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28 Cards in this Set
- Front
- Back
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1. Next step in tx of thermal injury?
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a. Definitive airway management by intubation is appropriate in this pt w/possible inhalation injuries and carbon monoxide (CO) poisoning.
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2. Immediate and late complications of severe thermal injury?
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a. Airway compromise and tissue hypoperfusion are common early complication.
b. Sepsis and functional loss are possible late complications. |
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3. How should fluids be given for serious thermal injury?
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a. Lactated Ringer solution at 2-4 mL/kg/% burn.
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4. Indications for intubation w/respect to thermal burns and appearance of the oropharynx?
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a. If the oropharynx is dry, red, or blistered, the pt will probably require intubation.
b. In general, when indicated, endotracheal intubation should be performed early, before a surgical airway is required secondary to pharyngeal and laryngeal oedema. |
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5. How does CO poisoning affect the oxyhemoglobin curve?
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a. It shifts it to the left.
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6. What value should all pts injured in closed-space fires have checked in their blood?
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a. Carboxyhemoglobin (COHgb) levels.
b. A COHgb level of greater than 30% may indicate significant CNS dysfunction. |
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7. Risk w/COHgb level >60%?
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a. May portend coma and death.
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8. Note: one can develop a 30% COHgb level w/I 3 min in a moderately smoky fire.
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8. Note: one can develop a 30% COHgb level w/I 3 min in a moderately smoky fire.
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9. Risk of burn sizes exceeding 20% TBSA?
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a. Can result in a systemic response, w/significant interstitial oedema in the distance soft tissues.
b. With these large burns, an initial decrease in cardiac output is seen, followed by a hypermetabolic state. |
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10. What burn pts can often be resuscitated w/oral fluids>
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a. Burns involving <15% TBSA.
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11. Hydration for larger burns?!?!
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a. Isotonic IV fluids such as lactated ringer should be used (larger volumes of normal saline can cause hyperchloremic metabolic acidosis).
b. Fluid needs are estimated by the Parkland or Baxter formula. |
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12. Parkland formula for fluid needs?
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a. For adults and children weighing >10 kg, the total 24-hr volume is calculated using 4 ml/Kg/% burn.
b. Half of this amount is given in first 8 hours c. Remainder is given in next 16 hours. |
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13. What is preferred fluid-wise in the first 12-18 hours?
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a. Colloids such as albumin bc of increased capillary permeability.
b. Can be used subsequently if resuscitation is not being achieved w/the crystalloid regimen. |
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14. Note: Inhalational injuries, extensive and/or deep burns, and delayed resuscitation usually result in larger fluid requirements than initially calculated!
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14. Note: Inhalational injuries, extensive and/or deep burns, and delayed resuscitation usually result in larger fluid requirements than initially calculated!
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15. What is a helpful way of assessing the adequacy of the resuscitation?!
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a. Measuring urine output!
b. Adults should achieve 0.5mL/kg/h of UOP. |
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16. Note: Excess UOP should also be avoided unless one is treating myoglobinuria.
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16. Note: Excess UOP should also be avoided unless one is treating myoglobinuria.
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17. Note: when calculating total percentage of burn involvement in a pt w/more serious burns?
a. First-degree burns are not included |
17. Note: when calculating total percentage of burn involvement in a pt w/more serious burns?
a. First-degree burns are not included |
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18. Fourth-degree burns?
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a. Are those that extend through skin and subq fat, even involving deeper structures.
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19. Should steroids be used w/burns?
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a. NO. Bc a burn site can become infected and allow microbes systemic access, steroids should not be used for any burn greater than 10% TBSA.
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20. Prophylactic IV abx for burns?
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a. Prophylactic IV abx are usually not used bc they select for resistant organisms.
b. The different creams commonly used have local broad microbial activity that can resist colonization. |
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21. Silver sulfadiazine (SS)?
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a. Does not penetrate the eschar and so it not helpful in an infected burn.
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22. Sulfamylon?
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a. Less commonly used bc it is painful on application.
b. Furthermore, it can cause severe systemic metabolic acidosis through carbonic anhydrase inhibition. |
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23. Use of Sulfamylon (mafenide)?
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a. It penetrates the eschar and is therefore useful for full-thickness infected burns (there is less pain on application) and for unexcised burns w/colonization.
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24. Silver nitrate AE?
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a. Does not penetrate the eschar and turns the area black.
b. Can result in severe leaching of sodium and chloride, which can lead to profound hyponatraemia and hypochloremia, particularly when used on large areas of children. |
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25. Use of Pigskin?
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a. Can be used on flat, clean wounds.
b. Its growth factors can encourage epithelialization in partial-thickness burns. |
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26. Location affected and characteristics of 1st-degree burns?
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a. Epidermis
b. Erythema and pain |
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27. Course of 1st-degree burns?
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a. Heals in 3-4 days w/o scarring.
b. The dead epidermal cells desquamate (peel). c. Sunburns that blister are actually superficial dermal burns. |
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28. Treatment of1st-degree burns?
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a. Lotions (like aloe) and NSAID drugs.
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