Thermal injuries

Question 1

What is the treatment for carbon monoxide poisoning?

Answer 1

100% O2

Question 2

What is the treatment for cyanide poisoning?

Answer 2

hydoxycobalamin

Question 3

What are the symptoms of cyanide poisoning?

Answer 3

-elevated lactate
-persistent acidosis
-unexplained hypoxemia

Question 4

What are the criteria to transfer to a burn center?

Answer 4

-2nd degree burns > 10% TBSA
-3rd degree burns
-burns that involve hands, feet, face, genitalia, perineum, major joints
-chemical burns
-electrical burns including lightning
-any burn w/ concomitant trauma
-inhalation injury
-pts w/ pre-existing medical disorders that could complicate management, prolong recovery, or affect mortality
-hospitals w/o qualified personnel or equipment

Question 5

What is the “pharmacologic triad” (per Osler) that should be used for inhalation injuries?

Answer 5

-bronchodilators = treats bronchospasm
-nebulized heparin = reduces cast formation
-N-acetylcysteine = mucolytic (loosens mucous plugs)

Question 6

What is the parkland formula for burn resuscitation?

Answer 6

4mL/kg/% TBSA in 24hrs (first half given in first 8hrs from time of injury)

Question 7

What is the modified Brooke formula for burn resuscitation?

Answer 7

2mL/kg/% TBSA in 24hrs (first half given in first 8hrs from time of injury?

Question 8

What UOP should be targeted for high voltage electrical injuries w/ evidence of myoglobinuria?

Answer 8

75 - 100mL/hr

Question 9

What are the advantages to silver sulfadiazine?

Answer 9

-broad spectrum (GPC, GNR, fungal)
-painless application
-large burns

Question 10

What are the adverse effects of silver sulfadiazine?

Answer 10

-transient leukopenia
-transient thrombocytopenia
-poor eschar penetration

Question 11

What are the advantages to silver nitrate?

Answer 11

-good coverage (GPC, GNR, fungal)
-painless application
-large burns

Question 12

What are the adverse effects of silver nitrate?

Answer 12

-staining
-hyponatremia
-poor eschar penetration
-methemoglobinemia

Question 13

What are the advantages to using mafenide acetate (sulfamylon)?

Answer 13

-broad spectrum (GPC, GNR)
-good eschar penetration
-small burns

Question 14

What are the adverse effects of mafenide acetate (sulfamylon)?

Answer 14

-metabolic acidosis
-painful application
-not effective against fungal

Question 15

What UOP is needed for electrical burn (mL/kg/hr)?

Answer 15

1mL/kg/hr

Question 16

Why do electrical burns develop myoglobinuria?

Answer 16

damage to renal tubules

Question 17

What type of necrosis is seen due to acid burns?

Answer 17

coagulative

Question 18

What type of necrosis is seen due to burns from a base?

Answer 18

liquefaction

Question 19

What electrolyte abnormality is seen with hydrofluoric acid burns?

Answer 19

hypocalcemia
(fluoride ion precipitates calcium)

Question 20

What topical treatment should be used for hydrofluoric acid burns?

Answer 20

calcium gluconate 2.5% gel

Question 21

At what temperature and class do you start to see bradycardia in hypothermia?

Answer 21

moderate - 28C - 32C (82.4F - 90F)

Question 22

At what temperature and class do you start to see coagulopathy in hypothermia?

Answer 22

mild - 32C - 35C (90F - 95F)

Question 23

At what temperature and class do you start to see metabolic acidosis in hypothermia?

Answer 23

moderate - 28C - 32C (82.4F - 90F)

Question 24

At what temperature and class do you start to see profound hypovolemia in hypothermia?

Answer 24

severe - 20C - 28C (68F - 82.3F)

Question 25

At what temperature and class do you start to see cold-induced diuresis in hypothermia?

Answer 25

moderate - 28C - 32C (82.4F - 90F)

Question 26

What characterizes heat stroke?

Answer 26

hyperthermia w/ CNS derangements (AMS, seizures, persistent delirium) -pathology is not exertional

Question 27

What cooling rate do you want when treating exertional heat stroke?

Answer 27

> 0.1C/min to < 39C

Question 28

What is the pathophysiology of neuroleptic malignant syndrome?

Answer 28

decreased dopaminergic activity at D2 receptor in CNS -either d/t a dopamine antagonist medication (antipsychotics, anti-emetics, cocaine, amphetamines, or TCAs) -or from stopping dopaminergic medications (bromocriptine, levodopa, amantadine)

Question 29

What are s/s of neuroleptic malignant syndrome?

Answer 29

-hyperthermia -labile blood pressures -muscle rigidity -AMS

Question 30

What symptom of serotonin syndrome help distinguish it from other drug-induced hyperthermias?

Answer 30

hyperreflexia/clonus

Question 31

What stage of hypothermia has impaired consciousness and little to no shivering?

Answer 31

moderate/stage 2

Question 32

What is the most effective rewarming technique in hypothermic patient?

Answer 32

cardiopulmonary bypass - rewarms at 9C/hr -VA ECMO at 6C/hr -VV ECMO at 4C/hr -thoracic lavage at 3C/hr -hemodialysis at 2-4C/hr -peritoneal dialysis at 1-3C/hr

Question 33

What body temperature defines perioperative hypothermia?

Answer 33

< 36C

Question 34

What is the most common side effect of dantrolene sodium?

Answer 34

muscle weakness, most commonly diminished hand grip strength

Question 35

What is the most concerning side effect of dantrolene sodium?

Answer 35

hepatocellular injury

Question 36

What is the MOA of dantrolene sodium?

Answer 36

binds to Ryanodine receptor RyR1 in sarcoplasmic reticulum of skeletal muscle -prevents release of calcium stores into cytoplasm of myocyte -inhibits muscle contraction

Question 37

What is the dosing for dantrolene sodium for malignant hyperthermia?

Answer 37

1-2.5mg/kg IV q5-10min -standard duration of therapy is between 24-72hrs

Question 38

What are independent risk factors for unintential perioperative hypothermia?

Answer 38

-chronic renal impairment -anemia -recent unintential weight loss

Question 39

Why is a fever in a burn patient not necessarily indicative of infection?

Answer 39

their hypothalamic thermoregulatory set point is elevated in patients w/ significant burn injuries -mediated by release of pyrogenic cytokines (IL 1, IL 6)