Thermal Injury Flashcards

1
Q

ABCDE of Trauma

A

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

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2
Q

What to do if airway burns are suspected

A

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

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3
Q

What are the three stages of airway burns?

A

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

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4
Q

What is oncotic effect ?

A

Draw out fluid from capillaries- third space loss - dehydration

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5
Q

How to treat oncotic effect

A

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

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6
Q

Hypovolemic shock is seen when

A

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

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7
Q

Management in patient with small areas of burns

A

Oral fluids with salt. Patient will have more solid wasting

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8
Q

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

A

IV. Fluids, parklands, formula.

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9
Q

What is Parkland formula?

A

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

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10
Q

Fluids=

A

Crystalloid based - ringer lactate/Hartman solution

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11
Q

In children, fluids =

A

RL + dextrose containing maintenance fluid

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12
Q

Maintenance fluid calculations are

A

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

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13
Q

Colloid resuscitation formula was given by

A

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

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14
Q

Berkow formula is used to

A

Calculate TBSA in children

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15
Q

Lund and browder chart is

A

Best method to calculate TBSA

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16
Q

Zone of coagulation

A

Most severely burn area
; Irreversible

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17
Q

Zone of hyperemia

A

Outermost ;; vasodilation ;; hyperemia ;; recovers

18
Q

Zone of stasis

A

• 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.

19
Q

BEE: basal energy expenditure

A

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

20
Q

Which formula is most commonly used to calculate protein requirement

A

Davies formula

21
Q

Curreri sutherland formula used to

A

Calculate calorie requirement

22
Q

What is eschar

A

Thickened tissues after burns

23
Q

Silver sulphadiazine :

A

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

24
Q

Silver nitrate

A

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

25
Q

Mafenidine acetate(5%)

A

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

26
Q

Cerium nitrate

A

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

27
Q

Causes of death following burns

A

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

28
Q

How to manage acid or alkaline burns

A

ESCHAROTOMY

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

29
Q

How to manage hydrofluoric acid burns

A

• 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.

30
Q

Describe electrical burn

A

• (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.

31
Q

Pattern of indirect lightning injury

A

Filigri burns

32
Q

Best way to take temperature in hypothermic patient

A

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

33
Q

Most effective method to rewarm a patient

A

CPB

34
Q

What is frostbite?

A

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

35
Q

Stages of frostbite

A

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

36
Q

What is trench foot

A

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

37
Q

Management of frostbite and trench foot

A

• 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.

38
Q

Modified baux formula used in

A

Calculates the Risk of mortality following burns.

39
Q

most important factor determining mortality:

A

Presence of inhalational injury.

40
Q

The best fluids used for burns is

A

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