Burns

Question 1

Burn Classification

Answer 1

• 1st Degree - Superficial (sunburn)
• 2nd Degree - Partial Thickness (Blisters)
• 3rd Degree - Full thickness (completely destroyed tissue)

Question 2

Brooke Burn Formula

Answer 2

2cc/kg x BSA = fluids over 24 hours

1st half in 1st 8 hours from time of burn

Question 3

Universal Burn Formula

Answer 3

2-4 cc/kg x BSA = fluids over 24 hours

1st half in 1st 8 hours from time of burn

Question 4

Parkland Burn Formula

Answer 4

4cc/kg x BSA = fluids over 24 hours

1st half in 1st 8 hours from time of burn

Preferred Formula

Question 5

Burn Fluid Resuscitation

Answer 5

• Only count 2nd/3rd degree burns in BSA
• Parkland is the preferred formula
• Lactated Ringers is the preferred fluid

Question 6

Palmer Method

Answer 6

Represents 1% BSA in both adults and children

Question 7

Average Urine Output (Adult)

Answer 7

30-50mL/hr

Question 8

Adynamic Ileus

Answer 8

Seen in patient’s with >20% BSA burns. Decreased bowel movements. Can cause problems in-flight due to the expansion of wet gasses.

Question 9

Electrical Burn Predictors of Severity

Answer 9

• Voltage and amperage (amperage is better predictor)
• Resistance of internal body structure
• Type of pathway and current
• Duration and intensity of contact

Question 10

Alternating Current (A/C)

Answer 10

• Household current (110v A/C)
• Will cause continual muscle contractions
• Unable to pull themselves away
• Explosive exit wound
• Causes V-Fib

Question 11

Direct Current (D/C)

Answer 11

• Victim able to pull themselves away from current
• Discrete exit wound
• Causes asystole

Question 12

Myoglobinuria

Answer 12

• Common in severe electrical injuries
• Treatment similar to crush injuries
• Maintain a urine ouput of 100mL/hr to perfuse kidneys and prevent renal failure (acute tubular necrosis or ATN)
• NaHCO3 to correct acidosis
• Mannitol to increase UOP and minimize ATN

Question 13

Acid Burns

Answer 13

• Cause coagulative necrosis
• Dilute with water
• Neutralize hydrofluoric acid with calcium gluconate

Question 14

Alkali Burna

Answer 14

• Dehydrate cells causing saponification (liquefaction necrosis)
• Dilute with copious amounts of water
• Worse than acid burns

Question 15

Supraglottic Inhalation Burns

Answer 15

• Injury results from thermal insult
• Above the vocal cords
• Facial burns, carbonaceous sputum, singed facial hair, stridor
• Treat with oxygen, corticosteroids, supportive

Question 16

Infraglottic Inhalation Burns

Answer 16

• Results from chemical insult
• Below the vocal cords
• increased pulmonary capillary permeability (causes pulmonary edema)
• Treat with oxyen, corticosteroids, supportive care

Question 17

Carbon Monoxide (CO) Intoxication

Answer 17

• Causes asphyxiation
• Cherry red skin due to carbodyhemoglobin - histotoxic hypoxia
• Headache is a common finding
• Assume if patient was in enclosed area
• Causes false high SPO2
• Needs 100% oxygen

Question 18

Synthetic Material Fires

Answer 18

• Fires involving combustion of cellulose, nylon, wool, silk, asphalt, polurethane
• Risk of hydrogen cyanide poisoning - histotoxic hypoxia
• Released during incomplete combustion of plastics and acrylics
• Treated with sodium thiosulfate, amyl nitrate, and sodium nitrite OR Cyanokit