burns Flashcards
Parkland formula
4cc X % BSA X Kg of body weight, this i s the amount needed over first 24 hours. Admin 50% in the first 8 hours and the next 50% over 16 hours the goal is GOOD urine output 30-50 ml hour adults. 1-2 ml/kg/hr children
Composition of fluid for burns
< 30% BSA ringers Lactate
> 30 % BSA ringers lactate with 50ml bicarb (hypertonic) helps to reduce edema)
no fluid bolus
resuscitative/emergent phase
immediately after bun vascular space becomes permeable allowing plama to leak into interstitium can result in hypovolemic shock get fluids quick. may last 7 days, usually 3-5 days
Zone of coagulation
heat source worst, full thickness or 3rd degree burn, non viable
Zone of stasis
surrounds zone of coag, cells may be salvaged, if resuscitation and elevations to reduce edema is not addressed the result will be conversion from partial to full thick ness
Zone of hyperemia
borders zone of stasis, least affected area, usually heals spontaneously, also know as superficial 2nd degree area or 1st degree
Acute phase
starts immediately after burn and continues until end of wound closure. determination of burn made and treatment plan.
first degree burn
sun burn, pain, red. involved outer epidermis.
second degree burn
wet, pain , swelling, entire epidermis and portions of dermis. can be superficial or deep (partial thickness) usually pink to light red
third degree
no pain, white, dry, no edema, entire epidermis and dermis destroyed (full thickness) eschar, waxy white color. No swelling b/c skin not elastic
Topical antimicrobials
1% silver sulfadiazine or silvadene is a combo of sulfadiazine and silver, silver binds with DNA & releases sulfonamide that interferes with metabolic pathways, complications - transient leukopenia , tx by stopping cream, silvaden uses on second degree burns superficial to deep dermal
Bacitracin antimicrobial for minor burns, petrolatum based keeps wound moist and bandage non adherent, you dont need a bazooka silvadene to go rabbit hunting when bacitracin will do, its cost effective
mefenidine acetate or sulfamylon 10% a cream that covers broader spectrum of bacteria, more systemic side effects such as metabolic acidosis, causes burning after application. it is used primarily on ear burns to prevent cartilage from becoming infected.
nystatin, bactroban and silver nitrate helps prevent gauze from sticking. if wound is full of debris an adherent bandage is needed for debridement. if wound is clean adaptic or xerflo on adherent .
biological dressings
animal hides to fetal membranes, cadaver tissue, most common is pig skin, 0.8 inches thick, best for superficial second degree burns. longer post burn period is before treatment less chance for biological to be applied.
To apply biological dressings
wash with soap and water abrasive actioin, remove debris, lay pigskin dermal side down apply bandage, a sign pig skin is is doing its job is becomes translucent. once wound healed a thin layer of bacitracin applied to pigskin and pt instructed of its removal
Synthetic substances
Biobrane, its nylon silicone mesh with porcine peptides bound to mesh used on partial thickness and donor sites. if wound is deep and one part superficial don’t use biobrane.
Combined, synthetic and biological dressings
used more frequently, promote epithelialization, decrease pain, and amount of time needed for wound care, expensive! integra act like scaffolding for dermis to rebuild upon.
