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40 Cards in this Set

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