Burns

Question 1

Parkland Fluid Resucitation

Answer 1

4cckg body weightPercentBodySurfaceAreaBurned
Give half in first 8 hours post burn (no matter when the patient arrives), then give the other half during the next 16 hours (post first 8 hours)
**Add 25% for inhalation injury

Question 2

Why do we give IVF to burn patients?

Answer 2

3 zones: zone of coagulation, zone of stasis, zone of hyperemia. IVF pushes the ZOS into ZOH, thereby decreasing the ZOC (i.e. lessening the amout of burn).

Question 3

Best measurement of resuscitation?

Answer 3

urine output.

Question 4

TBSA + age ~= ???

Answer 4

Mortality

Question 5

1st degree burn

Answer 5

Sunburn, erythema, swelling

Question 6

2nd degree burn

Answer 6

into dermis, really painful, blisters

Question 7

What do we do with blisters?

Answer 7

CLEAR them (aka pop them). why? b/o a high conc. of inflamm mediators leading to greater damage. If HEMORRHAGIC (blood) blisters… leave them alone, b/c they are protecting deeper tissue structures.

Question 8

3rd degree burn

Answer 8

painless, penetrates into subcutaneous, need grafting

Question 9

4th degree burn

Answer 9

penetrates deep, muscle, bone, organ, life-threatening

Question 10

What is the side effect of silvadene?

Answer 10

If sulfa allergy… abx ointment. Neutropenia common complication (reverses in a few days)

Question 11

What is Mafenide acetate (Sulfamylon)? Complications?

Answer 11

penetrates eschar & painful. accentuates post-burn hyperventil. Complication = carbonic anhydrase inhibitor (causes metabolic acidosis)

Question 12

What is the treatment side effect of silver nitrate?

Answer 12

Leaches Na+. K+, Ca2+, Cl- (so hypocalcemia, hyponatremia, hypocloremia)

Question 13

Are antibiotics necessary in the initial 24-72 hours post burn?

Answer 13

NO!

Question 14

If a burn is bad and goes all they way around the body or body part, what procedure could help releave the pressure on the underlying tissue?

Answer 14

Escharotomy–cut skin to releave pressure.

Question 15

What is unique about IVF and electrical burns?

Answer 15

IVF to keep urine output >100cc/hr (tea color common). Use a lot more IVF!

Question 16

1st degree frostbite

Answer 16

erythema

Question 17

2nd degree frostbite

Answer 17

blisters

Question 18

3rd degree frostbite

Answer 18

full thickness into subcutaneous tissue. Usually see tissue loss.

Question 19

4th degree frostbite

Answer 19

gangrene

Question 20

What is the rapid rewarm temp of H2O use in Tx of frostbite?

Answer 20

104 degree F or 40 C

Question 21

What do you not want to do with frostbite?

Answer 21

debride, massage, burn (in rewarm), amputate. Take your time!

Question 22

What injury do acids cause?

Answer 22

coagulation necrosis

Question 23

How do you treat hydrofluoric acid chemical injury?

Answer 23

v. painful. 5% CaGluconate and Mg2+ topical, subcutaneous, and intra arterial until the pain stops and stays away.

Question 24

What type of chemical injury does alkalis or bases cause?

Answer 24

Liquefaction necrosis. penetrates deeper, lasts longer. Tx; flush with H2O even longer. Do not neutralize.

Question 25

How do you treat a phosphorus chemical burn?

Answer 25

irrigate & cover with wet dressings, copper sulfate (+ phosphorus) –> makes black cupric phosphide particles. Id and debride in O.R.