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Questions and Answers
Which of the following types of burns is the least common?
Which of the following types of burns is the least common?
What percentage of Total Body Surface Area (TBSA) burned do adults start with?
What percentage of Total Body Surface Area (TBSA) burned do adults start with?
In the Parkland formula, what is the preferred crystalloid for fluid resuscitation?
In the Parkland formula, what is the preferred crystalloid for fluid resuscitation?
Which burn zone represents the area with the most severe damage?
Which burn zone represents the area with the most severe damage?
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How long is the first half of the calculated fluid infused in the Parkland formula?
How long is the first half of the calculated fluid infused in the Parkland formula?
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What depth of burn involves damage to the epidermis and minimal layers of dermis?
What depth of burn involves damage to the epidermis and minimal layers of dermis?
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What is the TBSA percentage for the perineum in the Rule of Nines?
What is the TBSA percentage for the perineum in the Rule of Nines?
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Which factor is NOT considered when determining burn severity?
Which factor is NOT considered when determining burn severity?
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Which of the following complications can arise from untreated ulcerative colitis?
Which of the following complications can arise from untreated ulcerative colitis?
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What is a common manifestation of hepatitis?
What is a common manifestation of hepatitis?
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Which route is NOT commonly associated with the transmission of hepatitis?
Which route is NOT commonly associated with the transmission of hepatitis?
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What is the primary treatment option for acute hepatitis?
What is the primary treatment option for acute hepatitis?
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Which type of hepatitis virus requires the presence of another virus for infection?
Which type of hepatitis virus requires the presence of another virus for infection?
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Which condition is a leading cause of cirrhosis of the liver?
Which condition is a leading cause of cirrhosis of the liver?
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What can be an outcome of effective management failed acute hepatitis?
What can be an outcome of effective management failed acute hepatitis?
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Which of the following describes a common risk factor for developing hepatitis?
Which of the following describes a common risk factor for developing hepatitis?
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What is a primary symptom of metabolic acidosis due to ketone production?
What is a primary symptom of metabolic acidosis due to ketone production?
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Which diagnostic criteria indicates the presence of hyperosmolar hyperglycemic syndrome?
Which diagnostic criteria indicates the presence of hyperosmolar hyperglycemic syndrome?
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What is the most common treatment for hyperosmolar hyperglycemic syndrome?
What is the most common treatment for hyperosmolar hyperglycemic syndrome?
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Which type of thyroid cancer is most common in females?
Which type of thyroid cancer is most common in females?
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In which part of the gastrointestinal tract does Crohn's disease primarily manifest?
In which part of the gastrointestinal tract does Crohn's disease primarily manifest?
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What is a common complication of Ulcerative Colitis?
What is a common complication of Ulcerative Colitis?
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Which of the following symptoms is NOT typically associated with metabolic acidosis due to ketones?
Which of the following symptoms is NOT typically associated with metabolic acidosis due to ketones?
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What is a common feature in the diagnosis of Inflammatory Bowel Disease?
What is a common feature in the diagnosis of Inflammatory Bowel Disease?
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What are the common manifestations of liver cancer?
What are the common manifestations of liver cancer?
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Which of the following is a complication of pancreatitis?
Which of the following is a complication of pancreatitis?
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What is a significant risk factor for developing liver cancer?
What is a significant risk factor for developing liver cancer?
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Which sign is indicative of retroperitoneal hemorrhage in acute pancreatitis?
Which sign is indicative of retroperitoneal hemorrhage in acute pancreatitis?
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What often causes the autodigestion seen in acute pancreatitis?
What often causes the autodigestion seen in acute pancreatitis?
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What is the prognosis typically associated with late-stage liver cancer?
What is the prognosis typically associated with late-stage liver cancer?
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Which of the following management techniques is NOT typically associated with liver issues?
Which of the following management techniques is NOT typically associated with liver issues?
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What is indicated by ascites in liver conditions?
What is indicated by ascites in liver conditions?
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What is a common symptom associated with pancreatic disease?
What is a common symptom associated with pancreatic disease?
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Which of the following risks is associated with pancreatic cancer?
Which of the following risks is associated with pancreatic cancer?
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What is a characteristic feature of rheumatoid arthritis?
What is a characteristic feature of rheumatoid arthritis?
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What defines the etiology of Diffuse Connective Tissue Diseases?
What defines the etiology of Diffuse Connective Tissue Diseases?
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Which management option is least likely to be used for chronic pancreatitis?
Which management option is least likely to be used for chronic pancreatitis?
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What is a notable demographic characteristic of Systemic Lupus Erythematosus (SLE)?
What is a notable demographic characteristic of Systemic Lupus Erythematosus (SLE)?
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Which manifestation is commonly seen in pancreatic cancer?
Which manifestation is commonly seen in pancreatic cancer?
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During which age range is rheumatoid arthritis most likely to develop?
During which age range is rheumatoid arthritis most likely to develop?
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What is the primary metabolic change observed in burn patients following a burn injury?
What is the primary metabolic change observed in burn patients following a burn injury?
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Which of the following accurately describes the zone of stasis in burn injuries?
