Thermal injury Flashcards
Burn management in ER
Use sterile technique when touching patient. Saline soak for analgesia if burns less than 25% of BSA. Weight patient. Begin fluid resuscitation. Elevate burns when possible to avoid edema.
Size of palm is what percent of BSA?
1%
Rule of 9s for estimating BSA
18% for anterior torso and for posterior torso, 9% for each side (anterior and posterior) legs, 4.5% for each side arm and for each side head
What types of burns can be treated outpatient?
Most first degree burns. Second degree burns that are less than 10% BSA, excluding most burns of hands, face, perineum, eyes.
Parkland formula for fluid resuscitation for burns
For the first 24 hours: LR at 4 cc/kg/%BSA burn. Give half in the first 8 hours and half in the next 16 hours. For the second 24 hours: D51/2 NS and replace albumin as needed.
For peds do 3 cc/kg/%BSA
Endocrine response to burn is ..
Hyperglycemia
Cardiovascular system changes in response to burn
Increased micro vascular permeability from release of vasoactive substances. Increased LVEF but decreased CO, peripheral vasoconstriction, decreased renal perfusion and oliguria.
After resuscitation, hyper dynamic state persists. There are elevated metabolic requirements, with a catabolic state.
Pulmonary changes with burn
Shallow respirations in response to hypovolemia. After resuscitation, hyperventilation leads to mild respiratory alkalosis.
GI effects of burn
Most patients with greater than 25% BSA will have an ileus that usually resolves between days 3 and 5. GI permeability is increased which can lead to bacterial translocation. Need NG tube and h2 blocker
Endocrine effects of burn
Decreased insulin and t3. Increased glucagon, cortisol, catecholamines.
Immunologic effects of burn
Loss of skin barrier function. Decreased WBC, esp lymphocytes. Dysfunction of PMNs.
What may be required if escharotomy fails?
Fasciotomy, which does require general anesthesia. Escharotomy does not. Most common compartment requiring fasciotomy is anterior tibial compartment.
Feature of burn excision operations
Required for most deep second and third degree burns, after stabilization of patient. Limit operations to less than 20% BSA at a time, or less than 2 hours OR time.
What can skin be grafted with once debridement is complete?
Split-thickness skin graft (STSG), full thickness skin graft, or biologic dressing (allograft, zenograft aka pig, or biobrane). Note that biologic dressings come off when reepithelialization occurs
Treatment of invasive burn infection
Change to Sulfamylon (mafenide acetate, penetrates eschar well) and start systemic antibiotics.