Burn Management
Parkland who?
Buzz!
The Kitchen Sink
Brrr!
100
What type of burn (not burn pattern) is most associated with compartment syndrome?
Electrical burns
100
What is the parkland formula and how is the calculated volume administered (with respect to time).
Parkland Formula = 2-4 * TBSA * Ideal Body Weight (in Kg).
Half to be delivered in 1st 8h from burn, half over subsequent 16h.
100
What are the two forms of electric current? Which one causes more severe injuries, proportionally? What is the major determinant of tissue damage?
Alternating and direct current
-Alternating current
-Voltage is the major determinant of tissue damage
100
Surprise! 300 points! IF you can answer...
What are some special considerations for high pressure chemical injection injuries, most commonly to the hand?
Chemicals are injected at extremely high pressures, which can cause a seemingly innocuous injury which can rapidly progress to necrosis and compartment syndrome much further from the apparent zone of injury. Treatment is emergent aggressive I&D and usually fasciotomy.
100
What are the initial steps in management of a frostbite injury?
Rapid rewarming of the affected area in a 100-104 degree water bath, NSAIDs, manage associated organ injuries (i.e. kidneys, electrolyte abnormalities, etc.)
200
What are some clinical indicators to suggest possible inhalation injury and need for intubation?
Facial burns, singed facial/nose hair, carbonaceous sputum, hoarseness, intoxication, stridor, hypoxemia
200
Describe superficial and deep partial thickness burns, specifically differences in presentation/appearance of the wound. What layers of tissue do they involve?
Superficial: burn of the epidermis and papillary dermis, typically painful with blanching redness and blistering.
Deep: burn of the epidermis and deeper dermis, involving follicular and glandular structures. Often do not blanch and may have absent sensation.
200
Electrical burn injury severity is proportional to ___ area conducting the current, therefore the body parts that typically display the most severe injuries are the ___s and ___s.
Cross-sectional, wrists, ankles
200
Fill in the blank:
- Compared to STSGs, full thickness skin grafts have more ___ contracture immediately due to ____ in the dermis, whereas STSGs have more ____ contracture over the long term.
primary, elastin, secondary
200
Bonus! 400
What kind of skin condition should burn patients be monitored for?
Marjolin's ulcers
300
What are the 3 zones of a burn? Are they reversible?
-Zone of coagulation (irreversible tissue loss)
-Zone of stasis (reversible if adequately resuscitated)
-Zone of hyperemia (expected to heal)
300
Compared to adults, what percent of TBSA does the head and neck comprise for a child?
18%
300
What considerations should be kept in mind in working up a high voltage electrical injury? Name 2
-Victims often thrown, which can cause non-intuitive traumatic injuries
-If current passes from arm to arm, cardiac dysrhythmias are common, including VFib
-Damage to tissues far from site of what can otherwise be an innocuous looking superficial burn
-Rhabdomyolsis from sustained muscular tetany can cause ATN and oliguria, electrolyte abnormalities
300
What are the differences between alkali and acid chemical burns? Which is worse and why?
Acids cause coagulative necrosis
Alkali causes saponification of tissues and typically deeper penetration and are therefore often more severe
300
After thawing, what therapy should be initiated?
Thrombolysis
400
What are some of the clinical indicators supporting the use of an emergent escharotomy?
-full thickness torso burns limiting ventilation
-circumferential burns causing compartment syndrome
400
What metric assesses resuscitation status and guides adjustment to fluid rate? What are the target numbers in adults and pediatric patients, respectively.
Resuscitation should be titrated to urine output, for adults this should be 0.5 cc/kg/hr, for peds it should be 1.0 cc/kg/hr
400
What is an electrical arc and what kind of bburn do they cause?
-Arc of ionized particles between a high voltage power source near a grounded body with significantly different electrical potentials
-causes a flash burn, no conduction of electrical current but high temperature surface burn
400
Where should mafenide be used? What laboratory test abnormality can be seen with its use? Why?
Ears
-Metabolic acidosis due to it's carbonic anhydrase activity
400
There are two mechanisms by which frostbite causes tissue injury, what are they (description suffices)?
-Direct cellular damage due to crystal formation and osmotic gradient
-Progressive dermal ischemia
500
Fill in the blanks:
head: 4.5% per side, 9% total
torso: 18% per side
Arms: 4.5% per side, 9% total
1% genitals
Legs: 9% per side, 18% total
Neck: 1%
500
Patients who do not meet urine output goals within the first 8h of resuscitation, what should be added to the resuscitation strategy and why?
Colloids such as FFP or albumin to prevent fluid creep
500
What are the two mechanisms of tissue injury in electrical burns? Describe them
-True electrical: energy conducted through tissue causes sustained muscle contraction and direct cellular injury
-thermal injury induced by resistance to conduction through tissues causes coagulative necrosis
500
How does hydrofluoric acid differ from other acid burns? What is different about its management?
Hydrogen ion causes typical coagulative necrosis, but the fluoride ion will leach calcium and magnesium from tissues causing severe pain and bone erosion unless irrigated/injected with calcium solutions.
500
Broadly describe the 4 degrees of frostbite injury?
-1st Degree: numb white plaque with surrounding erythema
-2nd Degree (superficial frostbite): superficial injury with fluid filled blisters with surrounding erythema and edema, pins and needles sensation
-3rd Degree (deep injury): hemorrhagic blisters over non-perfused skin
-4th: insensate woody tissue