Which of the following accurately describes the zone of stasis in burn injuries?
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What is a common renal complication seen in burn patients, particularly those with electrical injuries?
What is a common renal complication seen in burn patients, particularly those with electrical injuries?
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What is a key priority in the management of burn patients during the emergent phase?
What is a key priority in the management of burn patients during the emergent phase?
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What is the leading cause of death in burn patients after the first 24 hours post-injury?
What is the leading cause of death in burn patients after the first 24 hours post-injury?
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Which type of burn injury requires urgent flushing with water if chemicals are involved?
Which type of burn injury requires urgent flushing with water if chemicals are involved?
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What surgical procedure is primarily performed to relieve pressure in burn patients experiencing compartment syndrome?
What surgical procedure is primarily performed to relieve pressure in burn patients experiencing compartment syndrome?
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Which element should be monitored closely in burn patients due to the risk of hyperkalemia?
Which element should be monitored closely in burn patients due to the risk of hyperkalemia?
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What is a long-term psychological consideration that must be addressed in burn recovery?
What is a long-term psychological consideration that must be addressed in burn recovery?
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Which of the following is NOT a systemic effect of burns?
Which of the following is NOT a systemic effect of burns?
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Study Notes
Burns
- Classified by etiology (thermal, electrical, chemical, radiation)
- Thermal burns: flash, scald, house fires, cooking accidents
- Electrical burns: arc between two objects
- Chemical burns: 3% of all burn admissions
- Radiation burns: least common, severity depends on exposure location, depth, and duration.
- Depth of tissue damage: superficial, superficial partial-thickness, deep partial-thickness, full-thickness
- Superficial: epidermal damage, erythema, resolves in 24-72 hours
- Superficial partial-thickness: involves epidermis and minimal dermis
- Deep partial-thickness: involves epidermis and deeper layers of dermis
- Full-thickness: destroys epidermis, dermis, and portions of subcutaneous tissue
- Total Body Surface Area (TBSA): crucial for fluid resuscitation and treatment calculation.
- Adults: TBSA starts at 20%
- Elderly and Pediatrics: TBSA starts at 10%
- Severity: factors include the extent of the burn, age of the patient, medical history, and location of the burn.
- Burn Zones include Coagulation, Stasis and Hyperemia zones.
Rule of Nines
- Commonly used method for estimating TBSA burned.
- Diagram showing body segments and their percentage of TBSA.
- Anterior view and posterior view body diagrams showing percentage per body part.
Fluid Resuscitation Using Parkland Formula
- 4 ml LR x weight in kg x %TBSA
- LR (Lactated Ringers) is the crystalloid of choice
- One half of calculated fluid infused in 8 hours
- The other half infused over 16 hours.
Anatomical Changes
- Zone of Coagulation: most severe damage from heat source, extensive protein coagulation. Eschar (dead tissue) frequently present.
- Zone of Stasis: surrounds Coag, with damaged cells and impaired circulation.
- Zone of Hyperemia: outermost layer. Blood flow increases to deliver nutrients for tissue recovery. Location over joints or other sensitive areas requires heightened care.
Systemic Effects of Burns
- Significant consequences on multiple organ systems due to cytokine and mediator release
- Impact on respiratory, cardiovascular, renal, and gastrointestinal systems
- Metabolic changes including increased caloric needs and impaired wound healing.
- Immunological responses with high risk for infection
- Systemic inflammatory response syndrome (SIRS)
Sepsis
- Leading cause of death in burn patients after first 24 hours.
- Infection control is paramount
- Approximately 28-65% of burn patients die due to sepsis.
Special Considerations for Special Burns (Inhalation, Electrical, Chemical)
- Inhalation: often involves carbon monoxide and CO2 poisoning, requiring immediate high oxygen therapy.
- Electrical: extent of injury isn't always apparent, necessitating attention to spinal cord injuries and compartment syndrome.
- Chemical: immediate flushing with water and further specialist assessment and intervention is critical.
Burn Phases
- Emergent Phase: airway management, fluid resuscitation, addressing life-threatening injuries, stabilization, and early intervention
- Intermediate Phase: wound care, infection control, and managing secondary complications
- Rehabilitative Phase: preventing contractures, managing lingering physical and psychological effects.
Endocrine System
- Complications of Diabetes Mellitus (DM): inadequate insulin impacting normal cellular metabolic processes
- Diabetic Ketoacidosis (DKA): rapid breakdown of fat, producing ketones, triggering lower pH, and metabolic acidosis.
- Hyperosmolar Hyperglycemic Syndrome (HHS): high glucose, dehydration, but not high ketones, commonly resulting from infection.
- Diagnoses for DKA or HHS: serum glucose >250mg and/or ketones in the urine, pH <7.3, bicarbonate <18mEq/L, possible altered level of consciousness (LOC) or coma.
Diabetic Ketoacidosis (DKA)
- High blood sugar, dehydration, without ketones, result of infection
- Pathophysiology: less insulin. Fat is broken down for energy; ketones result in lower pH
- Manifestations: high blood sugar, dehydration
- Diagnostics: glucose > 250, serum ketones and pH <7.3, HCO3 levels <18.
