Thermal Injury Flashcards
ABCDE of Trauma
Airway,
breathing
circulation,
disability
exposure (causes of burn ; extent of burns)
What to do if airway burns are suspected
Prophylactic intubation (cause there is chance of laryngeal edema airway obstruction) .
If burns >40% TBSA - prophylactic intubation
What are the three stages of airway burns?
1) Acute pulmonary insufficiency
2) ARDS like picture
3) bronchopneumonia
What is oncotic effect ?
Draw out fluid from capillaries- third space loss - dehydration
How to treat oncotic effect
IV. Fluids, except colloids for 12 to 24 hours.. if colloids (albumin) given, albumin will draw out more fluid —> more space loss —> more dehydration.
Hypovolemic shock is seen when
> 10% burns in child ;
15% burns in child
Management in patient with small areas of burns
Oral fluids with salt. Patient will have more solid wasting
Fluid management, impatient with greater than 10 to 15% of TBSA
IV. Fluids, parklands, formula.
What is Parkland formula?
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
Fluids=
Crystalloid based - ringer lactate/Hartman solution
In children, fluids =
RL + dextrose containing maintenance fluid
Maintenance fluid calculations are
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
Colloid resuscitation formula was given by
Muir and Barclay formula..
Colloid should only be started after first 12 to 24 hours due to massive fluid shift
Berkow formula is used to
Calculate TBSA in children
Lund and browder chart is
Best method to calculate TBSA
Zone of coagulation
Most severely burn area
; Irreversible
Zone of hyperemia
Outermost ;; vasodilation ;; hyperemia ;; recovers
Zone of stasis
• 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.
BEE: basal energy expenditure
• Normal: 1 (20 kcaV/kg/day).
• mild-moderate sepsis : 1.4.
• severe sepsis/shock: 1.8.
• severe burns : 2 (40 kCal/kg/day.)
Which formula is most commonly used to calculate protein requirement
Davies formula
Curreri sutherland formula used to
Calculate calorie requirement
What is eschar
Thickened tissues after burns
Silver sulphadiazine :
• most commonly used
• Frequent change of dressing.
• Good against Pseudomonas, gram negative bacteria.
• Doesn’t penetrate eschar.
Silver nitrate
• Good action against Pseudomonas.
• Little action against gram negative.
Mafenidine acetate(5%)
• penetrate Eschar : Deeper layers.
• very painful to apply.
• Can cause metabolic acidosis.
Cerium nitrate
• Best Agent
• Immunomodulatory effect (helps in healing, prevents wound infection).
Causes of death following burns
• Immediate : Asphyxia > Neurogenic shock.
• Early (1-3 days) : Hypovolemic shock.
• Late (> 3 days) : septic shock.
• overall: Septic shock
mc organism: Pseudomonas (dressing turns green)
How to manage acid or alkaline burns
ESCHAROTOMY
.• Never neutralize (exothermic reaction
can extend the burs).
• Wash with water, except elemental sodium and phosphorus burns.
• Chemical powder : Just brush it off
How to manage hydrofluoric acid burns
• 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.
Describe electrical burn
• (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.
Pattern of indirect lightning injury
Filigri burns
Best way to take temperature in hypothermic patient
Rectal > esophageal
• Hypothermia (30 min of cold exposure)
Most effective method to rewarm a patient
CPB
What is frostbite?
• ice crystals formed in tissue cause membrane injury { microvascular damage.
• Rewarming can lead to re perfusion injury.
Stages of frostbite
4 stages
• stage I : Hyperemia
• stage a : Large vesicles; skin loss.
• stage 3: Hemorrhagic vesicles; full thickness skin loss.
• stage 4 : muscle/bone involed.
What is trench foot
• Prolonged exposure to cold § tissue is wet.
• microvascular.
• stasis & occlusion.
Management of frostbite and trench foot
• 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.
Modified baux formula used in
Calculates the Risk of mortality following burns.
most important factor determining mortality:
Presence of inhalational injury.
The best fluids used for burns is
Ringer lactate or Hartmann’s solution ; it prevents metabolic acidosis
