Lecture 10: Burns

Question 1

What are the characteristics of a 1st degree burn and its Tx?

Answer 1

Superficial (aka sunburn), NO blisters or Nikolsky’s

Tx: moisturizing agent

Question 2

What are the major differences b/t 2nd degree superficial and deep burns?

Answer 2

Superficial - blister w/blanching, heals faster, +/- Nikolsky
Deep - yellow eschar appearance, NO blanching, longer healing

Question 3

What is a sign to look for that a 2nd degree superficial burn might be healing?

Answer 3

spots of dryness

shiny = fresh wound

Question 4

What are two Tx considerations for deep but not superficial 2nd degree burns?

Answer 4

Deep –> consider grafting, these may heal w/scarring

Question 5

Why should you watch burns for the 1st 24-48 hrs?

Answer 5

They may convert (Ex: from 2nd –> 3rd degree)

Question 6

How does a 3rd degree differ from a 2nd degree burn?

Answer 6

NO VIABLE DERMIS, NON-blanching, zone of necrosis

superficial scratch –> no pain

Question 7

How should you Tx a 3rd degree burn?

Answer 7

Remove char
Silver Sulfadiazine
EARLY excision & grafting

Question 8

How does a 4th degree differ from a 3rd degree burn?

Answer 8

Tendon, muscle, bone involved
Nerve damage –> Little/no sensation
Signif need for amputations

Question 9

If a patient has 1st degree burns along with 2nd and 3rd degree burns do you include them all when calculating the TBSA?

Answer 9

NO - only 2nd and 3rd degree used to calculate the TBSA

Question 10

What is the TBSA threshold for initiating fluid resuscitation? What fluid should you use?

Answer 10

only start fluids when TBSA >20%

LR

Question 11

What is the Parkland Formula?

How quickly do you replace their fluids?

Answer 11

4cc x TBSA x Wt (kg) = Total fluid amt for the 1st 24 hrs

Replace 1/2 in first 8 hrs and next 1/2 in the next 16 hrs

Question 12

What are the urine output goals for adults?

Answer 12

.5 cc/kg/hr

Note: higher for peds (1) and electrical burns (1-1.5)

Question 13

Describe the rule of 9’s

Answer 13

Head (front + back) = 9%
1 Arm (front + back) = 9%
1 Leg (one side) = 9%
Chest (one side) = 18%

note: palm + fingers & genital area = 1%

Question 14

When should patients be referred to a burn center?

Answer 14

Partial thickness burn w/ > 10% TBSA 
ANY 3rd degree burn 
electric or chemical burns
inhalation injury
pts w/burn + trauma 

Note: only some listed above

Question 15

What the Tx for any inhalation injury?

Answer 15

100% O2

Question 16

How must you test for CO poisoning?

Answer 16

Via an ABG! - pulse ox only shows O2 level

Question 17

What Tx is specific for CO poisoning?

Answer 17

Hyperbaric O2

- but only in severely high COHb, not for critical pts or large TBSA

Question 18

What Tx is specific for CN poisoning?

Answer 18

need 100% O2 + antidote

Hyperbaric O2 wont work!

Question 19

A patient presents w/pain in his L leg which also has pallor, paresthesia, paralysis, poikilothermia and you are unable to get a pulse in the leg, what is the most likely Dx and Tx?

Answer 19

Compartment Syndrome - The 6 P’s

Tx: escharatomy

Question 20

When should you consider adding NG tubes to supplement PO nutrition in burn patients?

What kind of supplementation do burn patients need?

Answer 20

When TBSA > 20%

Supp: Vit A, C, E and Zinc

Question 21

When should you consider doubling the basal rate for burn patients?

Answer 21

When they are in a hypermetabolic state (higher energy needs)