- Treatment: fluid and electrolyte replacement, insulin.
- Potential consequences include hypotension, tachycardia, kussmal respirations.
Hyperosmolar Hyperglycemic Syndrome (HHS)
- High blood glucose, severe dehydration
- Pathophysiology: Enough insulin to prevent ketones, but not enough to regulate blood sugar and cause dehydration
- Manifestations: profound dehydration, altered level of consciousness possible
- Diagnostics: glucose > 600, serum osmolality > 320
- Treatment: fluid replacement, insulin.
Thyroid Cancer
- Classification: papillary, follicular, medullary, anaplastic
- Manifestations: nodule
- Diagnosis: ultrasound, biopsy
- Treatment: radiation, surgery, lifelong hormone replacement. Common in females
Gastrointestinal System: Inflammatory Bowel Disorders
- Types: Crohn's disease and Ulcerative colitis
- Incidence higher in US, Canada, UK, Sweden and Norway, with Canada's incidence being the highest globally.
- Management: controlling symptoms (diarrhea, abdominal pain, cramping), addressing fluid/electrolyte imbalance and stool blood, potentially requiring colectomy in severe cases.
- Complications: increased risk of small bowel or colon cancer.
Esophageal, Stomach, Colorectal Cancer
- Different types of GI cancers requiring specific knowledge of anatomy, physiology, diagnostics, treatment, and patient education.
Hepatic and Pancreatic System
- Hepatitis (viral and non-viral): Types HepA thru HepG, with different routes of contagion and treatment options. Hepatitis is caused by several viruses and is transmitted through fecal-oral, blood, or bodily fluids. Chronic cases can potentially lead to liver cancer.
- Cirrhosis: HepC leading cause, followed by chronic excessive alcohol consumption. Pathophysiology involves altered blood flow within liver. Potentially leading to scarring and liver failure.
Liver Cancer
- Risk factors include age > 65, male, history of chronic hepatitis B/C and heavy/prolonged alcohol abuse.
- Usually fatal within 6-12 months
- Manifestations: often asymptomatic until advanced, including pain, weight loss, anorexia, weakness, fatigue, jaundice, and ascites
- Management: early diagnosis is difficult, treatments are varied and range in effectiveness. Often only effective treatment involves surgery (if appropriate), and/or transplantation.
Pancreatitis
- Acute: reversible inflammation, risk factors include ETOH, gallstones, or trauma.
- Chronic: irreversible. Risk factor: prolonged alcohol use, causes digestive enzymes to autodigest surrounding tissues and pancreas.
- Manifestations: severe epigastric pain radiating to back, intensity peaks minutes after eating or drinking, tender abdomen,guarding, rebound tenderness, and Cullen's sign, Grey Turner's sign.
- Management: pain relief, fluid/electrolyte management, supportive care, nutritional support, and surgical interventions (if needed).
Pancreatic Cancer
- Quick to spread and high mortality rate
- Risk factors: age/gender, history of chronic pancreatitis, high fat diets, smoking, and/or diabetes.
- Often asymptomatic until advanced, presenting with dull pain in epigastric/back areas, weight loss, jaundice, and possible vague symptoms similar to other GI disorders.
- Treatment: ERCP (endoscopic retrograde cholangiopancreatography), combined radiation and chemotherapy. Sometimes a Whipple procedure.
Autoimmune Disorders
- Includes arthritis and rheumatic diseases
- Arthritis: primary affects joints, also muscles, bone, ligaments, and cartilage
- Classification: monoarticular or polyarticular. Inflammatory or noninflammatory
- Marked by inflammation, autoimmunity, and degeneration
Diffuse Connective Tissue Diseases
- Group of chronic disorders causing inflammation and degeneration in connective tissues
- Unknown cause, likely immunologic
- Characterized by periods of exacerbation and remission
- Includes conditions like rheumatoid arthritis and systemic lupus
- Specific symptoms and diagnoses will vary for each condition.
Rheumatoid Arthritis
- Development: ages 20-40, more common in females
- Pathophysiology: synovial tissue moves into the joint leading to inflammation
- Symptoms: morning stiffness longer than an hour, pain, warmth, swelling of the joints.
- Management: ROM exercises, protection of bony prominences, immunosuppressants or anti-inflammatory medications
Systemic Lupus Erythematous (SLE)
- Combo of genetic, immunologic, and environmental factors involved.
- Manifestations: fever, malaise, weight loss, commonly affects muscles, renal systems, nervous system, cardiovascular system, and respiratory system. Butterfly rash.
- Diagnostics: no specific unique test. Table 20.9 (pg. 398 - 399) useful for differential diagnosis.
- Management: anti-inflammatory medications, corticosteroids, cytotoxic agents for controlling inflammation and immune response.
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Description
Test your knowledge on the various classifications of burns, including thermal, electrical, chemical, and radiation burns. Explore the depth of tissue damage and Total Body Surface Area (TBSA) assessments crucial for treatment. This quiz will challenge your understanding of burn severity and treatment considerations.
