Therapeutics Iii Exam 3- Burneds Notice

Front 1

Burns and death- what rank?

Back 1

Second to MVA in accidental death.

Front 2

burns- gender, age

Back 2

Burns are almost 3 times more common in males, than in females.

41% < 19 yo

Front 3

3 types of burns

Back 3

Thermal Injury (fire, scalds)
Electrical Burns
Chemical Burns

Front 4

OTC Treatment - Minor Burns- definition of minor burns and how to treat (3)

Back 4

1º Burns (Reddened, inflamed skin – no or only minor blisters)

simple analgesics for pain

triple antibiotic cream to prevent infection

Topical anesthetics are not usually helpful

Front 5

Burn Triage- where to refer (4) for type of burn

Back 5

minor burns (1st degree)- OTC care

Outpatient Clinic if burns are 2nd degree and <2% of BSA

Community Hospital - Moderate Burns

Triage - Referral Hospital - Critical Burns

Front 6

moderate burns and where to refer to

Back 6

2º or 3º Burns of < 10% BSA, except burns of face, hands, feet or perineum.

outpatient clinic

Front 7

6 examples of critical burns

Back 7

2º or 3º Burns on > 10% BSA
 Burns of face, hands, feet, genitalia, perineum, and major joints
 Circumferential burns of the extremity and/or chest
 Electrical burns including lightning injury
 Chemical burns with serious threat of functional or cosmetic impairme
complicated (by other disease) burns

Front 8

3 things taht can complicate burns and make them "critical"

Back 8

1. Respiratory tract injury
2. Major soft tissue injury or fractures
3. Social, emotional or long term rehabilitation issues.

Front 9

4 skin functions

Back 9

 Provide protection from injury and infection.
 Regulate transcutaneous fluid loss.
 Provide sensation.
 Regulate body temperature.

Front 10

Burns classification (1, 2, 3dary)- how deep into skin

Back 10

1- superficial- epidermis
2- partial- dermis upper portion
3- dermis/hypodermis- deep

Front 11

how to tell a second degree burn (3) from third degree

Back 11

if it blanches when you press it and color returns- only partial burn- will heal

partial deep may need to be debrided

whereas 3rd degree burns are yellowy and do not blanch (no capillary flow_

or if hairs...don't come out...

Front 12

Rule of Nines- body parts

Back 12

all 9%

each arm
head
chest
ab
back
lower back
upper legs
bottom legs
penis is like 1% HAHAHA

Front 13

3rd degree burns- need what kind of extra care initially

Back 13

debridement

skin graft (piggy or human- must be homograft eventually- from self)

Front 14

parenteral intake- steps and what fluid to use (3)

Back 14

Determine patient’s body mass in Kg.
 Use Lactated Ringers (LR) as the initial replacement fluid.
 Select the correct resuscitation formula based on body mass.

Front 15

Parkland Formula- when to use
what's the formula

Back 15

if the patient is more than 30 Kg
Volume = (% BSAB)(Body Mass Kg)* 4 ml/Kg

Front 16

how to apply parkland/galveston formula (2)

Back 16

Give one-half of this in first 8 hours
 And remaining one-half in the next 16 hours after injury.

Front 17

Galveston Formula- when to use

Back 17

(if the patient is less than 30 Kg

Front 18

Galveston formula- what is it

Back 18

Volume = (BSA in m²)(2000 ml) + (BSA in m²)(% BSAB)* 50 ml

Front 19

Colloids- example

when to use

y u know use otherwise

Back 19

Hetastarch (Hespan) - expands plasma volume (large molecules that draw in fluid- BUT if you give too early and you're all damaged, they can leak into tissue and cause edema)
only use > 25% BSAB

Front 20

dosing of colloids

Back 20

limit to 1 L per 24 hours (40 ml/hr)

Front 21

when to use mannitol in burn victims

Back 21

Mannitol for hemoglobinuria or myoglobinuria on admission. (muscle or blood breakdown)

Front 22

during rescultation period- when to use certain routes of fluid
(4)

Back 22

For BSAB > 20%, insert NG
Patients are N.P.O. (no oral) until they are completely resuscitated.
 Begin intragastric feedings in adults at 20 ml/hour.
 then Begin PO fluids when IV rate at maintenance, advance diet as tolerated

Front 23

wound surveillance- when to take cultures (3)

Back 23

Admission surveillance cultures.
 Routine weekly surveillance cultures.
 Cultures should be obtained whenever the wound has abnormal drainage or color.

Front 24

wound antibiotics- phases- and when to use which abx (3)

Back 24

Wounds will be initially dressed with silver sulfadiazine (Silvadene).
 Sulfamylon will be used to cover wounds with significant eschar (scabby- silvadene can't penetrate)
 When wounds have sufficiently closed, triple antibiotic can be used.

