Adult Emergencies

Question 1

fluid resus in burn type: Flames or scalding Adults and children over 14 years

Answer 1

2 ml Hartmanns x kg x % TBSA. urine output: 0.3-0.5ml/kg/hr OR 30-50ml per hou

Question 2

Indication for fluid Resus in burns

Answer 2

> 15% total body area burns in adults (>10% children)

Question 3

Flames or scalding Children less than 14 years

Answer 3

3 ml Hartmanns x kg x % TBSA uo: 1ml/kg/hr

Question 4

Flames or scalds Children less than 30Kg and infants

Answer 4

3 ml Hartmanns x kg x % TBSA. Plus a sugar-containing solution at maintenance rate uo:1ml/kg/hr

Question 5

Electrical injury All ages

Answer 5

4 ml Hartmanns x kg x % TBSA until urine clears uo:1-1.5 ml/kg/hr until urine clears

Fluid resuscitation in electrical burn patients is different because they have far greater soft tissue involvement in muscle compartments and associated muscle death that can result in myoglobinuria

Question 6

Fluids After 24 hours

Answer 6

Maintenance crystalloid (usually dextrose-saline) is continued at a rate of 1.5 ml x(burn area)x(body weight)

Question 7

Splenic Emergencies: The management is dictated by

Answer 7

associated injuries, haemodynamic status and extent of direct splenic injury:

• Conservative:
  Small subcapsular haematoma
  Minimal intra abdominal blood
  No hilar disruption
• Laparotomy with conservation:
  Increased amounts of intraabdominal blood
  Moderate haemodynamic compromise
  Tears or lacerations affecting <50%
• Resection:
  Hilar injuries
  Major haemorrhage
  Major associated injuries

Question 8

Splenectomy Complications

Answer 8

Complications
Haemorrhage (may be early and either from short gastrics or splenic hilar vessels
Pancreatic fistula (from iatrogenic damage to pancreatic tail)
Thrombocytosis: prophylactic aspirin
Encapsulated bacteria infection e.g. Strep. pneumoniae, Haemophilus influenzae and Neisseria meningitidis