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Skin MS: Week 2 > Burns > Flashcards

Flashcards in Burns Deck (38)
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1

Parkland Formula

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

2

IVF supplemented with _________

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

3

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

4

Best measure of resuscitation

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

5

Mortality formula

TBSA + Age

6

TBSA estimation and when matters

Palm ~1%
TBSA only matters in 2,3,4th degree with resp/airway injury 25%

7

Burn care: Nutrition

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

8

Suspicion of Child Abuse

Stocking and glove, buttocks, uniform/clear delineation

9

1st degreee

sunburn (erythema, swelling)

10

2nd degree

BLISTERS (into dermis, painful)

11

What to do with burn blisters?

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

12

3rd degree

Painless (destroys nerves)
Penetrates into subcutaneous
needs grafting

13

4th degree

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

14

Treatments for burn: Silvadene

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

15

Tx for burn: Mafenide acetate (sulfamylon)

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

16

Tx for burn: Silver Nitrate

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

17

Burns and Eyes

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

18

Prophylactic tx?

Not needed - already topical abx

19

Special about circumferential burns

Escharotomy - cuts in skin to relieve pressure into hypodermis

20

Skin grafts burns

~4-5 days after burn
May use cadaver, pig - rejected but still help heal

21

Long term consequences of burn

glucose metabolism irreguar, nutritional deficit, energy/mobility loss

22

Electrical Injury

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

23

Tx for Electrical Injury

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

24

Frostbite

Similar to burns - classify the same, tx differently
Ice crystals disrupts cell membrane/physiology --> microvascular occlusion

25

Frostbite 1st degree

erythema

26

frostbite 2nd degree

blisters

27

frostbite 3rd degree

full thickness, into subcutaneous, usually with tissue loss

28

frostbite 4th degree

gangrene

29

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

30

frostbite consequences

paresthesias, cold intolerance, arthritis, growth abnormal