1
Q
There are ___ types of burns? List them.
A
5
- Heat
- Electrical
- Friction
- Chemical
- Radiation
2
Q
_____ is the most common & most ______ type of burn.
A
Heat
Minor
3
Q
_______ is the most extensive and dangerous type of burn
A
Electrical
3
Q
What type of reactions do chemical burns cause to the body? (3)
A
- pH alteration
- Disruption of cell membranes
- Direct toxic effect on metabolic process
4
Q
_______ burns are not common but devastating
A
Radiation
5
Q
With heat burns, what factors contribute to the depth of injury? (3)
A
- Contact temperature
- Duration of contact
- Thickness of skin
6
Q
Heat burns usually involve the _________ (2) layers of skin
A
- Epidermis
- Dermis
7
Q
Describe an electrical burn
A
Electrical energy is transformed to heat when current passes through the body
8
Q
Where does the electrical/heat energy travel with electrical burns?
A
Most common: From point of contact to the ground
If both hands are in contact –> will travel from 1 hand thru center of body to other hand
9
Q
With electrical burns, what factors contribute to the magnitude of injury? (3)
A
- Pathway of current
- Resistant to current flow
- Strength/duration of current flow
10
Q
______ is a common arrhythmia to see with _____ burns. Why?
A
Vfib
Electrical
Disrupts membrane potential
11
Q
Friction burns are a combo of ________ disruption & _______ generated by friction. What consideration should we have with these type of burns? (2)
A
Mechanical
Heat
Considerations:
1. Increase risk of infection dt friction burn being caused by contaminated surface
2. Usually extremely painful
12
Q
With chemical burns, what factors contribute to the magnitude of injury? (2)
A
- Duration of exposure
- Name of agent
13
Q
Superficial Partial Thickness burns are called ________ burns. They heal in _____ days. Describe pain w/ these burns. Is this counted is TBSA?
A
2nd degree
10 - 14 days
They are very painful dt nerve endings being exposed
Yes, this is counted in TBSA for burns
14
Q
With chemical burns, acid causes necrosis by ___________ & alkalosis by ________
A
Coagulation
Liquefaction
15
Q
T/F: Burns are usually uniform in depth
A
F
They are usually not uniform. They have a mix of deep & superficial sections
15
Q
T/F: some chemicals respond violently to water
A
T
16
Q
What is the solution for chemical burns? (2)
A
- Specific antidote
Or
- Dilution
17
Q
Radiation burns are caused by _______ which causes damage. What factors contribute to the magnitude of injury? (2)
A
Ionization
- Dose/time of exposure
- Types of particles
18
Q
Superficial burns are called ________ burns. They heal in _____ days. Describe pain w/ these burns. Is this counted is TBSA?
A
1st degree burns
3-6 days
It is painful & there is hypersentivity
NO, it is not counted in TBSA for burns
18
Q
What type of burn is a sunburn?
A
Radiation burn
18
Q
_________ (2) have deeper burns. Why?
A
- Adults > 55yo
- Kids < 5yo
They have greater areas of thin skin. Thin skin = deeper burns
19
Q
Burns fully declare at the _______ mark. What does this mean?
A
24-48 hour
Your initial contact with the burn is not how it will look. It will get worse and will be in its final form at 24-48 hour mark.
20
Q
Superficial Partial Thickness burns involve the ______ (2) layers. The skin is ______ & ______ in color. The surface is _______ & blisters are __________.
A
- Epidermis
- Dermis
Mottled
Red
Weeping
Present
20
Superficial burns involve the ______ layer only. The skin is ______ & ______ in color. The surface is _______ & blisters are __________.
Epidermis
intact
red
dry
not present
21
What are common burn patterns in abused children? (3)
1. Bil feet burns
2. Cigarette burns
3. Butt burns
(Make sure that the story makes sense, think about your own reflexes)
22
Describe the scarring difference for each type of burn
1st degree: No scar
2nd degree: Minimal scarring
3rd degree: Varying degree of scarring
23
Deep Partial Thickness burns involve the ______ & deep into the _______ layers. The skin has ______ blanching & ______ in color. The surface has _______ & blisters are __________.
