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48 Cards in this Set
- Front
- Back
Burns and death- what rank?
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Second to MVA in accidental death.
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burns- gender, age
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Burns are almost 3 times more common in males, than in females.
41% < 19 yo |
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3 types of burns
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Thermal Injury (fire, scalds)
Electrical Burns Chemical Burns |
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OTC Treatment - Minor Burns- definition of minor burns and how to treat (3)
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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 |
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Burn Triage- where to refer (4) for type of burn
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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 |
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moderate burns and where to refer to
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2º or 3º Burns of < 10% BSA, except burns of face, hands, feet or perineum.
outpatient clinic |
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6 examples of critical burns
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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 |
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3 things taht can complicate burns and make them "critical"
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1. Respiratory tract injury
2. Major soft tissue injury or fractures 3. Social, emotional or long term rehabilitation issues. |
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4 skin functions
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Provide protection from injury and infection.
Regulate transcutaneous fluid loss. Provide sensation. Regulate body temperature. |
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Burns classification (1, 2, 3dary)- how deep into skin
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1- superficial- epidermis
2- partial- dermis upper portion 3- dermis/hypodermis- deep |
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how to tell a second degree burn (3) from third degree
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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... |
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Rule of Nines- body parts
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all 9%
each arm head chest ab back lower back upper legs bottom legs penis is like 1% HAHAHA |
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3rd degree burns- need what kind of extra care initially
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debridement
skin graft (piggy or human- must be homograft eventually- from self) |
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parenteral intake- steps and what fluid to use (3)
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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. |
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Parkland Formula- when to use
what's the formula |
if the patient is more than 30 Kg
Volume = (% BSAB)(Body Mass Kg)* 4 ml/Kg |
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how to apply parkland/galveston formula (2)
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Give one-half of this in first 8 hours
And remaining one-half in the next 16 hours after injury. |
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Galveston Formula- when to use
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(if the patient is less than 30 Kg
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Galveston formula- what is it
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Volume = (BSA in m²)(2000 ml) + (BSA in m²)(% BSAB)* 50 ml
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Colloids- example
when to use y u know use otherwise |
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 |
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dosing of colloids
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limit to 1 L per 24 hours (40 ml/hr)
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when to use mannitol in burn victims
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Mannitol for hemoglobinuria or myoglobinuria on admission. (muscle or blood breakdown)
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during rescultation period- when to use certain routes of fluid
(4) |
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 |
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wound surveillance- when to take cultures (3)
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Admission surveillance cultures.
Routine weekly surveillance cultures. Cultures should be obtained whenever the wound has abnormal drainage or color. |
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wound antibiotics- phases- and when to use which abx (3)
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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. |
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debridement
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cheese slicer...
cut away until you see blood...that's healthy tissue the cover with dressings |
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Prophylactic Use of Systemic Antibiotics - when to give
single or combo? |
Prior to going to the OR for debridement and for 24 hours afterwards.
A single antibiotic should be used. |
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ppx abx- what to use for:
coagulase negative staph gram - no culture growth |
For Coagulase negative staph (CNS) use vancomycin.
For gram negatives use gentamicin. If there is no growth on any culture use cefazolin |
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duration of wound treatment for infections
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Treatment of wound infections is not restricted to 5 to 7 days.
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Burn patients and CrCl
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Burn patients are hypermetabolic and have an increased CrCl.
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dosing and monitoring of systemic abx (3)
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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 |
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burn pain- approach to dosing
expected pain ratings |
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) |
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when to stop abx
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treat until sx improve
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Fluid Resuscitation and Immediate Postop Period- 2 choices for pain killer
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morphine
Midazolam (Not post-op, but prior to hydrotherapy and other painful events.)- anti anxiety... |
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midazolam- when given
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(Not post-op, but prior to hydrotherapy and other painful events.)
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what drug should you NEVER use for pain
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Never use NSAIDs
They interfere with blood coagulation |
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Wound Care Phase- pain management options (5)
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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 |
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topical anesthetic limitations (2)
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Not for under 12 YO and no more than 2 g per time
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Morphine Allergies options (2)
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miperidine
Hydromorphone |
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2 non pharm options for pain management
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Distraction Techniques
hypnosis |
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Discharge/Rehab Phase (3)
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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. |
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PCA
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patient controlled anesthesia
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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?
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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) |
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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?
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9+9+9+9+ 4?? BSAB = 40%
40 * 80 *4 = 12800 6400 / 8 hrs 6400 / 16 hrs |
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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?
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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 |
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dosing of morphine- IV, Oral
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IV 0.1 mg/kg Q2-4H (30-60 mg)
Oral 0.3 mg/kg Q2-4H |
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midazolam dosing IV and oral
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IV 0.03 mg/kg
oral: 0.3-0.5 mg/kg prn or right before op |
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APAP dosing- kids vs adults
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Dosage: Children 10 - 15 mg/kg/dose Q4H prn
Dosage: Adults: 650 mg Q4H prn |
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hydromorphone dosing
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2-4 mg Q4-6H must be given 60 minutes before procedures
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