Front 25

debridement

Back 25

cheese slicer...

cut away until you see blood...that's healthy tissue

the cover with dressings

Front 26

Prophylactic Use of Systemic Antibiotics - when to give
single or combo?

Back 26

Prior to going to the OR for debridement and for 24 hours afterwards.
 A single antibiotic should be used.

Front 27

ppx abx- what to use for:
coagulase negative staph
gram -
no culture growth

Back 27

For Coagulase negative staph (CNS) use vancomycin.
 For gram negatives use gentamicin.
 If there is no growth on any culture use cefazolin

Front 28

duration of wound treatment for infections

Back 28

Treatment of wound infections is not restricted to 5 to 7 days.

Front 29

Burn patients and CrCl

Back 29

Burn patients are hypermetabolic and have an increased CrCl.

Front 30

dosing and monitoring of systemic abx (3)

Back 30

Vancomycin and aminoglycoside dosages must be selected appropriately for the patient’s size, renal function and extent of burn.
 Renal function should be monitored at least every 3 days.
 Serum drug levels do not need to be monitored when the antibiotics are used prophylactically

Front 31

burn pain- approach to dosing
expected pain ratings

Back 31

Pain ratings are expected to be 3 or less on the VAS
 Give the maximum amount of pain medication ordered (like if there is a range given- then decrease as necessary)

Front 32

when to stop abx

Back 32

treat until sx improve

Front 33

Fluid Resuscitation and Immediate Postop Period- 2 choices for pain killer

Back 33

morphine
Midazolam (Not post-op, but prior to hydrotherapy and other painful events.)- anti anxiety...

Front 34

midazolam- when given

Back 34

(Not post-op, but prior to hydrotherapy and other painful events.)

Front 35

what drug should you NEVER use for pain

Back 35

Never use NSAIDs
They interfere with blood coagulation

Front 36

Wound Care Phase- pain management options (5)

Back 36

MS Contin *** (morphine oral) will be given every 8-12 hours around the clock

MSIR (immediate release) will be given before each hydrotherapy and on a PRN basis.- cheapest , all forms, most effective

Midazolam

2 % Topical Lidocaine (not really)

Tylenol

Front 37

topical anesthetic limitations (2)

Back 37

Not for under 12 YO and no more than 2 g per time

Front 38

Morphine Allergies options (2)

Back 38

miperidine
Hydromorphone

Front 39

2 non pharm options for pain management

Back 39

Distraction Techniques
hypnosis

Front 40

Discharge/Rehab Phase (3)

Back 40

MS Contin and Midazolam should be discontinued at least 2 days before planned discharge.
 MSIR should be continued for pain associated with PT and dressing changes.
 Outpatient prescriptions for MSIR.

Front 41

PCA

Back 41

patient controlled anesthesia

Front 42

A 30 Y.O. WM comes into the pharmacy and wants a salve to treat his hands. While cleaning auto parts with gasoline his cigarette ignited his cleaning rag and both hands were burned. The hands are red, swollen and there are numerous vesiculations. How would you recommend that these wounds be treated?

Back 42

keep clean - wash gently and wrap hands with seran wrap (occlusive- to prevent fluid from disappearing)

refer to PCP because it's on hands (contractures- can limit hand movement later on)

Front 43

21 Y.O. WM was asleep at home when the house caught fire. The paramedic examines the victim, estimates his weight at 80 Kg and reports that both legs are burned, and the right side of his face. What fluid and what rate do you recommend over the radio?

Back 43

9+9+9+9+ 4?? BSAB = 40%

40 * 80 *4 = 12800

6400 / 8 hrs
6400 / 16 hrs

Front 44

Once the patient is at the Burn Treatment Center and fluid resuscitation is complete, he underwent skin grafting. During his recovery period he needs pain management. What drugs and what dose what you use for this patient?

Back 44

MS Contin 30-60 mg q 8-12 hrs + PCA
MSIR for breakthrough pain q2-4 hrs prn
midazolam too???? 0.3-0.5 mg/kg

Front 45

dosing of morphine- IV, Oral

Back 45

 IV 0.1 mg/kg Q2-4H (30-60 mg)

 Oral 0.3 mg/kg Q2-4H

Front 46

midazolam dosing IV and oral

Back 46

IV 0.03 mg/kg
oral: 0.3-0.5 mg/kg

prn or right before op

Front 47

APAP dosing- kids vs adults

Back 47

Dosage: Children 10 - 15 mg/kg/dose Q4H prn
 Dosage: Adults: 650 mg Q4H prn

Front 48

hydromorphone dosing

Back 48

2-4 mg Q4-6H must be given 60 minutes before procedures