Burns Flashcards
Main causes of early death (<48 hrs):
Shock and/or
inhalation injury
Main causes death After 48 hours
Multi-organ failure &
sepsis
rule of 9s adultf
head = 9 back = 18 chest = 18 arms = 9 perineum = 1 legs = 18
rule of 9s for children
head = 18 back = 18 chest = 18 arms = 9 perineum = 1 legs = 13.5
what is classified as Major Burn
2° or 3° burn, >10% TBSA
Electrical burn
Inhalation injury (regardless of
If patient age + %TBSA is >115 then
> 80% mortality
4 types of burn injury
chemical
electrical
thermal
inhalation
protective phenomenon with inhalation injuries
Heat in upper a/w is
dissipated - will see reflex laryngospasm to protect lower a/w
warning signs of inhalation injury
Hoarseness, sore throat, dysphagia,
hemoptysis, tachypnea, respiratory distress, elevated
carbon monoxide levels
If upper a/w damage present,
EARLY intubation is indicated
even when asymptomatic
why AVOID SUCCINYLCHOLINE IF > 24 HRS POST-INJURY
Burn = receptor up-regulation (increased acetylcholine receptors) = massive hyperkalemia = cardiac arrest/death
best choice of intubation if swelling/obstruction present
awake intubation
what does progressive air leak around ETT indicate
a/w swelling subsiding
what does CO poisoning cause
decreased SaO2 & metabolic acidosis
pt will present “drunk”
cyanide poisoning causes
metabolic acidosis from blocking intracellular o2 use
symptoms of cyanide poisoning
Changes in LOC, seizures, dilated pupils, hypotension,
apnea, high lactate levels
rx for cyanide poisoning
vit b12a
next step in rx burn pt after securing a/w?
aggressive fluid resuscitation to prevent hypovolemic shock from leaking fluid and edema
parkland formula?
4ml x BSA% x weight (kg)
give half amount of 8 hours, other half over 16
what fluids to use with burn patients for resuscitation?
heavy isotonic crystalloid with no colloid or blood
what do children require during fluid rescus that adults do not
maintenance glucose
trend to minimize baratrauma
low TV and low PIP
common guidelines for debridement and grafting
- no more than 20% of body surface at a time
- stop surgery at core temp <35%
- stop when 10 units (3500 mL) of prbc given
what med must be avoided?
succ unless it is used on admit
