Outpaitent Burn Care

Question 0

What are the first questions to ask?

Answer 0

1. can the patient breath–if no, then ABCs
2. how extensive is the burn–>10% = hospitalize
3. what about fluid replacement–> >20% burn needs IV fluid
4. how did it occur–> tells you how to manage the burn
5. do i keep this patient in my practice?

Question 1

Where is the most primary cause of burn deaths in kids?

Answer 1

home. most are under 14 years old. It is the leading cause of death for non-MVA 1-4 years.

Question 2

Describe the extent of the burn injury

Answer 2

severity of burn injury is the product of 
- temperature of the burning agent
-time of the exposure
severity influences depth
extent is determiend by TBSA

Question 3

What is a partial thickness injury?

Answer 3

• superficial : epidermal involvment
• deep: extension into dermis

Blisters, pink, moist, painful. Will heal without surgery, but scar will form. No nerve damage.

Question 4

Describe a full thickness burn?

Answer 4

all dermis is injured–> yellow, dry, leathery, non-painful. Need surgical excision and skin grafting.

Question 5

do kids need more fluid than an adult for replacement?

Answer 5

yes. disproportionate body surface area to body weight imposes more fluid requirements. They are more prone to ischemic changes with edema, they have renal immaturity, and limited heat conservation because they have lower muscle mass.

Question 6

What is a first degree burn?

Answer 6

red, dry painful, not counted in TBSA. treat by drinking a lot of electrolyte fluids.

Question 7

Describe a second degree burn

Answer 7

moist, pink, painful, blisters, superficial should heal quickly. deeper dermal burn probably needs excision. These are partial thickness

Question 9

describe third degree burn

Answer 9

dry, leathery, non painful because it has gotten through to the nerve. typically fully thickness

Question 10

What is the rule of nines?

Answer 10

It is a system to see how much TBSA was burned. It is most important for determining regulation of fluid resuscitation. The rule of nines is for adults. Palm = 1%

Question 11

What are the pediatric rules of nines?

Answer 11

palm = 1%.

subract 1% from head and add it do legs each year.

Question 12

What should be used for oral resuscitation?

Answer 12

pedilyte, milk or soy, gatorade…NO WATER. It must contain electrolytes

Question 13

10% requires IV fluid replacement with

Answer 13

lactated ringers.
2-4cc / kg adult
3-4 cc/kg pedi/% burn/24 hours

Question 14

how can you tell if the fluid replacement is working?

Answer 14

UOP

It is a reliable reflection of renal artery pressure.

Question 15

When is escharotomy needed?

Answer 15

when you worry about skin perfusion, specifically compartment syndrome. cut through the wound to allow for skin to get perfused/become more elastic.

Question 16

Are burn victims able to regulate their temp?

Answer 16

no, they lose that function. they prefer it warm.

Question 17

who gets scald injuries the most?

Answer 17

60

Question 18

What is the most common burn in toddlers? >4yo?

Answer 18

contact burns, flame burns

Question 19

you walk in on a burn taking place…what should you do?

Answer 19

ABCs first
then,
stop burning process. remove clothing. cool water is okay for short term.
When they arrive to clinic, give appropriate narcotic treatment. then use anti-bad soap to clean with warm water.

Question 20

How should silvadene be used?

Answer 20

below the clavicle, 2nd medical problems if gets in eyes.
Needs an Rx
Twice daily with dressing changes
Has activity against GPC, AND GNR

Question 21

What topical is best for faces?

Answer 21

bacitracin. It needs frequent application and it only works against GPC.

Question 22

What topical might you prescribe if you want to limit dressing changes?

Answer 22

acticoat.

Question 23

Are systemic antibiotics indicated to help prophylactically?

Answer 23

NO! IF cellulitis does develop, it is usually streptococcal in nature. If it is unresponsive to treatment, admit.

Question 24

When is surgical intervention indicated?

Answer 24

when healing is not expected to progress without a significant scar formation limiting function or cosmesis

Question 25

Describe the post-op healing process:

Answer 25

5 days tip new blood supply visible
5-14 days of fragility
2wk-6wk of edema management and hydrating grafts
6 wks -18 months of scar management, hydration and sun avoidance.

Question 26

What is considered a high voltage burn?

Answer 26

> 1000 v – neuro and cardiac problems, and can get associated symptoms with falls, and serious trauma. Sometimes you may see a contact site: area where electricity exits the body.

Question 27

If a keloid scar develops, what does it respond to?

Answer 27

steroid injection or excision.

Question 28

What is the criteria for cancer?

Answer 28

>10% of TBSA burn in pecs, >20% burn in adults
any 3rd degree burns
critical ares that are burned
complex burns: electrical or chemical
failure to heal by 2-3 weeks
inability to tolerate wound care/pain
social concerns

Question 29

What should you do about blisters?

Answer 29

leave them alone!!!

Question 30

how often should follow up visits be?

Answer 30

every week til it has healed