Epidermis
Dermis
Absent/Prolonged
Pale
Decreased moisture
Absent
24
Deep Partial Thickness burns are called ________ burns. They heal in _____ days. Describe pain w/ these burns. Is this counted is TBSA?
2nd degree
21-28 days
Very painful dt exposed nerve endings
Yes, this is counted in TBSA for burns
25
________ is required for both Deep partial & full thickness burns. What does this affect? (2) Why?
Skin grafting
1. Inability to control temp
2. Diffifcult to get vascular access
Grafts dont have the same structures
26
What types of burns are included in TBSA for burns? (2)
2nd and 3rd degree
27
With Full Thickness burns the _____ layer is destroyed. The skin is ______ & ______ in color. The surface is _______ & blisters are __________.
Dermis
Charred
translucent
dry
Not present
28
Fulll Thickness burns are called ________ burns. Blanching on the skin is _______. Describe pain w/ these burns. Is this counted is TBSA?
3rd degree
Not present (Nonblanchable)
Painless dt nerve ending being burned off.
Yes, it is included in the TBSA for burns.
29
No blanching = no ___________
perfusion
30
The rule of 9 for ADULTS is about _____ accurate. Describe the percentages for adults.
60-70%
Head: 9%
Each arm: 9%
Each leg: 18%
Anterior/posterior trunk: 18%
Perineum: 1%
31
Describe the percentages for infants for rule of 9.
Head: 21%
Each leg: 13.5%
Anterior/posterior trunk: 13%
Each arm: 10%
Butt: 5%
Perineum: 1%
32
What is the Palmer method? Describe it
Another method for TBSA burn calculation
Using the pt's palm --> fingers together = 1% of TBSA
(Best for smaller burns & more accurate than rule of 9)
33
Larger burn TBSA are usually __________ dt burns not fully declaring immediately. What other populations may experience trouble w/ burn accuracy? Why? (2)
underestimated
1. Women w/ large breasts (D or larger):
-Will have a larger TBSA effected than calculated from rule of 9
2. Obese:
-**Underestimates torso**
-**Overestimates extremities**
34
The 2 conflicting priorites w/ burns are ____________ (2). Describe what's happening.
1. **Edema** --> Increased permeability causes loss of plasma from microvascular into interstitial
2. **Hypovolemic shock** --> causes decreased perfusion
(Shock is caused by the increased permeability but if you overdo fluids to help with the shock the edema is gonna keep getting worse)
35
Fluid loss in burn pts are a function of ________ (2)
1. Burn size
2. Pt wt
36
Pt's with _____% TBSA burns will develop shock. What considerations should we have? (2)
>20%
1. Need IV resuscitation in an ICU
2. Need to go to specialized burn center
37
What is the goal in treating severe burns? What are potential consequences for under resuscitation? (3) Over resuscitation? (2)
Maintain organ function
Under:
1. Decrease perfusion
2. Burn shock
3. End Organ failure
Over:
1. Abdominal compartment syndrome
2. Pulmonary edema/ARDS
38
With under perfusion in burns, which organ is particularly sensitive to being affected? Why?
Kidneys
Increased myoglobin --> blocks kidney filtration
39
The metabolic response to severe burns is called ____________. What is this? What does this caused the body to do? (6) what do we do to try to prevent this?
Auto-cannibalism
The body goes into a **hypermetabolic state** that causes the body to "eat" itself
1. Loss of fat
2. Loss of lean body mass
3. Gluconeogenesis
4. Lipolysis
5. Hypermetabolism
6. Insulin resistance
Feed pt early (tube feeds)
40
The metabolic response to severe burns depends on ________ (3). Describe how it affects each.
1. Intensity of burn
2. Duration of burn
- depends on magnitude of injury & degree of pain
3. If TBSA >40%
-**metabolic rate doubles**
-cannibalism for a months
-**causes immunodepression** --> recurrent infections & poor wound healing
41
Burns affect on carbohydrates causes an increase in _________ (3) dt the hypermetabolic state. What does this cause? (3)
1. Cortisol
2. Catecholamines
3. Glucagon
Causes a **diabetic-like state** dt:
1. Accelerated hepatic glucogenesis
2. Peripheral insulin resistance
3. Impaired intracellular glucose transport
42
Insulin resistance in burns can last up to _____.
