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40 Cards in this Set
- Front
- Back
How are Burns classified?
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1. (TBSA) Total Body Surface Area
2. Depth of burn 3. Presence or absence of inhalation injury |
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Definition of a minor burn injury?
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<15% TBSA in Adults
<10% TBSA in children or Full thickness <2% TBSA but not involving a joint, eyes, ears face or perineum |
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Definition of a moderate burn injury?
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15-25% TBSA in Adults
10-20% TBSA in kids Full thickness burns 2-10% involving any joint, eyes, ears, perineum |
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Definition of a major burn injury?
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> 25% TBSA in Adults
>20% TBSA in children or adults >50yrs ***Any burns that involve face, eyes, ears, joint, hands, feet, or perineum. *** Any burn that are caused by caustic chemical burns, or hi-voltage injury ***Burns that involve inhalation injury, trauma, or co-morbid illness. |
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What is the pathophysiology involved with a burn? (Big 3+1)
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1. Hypovolemia
2. Hypothermia 3. Hyperdynamic +ARDS (later) |
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What occurs locally to the burned tissue immediately after injury? (occurs systemically if burn is large enough)
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Inflammatory mediators are released from burned( and unburned) tissue:
-oxygen radicals -arachidonic acid metabolites -histamine -prostaglandins -leukotrines -products of platelet activation -complement cascade |
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How is the CV system affected by a major burn?
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1. Loss of vascular and endothelial integrity
2. Loss of plasma proteins from intravascular compartments 3. Hypovolemia--hypotension--CV collapse |
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What is the hemodynamic response to a major burn?
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--Initially catecholamine responses- tachycardia, and vasoconstriction preserve CO.
--CO declines(within min) with loss of intravascular fluid. --Coronary blood flow is reduced- Dec-ing CO, Inc SVR |
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What is the burn classification of a burn that involves the epidermis and dermis, and is expected to heal spontaneously unless it is deep?
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Second degree burns
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What burn classificationinvolves the full destruction of epidermis and dermis requiring wound escsion and grafting, causing some limtation in function and scarring?
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3rd degree -full thickness burns
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What class of burn injury involves muscle and fascia, and bone and requires complete excision and reconstruction
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Fourth Degree Burn
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What is the rule of 9's?
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A way to estimate the extent of burns but may under estimate peds.
Head-arms (each) =9% legs-torso front/back each=18% perineum=1% pediatrics: head=18%, legs=13.5%ea |
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What is the goal of fluid resuscitation in burn injuries?
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Parkland formula 24 hr fluid resuscitation:
%BSA burned x wt(kg) x4 --give 1/2 in first 8hrs --give 1/2 over hrs 9-24. |
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What is the endpoint of fluid resuscitation?
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Good urine output:
0.5cc/kg/hr or 30ml/hr (<30kg then 1cc/kg/hr) |
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What happens to the dose curve of anesthetics with burn pts?
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Shifts curve to Right (require higher doses)
--Higher narcotic requirements --inc resistence to Muscle relaxants (10days-60days after) |
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What anesthetics should be avoided with burn pts.?
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Succinylcholine can cause hyperkalemia with increased risk 8-12 hrs after to greatest risk at 10days to 18months.
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What is the fluid of choice for immediate fluid resuscitation for burns? What should be avoided?
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Fluids for initial resuscitation should be crystalloids, colloids should be avoided until 24hrs post injury.
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What are the primary mediators of systemic inflammation after burn injuries?
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cytokines
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How much fluid is lost from the vascular compartment on the first postburn day?
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4ml/kg for each % of BSA burned
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What is the metabolic response to burn injury?
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Increased Metabolism (hypermetabolic state)
Inc. CO2 production Inc. O2 utilization Impaired thermoregulation |
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How is blood loss calculated and replaced from escharotomy?
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Blood loss: 170-390 ml/% TBSA excised and grafted
Replacement: %BSA(excised) x 6 x EBV/100 x 350(3500) |
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Inhalation Injury can occur cue to exposure to super heated air steam and toxic compounds causing...
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massive pulmonary edema
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What are three types of inhalation injury?
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1. Exposure to Inert gases( CO2, methane, propane and acetylcholine)
2. Exposure to irritant gases (ammonia, formaldehde, chlorine) 3. Exposure to systemic toxins (carbon monoxide, Hydrogen cyanide, hydrogen sulfide) |
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What is the mechanism of injury with inert gases?
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They displace air or O2 producing asphyxia at the cellular level
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What is the MOI with irritant gases?
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Agents dissolve in water in the lining of the respiratory tract and produce a chemical burn and inflammatory response.
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What is the MOI with systemic toxins?
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They interfere with the delivery of Oxygen for cellular energy production and lead to brain and other organ damage.
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What toxin is responsible for 80% of deaths associated with smoke inhalation?
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Carbon Monoxide
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What is the carboxyhgb level when your patient has headaches tinnitus and nausea?
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<20%
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what is the carboxyhgb level when your patient is weak and drowsy?
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20 - 40%
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What is the carboxyhgb level when your patient has severe neurological dysfunction and coma?
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>40%
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What is the carboxyhgb level when your patient has cardiac dysrhythmias brain injury, and death?
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55- 75%
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What is the treatment for Carbon monoxide poisoning?
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CO shifts the oxyhgb curve to the LEFT reducing the unloading of O2,...(O2sats are nl)
tx with 100% Oxygen, (hyperbaric chamber is best) |
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Where in the airways is the injury the greatest from Smoke inhalation?
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The upper airways are affected first and the most.
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Where in the airways does steam injury cause the most injury?
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Steam causes burns to the lower airway and lung parenchyma
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What is the common injury due to in the upper airways from smoke inhalation?
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Swelling causing obstruction
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what happens to the lower airway with smoke inhalation?
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More serious injury, cilia function ceases, causing mucus accumulation, edema, sloughing, and bronchospasm
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What happens to the lung parenchyma with smoke inhalation?
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pneumonitis with increased ciliary permeability and loss of surfactant
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What is needed for a definitive diagnosis of carbon monoxide posioning?
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an ABG for carboxyhgb levels, and a measured O2 satuation (not calculated)
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What is the elimination 1/2 time of CO on room air?
...on 100% O2? ...w/ hyperbaric oxygen? |
Room air: 250 min
100% O2: 45 min HYPerB O2: 4.3 min |
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What does the O2 at measure when a pt has 100% Carbon monoxide poisoning?
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82% (Carboxyhgb has a similar absorption spectrum to oxyhgb.)
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