Thermal Injury

Question 1

ABCDE of Trauma

Answer 1

Airway,
breathing
circulation,
disability
exposure (causes of burn ; extent of burns)

Question 2

What to do if airway burns are suspected

Answer 2

Prophylactic intubation (cause there is chance of laryngeal edema airway obstruction) .
If burns >40% TBSA - prophylactic intubation

Question 3

What are the three stages of airway burns?

Answer 3

1) Acute pulmonary insufficiency
2) ARDS like picture
3) bronchopneumonia

Question 4

What is oncotic effect ?

Answer 4

Draw out fluid from capillaries- third space loss - dehydration

Question 5

How to treat oncotic effect

Answer 5

IV. Fluids, except colloids for 12 to 24 hours.. if colloids (albumin) given, albumin will draw out more fluid —> more space loss —> more dehydration.

Question 6

Hypovolemic shock is seen when

Answer 6

> 10% burns in child ;
15% burns in child

Question 7

Management in patient with small areas of burns

Answer 7

Oral fluids with salt. Patient will have more solid wasting

Question 8

Fluid management, impatient with greater than 10 to 15% of TBSA

Answer 8

IV. Fluids, parklands, formula.

Question 9

What is Parkland formula?

Answer 9

2 * body weight * TBSA.
[First-degree burns are excluded]
Amount of fluid in first 24 hours : half in the first 8 hours ; second half in the next 16 hours

Question 10

Fluids=

Answer 10

Crystalloid based - ringer lactate/Hartman solution

Question 11

In children, fluids =

Answer 11

RL + dextrose containing maintenance fluid

Question 12

Maintenance fluid calculations are

Answer 12

100 ML/KG for the first 10 KG in 24 hours
50 ML/KG for next 10 KG’s in 24 hours
20 ML/KG for every KG after 20 KG’s in 24 hours

Question 13

Colloid resuscitation formula was given by

Answer 13

Muir and Barclay formula..
Colloid should only be started after first 12 to 24 hours due to massive fluid shift

Question 14

Berkow formula is used to

Answer 14

Calculate TBSA in children

Question 15

Lund and browder chart is

Answer 15

Best method to calculate TBSA

Question 16

Zone of coagulation

Answer 16

Most severely burn area
; Irreversible

Question 17

Zone of hyperemia

Answer 17

Outermost ;; vasodilation ;; hyperemia ;; recovers

Question 18

Zone of stasis

Answer 18

• In between.
• Reversible injury.
•associated with thrombosis of the vessels
• Proper management and care -> zone of Hyperemia -> Recovers.
If not -> Infection sets in -> Necrosis -> Irreversible damage.

Question 19

BEE: basal energy expenditure

Answer 19

• Normal: 1 (20 kcaV/kg/day).
• mild-moderate sepsis : 1.4.
• severe sepsis/shock: 1.8.
• severe burns : 2 (40 kCal/kg/day.)

Question 20

Which formula is most commonly used to calculate protein requirement

Answer 20

Davies formula

Question 21

Curreri sutherland formula used to

Answer 21

Calculate calorie requirement

Question 22

What is eschar

Answer 22

Thickened tissues after burns

Question 23

Silver sulphadiazine :

Answer 23

• most commonly used
• Frequent change of dressing.
• Good against Pseudomonas, gram negative bacteria.
• Doesn’t penetrate eschar.

Question 24

Silver nitrate

Answer 24

• Good action against Pseudomonas.
• Little action against gram negative.

Question 25

Mafenidine acetate(5%)

Answer 25

• penetrate Eschar : Deeper layers.
• very painful to apply.
• Can cause metabolic acidosis.

Question 26

Cerium nitrate

Answer 26

• Best Agent
• Immunomodulatory effect (helps in healing, prevents wound infection).

Question 27

Causes of death following burns

Answer 27

• Immediate : Asphyxia > Neurogenic shock.
• Early (1-3 days) : Hypovolemic shock.
• Late (> 3 days) : septic shock.
• overall: Septic shock
mc organism: Pseudomonas (dressing turns green)

Question 28

How to manage acid or alkaline burns

Answer 28

ESCHAROTOMY

.• Never neutralize (exothermic reaction
can extend the burs).
• Wash with water, except elemental sodium and phosphorus burns.
• Chemical powder : Just brush it off

Question 29

How to manage hydrofluoric acid burns

Answer 29

• Can chelate calcium -> Hypocalemia, hyperkalemia
- Predisposed to arrythmia (leading cause of death.
• Extremely painful.
• RX: Small areas - Calcium gluconate gel. • moderate -> IV calcium gluconate + Oral.
• Large areas - IV + intra arterial calcium gluconate.

Question 30

Describe electrical burn

Answer 30

• (AC sockets in house): Tetany (repititive muscle contractions) -> muscle injury myoglobinuria.
ii.Direct current (DC) : Heart Block.
• High degree (3/4th).
• Entry & exit burn points.
• most common cause of death : Arrythmias (<24 hours).
• muscle injury + myoglobinuria-= Brown urine. Renal Failure (therefore, aggressive fluid therapy.

Question 31

Pattern of indirect lightning injury

Answer 31

Filigri burns

Question 32

Best way to take temperature in hypothermic patient

Answer 32

Rectal > esophageal
• Hypothermia (30 min of cold exposure)

Question 33

Most effective method to rewarm a patient

Answer 33

CPB

Question 34

What is frostbite?

Answer 34

• ice crystals formed in tissue cause membrane injury { microvascular damage.
• Rewarming can lead to re perfusion injury.

Question 35

Stages of frostbite

Answer 35

4 stages
• stage I : Hyperemia
• stage a : Large vesicles; skin loss.
• stage 3: Hemorrhagic vesicles; full thickness skin loss.
• stage 4 : muscle/bone involed.

Question 36

What is trench foot

Answer 36

• Prolonged exposure to cold § tissue is wet.
• microvascular.
• stasis & occlusion.

Question 37

Management of frostbite and trench foot

Answer 37

• Gradual rewarming of legs (water at 40 degree).
• Don’t rub tissue: extremely painful.
• Be aware of re perfusion injury.
• Hyperkalemia & acidosis can occur.
• if gangrene: then wait for demarcation line.
• Best method to record temperature in hypothermic patient : Rectal > esophageal temperature.

Question 38

Modified baux formula used in

Answer 38

Calculates the Risk of mortality following burns.

Question 39

most important factor determining mortality:

Answer 39

Presence of inhalational injury.

Question 40

The best fluids used for burns is

Answer 40

Ringer lactate or Hartmann’s solution ; it prevents metabolic acidosis