Burns

It's Electric

100

Name 2 tests that you must obtain if concerned for electrical injury.

EKG

Cardiac monitoring

Cardiac enzymes

Creatine kinase

Urinalysis for myoglobin

200

A pressure gradient greater than ___ mmHg is an indication to perform fasciotomy. 

A pressure gradient greater than 30 mmHg is an indication to perform fasciotomy.

300

Name the voltage that differentiates high from low-voltage burns.

High-voltage burns > 1000 V

Low-voltage burns < 1000 V

400

In an electrical burn to the hand, which 2 muscles are at most risk for necrosis?

Deep flexor compartment:

- Flexor digitorum profundus (FDP)

- Flexor pollicis longus (FPL)

500

List the tissues from highest to lowest inherent resistance. (6)

Bone

Fat

Tendon

Skin

Muscle

Blood Vessels/Nerves

B F T S M B = Big Fat Tendons Stop Muscle Bleeding

Brrr, it's Cold in Here

100

What is the optimal timeline for surgical excision/amputation in frost-bite?

Weeks to months

200

What is the difference between passive and active rewarming? Which do you use for frostbite treatment?

300

What class of medication has been shown to improve salvage if used within the first 24 hours after injury? 

Thrombolytics (tPA)

400

What prostacyclin analog is used in some centers as an alternative to thrombolytics for severe frostbite? (e.g. presentation > 24 hrs after injury)

Iloprost

- Vasodilator + inhibits platelet aggregation

- Improves microcirculatory flow in ischemia tissue

500

What is the pathophysiology of frost bite (include all 3 aspects)?

Vasoconstriction

Endothelial injury

Microvascular thrombosis

These chemicals hit me like white wine

100

What is a systemic side effect of phenol burns?

Cardiac toxicity

Treat with polyethylene glycol.

200

What is the first-line treatment in cyanide poisoning?

Hydroxocobalamin

Binds cyanide --> forms cyanocobalamin (vit B12) --> excreted in urine

300

Fireworks, industrial accidents, and military munitions are examples of what kind of chemical burn?

White phosphorous

- Stains with copper sulfate or can see with ultraviolet light

- Treatment - surgical excision

400

Alkaline burns cause ______ necrosis.

Acid burns cause _____ necrosis.

Alkaline burns cause liquefactive necrosis.

Acid burns cause coagulative necrosis.

Alkaline burns are typically more severe because coagulative necrosis is irreversible. In contrast, acid burns are somewhat reversible with immediate and significant dilution.

500

What electrolyte abnormality can result from hydrofluoric acid injury? 

Hypocalcemia

B/c fluoride's propensity to bind to the calcium in the body that has been mobilized from the bones.

Treatment: Topical calcium gluconate gel and 10% calcium gluconate IV

It's Getting Hot in Here

100

What bacteria are burn patients especially susceptible to?

Pseudomonas aeruginosa 

200

What is the Baux score mortality estimation?

Age + TBSA = % Mortality

Historically thought of as rough estimate of mortality, but model consistently overestimates mortality now.

300

Name the various burn depths, layers affected, and their clinical characteristics. 

400

What is this person's TBSA?

Entire left arm with deep partial thickness burn

Entire right arm with superficial

Half of anterior torso with superficial partial thickness

Anterior left leg with deep partial thickness

No full thickness burns

9+9+9 = 27

Entire left arm with deep partial thickness burn (9)

Entire right arm with superficial (0)

Half of anterior torso with superficial partial thickness (9)

Anterior left leg with deep partial thickness (9)

No full thickness burns (0)

500

Name the three Jackson Zones denoting the response of local tissues toward heat.

Zone of coagulation (necrosis) - central area of burn with total necrosis and nonviable tissue

Zone of stasis (edema) - area immediately surrounding zone of coagulation, can be improved/influenced by proper resuscitation and wound care 

Zone of hyperemia - outermost layer, erythema, localized swelling, zone recovers w/in 48-72 hours

Staying Alive

100

Burns > ___ % TBSA in adults and ___ % TBSA in pediatrics require resuscitation protocol.

20% TBSA in adults

15% TBSA in pediatrics

200

What vitamin is thought to help stabilize endothelial injury seen in burn shock?

Vitamin C

Tanaka et al found that vitamin C administered at a rate of 66 mg/kg/h limited the crystalloid requirement for initial resuscitation.

300

Name the notable side effect for each of the following burn treatments:

Mafenide acetate (sulfamylon)

Silver sulfadiazene 

Silver nitrate 

Mafenide acetate - metabolic acidosis

MA

Silver sulfadizene - leuopenia

deen - peen

Silver nitrate - Hyponatremia

Na

400

A 47-year-old, 50-kg otherwise healthy woman presents to the trauma bay with 55% total body surface area burns to the chest, back, and extremities. She has an additional 10% TBSA of first-degree burns. Pulses are intact and extremities are warm. The burns are pink and blanching, but bullae are present in most areas. The patient was given 2L of Lactated Ringer’s (LR) in the field over the last 2 hours since sustaining the burn. What is the recommended initial rate of resuscitation for this patient?

583.3 ml/hr

Parkland Formula

% TBSA x kg x 4

55 %TBSA x 50 kg x 4 = 11,000

11,000/2 = 5,500 

5,500 - 2,000 = 3,500 

3,500/6 = 583.3333

500

Name 4 criteria for transfer to a burn center.

> 10% TBSA (excluding superficial burns)

Critical areas (face, hands, feet, genitalia, perineum, major joints)

Any full-thickness burn

Special mechanism - electrical burns, chemical burns, inhalation injury

Associated injuries - burns with trauma, significant co-morbidities

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