the pathway of _______, the ____ of tissues to electrical current flow, and the ____ and ____ of the electrical flow

  • electrical current
  • resistance
  • strength and duration

13

Burns: Inhalation

toxic chemicals produced in fires can injure the lower airways and cause a ______ burn

chemical

14

Burns: Inhalation

how smoke usually only burns the  what

pharynx

15

Burns: Inhalation

stream can cause injury where?

below the glottis

16

Burns: Inhalation

carbon monoxide produced from combustion can inpair cellular what?

 

respiration

17

Burns: Radiation

____ frequency and ______ energy can disrupt and destroy tissues

  • Radio
  • ionizing

18

Burns: Radiation

what is the most common type of radiation burn?

 

sunburn

19

Burns: Radiation

depending on the photon, radiation burns can cause very deep ____ burns

internal

20

Burns: Radiation

radiation burns are associated w/ what b/c of their ability to interact w/ and damage DNA

Cancer

21

Burns: Radiation

_______is dependent on dose, _____ of exposure, and ____ of particle

  • Severity
  • time
  • type

22

Burns: Assessment

what are the 5 things you want to assess with burns?

  1. Depth
  2. Extent
  3. Location
  4. Pt's age
  5. Pt's comorbidities

23

Skin: Anatomy

what are the layers of the skin (top down )

  • Epidermis
  • Dermis
  • Sub Q fat
  • Muscle

24

Skin: Anatomy

what are the 5 layers of the epidermis( top down)

 

  1. Stratum corneum
  2. Stratum lucidum
  3. Stratum granulosum
  4. Stratum spinosum
  5. Stratum Basale

( cute latin girls suck balls)

25

Skin: Anatomy

what is contained in the dermis

 

  • Hair follicle
  • Sweat glands

 

26

Skin: Anatomy

what is contained in the Sub Q

  • Sub q artery
  • Sub Q Vein

27

Burns: Degrees
 

Define 1st degree

  • superficial burn limited to epidermis
  • (AKA sunburn Basic)

28

Burns: Degrees

what is a superficial 2nd degree burn

  • Involves epidermis and superficial layers of dermis
  • (usually a blister)

29

Burns: Degrees

what is a DEEP 2nd degree burn

  • Involves epidermis and most of dermis

30

Burns: Degrees

what is a third degree burn?

  • full thicknness burn
  • Involves epidermis
  • all layers of dermis
  • and sub q

31

Burns: Degrees

what is a 4th degree burn

  • full thickness burn
  • extends down to muscle and/ or bone

32

Burns: 1st degree

depth

Epidermis

33

 

Burns: 1st degree

appearance

 

dry

red

blanches

34

Burns: 1st degree

sensations

painful

35

Burns: 1st degree

outcome

heals spontaneously

36

Burns: partial thickness 2nd degree superficial

depth

epidermis and superficial dermis

37

Burns: partial thickness 2nd degree superficial

appearance

blisters

moist

red

weeping

blanches

38

Burns: partial thickness 2nd degree superficial

sensation

painful to air and temp

39

Burns: partial thickness 2nd degree superficial

outcomes

heals spont

40

Burns: partial thickness 2nd degree Deep

depth

Epidermis

deep dermis

41

Burns: partial thickness 2nd degree Deep

appearance

blisters

wet/waxy

patchy to cheesy

white to red

DOES NOT BLANCH

42

Burns: partial thickness 2nd degree Deep

sensation

pain to pressure only

43

Burns: partial thickness 2nd degree Deep

outcomes

requires excision and usually grafting

44

Burns: Full thickness 3rd

depth

destruction of epidermis and dermis

45

Burns: Full thickness 3rd

appearance

 

waxy white

leathery

gray/ charred/ black

dry

inelastic

DOES NOT BLANCH

46

Burns: Full thickness 3rd

Sensation

deep pressure only

47

Burns: Full thickness 3rd

outcome

complete excision

limited function

48

Burns: Full thickness 4th

Depth

muscle

fascia

bone

49

Burns: Full thickness 4th

appearance

 

waxy white

leathery

gray/ charred/ black

dry

inelastic

DOES NOT BLANC

 

50

Burns: Full thickness 4th

sensation

 

 

deep pressure only

51

Burns: Full thickness 4th

outcome

complete excision

limited function

52

Burns:

what burns are partial thickness?

