Burns Flashcards
When managing fluids in Burn patients what ways do we assess the effectiveness of resuscitation?
With this in mind, a few ways to assess the effectiveness of resuscitation would be to measure urine output, central venous pressure, or cardiac output as these targets have been validated by randomized trials and are currently recommended for the management of burn patients.
Monitoring urine output using an indwelling bladder catheter is a readily available means of assessing fluid resuscitation and arguably the best method. Hourly urine output should be maintained at 0.5 mL/kg in adults. Patients with minimal or no urine output after sustaining severe burns, despite appropriate fluid resuscitation, generally do not survive. Measurement of cardiac output can be accomplished in several ways. Simply placing a transthoracic echo probe on the chest can give you a rough idea of cardiac output by visualizing the left ventricular function and the overall “squeeze” of the heart. A more invasive method would be to use a Swan Ganz catheter and using a thermodilution technique or the Fick equation to measure cardiac output. There are also numerous devices that attempt to estimate cardiac output in ICU patients. These are collectively called Non-invasive Cardiac Output Monitoring (NICOM) systems. While they have the advantage of being non-invasive, they are not yet validated for all patients and have numerous pitfalls.
burn victims can be deficient in what nutrient?
increased catabolic demand has likely unmasked chromium deficiency which is associated with insulin resistance.
General chemical burn management?
Acid and alkali burns are common reasons for emergency-department visits. Copious irrigation with water should be immediately initiated in the field, as it has been shown to decrease the severity of the burns and the length of hospital stay.
Any patient arriving at the emergency department should be evaluated with the ABCs (airway, breathing, and circulation) initially; in this case, the patient has a secure airway, is breathing without difficulty, and has stable blood pressure. The next step in evaluation is recognizing the offending agent; in this case, it is hydrofluoric acid. Depending on the pH of the compound involved, hours of irrigation may be warranted, particularly for cases of corneal burns. Hydroflouric acid is a strongly acidic compound, which causes extensive tissue necrosis when exposed to skin.
Following irrigation with water, calcium-gluconate gel may be applied locally to the affected areas. The most definitive treatment does include intra-arterial calcium injection, although this is not the most appropriate initial treatment. Calcium ions bind to free fluoride ions to prevent further toxicity and also to prevent systemic hypocalcemia.
Specific treatment for Tar burns?
Bitumen (Tar) Copious irrigation with cold water until bitumen cools and hardens
Treatment for burn with Chromic acid (found as a glass cleaner)
Chromic acid Standard decontamination; copious irrigation with water; consider adding 10% ascorbic acid to the irrigant
Treatment for burn with hydrofluoric acid?
Hydrofluoric acid Standard decontamination; copious irrigation with water; calcium-gluconate gel; consider intra-arterial calcium gluconate if pain is not controlled within 1 hour
Treatment for burns with Lime (calcium oxide)?
Lime (calcium oxide) Brush off as much as possible prior to contacting with water
Treatment with burns with methyl mercury? notes about this? Where is this found?
Methyl mercury Standard decontamination; copious irrigation with water; blister debridement and blister fluid removal
because of its volatility and its ability to pass through biological membranes such as the BBB and the placental barrier. The nervous system and kidneys are the two major target organs.
In general, fish-eating fish such as shark, swordfish, marlin, larger species of tuna, walleye, largemouth bass, and northern pike, have higher levels of methylmercury than herbivorous fish or smaller fish such as tilapia and herring. Within a given species of fish, older and larger fish have higher levels of methylmercury than smaller fish
Phenol burns treatment?
Phenol Irrigate with polyethylene glycol 400
Think of students in chem labs
How to treat phosphorus burns?
Phosphorous Avoid exposure to air; copious irrigation with water; keep covered with water.
characteristic smell of garlic.
Think from battlefield, or more commonly for me firework accidents
How to assess burn total body surface area?
The prognosis of burn victims is directly related to the body surface area (BSA) involved. Because this is easily calculated and varies by age, the topic is highly tested. Superficial involvement is not included in the calculation, and therefore, it only includes burn areas of superficial partial-thickness, deep partial-thickness, full-thickness, and those that extend into underlying tissues. For adults, measurement can be performed by the “rule of nines,” whereby various body parts are made up of multiples of 9. In this question, the patient’s whole torso is affected (18%+18%) and both arms (9%+9%) which is equal to 54%.
Head: 9%
EACH complete arm: 9%
EACH complete leg: 18%
Anterior trunk (abdomen and chest): 18%
Posterior trunk (upper and lower back): 18%
Genitals: 1%
The assessment of children is different because they have larger heads and smaller lower extremities. This can be referenced in the Lund-Browder chart. This chart varies by age and can be complicated because it is broken up by multiple anterior and posterior segments of each extremity and trunk. This is summarized for a child at 5 to 10 years old:
Anterior AND posterior head: 13%
Anterior AND posterior neck: 2%
Anterior trunk (abdomen and chest): 13%
Posterior trunk (upper and lower back): 13%
Anterior AND posterior of EACH arm and hand: 9.5%
EACH anterior thigh, leg, and foot: 8.25%
EACH posterior glute, thigh, and leg: 9%
Genitals: 1%
A quick estimate for small areas of involvement uses the palm method. This provides an estimate using the patient’s palm including fingers, where each area covered by 1 palm surface represents 1% of total BSA.
