EM, ICU, and surgery Flashcards
When is inpatient management necessary for burns?
2nd degree > 10% body surface area
3rd degree > 2% body surface area
2nd or 3rd affecting face, hands, genitals, or major skin flexion creases
What is the formula for determining IV fluid resuscitation for burn victims?
4mL x body weight (kg) x % body surface area burned
Sample question: 100kg man has a 3rd degree burn of his left arm. How much fluid should be given?
4 mL x 100kg x 9% = 3600mL
Remember the Rule of 9s in adults…head x2 in kids (percent taken from legs and genitals)
A burn victim is brought in with extensive burns (>25% of body). What needs to be done?
Airway management (often intubation) IV fluids Temp control (risk of hypothermia)
A burn victim is brought in with an extensive facial burn. What needs to be done?
Airway management (often intubation) IV fluids Temp control (risk of hypothermia)
A person is brought in after escaping from a house fire with no obvious burns. What should be considered?
Check carboxyhemoglobin levels…if elevated put on high flow O2 and monitor for respiratory compromise
What medications should be used for burn victims?
Topical silver sulfadiazine or bacitracin on bandages
Tetanus toxin if unknown/not UTD
What bacterial infection can develop in burn victims?
Pseudomal sepsis
What can be complications of electrical burns?
MI
Cataracts
Seizures
How is risk of mortality determined with burn victims?
> 60yo
40% body surface burned
Inhalation injury
0 –> 0.3%
1 –> 3%
2 –> 33%
3 –> 90%
What is the end stage pathophysiology of fresh water drowning? (drowning in the hypoxia d/t submersion in a fluid sense)
Hypotonic fluid in alveoli –> free water into capillaries –> hypotonic blood serum –> free water into RBCs –> RBC swelling/lysis
What is the end stage pathophysiology of salt water drowning? (drowning in the hypoxia d/t submersion in a fluid sense)
Hypertonic fluid in alveoli –> free water from capillaries into alveoli –> pulmonary edema and increased hypertonic serum
Patient comes after a long jog on a hot day with weakness, headache, and profuse sweating. Temp is a little high, but labs are normal. What is the diagnosis? What should be done? What can happen?
This is Heat Exhaustion
Give oral hydration (unless patient worsens) and electrolyte replacement (so give gatorade)
This can progress to Heat Stroke
NFL player comes in after a training camp practice with confusion, blurred vision, nausea, and little/no sweating. Body temp is really high and WBC, Cr, and BUN are all elevated. What is this? What should be done? What are the complications?
This is Heat Stroke…RIP Korey Stringer
Cool environment
Spray with water and then fan
Benzodiazepines to relax muscles
Rhabdo, seizures, brain damage, death
Patient comes in after his truck breaks down out on the ice. He is shivering uncontrollably and is confused. His temp is
J waves (little bump after QRS)
Vtach
Vfib
Warm him up, externally (bath, blankets) or internally (warm IV, ingested fluids)
Patient stops shivering and is unable to maintain body temp…blood viscosity will fatally increase