  • 2nd superficial
  • 2nd deep

53

Burns:

what burns are full thickness

  • 3rd
  • 4th

54

Burns:

the extent of the burn s expressed in what?

TBSA

(total body surface area)

55

Burns:

the ___ ___ ___ is commonly used to estamiate the burn injury in adults

rule of nines

56

Burns:

the ____-____ chart is reccomended for estimates in pediatric population

lund-Browder

57

Burns:

what method may be used to assess irregular and patchy burn injuries

The palm method

58

Burns:

name the rule of nines

  • head- 4.5 and 4.5 =9
  • chest and abd 18
  • Back 18
  • Right arm 4.5 and 4.5 =9
  • Left arm 4.5 and 4.5 = 9
  • right leg 9 and 9=18
  • left leg 9 and 9 =18
  • no no area = 1%

59

rule of nine pic

 

A image thumb
60

Lund-browder chart

picture

 

A image thumb
61

Burns:

what is the palm of hand estimation

the palm of the PATIENTS hand represents 0.5% of TBSA

the palm of thr PATIENTS hand including the fingers is 1% of TBSA

62

Palm of hands estimation

pic

 

A image thumb
63

Location of injury and complications:

facial and chest burns may indicate possible damage to what?


respiratory system

64

Location of injury and complications:

3rd and 4th degree burns on neck, chest, and abd, could restrict what efforts

respiratory

65

Location of injury and complications:

circumferential burns can restrict what and compress neurovascular bundles

blood flow

66

Location of injury and complications:

burns on what can restrict range of motion

Joints

67

Burn  Injury and age of Pt:

children and elderly tend to have ____ skin

thinner

68

Burn  Injury and age of Pt:

higher motolity in what poopulation due to deeper and more severe burns

children and elderly

69

Burn injury grading system:

what are the 3 classes

 

  • minor
  • Moderate
  • Major

 

70

Burn injury grading system:

what is the criteria for MINOR burns in

  1. adult
  2. Peds
  3. Full thickness

  1. <10%
  2. <5%
  3. <2%

71

Burn injury grading system:

what is the criteria for Moderate burns in

  1. adults
  2. peds
  3. full thickness

  1. 10-20%
  2. 5-10%
  3. 2-5%

72

Burn injury grading system:

what is the criteria for Major burns

  1. adult
  2. peds
  3. Fullthickness

  1. >20%
  2. >10%
  3. >5%

73

Patho of burn injury:

what is the patho of a burn?

Acute burn injury

Inflammatory mediators released

increased capillary permeability

extravasation of fluids into burned tissue

tissue edema

74

Mediators of burns:

what are local mediators released

  • Histamine
  • Prostaglandins
  • Bradykinin
  • Nitric oxide
  • Seratonin
  • Substance P

75

Mediators of burns:

what are systemic mediators released

  • Cytokins
  • Endotoxins
  • Nitric oxide

76

Mediators of burns:

what is the systemic response of the body from all the mediators released from a burn injurt

immune supression

hypermetabolism

Protein catabolism

Sepsis

Multiple organ system failure

77

what are the 2 main phases of a burn

burn shock

Hypermetabolic phase

78

Hypermetabolic phase of a burn:

CO and HR can increase up to how much?

150-300%

79

Effects of burns: Cardiac

what are early effects

hypovolemia

myocardial depression

80

Effects of burns: Cardiac

late effects

systemic HTN

tachycardia

Increased CO

81

Effects of burns: PULMONARY

early effects

  • Upper airway obstruction
  • Airway damage (laryngospasms)
  • Chemical pneumonitis
  • Pulmonary edema

82

Effects of burns: PULMONARY

late effects

  • restriction of chest wall
  • Oxygen toxicity
  • barotrauma
  • Infections
  • Laryngeal damage
  • Tracheal strictures

83

Effects of burns: Electrolytes/ renal

early efefcts

  • Decreased renal blood flow (hypovolemia)
  • Myoglobinuria
  • Hyperkalemia
  • Oliguria/anuria

84

Effects of burns: Electrolytes/ renal

late effects

  • Increased renal blood flow
  • varible drug clearance
  • Hypokalemia (diuresis)

