burns

Question 1

important history for burns

Answer 1

length of exposure
inhalation - voice, SOB, sore throat
time when burn occurred
associated injuries
pain
PMH

Question 2

s/s of laryngeal edema

Answer 2

drooling
difficulty swallowing
singed nares or eyebrows
burns to face
dark soot/mucus from nares or mouth
hoarseness

brunch and/or intubation!!!

Question 3

methods for estimating TBSA burn

Answer 3

rule of 9’s
Lund & Browder
palmar method

Question 4

rule of 9’s

Answer 4

head (front and back) 9%
each arm 9%
chest 18%
back 18%
perineum 1%
each leg 18%

Question 5

palmar method

Answer 5

patients palm is 1% TBSA

Question 6

burn depths

Answer 6

first degree - superficial, epidermis only

second degree - superficial partial thickness and deep partial thickness; epidermis & dermis

third degree - full thickness dermis (no pain)

fourth degree - extension to deep tissue, life threatening

Question 7

how to assess burn depth

Answer 7

bleeding - more bleeding with prick = more superficial

sensation - pain = more superficial

appearance & blanching - check cap refill, thermography (deeper wounds are cooler), laser doppler to eval blood supply

Question 8

burn classification

Answer 8

minor - <15% TBSA
moderate 15-25% TBSA with <10% full thickness
major - >25% TBSA, high voltage, or inhalation

Question 9

first line mgmt for major burn not at burn center

Answer 9

cover with clean and sterile gauze/towel and ship out to a burn center

Question 10

criteria for transfer to burn center

Answer 10

partial thickness >10% TBSA
face, hands, genetalia, major joints
third degree burns
electrical burns
chemical burns
inhalation injury
complex PMH complicating recovery
concomitant trauma
children in nonpeds hospital
extensive rehab needs

Question 11

complication to keep an eye out for in burns

Answer 11

rhabdomyolysis (electrical)
compartment syndrome
carbon monoxide poisoning
inhalation injury

Question 12

rhabdo monitoring & treatment

Answer 12

trend CK

check urine myoglobin

tea-colored urine

prevent hyper K, aggressive fluid resuscitation

Question 13

carbon monoxide poisoning

Answer 13

check carboxyhemoglobin level and VBG if prolonged smoke exposure

normal in nonsmoker =0-2.3%
smoker normal =2.1-4.2%

extremely elevated lactate >8 suggests cyanide poisoning

Question 14

inhalation injury mgmt

Answer 14

ABCs!

CXR

nasolaryngoscopy or bronch if suspected airway burn

Question 15

parkland formula

Answer 15

fluid resuscitation
adults: 4 ml/kg * TBSA during first 24 h

give 1/2 in first 8 hours, second 1/2 in next 16 hours

crystalloid - probably LR

monitor UOP (at least .5ml/kg/hr)

be sure to account for fluid given in transportc

Question 16

compartment syndrome diagnostics & mgmt

Answer 16

intracompartmental pressure >30 mmHg

intracompartmental pressure >20 with hypotension

interrupted arterial perfusion for >4 hours

fasciotomy, escharotomy

Question 17

pain mgmt for burns

Answer 17

fentanyl 1-2 mcg/kg IV
morphine 0.1 mg/kg IV
consider PCA
consider ketamine for dressing changes
consider benzos

Question 18

first degree burn

Answer 18

epidermis

dry and red, blanches

painful

heals spontaneously

Question 19

second degree burn

Answer 19

epidermis and dermis

blistering, moist, red and weeping, may not blanch

painful,

may heal spontaneously, may require grafting

Question 20

third degree burn

Answer 20

destruction of epidermis and dermis

white, waxy, leathery, black, does not blanch

painful to deep pressure only

requires excision