3 years
43
Burns affect on lipids causes _________ dt the hypermetabolic state. What does this cause? How do you Tx this?
Accelerated lipolysis
Increase B2 & B3 adrenergic stimulation --> increased cAMP --> increased glucagon, TNF, IL --> increased FFA --> Increased ATP production
Tx = **Beta Blocker** --> decreases lipid oxidation --> decreases metabolic rate
44
Burns affect on protein causes an increase in _________ of skeletal muscle dt the hypermetabolic state. What does this cause?
Proteolysis
Provides substrate for hepatic glucogenesis (increases process)
45
With the burn affects on protein, the degree of loss is ________ to the degree of stress. What does this mean? How does cortisol affect this? TNF, IL-1, IL-6?
Proportional
Proteolysis is **doubled** in severe burns
Affects:
Cortisol = **Improves** proteolysis
TNF, IL-1, IL-6 = **Worsens**
46
What is considered "Initial Stabilization" when managing a severe burn patient? (5)
**Basic ABCs**
1. Securing airway/respiratory support
2. Fluid resuscitation
3. Cardiovascular stabilization
4. Pain control
5. Local care of burn wounds
47
What is considered "secondary priorities" when managing a severe burn patient? (6)
1. Continued pain control
2. Thromboprophylaxis
3. Wound closure
4. Nutritional support/emotional support
5. Control of hypermetabolism
6. Prevention of infection
48
Burn patient are often sent home on a _______ diet. Why?
High protein
To help offset the hypermetabolic state
49
What considerations should we have with Thromboprophylaxis & burn pts?
We may be limited in the mechanical options dt the severity of the burns & even w/ mechanical options we may have to weigh out the pros/cons and use them anyway if they cannot use other methods
50
We need ______ levels of analgesics in severe burn pts, therefore they need to be _______. What are ways to manage pain in burn pts? (8)
Constant
Scheduled
1. Long acting opioids (methadone)
2. NSAIDs (acetaminophen)
3. PCA infusions (morphine)
4. IV ketamine
5. Supplemented with/ anti-anxiety drugs (low-dose benzo)
6. Nitrous Oxide 50/50
7. Peripheral nerve blocks
8. Avoidance/approach (dont touch it!)
51
_______ may be altered in burn patients. How does this affect dosing for pain medication? Why?
PK/PD
May need to deviate from normal dosing
To avoid toxicity or decrease efficacy dt hypermetabolic state & renal issues caused from the burns.
52
F/T: IM opioids is the best option for burn pts
F
dt absorption being uncertain -- **want to do IV only** (maybe PO later on)
EVEN ON NONBURNED AREAS DO NOT DO IM INJECTIONS
53
Why is fluid resuscitation necessary after burns? (2)
1. Impaired endothelial barrier --> **increased capillary permeability** --> loss of intravascular oncotic pressure --> copious loss of intravascular fluids --> edema dt fluid leak leaking into the interstitium --> eventually wounds/body begins weeping
2. Systemic inflammatory reaction --> release of histamines, prostaglandins, cytokines --> vasodilation
54
What mediators are released after burns causing vasodilation? (3)
1. Histamine
2. Prostaglandins
3. Cytokines
55
With burns we can give a _________ to help prevent systemic inflammatory reactions caused by the release of __________ which causes vasodilation.
Antihistamine
Histamine
56
With burns, we will initiate IV fluid resuscitation generally for _____% or ____ TBSA
15% or more
(15% or greater we need to start IV fluid protocol)
57
The TBSA of your pulmonary system is about the size of a _________ & bc of this airway burns are normally ________
Tennis court
Underestimated
58
Pts with _____________ (3) will require higher volumes with IV resuscitation w/ Burns
1. Inhaled burns
2. Electrical burns
3. Delayed resuscitation
59
With IV fluid resuscitation with burns we should consider titrating the formula down in regards to __________
Adequate urine output
60
Equation: Parkland formula
Adults:
4ml/kg/%TBSA
Pediatrics:
2-4ml/kg/%TBSA
-Give 1/2 within 1st 8 hours
-Give 2nd half in last 16 hours
(start time = time of injury)
61
When calculating IV fluid resuscitation for burns, what is the start time for fluids?
