Burns

Question 1

4 things to know about every burn patient

Answer 1

Extent, depth, age, associated illness or injury

Question 2

Rule of 9 for calculating burn area

Answer 2

front of leg = 9%, lower front of abdomen = 9%, whole arm = 9% upper front of chest = 9%, whole head = 9%

Question 3

1st degree burn

Answer 3

epidermis, red or grey with cap refill, painful, dry, not blistered initially (superficial burns w/o blister) heals in 3-5d

Question 4

2nd degree burn - superficial

Answer 4

blistered, epidermis + upper dermis, may have waxy appearance/wet, pink to red, blanches, heals 10-21d

Question 5

3rd degree burn

Answer 5

progressive loss of adnexal structures (hair, sweat glands, smooth skin) (waxy white or gray with scarring), loss of pain

Question 6

23-yo man presents to the ER with what appears to be 2nd degree burns to the complete circumference of both legs. Approximately how much of the total body surface area TBSA did the patient burn?

Answer 6

whole R leg = 18
whole L leg = 18
TBSA = 36%

Question 7

Prognostic Burn Index

Answer 7

PBI= Age + TBSA (+20% if inhalation injury)

Question 8

Prognostic Burn Index is used as

Answer 8

crude estimate of mortality and triaging

Question 9

Associated illness of severe burns

Answer 9

GI complications: pancreatitis, stress ulcers

Question 10

Associated illness of severe burns may occur

Answer 10

24-48 hours later up to a week

Question 11

Associated injuries of severe burns

Answer 11

smoke inhalation, electrical burns

Question 12

What type of burn must you be cautious of?

Answer 12

electrical burn, deep tissue burns without significant superficial trauma, more significant than they appear

Question 13

50 yo woman presents with a 18% TBSA smoke inhalation burn injury. What is her TBI?

Answer 13

TBI = Age + TBSA + 20% for smoke inhalation

50 + 18 + 20 = 88

Question 14

ABCDE’s; A/B:

Answer 14

Airway and breathing, intubate to prevent airway edema if inhalation injury or direct thermal injury

Question 15

ABCDE’s: C

Answer 15

Circulation: establish vascular access with either IV, Intra-osseous, or arterial line for critically ill

Question 16

What type of antibiotics would you give for non-superficial depth burn wounds?

Answer 16

Topical

Question 17

2nd degree burn - Deep

Answer 17

red/white, dry, epidermis + most of dermis, no blanching, diminished sensation

Question 18

A prognostic burn index > ____ has a bad prognosis

Answer 18

50

Question 19

Burn → inflammatory reactions →

Answer 19

shock (hypovolemic) → multi-organ failure (kidney, heart, lungs)

Question 20

All burns deeper than superficial thickness, patient should receive

Answer 20

tetanus immunization if not up to date

Question 21

Regardless of immunization status, all burn patients should receive

Answer 21

Tetanus toxoid-containing vaccine

Question 22

If patient has unknown tetanus status or does not have 3-steps complete

Answer 22

tetanus immunoglobulin

Question 23

21 yo homeless woman presents with a 2nd degree burn to her left leg. Patient has no medical records and is intoxicated and cannot provide history. What should you administer to prevent tetanus infection?

Answer 23

tetanus immunoglobulin + Tetanus toxoid-containing vaccine

Question 24

Escharatomy

Answer 24

dry black, necrotic scab that may impede blood flow if on extremities, may need surgical removal or incision to re-establish BF

Question 25

Fasciotomy

Answer 25

limb-saving procedure when used to treat acute compartment syndrome, relieves pressure by making an incision to re-establish BF

Question 26

Abdominal compartment syndrome

Answer 26

Surgical Emergency!, must open to relieve pressure (bladder pressure > 30), leads to respiratory failure and MOF

Question 27

Debridement - Minor burns

Answer 27

debrided at bedside, topical antibiotics

Question 28

1st and 2nd degree burns will epithelialize in

Answer 28

7-10 days

Question 29

Treatment for severe burns

Answer 29

Early excision and grafting as early as 24h, prevent autograft rejection and systemic infection

Question 30

Burn patients need MORE

Answer 30

energy, nutrients, antioxidants

Question 31

Enteral nutrition started within

Answer 31

24h if possible

Question 32

Burn patients need what percentage of their Basal Energy Expenditure (BEE)

Answer 32

100-120

Question 33

What is the formula for calories needed?

Answer 33

25kcal/kg + 40kcal/% TBSA

Question 34

systemic complications from burns may result in

Answer 34

Respiratory injury/ Respiratory failure/ Acute respiratory distress syndrome (ARDS), Sepsis, Multi-organ failure (MOF), Venous thromboembolism (VTE)

Question 35

Core body temperature (CBT)

Answer 35

burn patients lose their ability to maintain a core body temperature, in TBSA is > 20% keep room air >30C to maintain body heat

Question 36

What co-morbidity is associated with the worst outcomes for burn patients?

Answer 36

Hyperglycemia

Question 37

45 yo woman with significant PMH diabetes type II. Hospitalized ICU for 7 days. Post-op day #2 status post debridement and grafting of 3rd degree burn wound on left forearm. Wound is infected and gram stain revelaed an aerobic gram negative rod. What is the pathogen?

Answer 37

Burn Victims ALWAYS think PSUEDOMONAS AERUGINOSA

Question 38

25 yo firefighter presents with a 40% TBSA burn. He weighs 200 lbs. Approximately how many kcal does this patient need.

Answer 38

200lb = 90 kg x 25 = 2250kcal
40 x 40 = 1600 kcal
TOTAL = 3850 kcal