Burns

Question 1

Ideal IV fluid resuscitation for patients w/ >20% body area burned

Answer 1

Titrate to MAP > 60 mmHg and urine output >30 mL/hr
* 80-100 cc/hr urine output is ideal in adults*
(MAP = mean arterial pressure)
*use large-bore needles, 2 if >40% TBSA

Question 2

Indications for intubation bc inhalational injury

Answer 2

a) PaO2/FiO2 < 200

b) Carbon monoxide toxicity

Question 3

Components of initial assessment in burn patients

Answer 3

1. airway management
2. ID other injuries
3. assess burn size (% of total body surface area, “TBSA”)
4. Dx CO or cyanide poisoning

Question 4

Most common pre-hospital complication in burn victims

Answer 4

hypothermia.

* may contribute to resuscitation failure

Question 5

Give prophylactic antibiotics to burn patients?

Answer 5

No! promotes fungal infections & resistant organisms

*but should give tetanus vaccine in Emerg. room

Question 6

“rule of 9s” for estimating burn size (in %TBSA)

Answer 6

In adults:

• anterior and posterior trunk = 18% each
• lower extremities = 18% each
• upper extremities = 9% each
• head = 9% *head = more % in kids

Question 7

Dx and Tx for CO poisoning

Answer 7

Dx: unexpected neuro Sxs + high arterial carboxyHb
* pulse ox will be falsely normal or high!
Tx: give 100% O2

Question 8

hydrogen cyanide toxicity Dx & Tx

Answer 8

Dx: persistent lactic acidosis & ST elevation on ECG
Tx: give Na thiosulfate (slow fix), hydroxocobalamin (fast fix), & 100% O2

Question 9

3 categories of burn types + associated risks

Answer 9

1. thermal (flame/contact/scald) *highest mortality

2. electrical
   * risk cardiac arrhythmias & compartment syndrome/rhabdomyolysis
3. chemical *metabolic derrangements & hemolysis

Question 10

Rating burn severity

Answer 10

1st degree: superficial
2nd degree: partial thickness of dermis (blisters, painful)
3rd degree: full thickness of dermis (hard, nonblanching)
4th degree: reaches underlying soft tissue

Question 11

Determining prognosis of burn wound

Answer 11

• very difficult bc burns evolve over 24-48 hrs.

Factors: age, burn size, +/- inhalational injury, & comorbidities/concurrent trauma

Question 12

Parkland formula

Answer 12

to calculate how much volume to resuscitate with in 1st 24 hrs:
4 x % TBSA burned = # mL of lactated ringers
*give half in 1st 8 hrs after burn, rest in following 16 hrs

Question 13

Common complications associated with inhalational burns

Answer 13

2-3 days after burn: ARDS

3-10 days after burn: pneumonia