Burns Flashcards
Explain the rule of 9s: What differs in children?
Head: 9% Each arm: 9% Each full leg: 18% Chest: 18% Back: 18%
For kids, their heads are 18%
What type of shock are burn pts at risk for?
hypovolemic and distributive for >72 hours
Early effects (24-48 hours) of burns:
decreased CO, decreased response to catecholamines, increased SVR, metabolic acidosis
Late effects (>48 hours) of burns:
increased CO, decreased SVR
What is the Parkland formula?
4 ccLR/kg x % body surface area over 24 hours. Half given in first hours, other half given over 16 hours
When do you avoid sux in burns?
avoid 24 hours after the burn
What do you want to gather from the hx in a burn patient?
inhalation injury (closed space fire? house/car? ), tpe of burn-electrical, chemical, thermal
Physical exam of burn patient:
ABCs as per ACLS
Appearance-facial burns/edema, stridor, respiratory distress?
extent of burns
sites for IV access
Lab tests/imaging in burn pts:
ABG CBC electrolytes creatinine CXR Cyanide level (exposure from burning plastics)
What are your goals for optimization of burn patients/
Secure airway before edema Urine output: >0.5-1.0 cc/kg/hr AVOID HYPOTHERMIA Avoid infection avoid coparment syndrome blood products as required
Options for anesthesia with burns:
GETA ususally
How do you want the room set up for ppl with burns?
standard monitors
foley catheter
a line, central line
difficult airway equipment
How do you want to induce a burn patient?
Induce via ketamine or etomidate or porpofol as requied.
Uncut ETT? use the uncut ones because of post operative edema/
How would you maintain anesthesia in a burn patient?
balanced technique; resistance to NDMRs possible
emergence in burn patient?
keep intubated depending on size of burn
