Burns

Question 1

Fluid resusc

Answer 1

Parkland…4cc/kg/TBSA
Half 1st 8 hours p burn
Other half…next 16 hours
(inhalation injury add 25%

Question 2

Burn Zones

Answer 2

Coagulation…dead
Stasis………..in limbo
Hyperemia…↑blood flow, ….IVF pushes the ZOS (stasis) into the ZOH (zone of hyperemia), thereby ↓ ZOC i.e. lessening the amount of burn

Question 3

Best measure of resuscitation

Answer 3

URINE OUTPUT
Peds 1cc/kg/°, (Neonate 0.5cc)
Adult 0.5cc/kg/°

Question 4

mortality

Answer 4

TBSA…2º, 3º, 4º only (with respiratory/airway injury ↑ 25%)

TBSA + age ~ Mortality

Question 5

2nd degree burns

Answer 5

Blisters
Into dermis
Really painful

Question 6

blister treatment

Answer 6

CLEAR blisters…’pop em’,
why?…b/o a high conc of inflamm mediators that lead to greater damage
HEMORRHAGIC blisters… leave them alone, because they are protecting deeper structures

Question 7

primary burn medications

Answer 7

Silvadene (MC)
If sulfa allergy…Abx oint
Complic…Neutropenia (reverses in a few days)

Mafenide acetate (Sulfamylon)
Penetrates eschar & painful
Accentuates post-burn hyperventil
Complic…carbonic anhydrase inhibitor  i.e. metabolic acidosis

Silver nitrate
Broad spectrum & stains
Complic…leaches Na+, K+, Ca2+, Cl–

Question 8

frostbite treatment

Answer 8

Tx
Remove offending agent
 rewarm ASAP  ~104º F (~40º C)
NSAID’s
Silvadene dressings
Complete pressure relief
(tPA…if given w/i 24º, decreases the rate of amputation)

Do NOT …debride
…massage
…burn (rewarm)
…amputate

Question 9

Acid Injuries

Answer 9

Acids
Coagulation necrosis
H20 Irrig…hours…until pain & burning relief
Do NOT try to neutralize
BETTER tolerated

Question 10

HF (hydrofluoric acid)

Answer 10

VERY PAINFUL, lasts hours-days
Can progress to an alkali-like liquefaction necrosis
Tx: 5% CaGluconate & (Mg²+)
Topical, subcu, and intra-arterial until the pain stops & stays away
Pt may need HD

Question 11

Alkalis

Answer 11

Liquefaction necrosis
Penetrates deeper, last longer, saponification……………………..Irrig w/ H20 even longer
e.g. Lye (Easy-Off), cement, plaster of Paris (casts)
Do NOT neutralize

Question 12

Phosphorus

Answer 12

Munitions, fertilizers, insecticides, poisons
IGNITES on contact with air…
Tx: Irrigate & cover with wet dressings,
copper sulfate (CuSO4)->black cupric phosphide particles-> I&D in O.R.