Burn

Question 1

What is the rule of 9s for pediatric burns?

Answer 1

• head and neck: 18%
• upper extremities: 9% each
• lower extremities: 14% each
• anterior trunk: 18%
• posterior trunk: 18%

Question 2

What are the histologic zones of a burn?

Answer 2

• zone of coagulation: maximum damage, irreversible tissue loss
• zone of stasis: poor perfusion, questionable viability
• zone of hyperemia: increased tissue perfusion, may recover

Question 3

What is the parkland formula?

Answer 3

• 4mL/kg/%TBSA
• first half given over eight hours and second half given over the next sixteen hours
• limited to burns > 20%

Question 4

What is the modified Brooke formula?

Answer 4

• 2mL/kg/%TBSA
• first half given over eight hours
• limited to burns > 15%

Question 5

What fluid is preferred for burn resuscitation?

Answer 5

lactated ringers

Question 6

What is the target urine output for burn patients?

Answer 6

• adults: > 0.5cc/kg
• kids: > 1cc/kg

Question 7

Damage to the lower airways in a burn patient are due to what?

Answer 7

inhaled toxins

Question 8

What are the symptoms of carbon monoxide poisoning?

Answer 8

• neurologic: seizures, decreased mental status
• cardiac: arrhythmia, MI
• metabolic: acidosis

Question 9

How is carbon monoxide poisoning treated?

Answer 9

high flow nasal cannula, serial COHb measurements, sometimes hyperbaric O2

Question 10

How is cyanide poisoning treated?

Answer 10

hydroxocobalamin

Question 11

What are the side effects for the following burn ointments:
- bacitracin:
- mupirocin:
- silver sulfadiazine:
- mafenide acetate:
- silver nitrate:

Answer 11

• bacitracin: rash, nephrotoxicity
• mupirocin: irritation
• silver sulfadiazine: neutropenia, thrombocytopenia
• mafenide acetate: metabolic acidosis
• silver nitrate: methemoglobinemia, hyponatremia, hypokalemia, staining of the skin

Question 12

What are the indications for the following burn ointments?
- bacitracin:
- mupirocin:
- silver sulfadiazine:
- mafenide acetate:
- silver nitrate:

Answer 12

• bacitracin: 2nd degree burns with GP coverage
• mupirocin: staph infections, not for ppx
• silver sulfadiazine: 3rd degree burns with GN coverage
• mafenide acetate: 3rd degree burns with GN coverage, pseudomonas treatment
• silver nitrate: 3rd degree burns with GN and GP coverage

Question 13

What is the preferred burn antibiotic for pseudomonas?

Answer 13

mafenide acetate

Question 14

Which burn antibiotics are contraindicated for:
- sulfa allergy
- G6PD deficiency

Answer 14

• sulfa: silver sulfadiazine
• G6PD: silver nitrate

Question 15

How are mild, moderate, and severe hypothermia classified?

Answer 15

• mild: 90-94 degrees
• moderate: 84-89 degrees
• severe: 70-84 degrees

Question 16

What are the symptoms of hypothermia?

Answer 16

• mild (90-94): shivering, AMS
• mod (84-89): agitation, muscle spasticity, dilated pupils, bradypnea
• severe (<84): prolonged QRS, Osborn (J) waves, flaccid comatose, Vfib

Question 17

What EKG changes are seen in those with severe hypothermia?

Answer 17

prolonged QRS, Osborn (J) waves, Vfib

Question 18

How is frostbite treated?

Answer 18

• begin with treatment of hypothermia
• rapid active rewarming in heated water
• debridement of deeper injuries
• drainage of milky/clear blisters
• leave hemorrhagic blisters intact

Question 19

Hemorrhagic blisters are suggestive of what degree of frostbite?

Answer 19

3rd degree

Question 20

How are hydrofluoric acid burns treated?

Answer 20

with topical calcium gluconate gel

Question 21

How is methemoglobinemia treated?

Answer 21

methylene blue

Question 22

How do 1st and 2nd degree burns heal?

Answer 22

epithelialization, primarily from hair follicles

Question 23

Full thickness skin grafts have more of what kind of contracture?

Answer 23

more primary contracture due to elastin in the dermis

Question 24

What is the treatment for severe electrical injury?

Answer 24

• can cause rhabdo, thus require high volume resuscitation for severe injuries
• require cardiac monitoring and monitoring for compartment syndrome