Burns Flashcards
What is a normal heart rate due to a burn?
100-120 due to catecholamines. Anything above this may indicate hypovolemia, inadequate oxygenation, unrelieved pain/anxiety.
What is the preferred method for a peripheral IV?
Large bore through unburned skin if possible. Try to avoid IOs as it can cause osteomyelitis.
Both of these can be used if absolutely needed. If interfacility, consider a central line.
What is the initial fluid resuscitation rate prehospitally for 5 years old and younger?
125ml per hour of LR
What is the initial fluid resuscitation rate prehospitally for 6-13 year olds?
250ml per hour of LR
What is the initial fluid resuscitation rate prehospitally for ages 14 and older?
500ml per hour of LR
Are the typical indicators of pain, pallor, and parasthesia for compartment syndrome reliable in burns?
No. Absence of palpable pulses are best. Doppler is useful.
Do burns cause bleeding?
No. If bleeding is noted, maintain an index of suspicion for trauma.
What should be considered with periorbital burns?
Remove the contact lenses. Edema can prevent removal later and chemicals can adhere to the lenses.
How should burns be cooled?
With running water and the removal of all burned clothing, jewelry, etc.
Can ice be used to cool a burn?
No. Can cause local hypothermia which worsens tissue destruction. Also causes systemic hypothermia which raises metabolic demands.
Do you include 1st degree burns in the TBSA calculation?
No
What is the ACE fluid resuscitation algorithm?
A - Adult thermal burns 2ml/kg/TBSA
C - Children thermal burns 3/ml/kg/TBSA
E - Electrical burns 4ml/kg/TBSA (all ages)
Add D5LR at a maintenance rate for all peds burns per ABLS
When should a foley be placed?
In general, all burns TBSA >20% need one to monitor urine output.
Why should drugs administered IM or SQ be avoided in burns?
The route is unreliable due to changes in fluid volume and tissue blood flow.
What position should the patient be transported in?
HOB elevated 45 deg if possible, to minimize edema. Elevate any burned extremities as well, if possible.
What lab should be ran if inhalation injury is suspected?
An ABG with a carboxyhemoglobin to assess for carbon monoxide.
What is criteria for transport to a burn center?
1 - Partial thickness burns >10% TBSA 2 - Any 3rd degree burns 3 - Burns involving face, hands, feet, genitalia, perineum, or major joints 4 - electrical burns 5 - chemical burns 6 - inhalation injury 7 - burned children 8 - burned patients with medical conditions that could complicate recovery
The fluid resuscitation formula should be utilized and fluids administered at what percentage of burns?
> 20% per ABLS
What is the difference in the prehospital rates and the fluid resuscitation formulas (ACE and Parkland)?
The prehospital rates is meant to give the provider a starting point. The resuscitation should then be adjusted once a body weight and TBSA is better determined/calculated.
Does the palm method in determining % burns include the fingers or no?
The palm method is using the patient’s hand as a guide. The palm of the hand AND the fingers are considered 1% TBSA.
How is carbon monoxide produced?
By incomplete combustion.
How much more affinity does CO have for HGB than O2 does?
200x more
Reference ranges for carboxyhemoglobin?
5%-10% is found in some smokers
15%-40% causes some changes in CNS like headache, nausea, etc
>40% causes loss of consciousness, cheynes stokes, seizures, etc
How does CO poisoning affect an ABG?
It doesn’t affect the ABG because the amount of oxygen in the plasma is normal. Only a COHb level will change.
How can a victim receive hydrogen cyanide poisoning?
From the burning of synthetic materials such as carpet, plastics, furniture, draperies, etc.
Can a chest x-ray exclude the diagnosis of inhalation injury?
No. CXR is for trauma identification and tube placement.