85

Effects of burns: Endocrine and GI effects

GI response

  • Adynamic ileus
  • Stress ulcers
  • Impaired GI barrier to bacteria
  • Endotoxemia

86

Effects of burns: Endocrine and GI effects

Endocrine response

  • Increased serum NE
  • Hyperglycemia

87

Effects of burns:Hemotology

early effects

  • Activation of thrombotic and fibrinolytic factors
  • hemoconcentration
  • hemolysis

88

Effects of burns:Hemotology

late effects

  • Anemia
  • Thrombocytopenia

89

Effects of burns: Thermoregulation

Fxns of the skin such as what are diminished or obliterated

  • Vasoactivity
  • Sweating
  • piloerection
  • insulation

90

Effects of burns: Thermoregulation

hypermetabolic phase of burn injury results in what

 

  • increased skin and core temp

91

Effects of burns: Thermoregulation

what does GA do to the hypermetabolic response

  • Depresses vasoconstriction and metabolism
  • results in rapid decrease in body temp

92

Effects of burns:  Immunologic

what happens

  • Loss of protective barrier
  • immune system impaired
  • Burn eschar- ideal medium for bacterial growth
  • Macrophage activity in alveoli is impaired

93

Fluid resuscitation:

fluid resuscitation should be titrated to maintain a UOP if ___-__ ml/kg/hr in adults and ___-___ mL/kg/hr for peds

  • 0.5-1 mL/kg/hr -adults
  • 1.0-1.5 mL/kg/hr peds

94

Fluid resuscitation:

what is the parkland formula for the 1st 24hrs

  • LR
  • 4 mL/kg x % TBSA

95

Fluid resuscitation:

what is teh parkland formula for 2nd 24 hrs

 

 

  • crystalloids
  • 20-60% esamated plasma volume

 

  • Colloids
  • to OUP of 30 mL/hr

96

Fluid resuscitation:

Capillary leak is a its greatest when

 

  • 1st 24hrs post burn

 

97

Fluid resuscitation:

why is use of colloids contraversial in 1st 24 hrs

  • increased capillary permeability
  • leads to proteins leak into the interstitial space
  • leading to an oncotic effect in extracellular compartment and corsen edema and intravasular hypovolemia

98

Inhalation Injury:

patiens often exhibit no signs or symptoms for first ____ hours

 

24 hours

99

Inhalation Injury:

CO poisoning shifts oxyhemoglobing curve where?

left

100

Inhalation Injury:

CO poisoning does what to pulse ox readings

False high

101

Inhalation Injury:

what is the best tx for CO poisoning?

100% fio2

102

Inhalation Injury:

w/ CO poisoning the use of 100Fio2 decreases the half life of CO from 4-6 hours to what?

40-80 min

103

Inhalation Injury:

S/S of CO poisoning

  • H/a
  • Nausea
  • Breathlessness
  • Collapse
  • Dizziness
  • LOC

(just like a hangover)

104

Debredment and Dressing procedures:

sugical debredment is done by what 2 methods

  1. Tangential excision
  2. Fascial Excision

105

Debredment and Dressing procedures:

what is Tangential excision

  • thin slices of eschar are shaved

106

Debredment and Dressing procedures:

what is Fascial Excision

  • involves removing the burn eschar and underlying fat to the level of the muscle

107

Debredment and Dressing procedures:

massive blood loss of how much

10 PRBCs

108

Debredment and Dressing procedures:

how to estimate blood loss

2-3% of blood loss for each 1% of TBSA

109

Anesthestic management:

b/c the facemask may be uncomfortable what is a great way to intubate

AFOI

110

Anesthestic management:

all fluids should be what?

warm

111

Anesthestic management:

room temp should be what?

28 C

83 F

 

 

 

 

112

Anesthestic management:

what is a great drug for burn pts b/c it wil increase SVR and drcrease heat loss, increase HR and BP

Keta-fucking-mine

113

Anesthestic management:

what inhalation agaent may be best

N2O

b/c least depressant effect of CV

114

Anesthestic management:

do not use what NMBD

SCh

115

Anesthestic management:

many burn pt's may need a __-___ increase in NDMBD

2-5%

116

 

that is i guess

boo that sucked