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DVG and Fiser burns
Burn stuff from di Virgilio and the small Fiser book
45
Medical
Professional
01/19/2014

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Cards

Term
Most common type of burn
Definition
Scalding
Term
Guidelines for who should be referred to a burn center
Definition
# 2nd or 3rd degree burns of greater than 10% TBSA in pts < 10 yo or > 50 yo
# 2nd or 3rd degree burns > 20% TBSA in any age group
# 3rd degree burns > 5% TBSA in any age group
# Any burns to face, hands, feet, genitalia, perineum or major joints
# inhalational injury
Term
P:F ratio threshold for endotrachial intubation in a burn victim
Definition
< 250
Term
Hard signs of inhalational injury
Definition
# copious sputum production
# carbonaceous sputum
Term
Lab evaluation for possible endotrachial intubation
Definition
# ABG and Carbon Monoxide levels
Term
Percentage of burned TBSA above which the release of pro-inflammatory cytokines causes SIRS
Definition
> 20%
Term
Indications for placing routine central lines in burn patients
Definition
# > 50% TBSA
# for pts with significant comorbidities
Term
Ideal location for IV lines for > 40% TBSA burns to arms and legs
Definition
# AC fossa even if it means going through burned skin or eschar
Term
Rule of 9s
Definition
# Each upper extremity = 9%
# Each lower extremity = 18%
# Ant and post trunk = 18% each
# Head and neck = 9%
# perineum = 1%
# a person's hand is approximate 1% of their TBSA
Term
TBSA a/w 50% mortality
Definition
80%
Term
Fluid resucitation in pediatric burn pts
Definition
# children < 20 kg need glucose added
# 6 ml/kg/% TBSA
# UOP goals: 1.0-1.5 ml/kg body WEIGHT/hr)
# threshold for aggressive fluid resuscitation is 10-20%
Term
Additional IV med that can reduce fluid volume requirements and edema
Definition
IV vit C
Term
Best form of IVF resuscitation and why
Definition
Crystalloid; LR because the large volumes that are required will cause hyperchloremia and metabolic acidosis with NS
Term
Times to consider using colloid and why
Definition
Consider adding albumin in pts with massive burns requiring massive volumes of resuscitation because it has been shown to reduce the increase in intra-abdominal pressure involved in massive fluid resuscitation and therefore could theoretically reduce risk of abdominal compartment syndrome
Term
Topical burn antibiotic agent with anti-fungal properties
Definition
silver sulfadiazine
Term
Topical burn antibiotic agent that does not penetrate eschar
Definition
silver sulfadiazine
Term
Only topical burn antibiotic agent that penetrates eschar
Definition
Mafenide acetate
Term
Drawbacks of mafenide acetate
Definition
# metabolic acidosis (it is a carbonic anhydrase inhibitor)
# painful application
Term
Drawbacks of silver nitrate
Definition
# hyponatremia (common), hypochloremia, hypocalcemia and hypokalemia
# causes discoloration
# does not penetrate eschar
# ineffective against pseudomonas and some GPCs
Term
Drawbacks of silver sulfadiazine
Definition

# neutropenia and thrombocytopenia

# can't use in patients with sulfa alergy

# no eschar penetration

# ineffective against Pseudomonas and some GNRs

# Can cause methemoglobinemia (contraindicated in G6PD deficiency)

Term
UOP goals in burn patients
Definition
# 0.5-1.0 ml/kg/hr for adults
# 1.0-1.5 ml/hg/hr for children > 6 mo
# 2-4 ml/kg/hr for children < 6 mo
Term
MC type of infection in burn patients
Definition
PNA
Term
MC cause of death after inhalational injury
Definition
PNA
Term
Management of acid burns and type of damage caused by them
Definition
Copious water irrigation and coagulation necrosis
Term
Management of alkali burns and type of damage caused by them
Definition
Copious water irrigation and liquefactive necrosis
Term
B/w acid and alkali burns, which one produces deeper burns
Definition
Alkali because of liquefactive necrosis
Term
Management of hydrofluoric acid burns
Definition
spread calcium on the wounds
Term
Management of powder burns
Definition
wipe off powder prior to irrigation
Term
Management of tar burns
Definition
Cool then wipe away with lipophilic solvent
Term
important monitoring for electrical burns
Definition
Cardiac
Term
MC organism in burn wound infx
Definition
Pseudomonas (followed by Staph, E. coli and Enterobacter)
Term
Topical agents indicated immediately in all burns
Definition
Bacitracin or neosporin
Term
Topical burn antibiotic best for burns over joints
Definition
Mafenide acetate
Term
Topical burn antibiotic with best anti-pseudomonas properties
Definition
Mafenide acetate
Term
Topical burn antibiotic with broadest GNR coverage
Definition
Mafenide acetate
Term
MCC of burn wound sepsis
Definition
Pseudomonas
Term
MC viral infection in burn wounds
Definition
HSV
Term
Way to diagnose a burn wound infection
Definition
need biopsy and must have > 10^5 organisms
Term
Common causes of Toxic Epidermal necrolysis
Definition
Dilantin, bactrim, PCN and viruses
Term
management of toxic epidermal necrolysis
Definition
# supportive
# prevent dessication with topical antimocrobials and xenografts;
# no steroids
Term
Pathology seen in toxic epidermal necrolysis
Definition
separation of dermis and epidermis
Term
Only indication for abx in toxic epidermal necrolysis
Definition
if caused by staph (then it's called staphylococcal scalded skin syndrome)
Term
Common causes of Stevens-Johnson syndrome
Definition
# dilantin, PCN, bactrim and viruses
Term
Pathology seen in Stevens-Johnson syndrome
Definition
# Subepidermal bullae
# epidermal cell necrosis
# dermal edema
Term
Management of Stevens-Johnson syndrome
Definition
# supportive
# prevent dessication with topical antimocrobials and xenografts;
# no steroids
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