Time of injury NOT time arrival to the hospital
62
Equation: US Army ISR (Rule of 10)
**Adult:**
10ml/hr x %TBSA
(if >80kg, add 100ml for every 10kg over 80kg)
**Pediatric:**
3ml/kg/%TBSA
**Given in 24hrs**
(1/2 in the 1st 8 hours -- the rest in the last 16hrs)
63
What are reasons for a patient to transfer to a certified burn center? (5)
1. Full thickness burns >10% TBSA
2. High voltage electrical burns
3. Chemical burns
4. Associated inhalation injury
5. Face, hands, feet, perineum, major joints burns
64
The urine output goal for adults is _______ & for pediatrics it is ________.
Adults:
1cc/kg/hr
Pediatrics:
0.5-1cc/kg/hr
(Total goal = 30-50 cc/hr)
65
We use ________ (2) fluids in IV Full resuscitation and burns. What type of fluid do you want to avoid? Why?
1. LR
2. Any other isotonic solution
Normal saline
Increase risk of hypernatremia hyperchloremic acidosis
66
T/F: we should give a fluid bolus immediately to our burn patients to help with the vasodilation
F
No fluid boluses actually --> volume increases edema
67
What are the wt considerations w/ resuscitation for pediatrics w/ burns? (2)
If >40 kg -- use adult formula
If <14yo & <40kg -- use pediatric formula
68
Children ____ kg need to have what type of fluid fluids for IV fluid resuscitation with burns?
<20 kg
D5LR
69
When should you consider giving colloids w/ burns? (2). What type of colloid should you give?
**8-12 hours post burn**
1. If hourly IV rate exceeds 1500 ml/hr
2. Projected 24 hour total approaches 250ml/kg
You should give 5% albumin
70
What is the colloid infusion rate for pediatrics w/ burns? How does this affect crystalloids?
Colloids:
4-7ml/kg given at 0.5ml per minute
Reduce maintenance fluid by an equal volume per hour
71
Equation: Pediatric colloids
4-7ml/kg
Given at 0.5ml per minute
72
The cardiac resuscitative phase in severe burns is also called the _________. What happens during this phase? (5) How do we prevent this?
Cardiac output "Eebb" state
1. CO low (reduced by 60%)
2. Hypovolemia (dt increase permeability)
3. Reduced response to catecholamines
4. Increased SVR (dt vasopressin levels-- cardiogenic shock response)
5. Myocardial ischemia (dt decreased coronary flow)
How to prevent:
Ensure appropriate fluid resuscitation
73
The cardiac phase that is 72-96 hours post burns is called the _________. What happens during this phase? (3) How do we prevent this?
"flow" phase
1. Hyperdynamic --> increased CO, tachycardia
2. Increased myocardial O2 consumption
3. Decreased SVR
How to prevent:
Administer beta blocker
74
In Burns, the systemic inflammatory process that affects the lungs begins _________. How does this affect the pulmonary system? (5) What can we give to help?
Immediately
1. Can lead to pulmonary hypertension
2. Pulmonary capillary alveolar membrane disruption
3. Decreased plasma oncotic pressure
4. Increased extravascular lung water (pulm edema) --> impairs gas exchange
5. Bronchospasms --> **can give a bronchodilator**
75
How does restrictive lung defect affect the pts pulmonary status with burns? What is the Tx for this?
Impaired ventilation from circumferential burns/scars on chest which prevent lungs from expanding fully --> hypoventilation dt decreased elasticity
Tx: **Escharotomies**
- procedure on top of the chest to help lungs be able to expand again
76
What are common signs of inhalation injuries? (5)
1. Singeing of face/nasal hair (no eyebrows/lashes)
2. Oropharyngeal carbon/Carbonaceous sputum
3. Carboxyhemoglobin levels >10%
4. Wheezing, SOB, Horseness
5. Deep facial burns
6. >40% TBSA burn
7. Confirmation by bronchoscopy
77
With extensive facial burns, how might we secure that ETT? Why?
