Burn Flashcards
A 60-year-old chef involved in a fire. He was trapped in the kitchen For 30 min. When he was brought to the ER, his pulse was 120\min And BP:90\50 mmhg. He sustained burns covering his chest and abdomen, Right and left lower limb and Right upper limb. He was in severe pain & the burns looked erythematous with blisters. There was some soot around His mouth and nose (63%) .Upon asking his friends, they said that he was able to jump From the window of the 1st floor.
A 60-year-old chef involved in a fire. He was trapped in the kitchen For 30 min. When he was brought to the ER, his pulse was 120\min And BP:90\50 mmhg. He sustained burns covering his chest and abdomen, Right and left lower limb and Right upper limb. He was in severe pain & the burns looked erythematous with blisters. There was some soot around His mouth and nose (63%) .Upon asking his friends, they said that he was able to jump From the window of the 1st floor.
Q1. What’s the degree of burn in this scenario?
- 2nd degree
Q2. Management?
- ATLS protocol ABCDE - check airway if having soots – > prophylactic intubation. / Circulation – cannulas and fluids according to parkland formula/ monitor vitals, UOP
Q3. Specific sign for airway burns & inhalational injury during Airway
assessment in burn?
- Edema of tongue or lips, Soots around mouth, nasal hair burning, facial burn.
Q4. Which fluid to give? Colloids or crystalloids? Why?
- Crystaloids, as in the 1st 24 hrs pt has increase preamibility In case of giving colloid this Will aggrevate the case and increase fluids in 3 Rd space
Q5. Mention 5 Complications of burn ?
- Hypovolemic shock - sepsis - ARDS - Renal failure - constriction if burn circumferential
Q. if pt developed pyrexia what to do?
Invx for sepsis and take blood culture, wound swab and urine / Abx acc. To policy and micro / Antipyretics
Q. what are the surgical intervention in this pt?
Debridement, dressings and grafts acc. To degree / esharotomy
4 days later , the patient developed tachypnea with RR of 28\min & Oxygen
saturation of 88% on room air . X-ray chest done:
Q7. Definition?
- acute diffuse inflammatory form of lung injury chch by hypoxemia , decr. Compliance , diffuse pulm infiltrate , normal pawp, PaO2/FiO2 < 26.6
Q6. Diagnosis? What other differentials do you know?
- , ARDS,Pulmonary Edema, PNEUMONIA
Q8. Causes?
- Multiple truama / burn / acute pancreatitis/ sepsis/ DIC / transfusion associated with lung injury.
Q9. Management? How to support his ventilation?
- managed in ITU .. resp support – > PEEP and prone position to improve respiration. .. low dose steroids…. ABX for sepsis after C&S … Fluid replacement and use of dobutamine and dopamine for circulation support … .also we consider internal nutrition, prevention of TE , and gastric ulcer prophylaxis.
Q. how to know the severity of ARDS?
By Berlin CriteriaQ.
explain Berlin Criteria?
Classify ARDS into
Mild – PaO2/FiO2 = 200-300, Mortality =27%
Mod - ————— = 100-200, M ——— = 32%
Sev - —————–= < 100 , M ————= 45 %
Q10. What are the long-term sequelae of ARDS?
- Hypoxemia, decr. Pulmonary compliance, pulm. HTN ,
Q. how to manage circulation in this pt?
Acc. To ATLS protocol and giving fluid measured by parkland formula 2xTBSAxWt
Q13. What is the best time of transfer?
- After finishing the first shot of fluids after 8 hrs and the pt is showing improvement in his vital signs
