Burns

Front 1

initial steps in managing burns?

Back 1

assessing ABCs, asses presence/absence of airway burn, cooling injured areas, placement on clean sheets

Front 2

factors suggesting presence of airway burn (6)?

Back 2

carbonaceous sputum, facial burn, facial/nasal hair burns, hoarseness, low O2 sat, dypnea

Front 3

3 important steps in assessing burn?

Back 3

depth, type, and BSA (percentage body surface burned)

Front 4

rule of 9s?

Back 4

% body surface made up by 9% x face, L/R upper extremities, 18% L/R lower extremities, anterior/posterior trunk, 1% neck

Front 5

1st versus 2nd versus 3rd degree burns?

Back 5

1st: superficial layer of epidermis; pain; resolves 2-3 day without clinical significance
2nd: extends into dermis, +/- blisters which can become infected ( typically heal in 10-14 days if uninfected)
3rd: full skin thickness down to subQ tissue; irrev destruction of skin c sensation,capillary refill loss

Front 6

repair of 3rd degree burns typically with what?

Back 6

skin grafts

Front 7

indications for transfer to burn center?

Back 7

age (<5,>50), 3rd degree>5%BSA, 2nd degree>20%inhalation injury BSA, burns involving face,hands,feet,genitalia, chemical/electric burns, circumferential burns

Front 8

strategy of burn resuscitation?

Back 8

return plasma volume to normal to sustain adequate perfusion of tissues

Front 9

calculation of volume needed in first 24 hours after burn? What type of resusciatative fluid?

Back 9

%BSA x weight x 4ml/kg; replace first 1/2 over first 8 hours, second 1/2 over next 16 hours; LR is given

Front 10

After first 24-48 hrs, can use what fluid replacement in burns. why good? why not used in first 24 hrs?

Back 10

colloid; best at inc intravascular volume; capillaries are leaky in first 24 hrs (get too much leakage into interstitial space)

Front 11

topical treatment of first versus second versus third degree burns?

Back 11

1. first: nothing topical (just aseptic venvironment)
2. second: silver sulfadiazine (other topics antibiotics), occlusssive dressings changed freqeuntly
3. same as second + possible regular debridement

Front 12

prophylcatic antibiotics should be used in certain burns (true/false)

Back 12

false; only in documented infections

Front 13

dark urine post-burn. no RBCs on UA.
1. diagnosis?
2. risk?
3. managemnet (1-2)?

Back 13

1. myoglobinuria
2. at risk for ATN
3. aggressive fluids (UOP to 2-3x normal); urine alkalinization

Front 14

post burn - carbonaceous sputum.
1. diagnosis?
2. suspected cause always?
3. if that is present, what used (2)?

Back 14

1. inhalation injury
2. CO poisoning
3. 100% O2, hyperbaric oxygen chamber to remove from blood

Front 15

enclosed-space fire, patient presents with central cyanosis of trunk and seizures -
1. diagnosis?
2. what is unreliable in this case, what needs to be used instead?
3. treatment?

Back 15

1. methemoglobinemia (Fe2+ --> fe3+)
2. pulse ox unreliable (need ABG)
3. IV methylene blue

Front 16

what may be indicated in circumferential burns due to ablity to become thick, contracted (affect ventilation if on chest or cause ischemia in extremities)?

Back 16

escharotomy (helps avoid problem)

Front 17

suspect electrical burn - what is needed beside good neuro exam? name 3-4

Back 17

EKG, cardiac enzymes, CK (necrotic muslce risk), r/o myoglobinuria and renal failure

Front 18

nutritional status just prior to startingto be determined - what are three types?

Back 18

1. nondepleted - good nutritional status
2. depleted - malnourished
3. hypermetabolic - (e.g. stressed, such as in burns, pancreatitis, trauma)

Front 19

what are calorie requiremenents for each type of nutritional status?

Back 19

1. nondepleted - 1g/kg/day
2. depleted - intermediate
3. hypermetabolic - 2-2.5 g/kg/day
*All plus daily energy expenditure (~.5 kcal / kg / day)

Front 20

what is not a calorie source in TPN? what is it used for then?

Back 20

protein; only used to replace amino acids

Front 21

what makes up TPN calories typically?

Back 21

dextrose and fat (70/30 is common)

Front 22

fat usually given separate from TPN bag as what?

Back 22

fat emulsion

Front 23

usually 4.25% protein, meaning 4.25 grams protein per liter; what is the amount of nitrogen in this? what can be measured to determine amt of nitrogen being excreted?

Back 23

4.25 / 6.25 = aprximately .7 grams protein; urea

Front 24

important to maintain a positive ___ balance when on TPN

Back 24

nitrogen

Front 25

how many kcal in 500 g D50W and 500 ml fat emulsion and 42.5g of protein?

Back 25

1. 500 x 3.4 = 1700 kcal
2. 500 x 1.1 = 550 kcal
3. 42.5 x 4.1 = 170
Total: 2420 kcal

Front 26

patient on TPN x 2 weeks develops fever.
1. suspected?
2. next steps?

Back 26

1. line infection
2. change line, send tip for culture

Front 27

what lab values tend to become abnormal when on TPN

Back 27

LFTs (in 30% of patients)