Burns Flashcards by Elaina JoAnn

Parkland Formula

4cc/kg/TBSA
Half in first 8 hours after burn, Other half over next 16 hours
Add 25% if inhalation injury

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IVF supplemented with _________

Vitamin C - antioxidant (decrease overall burn injury, organ damage from cytokine release of free radicals)

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Why is IVF so important?

Coagulation is damaging, stasis in limbo (coagulates w/in 24 hrs usually), hyperemia = increased blood flow.
IVF pushes ZOS –> ZOH, to decrease ZOC –> lessening amount of burn

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Best measure of resuscitation

Urine output
Peds 1cc/kg/hr
Adults 0.5 cc/kg/hr
Neonates 0.5cc

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Mortality formula

TBSA + Age

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TBSA estimation and when matters

Palm ~1%

TBSA only matters in 2,3,4th degree with resp/airway injury 25%

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Burn care: Nutrition

Intubation - nasojejunal, nasogastric
Metabolism can increase to 200%
NEED PROTEIN to heal

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Suspicion of Child Abuse

Stocking and glove, buttocks, uniform/clear delineation

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1st degreee

sunburn (erythema, swelling)

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2nd degree

BLISTERS (into dermis, painful)

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What to do with burn blisters?

Clear - pop, d/t high conc of inflamm mediators –> greater damage
Hemorrhagic –> leave them alone, protecting deeper structures

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3rd degree

Painless (destroys nerves)
Penetrates into subcutaneous
needs grafting

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4th degree

penetrates deep (bone, organ)
severe, life-threatening

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Treatments for burn: Silvadene

Abx ointment
Complications: Neutropenia (reverse in few days)
Switch to bacitracin, etc.

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Tx for burn: Mafenide acetate (sulfamylon)

Penetrates eschar - painful
Accentuates post-burn hyperventilation
Complications - carbonic anhydrase inhibitor (metabolic acidosis)

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Tx for burn: Silver Nitrate

Broad spectrum
Stains
Complication - leaches Na, K, Ca, Cl
Methemoglobinemia rarely

Burns and Eyes

Worry if face, chemical, TBSa> 30%, impaired LOC, I&S needed
Ophtho exam w/in 8hrs of injury

Prophylactic tx?

Not needed - already topical abx

Special about circumferential burns

Escharotomy - cuts in skin to relieve pressure into hypodermis

Skin grafts burns

~4-5 days after burn

May use cadaver, pig - rejected but still help heal

Long term consequences of burn

glucose metabolism irreguar, nutritional deficit, energy/mobility loss

Electrical Injury

Look for entrance, exit wounds
Worry about what’s in between - mm, heart, etc.
Amps SUCK

Tx for Electrical Injury

ABCs
IVF to keep UO > 100cc/hr (tea pee)
EKG
Admit for observation 
OR I&amp;D dead tissue, fasciotomies

Frostbite

Similar to burns - classify the same, tx differently

Ice crystals disrupts cell membrane/physiology –> microvascular occlusion

Frostbite 1st degree

erythema

frostbite 2nd degree

blisters

frostbite 3rd degree

full thickness, into subcutaneous, usually with tissue loss

frostbite 4th degree

gangrene

Frostbite tx

remove offending agent, rapid rewarm (104F), NSAIDS, silvadene dressings, complete pressure relief, TPA - decrease rate of amputation DO NOT debride, massage, burn, amputate

frostbite consequences

paresthesias, cold intolerance, arthritis, growth abnormal

Chemical injury types

ORganic, acid, alkali, elements

Tx chemical injury

continuous water irrig, call toxicologist (except K, Li, Na - Class D extinguisher and mineral oil) eyes - saline, ophtho

Liquid tar tx

Stop process and disrobe cool H20 Vaseline tx burn

Petro based products tx

Remove agent copious h20 irrig Obs and tx - watch for systemic

Acid burn tx

Worry about coagulation necrosis H2O irrig for hours until pain/burning relief DO NOT neutralize Better tolerated

Hydrofluoric acid burn tx

VERY PAINFUL - lasts hours, days can progress to alkali-like liquefaction necrosis tx: 5% CaGluconate & Mg - topical, subcu, intraarterial until pain stops, may need HD

Alkalis burn

Liquefaction necrosis Penetrates deeper, lasts longer, saponification, irrig with water even longer eg. Lye (easy off), cement, paster of Paris (casts) Do not neutralize

Phosphorus injury tx

Munitions, fertilizers, insectisides, poisons Ignites on contact with air Irrigate and cover with wet dressings, copper sulfate --> black cupric phosphide particles --> I,D in OR