Burns

Question 1

First degree burn

Answer 1

Superficial. UV light, very short flash exposure. Dry & red skin, blanches with pressure. Painful. Heals in 3 to 6 days. No scarring

Question 2

2nd degree burn

Answer 2

Superficial, partial-thickness. Scald, short flash. Blisters, moist, red & weeping; blanches with pressure. Painful to air and temperature. 7-20 days to heal. Usually no scarring

Question 3

3rd degree burn

Answer 3

Deep partial-thickness. Scald, flame, oil, grease. Blisters (easily unroofed); wet or waxy dry; variable color (patchy to cheesy white to red); does not blanch with pressure. Perceptive of pressure only. 21 or more days to heal. Severe scarring, with contracture possible.

Question 4

4th degree burn

Answer 4

Full-thickness burn. Scald (immersion), flame, steam, oil, grease, chemical, high-voltage electricity. Waxy white to leathery gray to charred & black; dry & inelastic; does not blanch with pressure. Deep pressure sensation only. Do not heal on own. Severe scarring & contracture risk.

Question 5

How is body surface are estimated in burns?

Answer 5

Rule of nines. Head & neck 9%. Torso 36%. Arms 18%. Legs 36%. Perineum 1%.

Question 6

Carboxyhemoglobin

Answer 6

Arterial blood gas which reflects total hemoglobin bound by CO. >25% = severe intoxication, >15% gestation

Question 7

Goals of nutrition support

Answer 7

Promote wound healing. ↓infection rates. Minimize loss of LBM. Replete visceral & somatic protein stores. Facilitate transition to anabolic phase

Question 8

Steps in developing care plan

Answer 8

Wound assessment. Obtaining diet, medical, social hx. Establishing nutrient needs. Feeding route selection. Formula selection.

Question 9

Wound assessment

Answer 9

Type and size of burn. Location of burn. Hemodynamic status. Respiratory status.

Question 10

Estimation of kcal needs

Answer 10

Indirect - REE x 1.1-1.2 kcal/kg.

Question 11

Most commonly used formulas for burn patients?

Answer 11

Harris-Benedict. Curreri

Question 12

Curreri formula

Answer 12

25 kcal x ABWkg + 40kcal x %BSA burned.

Question 13

Burn factor <20%

Answer 13

1.2

Question 14

Burn factor 20-25%

Answer 14

1.6

Question 15

Burn factor 25-30%

Answer 15

1.7

Question 16

Burn factor 30-35%

Answer 16

1.8

Question 17

Burn factor 35-40%

Answer 17

1.9

Question 18

Burn factor >40%

Answer 18

2.0

Question 19

Protein requirements

Answer 19

20-25% of total energy needs. 1.5-4.0 g/kg. CRRT= >2 to 2.5g/kg

Question 20

Carb requirement

Answer 20

Minimum of 120g/day. 50-60% of kcal needs.

Question 21

Formula choice

Answer 21

Immune modulating - arginine, glutamine, omega-3. Also, BCAA, fiber, vit C, A, D for wound healing.

Question 22

Fat requirements

Answer 22

10-30% of kcal with 15-25% recommended. 2-4% EFA. 0.1g/kg/hr infusion. MCT oil.

Question 23

Most commonly used energy formula for children?

Answer 23

Solomon’s = RDA for age + 30 kcal x % TBSA. Caloric goal of 120-130% of REE.

Question 24

Nutrient supplementation for burns in children?

Answer 24

Multivitamin w/ trace elements - 1/day. Zinc - 25mg/day. Copper 2.5mg/day. Selenium - 50-170mg/day. Vitamin C 200mg/day

Question 25

Supplements in adults

Answer 25

> 20% BSAB: multi; vit C - 500mg x2/day, A - 10,000IU; Zinc - 45-50mg. <20% - 1 multi/day

Question 26

Oxandrolone

Answer 26

Steroid used to promote protein synthesis in burns >15% of BSA. No anti-insulin effects.