Sutures
Tape won't work dt extensive edema
78
With facial burns we apply ______ to the eyeLIDS & ______ in the eyes.
Bacitracin
Erythromycin
79
What considerations should we have w/eyes and facial burns? (3)
1. Protect the eyes
2. Look for/remove contact lenses
3. Consult ophthalmologist
80
CO levels of about _____% is when we start to see symtpoms? What are CO levels of smokers?
10%
Smokers: 4-9%
81
Carbon monoxide is caused by _______ Cyanide poisoning is caused by ________
Burning fuels
Burning plastics
82
What symptoms are associated w/ specific CO levels?
**1-3%** Normal non-smoker
**4-9%** smoker
**15-20%** overt signs of toxicity
-HA, N/V
**20-25%** signs of severe toxicity
-seizures, acute RF, MI
**>25%** unconscious & death
83
With severe burns, you have elevated needs of ________ (3) & want to start feeding within ______ hours of admission. Why? What consideration should we have with this? (2)
1. Protein
2. Vitamins
3. Energy
16 hours
Why: reduce magnitude of stress response on the body
Considerations:
1. Want to ensure high calorie/high protein intake
2. **Want nasoenteric feeds into the jejunum** --> will not need to d/c for Sx if already intubated
84
In severe burns, how does increased membrane permeability affect pharmacology?
Decreased plasma protein concentration --> **increases free fractions & volume of distribution**
85
Burns causes ________ of nACh-R that can last for ________. What does this cause? (2)
up-regulation
Months to years (1-2)
1. Resistance to nondepolarizing paralytics (25% TBSA & more)
2. Sensitivity to depolarizing
86
What effects does depolarizing paralytics have w/ severe burn pts? When do these effects begin? When do they become significant?
1. Increased sensitivity
2. Markedly increased serum K+
Begins: approximately **24hrs post** burn
Significant: **48-72hrs** post burn
87
T/F: Pulse Ox are not accurate with severe burn pts
T
Increased levels of CO falsely elevating SPO2
88
What considerations should we have with invasive lines & burn pts? (2)
Should be sutured dt weeping everywhere.
Probably should get art line vs noninvasive BP...
89
_________ is an alternative to Lactate levels when monitoring burn pts
Base deficit
90
With burn pts, they can lose up to ___degree C every ____ minutes therefore we need to use _________ warming devices.
1 degree C
15 mins
Convection
91
Signs of inhalation injury should always be treated as a __________. What do we need to make sure we do? (2) Why?
Known difficult airway
1. Take the airway early
2. Use proper equipment for a difficult airway the 1st time
The edema will only get worse, it will not get better
92
What are signs of impending airway obstruction with burns? (3) What should we do?
1. Stridor
2. Hoarseness
3. Dysphagia
Intubate immediately
93
T/F: It is optimal to use an LMA with burn pts
F
But if that's the only way that you can facilitate air movement/gas exchange please use it
94
Induction agent considerations w/ burns: Propofol
Good for the flow phase
Not as good for the ebb state -- causes vasodilation
95
Induction agent considerations w/ burns: Etomidate
Causes adrenal insufficiency -- not good in someone who needs their cortisol
96
Induction agent considerations w/ burns: Ketamine
Has analgesic effects
Often use for burn dressing changes
Preserves/stimulate SNS
Has depressant effects
97
Induction agent considerations w/ burns: Opioids
May be better used in the flow phase vs ebb phase
98
With burns, hemodynamic instability is caused by _________. What does this decrease? (2) What device can be used to monitor this? Why?
Hypovolemia
1. Decrease preload
2. Decrease cardiac output
**Rescue TEE** -- helps to rule out cardiogenic, distributive, MI
99
There is ____% total blood lost for every 1% burn excised or autograph harvest
2.6%
100
With burns, we should transfuse a pt if the Hgb is _______. If they have acute coronary syndrome we should transfuse at Hgb of ______.
