Burns Flashcards
Parkland Formula
4cc/kg/TBSA
Half in first 8 hours after burn, Other half over next 16 hours
Add 25% if inhalation injury
IVF supplemented with _________
Vitamin C - antioxidant (decrease overall burn injury, organ damage from cytokine release of free radicals)
Why is IVF so important?
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
Best measure of resuscitation
Urine output
Peds 1cc/kg/hr
Adults 0.5 cc/kg/hr
Neonates 0.5cc
Mortality formula
TBSA + Age
TBSA estimation and when matters
Palm ~1%
TBSA only matters in 2,3,4th degree with resp/airway injury 25%
Burn care: Nutrition
Intubation - nasojejunal, nasogastric
Metabolism can increase to 200%
NEED PROTEIN to heal
Suspicion of Child Abuse
Stocking and glove, buttocks, uniform/clear delineation
1st degreee
sunburn (erythema, swelling)
2nd degree
BLISTERS (into dermis, painful)
What to do with burn blisters?
Clear - pop, d/t high conc of inflamm mediators –> greater damage
Hemorrhagic –> leave them alone, protecting deeper structures
3rd degree
Painless (destroys nerves)
Penetrates into subcutaneous
needs grafting
4th degree
penetrates deep (bone, organ) severe, life-threatening
Treatments for burn: Silvadene
Abx ointment
Complications: Neutropenia (reverse in few days)
Switch to bacitracin, etc.
Tx for burn: Mafenide acetate (sulfamylon)
Penetrates eschar - painful
Accentuates post-burn hyperventilation
Complications - carbonic anhydrase inhibitor (metabolic acidosis)
Tx for burn: Silver Nitrate
Broad spectrum
Stains
Complication - leaches Na, K, Ca, Cl
Methemoglobinemia rarely
Burns and Eyes
Worry if face, chemical, TBSa> 30%, impaired LOC, I&S needed
Ophtho exam w/in 8hrs of injury
Prophylactic tx?
Not needed - already topical abx
Special about circumferential burns
Escharotomy - cuts in skin to relieve pressure into hypodermis
Skin grafts burns
~4-5 days after burn
May use cadaver, pig - rejected but still help heal
Long term consequences of burn
glucose metabolism irreguar, nutritional deficit, energy/mobility loss
Electrical Injury
Look for entrance, exit wounds
Worry about what’s in between - mm, heart, etc.
Amps SUCK
Tx for Electrical Injury
ABCs IVF to keep UO > 100cc/hr (tea pee) EKG Admit for observation OR I&D dead tissue, fasciotomies
Frostbite
Similar to burns - classify the same, tx differently
Ice crystals disrupts cell membrane/physiology –> microvascular occlusion
Frostbite 1st degree
erythema
frostbite 2nd degree
blisters
frostbite 3rd degree
full thickness, into subcutaneous, usually with tissue loss
frostbite 4th degree
gangrene
Frostbite tx
remove offending agent, rapid rewarm (104F), NSAIDS, silvadene dressings, complete pressure relief, TPA - decrease rate of amputation
DO NOT debride, massage, burn, amputate
frostbite consequences
paresthesias, cold intolerance, arthritis, growth abnormal
Chemical injury types
ORganic, acid, alkali, elements
Tx chemical injury
continuous water irrig, call toxicologist (except K, Li, Na - Class D extinguisher and mineral oil)
eyes - saline, ophtho
Liquid tar tx
Stop process and disrobe
cool H20
Vaseline
tx burn
Petro based products tx
Remove agent
copious h20 irrig
Obs and tx - watch for systemic
Acid burn tx
Worry about coagulation necrosis
H2O irrig for hours until pain/burning relief
DO NOT neutralize
Better tolerated
Hydrofluoric acid burn tx
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
Alkalis burn
Liquefaction necrosis
Penetrates deeper, lasts longer, saponification, irrig with water even longer
eg. Lye (easy off), cement, paster of Paris (casts)
Do not neutralize
Phosphorus injury tx
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
