Burns

[lightsandsirens5]

Just went through Burns tonight in EMSLive. Here are a just a few neat things I picked up. I'll ask them as a question then answer them all tomarrow.

What is the Modified Parkland Burn Formula?

The cause of death from an electrical burn can be any of these except:
Effect of current on heart
Cardiac Scarring
Massive current-caused muscle destruction
Thermal burning at contact site and along the path of current

You want to elevate a burned limb only with what type of burn?

What is Odynophagia? What can it be a symptom of?

 

[mycrofft]

Without using wikipedia..

PARKLAND: dunno. Cold saline on the scene and gasoline (to engine) are my blend. (I can hear the audience groaning at the cold saline part).
Electric burn: how long is that piece of string? (Old paradox): we talking house current, or Finger of God lightning? Given enough current, there are two answers not mutually exclusive: cardiac scarring (you would already be dead) and thermal burns along the path of the current (it causes primarily electrolytic damage, unless the current was enough to burn you like a fly, then you're dead from other sources).

Not to say thermal damage doesn't occur.

Odynopahgia....can't remember what we're eating today.

Now I'll go look them up and I promise not to edit. Thanks!

 

[rmellish]

Parkland is 4cc/kgx %TBSA burned. This volume is the total to be infused in the first 24hr, with half the volume in the first 8 hours. The formula is then modified to maintain a urine output of 0.5-1.0 mL/kg/h. Lactated Ringers is the preferred fluid.

 

[Seaglass]

What is the Modified Parkland Burn Formula?

Don't know.

The cause of death from an electrical burn can be any of these except:
Effect of current on heart
Cardiac Scarring
Massive current-caused muscle destruction
Thermal burning at contact site and along the path of current

I'm going to say cardiac scarring, since it's the only one I haven't heard mentioned. Honestly don't know.

You want to elevate a burned limb only with what type of burn?

I was taught to always elevate a burned limb, unless there are extensive burns on the torso, regardless of the type.

What is Odynophagia? What can it be a symptom of?

Trouble swallowing. Respiratory burn.

 

[VentMedic]

Originally Posted by lightsandsirens5
What is the Modified Parkland Burn Formula?

There are actually several resuscitation formulas including the Modified Parkland, Parkland, Brooke, Modified Brooke etc.

Parkland formula​

This is probably the most widely used formula: ​

(a) First 24 h: no colloids. RL in amount of 4 ml/kg/%burn for adults and 3 ml/kg/% burn for children. Ringer Lactate solution is added as maintenance for children as following: for children weighting 0–10 kg the amount is 4 ml/kg/h; between 10 and 20 kg the amount is 40 ml/h + 2 ml/kg/h; for more than 20 kg, the amount is 60 ml/h + 1 ml/kg/h. ​

(b) Next 24 h: colloids in amount of 20–60% of calculated plasma volume. No crystalloids. Glucose in water is added in amounts required to maintain urinary output of 0.5–1 ml/kg/h in adults and 1 ml/kg/h in children.​

Modified Parkland​

(a) First 24 h: RL in amount of 4 ml/kg/%burn (adults). ​

(b) Next 24 h: begin colloid infusion of 5% albumin at the amount of (0.3–1 ml/kg/%burn)/16 per hour.​

Good article on management of burns:

http://emedicine.medscape.com/article/1277360-overview

This article includes a table for the various fluid resuscitation formulas.

 

[lightsandsirens5]

mycrofft: I love the cold saline thing! And yes, I was talking about household or industrial current. Man made stuff. Altough I guess lightning is capable of producing the same results.

rmellish: That is the standard Parkland Formula. (And this may have been a bad question. I'm not sure who came up with the numbers for the modified or even if it is just a Seattle Harborview Med Center specific thing.) Was told last night that the "modified parkland" is 3 ml instead of 4 ml. I guess that pts were being overloaded at 4 ml, so Harborview is requesting that pt from outlying areas, like the other side of the state, be brought in on the modified formula.

Seaglass: Right on with the cardiac scarring. They told us that if it is enough current to scar your heart instantly, it has already killed you in some other way. Odynophagia=Painful Swallowing. Yep, it is a symptom of airway burns. As for the elevation, they told us that it should only be elevated above the heart if it is an electrical burn. She was saying that this is because it is cooked inside-out. I guess all others shold be equal level or lower? Good point though. I'll have to ask now.

Vent: Of course you are right. And thanks for the link.

~~~~~~~~~

Thanks for sharing. This is how we can all pick stuff up to make us better at the job. I learned sevaral thigs by having you all answer some questions from my test.

 

[mycrofft]

I forgot elevation.

I'd elevate 1st degree and small area 2nd degree. Elevating third and electrolytic burns could drain cellular debris (myoglobin being the biggee) to the trunk faster...maybe. Sounds theoretical to me.

 

[lightsandsirens5]

I'd elevate 1st degree and small area 2nd degree. Elevating third and electrolytic burns could drain cellular debris (myoglobin being the biggee) to the trunk faster...maybe. Sounds theoretical to me.

Ya know, sounds like it makes sense.........? Now that I have put forth that question, thinking I knew the answer, I have been unable to get ahold of my SEI or someone else who would know. Will keep at it though.

Flight nurse that was teaching class said only elevate elec burns.......??????

 

[Seaglass]

Ya know, sounds like it makes sense.........? Now that I have put forth that question, thinking I knew the answer, I have been unable to get ahold of my SEI or someone else who would know. Will keep at it though.

Flight nurse that was teaching class said only elevate elec burns.......??????

Thanks for asking. I tried Googling and didn't find anything helpful, so I'm looking forward to the answer.