BURNS Flashcards
A 22 y/o man is broughtto the emrgency room after a house fire. He has burns around his mouth, and his voice is hoarse but breathin unlabored. What most appropriate step in management
Examination of the oral cavity and pharynx, with fiberoptic laryngoscope if available
what percentage burn does a patient have who suffered burns to one leg (circumferential), one arm (circumferential) and the anterior trunl
45%
- anterior trunk 18 %
- 1 arm = 9 %
- 1 leg = 18%
children younder than 4 years have muh larger heads and smaller thighs in proportion to totalbody size than do adults.
- head = ~20%
A 40 y/o woman is admitted to the burn unit after an inductrial fire a plastics manufacturin plant with burns to the face and arms. Her ECG shows ST elevation and initial chemistry panel and arterial blood gas reveal an anion gap metabolic acidosis with normal arterial carboxyhemoglobin. What is the most appropriate next step?
Administration of 100% oxygen and hydroxycobaliamin
- Hydrogen cyanide toxicity may also be a component of smoke inhalational injury
- lactic acidosis
- ST elevation
- Treatment: sodium thiosuldate, hydroxycobalamin, 100% oxygen
Which is a common sequalae of electrical injury?
Cataracts
- myoglobinuria
- if there are no ECG canges in admission, the likelihood that it will appear later is miniscule
- Cataracts ae well-recognied sequala of high voltage electrical burns. They occur in 5 to 7 of patients. Usually bilateral
An 8 year ld boy is brought to the emergency room after accidentally touching a hot iton with his forearm. One xamination, the burned area has weeping blisters and is very tender to touch. What is the burn depth?
Second degree
- Superficial (first degree)
- no blisters
- Parial thickness (second degree)
- weeping, blisters, tender
- full thickness (third degree)
- leathery painess and nonblanching
- fourth degrees
Three hours adter a burn injury that consisted of circumferential, thrid degreee vurn at the wrist and elboe of the right arm, apatient losses sensation to light touch in his fingers. Motor funcition of his digits however remains intact. The most appropriate treatment now would be______
Doppler UTZ for assesment of peripheral flow and immediateescharotomy if flow is decreased.
- 3rd degre burn injuries = complete loss of elasticity
- neurovascular compromise
- slow capillary refill
- onset of neurologic deficits
- decreased or absent doppler ultrasonic pulse detection.
What is the fluid requirement for a 50 kg man with first degree burns to his left arm and leg, circumferential second degree burn to his right arm, and third degree burns to his torsa and right leg. Whats is the rate of initial fluid resuscitation?
4.5 L over 8 hours, followed by 4.5 L over 16 hours
- Parkland or baxter formula
- 3 to 4 ml/kg/%burn of LR
- half is given during the first 8 hours
- and the remaining half over the subsequent 16 hours
A patient with a 90% burn encompassing the entire torso develops an increasing PCO2 and peak inspiratory pressure. Which of the following is most likely to resole this problem?
Perform a thoracic escharotomy
- The adequacy of inspiration must be monitiored
- Early respiratory distress many be due to
- compromise of ventilation cause by chest inelasticity
- Pressures required for ventilation increase and arterial PCO2 rises
- Seldom require
- performed bilaterally in the anterir axillary lines
if there is significant extension onto adjacent abdominal wall = extend by a transverse incision along costal margin
Silver sulfadiazine
- USed as prophylaxis against burn wound infections with a wide range
- limited systemic absorption
- may inhibit epithelial migration in partial thickness wound healing
- causes neutropenia
- destroys skin grafts
Successful antibiotic penetration of a burn eschar can be achieved with______
Mafenide acetate
- antibioti agent that penetrates burn eschars
- Disadvantage:
- quite painful on any partial thickness areas
- carbonic anhydrase inhibitor - inhibits renal buffering mechanism - > chloride is retained, and metabolic acidosis reslts
Nutritional needs for burn patients
- For patients with greater than 40% TBSAm caloric needs are estiamted to be 25 kcal/kg/day olus 40%kcal/%TBSA/day
- patients with larger than 20% TBSA, early enteral feeding is safe
- Harris benedict equation
- Curreri formula
A 14 year old girl sustains a steam burn measuring 6 x 7 inches over the ulnar aspect of her right forearm Blisters develop over the entrie area of the burn wound, and by the time the patient is seen 6 hours after the injury, some of the blisters have ruptures spontaneously.
What are the accepted therapeutic regimens
- Application of SSD and daily washes, but no dressing
- Application of mafenide acetate cream but no dailu washes or dressing
- Homograft application withouth sutures to secure it in place, but no daily washes or dressings
Surgical treatment for burns
- Tangential excision consists of tangential slices of burn tissue until bleeding tissue is encountered. thus,excision can be associated with potentially significant blood loss
- Bleeding from tangential excision can be helped with injection of epinephrine tumescence solution, pneumatic tourniqutes, epinephrine soaked compresses and fibrinogen and thrombin spray sealant
- Meshed split thickness skin grafts allow serosangunous drainage to prevent graft loss and provide a greater area of wound coverage
A 45 year old woman is admitted to a hospital because of a third degree burn injury to 40% of her TBSA, and her wounds are treated with topical SSD. 3 days after, a burn wound biopsy semiquanitative culture shows 104 pseudomonas organism per gram of tissue. The patient is stable at this time. The most appropriate teatment is
Start subeschar clysis with antibiotics
14 days after admission to the hospital for a 30% partial thickness burn and hemodynamic instability requiren central venous acces, a patient develops a spiking temperature curve. On PE, the central venous catheter site was red, tendeer, and warm. the best treatment for this complciation is to
Remove central venous catheter, culture tip, and placement of new catheter on ontralateral side.
