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SURGERY_hlo > Burns > Flashcards

Burns Flashcards

1
Q

what do you give initially to a patient with burn

A

100% humidified oxygen

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2
Q

what should be established for resuscitation

A

Basilic vein-cut down

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3
Q

what are the formulas one can use to estimate TBSA

A
  1. Rule of 9s
  2. Palmar method
  3. Lund and Browder
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4
Q

What formula can be used to estimate fluid requirements

A
  1. Parkland

2. Consensus Formula

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5
Q

Parkland formula: Adult, Children (<2), children (2-10) ; and what fluid to give

A 
Adults: Plain Lactated Ringer's solution
 2-4mL x Body Wt (kg) x %TBSA Burn
o Children (2-10y/o): Dextrose containing Lactated Ringer's
solution
 3-4mL x Body Wt (kg) x %TBSA Burn
o Children (<2y/o): D5 0.3% NaCl
 3-4mL x Body Wt (kg) x %TBSA Burn
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6
Q

Consensus Formula

how to give fluids

A

2-4mL x Body Wt (kg) x %TBSA Burn (Plain Lactated
Ringer’s solution)

first 8 hrs - 1/2 of total amt
rem 16 hrs - 1/2

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7
Q

main basis for hydration

A

urine output

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8
Q

Rule of 9s imprecise for estiating BSA in

A

Children <15 yrs old or <30kg

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9
Q

hourly urine output

Adult vs children

A

Adult: 30-50 cc hr or 0.5 cc/kg/hr

 Children: less than 30kg, 1cc/kg/hr

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10
Q

Fluid calculations for the next 24 hrs

A

???

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11
Q

Fluid composition in 1st 24 hrs ; 2nd 24 hrs?

A

1st 24 hrs - crystalloids

2nd 24 hrs - crystalloids +/- colloids

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12
Q

Thermal burns: ice should be applied: T/F

A

false

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13
Q

major concern in electrical burns

A

cardiac electrical activity

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14
Q

Burn classification based on depth

A

1st deg, 2nd deg (sup or deep), 3rd degree burn

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15
Q

classify: erythema, epidermis, may desquamate, (-) blister

A 
First-degree Burn
o Erythema only
o Involves epidermis only
o Does not blister
o Desquamation may occur
Use topical ointment to relieve dryness and pain
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16
Q

classify: epidermis + varying portion of dermis; common- BLISTER, blanches

healing period?

A

Superficial Partial Thickness Burn
o Involves epidermis and varying portion of dermis
o Blanches under pressure
o Blistering is common
o Pink and painful
o Heals in 7-21 days with proper wound care

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17
Q

classify: deeper dermal injury, wound white or red, Diminished sensation, (-) blanching
healing?

A

Deep Partial Thickness Burn
Heals in 21-35 days but with severe contracture if not
managed surgically

Always need excision and skin grafting

18
Q

Classify: dry leathery, painless, involves subQ

A

Third-degree Burn
o Deep full thickness burn

Needs excision and grafting

19
Q

Zone:
irreversible cellular death
Need to excise and cover with Split thickness skin graft (STSG)

A

ZONE OF COAGULATION/NECROSIS

20
Q

Zone:
WOF
Labile area which may lead to necrosis if given the chance
Temporarily lacks a blood supply but is NOT avascular

A

ZONE OF ISCHEMIA/STASIS

need: good hydration

21
Q

Zone:
Area of increased vascular permeability
A reaction to zone of stasis

A

ZONE OF HYPEREMIA

22
Q

in doing first aid, if with respiratory and circulatory depression, perform..

A

escharotomy

23
Q

usual infectious agents

A

S. aureus and opportunistic gram negative species: Proteus, Klebsiella, Pseudomonas

24
Q 
topical antimicrobial agents 
Water soluble cream
 Broad spectrum
 Good eschar penetration
 Painful
A

Mefanide

25
Q

MOA of Mefanide

A

potent carbonic anhydrase inihibitor, mild inihibition of epithelialization

26
Q 
White cream
 Does not stain
 Painless
 Broad spectrum
 Penetrates eschar poorly but softens it
A

1% silver sulfadiazine

27
Q

silver sulfadiazine may cause what if used daily

A

transient leucopenia

28
Q

topical anti-mic
Stains skin and linen
 Leaches electrolytes (sodium)
 Has to be reapplied every several hours

A

0.5% silver nitrate

29
Q

Silver nitrate may cause

A

methemoglobinemia

30
Q

Most common complication of silver nitrate

A

electrolyte imbalance

31
Q

most commonly used dressing

A

duoderm (Hydrocolloid dressing)

32
Q

duoderm redressing every

A

3-5 days

33
Q

provides a wound barrier; associated with decreased pain; use complicated by accumulation of exudates, risking invasive wound infection; no antimicrobial properties

A

Tegaderm

34
Q

provides a moisture barrier; inexpensive and with decreased wound pain; use complicated by accumulation of transudate and exudates, requiring removal, no antimicrobial properties

A

op-site

35
Q

with elastic properties that form a seal with the wound, which promotes epithelialization

A

biobrane

36
Q

Biological and physiological consequences of burning

A

acute pulmonary edema, acidosis, hyperkalemia, hyponatremia (relative), dec leukocyte activity, immunoglobulin, helper T cells, fibronectin, INC - complement activation, IL1, TNF, suppressore T cells, and serum glucose

37
Q

nutritional care phases in burn patients

A
  1. Ebb phase
  2. Flow phase
  3. Anabolic phase
38
Q

1st 24hrs wherein body responds to correct fluid resuscitation

A

Ebb phase

39
Q

Gradual increase in CO, HR, oxygen consumption, increase body temperature

A

flow phase

40
Q

peaks 14 days after burning injury

o Attempt to normal body disposition if managed correctly

A

anabolic phase

SURGERY_hlo (6 decks)

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