Parkland formula
(4mL)(% BSA with 2°/3° burns)(BW in kg)
= fluid resusitation in first 24 hours
1/2 in first 8 hours, 1/2 in second 16 hours
They also need maintenance fluid.
SIRS criteria
- HR > 90
- T > 100.4F (38C) or < 96.8F (36C)
- RR > 20 or PaCO2 < 32 mmHg
- WBC > 12 or < 4, or > 10% bands
POS = >2/4
Lights criteria
Fluid:serum protein < 0.5
Fluid:serum LDH < 0.6
Fluid LDH < 200
Transudate (all 3 criteria satisfied) DDx:
- CHF
- Cirrhosis
- Nephrotic syndrome
- PE
Exudate (any one violated) DDx:
- malignancy
- PNA
- TB
- pancreatitis
- esophageal rupture
- collagen vascular disease
- chylothorax/hemothorax
CENTOR Criteria
- no Cough (+1)
- Exudates (+1)
- Nodes (+1)
- Temp (+1)
< 15 yo (+1) OR > 44 yo (-1)
Drugs given via ET Tube
Everyone:
- Lidocaine
- Atropine
- Naloxone
- Epinephrine
Adults Only:
- Vasopressin
Ranson’s criteria
At admission:
- age > 55
- WBC > 16
- glucose > 200
- LDH > 350
- AST > 250
After 48 hours:
- hct fall >10%
- BUN rise >5
- Ca <8
- PO2 <60
- base deficit >4
- Fluid sequestration
Wells probability of PE
- clinical s/s
- other dx less likely
- HR >100
- immobilization x3days or <4wks post-op
- h/o DVT/PE
- hemoptysis
- tx for malignancy w/in 6mo or palliative care
PE findings on EKG
“S1Q3T3”
- large S wave in lead I
- large Q wave in lead III
- inverted T wave in lead III
or RBBB
Nexus criteria
“NSAID”
- Neuro deficit
- Spinal tenderness (midline)
- AMS
- Intoxication
- Distracting injury
Can clear c-spine if all negative
Delta Pressure for compartment syndrome
Delta Pressure = diastolic BP - compartment pressure
If < 30 –> acute compartment syndrome
Galeazzi vs Monteggia injuries
Galeazzi: (distal)
- distal radius fx
- distal radioulnar joint dislocation
+/- ant. interosseous branch of median nerve injury
Monteggia: (proximal)
- proximal-mid ulnar fx
- radial head dislocation
Peds uncuffed ET tube sizes
(Age + 16)/4
ET depth: (age/ 2) +12
MAP
MAP = (SBP + (2 x DBP))/3 MAP = (CO x SVR) + CVP
Peds Maintenance IVF
4 ml/kg/hr (first 10 kg)
2 ml/kg/hr (next 10 kg)
1 ml/kg/hr (each 1kg additional)
