Plastics & Burn Flashcards
Parkland / Baxter formula versus American Burn Association Consensus / Modified Parkland formula.
Parkland: 3 to 4 ml /kg per % of burn
VS
American Burn Association: 2ml/kg per % of burn
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?
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
Most important basis for microstaging of melanoma
Depth of invasion
The most common subtype of melanoma is?
Superficial spreading
Disease free interval after excision of basal cell carcinoma of the lip depends on ______?
Histologic type
TBSA of partial thickness burns requiring referral to a burn center?
> 10% TBSA
Superficial burns are not included.
Presence of full thickness burns require referral.
TBSA of burns of a patient with partial thickness burns of the chest and right thigh ( using rule of 9s)
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%
American burn association formula of fluid resuscitation for the 1st 24hrs post-burn.
2ml PLR / kg/ % TBSA
50% is given on the first 8hrs
Next 50% is given in the next 16hrs
Definitive surgical management of burns?
Early tangential excision of burn wound followed by skin grafting
Depth of painless , leathery , non-blanching burn injury
Full thickness ( 3rd degree)
Duration of dilution in the initial management of caustic injury to the skin by alkaline substance?
2 hrs
Acids: 30mins
Squamous cell carcinoma of the skin from old scars or burn sites?
Marjolin ulcer
Biopsy technique used to diagnose nonmelanoma skin cancers (BCC & SCC)
Shave or Incisional biopsy
Characteristic of sun exposure correlated with malignant melanoma?
Intensity
For nonmelanoma skin cancers, cumulative exposure is more important.
Mainstay surgery for malignant melanoma?
Wide excision with 1-2cm margin depending on tumor thickness
Most common malignant eyelid tumor and usual for upper lip malignancy?
Casal cell carcinoma
Topical antimicrobial used in burn care that can cause metabolic acidosis?
Mafenide acetate
70kg Male with 20% tbsa of burn, what vol of PLR would be given in the first hour?
Solve using Parkland Formula.
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
Identify caloric needs of burn px 70kg , 20% TBSA by Curreri formula.
( 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
What formula is used for resuscitation of pediatric burns?
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
Has Gram positive coverage , soothes and moisturizes , good for facial care and epithelializing wounds but not appropriate for deeper wounds?
Bacitracin
Broad spectrum antibacterial and anticlostridial, Penetrates eschar well but painful and causes metabolic acidiosis by inhibition of carbonic anhydrase.
Mafenide
Anti-MRSA but has narrow or poor gram negative antimicrobial coverage.
Mupirocin
Antifungal but may interfere the activity of Mafenide.
Nystatin
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.
Silver Nitrate
Broad spectrum antibiotic and anti-pseudomonal, application causes no pain but penetrates eschar poorly and causes leukopenia
Silver sulfadiazine
Composition of Daikin solution?
15ml of Sodium hypochlorite solution ( Zonrox) + 985ml Plain NSS
Diagram used for precise estimation of the extent of burns?
Berkow Diagram
