Plastics & Burn

Question 1

Parkland / Baxter formula versus American Burn Association Consensus / Modified Parkland formula.

Answer 1

Parkland: 3 to 4 ml /kg per % of burn
VS
American Burn Association: 2ml/kg per % of burn

Question 2

Based on the parkland formula , a 70kg patient with 30% second degree burn should be given how much of lactated ringers solution in cc during the first 8 hrs of fluid resuscitation?

Answer 2

4.2 L ( 1st 8 hrs - 1/2 of total - from time of burn)

8.4L ( 1st 24hrs from time of burn)

Parkland formula
Fluids for 24 hrs= 4ml x % TBSA x wt in kg
= 4 x 30 x 70
= 84000 ml or 8.4 L

Question 3

Most important basis for microstaging of melanoma

Answer 3

Depth of invasion

Question 4

The most common subtype of melanoma is?

Answer 4

Superficial spreading

Question 5

Disease free interval after excision of basal cell carcinoma of the lip depends on ______?

Answer 5

Histologic type

Question 6

TBSA of partial thickness burns requiring referral to a burn center?

Answer 6

> 10% TBSA

Superficial burns are not included.
Presence of full thickness burns require referral.

Question 7

TBSA of burns of a patient with partial thickness burns of the chest and right thigh ( using rule of 9s)

Answer 7

18% TBSA

RULE OF 9’s
Head 9%
Chest 9%
Abdomen 9%
Upper back 9%
Lower back/ buttocks 9%
Arm 9%
Thigh 9%
Leg 9%
Genitalia/ Perineum : 1%

Question 8

American burn association formula of fluid resuscitation for the 1st 24hrs post-burn.

Answer 8

2ml PLR / kg/ % TBSA

50% is given on the first 8hrs
Next 50% is given in the next 16hrs

Question 9

Definitive surgical management of burns?

Answer 9

Early tangential excision of burn wound followed by skin grafting

Question 10

Depth of painless , leathery , non-blanching burn injury

Answer 10

Full thickness ( 3rd degree)

Question 11

Duration of dilution in the initial management of caustic injury to the skin by alkaline substance?

Answer 11

2 hrs

Acids: 30mins

Question 12

Squamous cell carcinoma of the skin from old scars or burn sites?

Answer 12

Marjolin ulcer

Question 13

Biopsy technique used to diagnose nonmelanoma skin cancers (BCC & SCC)

Answer 13

Shave or Incisional biopsy

Question 14

Characteristic of sun exposure correlated with malignant melanoma?

Answer 14

Intensity

For nonmelanoma skin cancers, cumulative exposure is more important.

Question 15

Mainstay surgery for malignant melanoma?

Answer 15

Wide excision with 1-2cm margin depending on tumor thickness

Question 16

Most common malignant eyelid tumor and usual for upper lip malignancy?

Answer 16

Casal cell carcinoma

Question 17

Topical antimicrobial used in burn care that can cause metabolic acidosis?

Answer 17

Mafenide acetate

Question 18

70kg Male with 20% tbsa of burn, what vol of PLR would be given in the first hour?
Solve using Parkland Formula.

Answer 18

70kg x 4ml x 20 tbsa divided by 2 then divided by 8 = 350 cc

Parkland formula ( Baxter)
4ml PLR / Kg / TBSA
First 1/2 given in the first 8 hr
Next 1/2 given for the next 16 hrs

Question 19

Identify caloric needs of burn px 70kg , 20% TBSA by Curreri formula.

Answer 19

( 70kg x 25 kcal / day = 1750 kcal / day ) + ( 40kcal x 20 TBSA/day)
= 1750 + 800
= 2550 kcal/ day

Curreri formula = 25 kcal/ kg/ day + 40kcal / TBSA / day

Question 20

What formula is used for resuscitation of pediatric burns?

Answer 20

Galveston Formula ( initial 24 hrs for children)

5,000ml / m2 TBSA Burned + 2,000ml/m2 TBSA (D5LR)
Half given during the first 8 hrs
Next half for the remaining 16 hrs

Question 21

Has Gram positive coverage , soothes and moisturizes , good for facial care and epithelializing wounds but not appropriate for deeper wounds?

Answer 21

Bacitracin

Question 22

Broad spectrum antibacterial and anticlostridial, Penetrates eschar well but painful and causes metabolic acidiosis by inhibition of carbonic anhydrase.

Answer 22

Mafenide

Question 23

Anti-MRSA but has narrow or poor gram negative antimicrobial coverage.

Answer 23

Mupirocin

Question 24

Antifungal but may interfere the activity of Mafenide.

Answer 24

Nystatin

Question 25

Broad spectrum that’s effective for both prophylaxis and treatment of wound infection , penetrates eschar poorly , causes hyponatremia, stains linen and dressings and induces methemoglobinemia.

Answer 25

Silver Nitrate

Question 26

Broad spectrum antibiotic and anti-pseudomonal, application causes no pain but penetrates eschar poorly and causes leukopenia

Answer 26

Silver sulfadiazine

Question 27

Composition of Daikin solution?

Answer 27

15ml of Sodium hypochlorite solution ( Zonrox) + 985ml Plain NSS

Question 28

Diagram used for precise estimation of the extent of burns?

Answer 28

Berkow Diagram