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Skin MS: Week 2 > Burns > Flashcards

Burns Flashcards

1
Q

Parkland Formula

A

4cc/kg/TBSA
Half in first 8 hours after burn, Other half over next 16 hours
Add 25% if inhalation injury

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2
Q

IVF supplemented with _________

A

Vitamin C - antioxidant (decrease overall burn injury, organ damage from cytokine release of free radicals)

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3
Q

Why is IVF so important?

A

Coagulation is damaging, stasis in limbo (coagulates w/in 24 hrs usually), hyperemia = increased blood flow.
IVF pushes ZOS –> ZOH, to decrease ZOC –> lessening amount of burn

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4
Q

Best measure of resuscitation

A

Urine output
Peds 1cc/kg/hr
Adults 0.5 cc/kg/hr
Neonates 0.5cc

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5
Q

Mortality formula

A

TBSA + Age

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6
Q

TBSA estimation and when matters

A

Palm ~1%

TBSA only matters in 2,3,4th degree with resp/airway injury 25%

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7
Q

Burn care: Nutrition

A

Intubation - nasojejunal, nasogastric
Metabolism can increase to 200%
NEED PROTEIN to heal

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8
Q

Suspicion of Child Abuse

A

Stocking and glove, buttocks, uniform/clear delineation

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9
Q

1st degreee

A

sunburn (erythema, swelling)

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10
Q

2nd degree

A

BLISTERS (into dermis, painful)

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11
Q

What to do with burn blisters?

A

Clear - pop, d/t high conc of inflamm mediators –> greater damage
Hemorrhagic –> leave them alone, protecting deeper structures

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12
Q

3rd degree

A

Painless (destroys nerves)
Penetrates into subcutaneous
needs grafting

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13
Q

4th degree

A 
penetrates deep (bone, organ)
severe, life-threatening
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14
Q

Treatments for burn: Silvadene

A

Abx ointment
Complications: Neutropenia (reverse in few days)
Switch to bacitracin, etc.

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15
Q

Tx for burn: Mafenide acetate (sulfamylon)

A

Penetrates eschar - painful
Accentuates post-burn hyperventilation
Complications - carbonic anhydrase inhibitor (metabolic acidosis)

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16
Q

Tx for burn: Silver Nitrate

A

Broad spectrum
Stains
Complication - leaches Na, K, Ca, Cl
Methemoglobinemia rarely

17
Q

Burns and Eyes

A

Worry if face, chemical, TBSa> 30%, impaired LOC, I&S needed
Ophtho exam w/in 8hrs of injury

18
Q

Prophylactic tx?

A

Not needed - already topical abx

19
Q

Special about circumferential burns

A

Escharotomy - cuts in skin to relieve pressure into hypodermis

20
Q

Skin grafts burns

A

~4-5 days after burn

May use cadaver, pig - rejected but still help heal

21
Q

Long term consequences of burn

A

glucose metabolism irreguar, nutritional deficit, energy/mobility loss

22
Q

Electrical Injury

A

Look for entrance, exit wounds
Worry about what’s in between - mm, heart, etc.
Amps SUCK

23
Q

Tx for Electrical Injury

A 
ABCs
IVF to keep UO > 100cc/hr (tea pee)
EKG
Admit for observation 
OR I&D dead tissue, fasciotomies
24
Q

Frostbite

A

Similar to burns - classify the same, tx differently

Ice crystals disrupts cell membrane/physiology –> microvascular occlusion

25
Q

Frostbite 1st degree

A

erythema

26
Q

frostbite 2nd degree

A

blisters

27
Q

frostbite 3rd degree

A

full thickness, into subcutaneous, usually with tissue loss

28
Q

frostbite 4th degree

A

gangrene

29
Q

Frostbite tx

A

remove offending agent, rapid rewarm (104F), NSAIDS, silvadene dressings, complete pressure relief, TPA - decrease rate of amputation

DO NOT debride, massage, burn, amputate

30
Q

frostbite consequences

A

paresthesias, cold intolerance, arthritis, growth abnormal

31
Q

Chemical injury types

A

ORganic, acid, alkali, elements

32
Q

Tx chemical injury

A

continuous water irrig, call toxicologist (except K, Li, Na - Class D extinguisher and mineral oil)
eyes - saline, ophtho

33
Q

Liquid tar tx

A

Stop process and disrobe
cool H20
Vaseline
tx burn

34
Q

Petro based products tx

A

Remove agent
copious h20 irrig
Obs and tx - watch for systemic

35
Q

Acid burn tx

A

Worry about coagulation necrosis
H2O irrig for hours until pain/burning relief
DO NOT neutralize
Better tolerated

36
Q

Hydrofluoric acid burn tx

A

VERY PAINFUL - lasts hours, days
can progress to alkali-like liquefaction necrosis
tx: 5% CaGluconate & Mg - topical, subcu, intraarterial until pain stops, may need HD

37
Q

Alkalis burn

A

Liquefaction necrosis
Penetrates deeper, lasts longer, saponification, irrig with water even longer
eg. Lye (easy off), cement, paster of Paris (casts)
Do not neutralize

38
Q

Phosphorus injury tx

A

Munitions, fertilizers, insectisides, poisons
Ignites on contact with air
Irrigate and cover with wet dressings, copper sulfate –> black cupric phosphide particles –> I,D in OR

Skin MS: Week 2 (12 decks)

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