What is the rule of 9s for pediatric burns?
- head and neck: 18%
- upper extremities: 9% each
- lower extremities: 14% each
- anterior trunk: 18%
- posterior trunk: 18%
What are the histologic zones of a burn?
- zone of coagulation: maximum damage, irreversible tissue loss
- zone of stasis: poor perfusion, questionable viability
- zone of hyperemia: increased tissue perfusion, may recover
What is the parkland formula?
- 4mL/kg/%TBSA
- first half given over eight hours and second half given over the next sixteen hours
- limited to burns > 20%
What is the modified Brooke formula?
- 2mL/kg/%TBSA
- first half given over eight hours
- limited to burns > 15%
What fluid is preferred for burn resuscitation?
lactated ringers
What is the target urine output for burn patients?
- adults: > 0.5cc/kg
- kids: > 1cc/kg
Damage to the lower airways in a burn patient are due to what?
inhaled toxins
What are the symptoms of carbon monoxide poisoning?
- neurologic: seizures, decreased mental status
- cardiac: arrhythmia, MI
- metabolic: acidosis
How is carbon monoxide poisoning treated?
high flow nasal cannula, serial COHb measurements, sometimes hyperbaric O2
How is cyanide poisoning treated?
hydroxocobalamin
What are the side effects for the following burn ointments:
- bacitracin:
- mupirocin:
- silver sulfadiazine:
- mafenide acetate:
- silver nitrate:
- bacitracin: rash, nephrotoxicity
- mupirocin: irritation
- silver sulfadiazine: neutropenia, thrombocytopenia
- mafenide acetate: metabolic acidosis
- silver nitrate: methemoglobinemia, hyponatremia, hypokalemia, staining of the skin
What are the indications for the following burn ointments?
- bacitracin:
- mupirocin:
- silver sulfadiazine:
- mafenide acetate:
- silver nitrate:
- bacitracin: 2nd degree burns with GP coverage
- mupirocin: staph infections, not for ppx
- silver sulfadiazine: 3rd degree burns with GN coverage
- mafenide acetate: 3rd degree burns with GN coverage, pseudomonas treatment
- silver nitrate: 3rd degree burns with GN and GP coverage
What is the preferred burn antibiotic for pseudomonas?
mafenide acetate
Which burn antibiotics are contraindicated for:
- sulfa allergy
- G6PD deficiency
- sulfa: silver sulfadiazine
- G6PD: silver nitrate
How are mild, moderate, and severe hypothermia classified?
- mild: 90-94 degrees
- moderate: 84-89 degrees
- severe: 70-84 degrees
What are the symptoms of hypothermia?
- mild (90-94): shivering, AMS
- mod (84-89): agitation, muscle spasticity, dilated pupils, bradypnea
- severe (<84): prolonged QRS, Osborn (J) waves, flaccid comatose, Vfib
What EKG changes are seen in those with severe hypothermia?
prolonged QRS, Osborn (J) waves, Vfib
How is frostbite treated?
- begin with treatment of hypothermia
- rapid active rewarming in heated water
- debridement of deeper injuries
- drainage of milky/clear blisters
- leave hemorrhagic blisters intact
Hemorrhagic blisters are suggestive of what degree of frostbite?
3rd degree
How are hydrofluoric acid burns treated?
with topical calcium gluconate gel
How is methemoglobinemia treated?
methylene blue
How do 1st and 2nd degree burns heal?
epithelialization, primarily from hair follicles
Full thickness skin grafts have more of what kind of contracture?
more primary contracture due to elastin in the dermis
What is the treatment for severe electrical injury?
- can cause rhabdo, thus require high volume resuscitation for severe injuries
- require cardiac monitoring and monitoring for compartment syndrome
