What is the rule of 9’s?
helps estimate % of burns: head, anterior chest, posterior chest, anterior abdomen, posterior abdomen, the whole head, anterior leg, posterior leg…. each count as 9%
The perineal area is 1%; each arm is 4.5%
What chart is frequently used to estimate burn % of a pediatric/newborn?
What is the palm of hand estimation for % TBSA burn?
the palm of the PATIENT’s hand represents 0.5% TBSA, the palm including fingers is 1% TBSA
What is the % difference in a minor, moderate, and major burn?
20% TBSA respectively
Describe the basic local pathophysiology associated with a burn?
acute burn injury….. inflammatory mediators released….. increased capillary permeability….. extravasation of fluids into burned tissues…. tissue edema
How should fluid resuscitation be regulated in a burn patient?
should be titrated to maintain a urine output of 0.5-1.0mL/kg/hr in adults and 1-1.5mL/kg/hr in pediatrics; replacement volume must be individually adjusted based on clinical response
What is the Parkland formula?
In the first 24 hours: give LR at 4mL/kg per % TBSA (1st half to be administered in the first 8hrs and the remaining in the next 8 hours)
Crystalloid in the second 24 hours: give 20-60% of the estimated plasma volume
Colloid in the 2nd 24 hours titrated to UO of 30mL/hr
When is capillary leak at its greatest?
in the first 24hrs after a burn injury
When does capillary integrity improve?
capillary integrity greatly improves 2nd day post burn
Why is the use of colloids controversial during the first 24hours following a burn?
d\t increased capillary permeability… if colloid leaks into interstitial space it can worsen the edema d\t oncotic effects
Based on the Parkland formula, if a patient weighs 70 kg and has burns of 40% TBSA… how much LR should be administered in the first 24hour period?
11,200mL…. so 5,600mL in the first 8 hours and 5,600mL in the following 16 hour period
T/F? Patients with >40% TBSA burns may have a metabolic rate 200% of normal rate.
What may cause a false high reading in the pulse-ox of a burn patient?
Why should Sux be avoided in burn patients?
exaggerated hyperkalemic response
What considerations should be made when administering non-depolarizing agents to a burn patient?
may require higher doses (2-5x) and have significantly quicker recovery times when TBSA burned is 10-40%