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#SIMS 4 PATCH NOTES APRIL 2018 SKIN#

Burn incidence and treatment in the United States: 2016. Once the burn cleaned, topical antimicrobial agent (SS, Mupirocin, polysporin, bacitracin) can be appliedġ.

#SIMS 4 PATCH NOTES APRIL 2018 SKIN#

Debride devitalized skin from blisters that rupture on their own to reduce rate of infection and improve cosmesis.If the blister is large, rupture is imminent, or it impairs with functional movement, it may be aspirated and debrided.

If the blister is intact and 1 cm2 can be debrided or left intact (there is contradictory evidence on topic).

General consensus regarding blister management:.

Use sterile saline and gauze to gently remove sloughing epidermis.

Silver sulfadiazine is commonly available, but no evidence to show it has reduced healing time or infection rates when compared to petroleum jelly products.

The Parkland formula is a general guide and ongoing fluid requirements should be monitored/tailored with urine output (0.5-1 ml/kg/h for adults) and input/output hemodynamics.

½ given in first 8 hours after the onset of burn and remainder given in remaining 16 hours.

The Parkland formula is a common method to estimate appropriate volume of fluid resuscitation.

Treat burns with > 20% TBSA with fluid resuscitation (lactated ringers preferred).

Use the largest tube possible to improve bronchoscopy later.

Expert consensus endorses early intubation for burns to the upper airway, airway edema, stridor or other signs of respiratory compromise.

Evaluate for stridor, hoarseness, shortness of breath, singed nasal hairs, cough, soot in oral cavity, history of being in fire in enclosed space.

THE PRIMARY PILLARS OF BURN TREATMENT INCLUDE AIRWAY MANAGEMENT, FLUID RESUSCITATION AND WOUND CARE.

Begin cardiotocographic monitoring in the viable pregnancy (>24 weeks) as soon as possibleĥ.The abdominal wall may be less sensitive to peritoneal irritation because of stretching of abdominal muscles from uterine growth.Significant intra-abdominal injury may be present without significant signs/symptoms.Fetal assessment (fetal heart tones, echo for movement).For hypotension suspected to be due to hemorrhage, O-negative blood is preferred.Be aggressive with fluid resuscitation to avoid shock.Bump the patient (or better yet), displace uterus to the left to prevent supine hypotensive syndrome.Pregnant patients start with lower blood pressures, bleed easier and have later changing vital signs.Anticipate and avoid shock, the principle cause of fetal mortality.Place a chest tube two inter spaces higher.Ventilation will be more difficult due to gravid state.Airway – Anticipate a more difficult airway (decreased O2 reserve, more airway edema, reduced neck motion from c-collar).