7-8 g/dL
10 g/dL
101
What are ways that we can reduce blood loss with burns/procedures? (3)
1. Topical thrombin
2. Staged procedures
3. SQ vasocontrictors
102
________ increases risk of thrombosis & ________ increases risk of thromboembolism in burn pts
Recumbant factor VII (rFVII)
IV TXA
103
In burn pts, shock is considered a MAP below ______. What pressors are used in these pts to help combat this? (2)
< 55mmHg
1. Vasopressin
2. NE
104
In burn pts w/ shock, the goal CVP is _______. What should you do if not at goal?
6-8 mmHg
Increase IVF rate by 20-25%
105
__________ is a technique to infiltrate large volumes of LA SQ when doing a graft for burns. What are the effects of this? (4)
Tumescent LA
1. Decreased blood loss
2. Easy excision of granulation tissue
3. Shorter surgical times
4. No hematoma or bruising postop
106
What does Tumescent LA consist of? What is the max dose?
Lidocaine 1G + epi + 10 meq NaHCO3/1000 NaCl
Max dose:
55mg/kg
107
For mechanical ventilation w/ burns, we want to elevate the HOB to ____ degrees. The target pCO2 is ______ & pH is _______.
30 degrees
pCO2: 30-35 mmHg
pH: >7.20
108
For mechanical ventilation w/ burns, what medication helps mobilze secretions?
Nebulizer 5000 units heparin w/ Albuterol every 4hrs
109
What causes abdominal compartment syndrome w/ burns? How does it affect the body? How is it Dx? What consideration should we have with this?
Over resuscitation can edema of the bowel which causes this
Increased abdominal pressure displace the diaphragm up
Dx by bladder pressures
Considerations: a burn patient has a **90% mortality** with an open abdomen (which is a Tx for this)
110
When should you start checking bladder pressures w/ burn pts?
If %TBSA is >20% --> Check bladder pressures every 4 hours
111
Value: Early intra-abdominal hypertension
Bladder pressure >12 mmHg
112
Value: Abdominal compartment syndrome
Bladder pressure >20mmHg
113
With burn patients, what consideration should we have with assessment of pain?
Always use the same pain scale consistently
114
With burn pts you want to elevate the extremities ________ degrees. What should you use to do this?
30-45 degrees
pillows 1st --> sling 2nd
115
How often should you examine limb pulses in burn pts? What should you do if you dont feel a pulse? What should you do next?
Every hour
Use Doppler
If pulses are truly lost --> **Escharotomy**
116
What is an Escharotomy? What does it do?
Cuts through the eschar tissue on the chest --> chest allow to expand --> Increases ventilation & Cardiac output
Increases perfusion to limbs
117
T/F: Scotal swelling does not require specific Tx
T
Unless there are burns directly to the area
118
Burn wounds are prone to ________. How do we help prevent this? (2)
Tetanus
1. Booster -- if last one was over 5 years ago
2. Booster + TIG -- if no previous vaccine at all
119
__________ (2) are not indicated for burn pts unless indicated.
1. Prophylaxis IV Abx
2. Steroids
120
__________ (2) are topic Abx used for burn wounds. We use _________ (2) every ______ to irritate the wound & ________ for dressings.
1. Silvadene
2. Sulfamylon
-1. Silverton water
2. Saline
every 8hrs
Silver/silver nitrate
121
______ can be used as a temporary skin substitue for burn dressings.
Biobrane
122
T/F: Silvadene can be used everywhere
F
It CANNOT be used on the face
Principles 2 Fall 2025
flashcards
Decks in class (17)
# Cards
-
OR Communication51
-
Burns127
-
Hospital Acquired Infections & Abx132
-
Anesthesia Implications for Obesity99
-
Geriatrics37
-
Positioning82
-
SCIP24
-
ERAS96
-
PACU122
-
Acute pain138
-
OFA33
-
Immune Dysfunction109
-
General & Laproscopic Sx96
-
GU Procedures88
-
Postop NV60
-
Oncology/Chemo136
-
Common Anesthesia Meds (Pharm ppt)133
