Which of the following statements regarding the above burn

Discussion in 'MRCS Forum' started by Lona., Dec 13, 2007.

  1. Lona.

    Lona. Guest

    Which of the following statements regarding the above burn patient is correct?
    a- High-dose penicillin should be administered prophylacticaly
    b- Tetanus prophylaxis is not necessary if the patient has been immunized in the previous 3 years
    c- The burns can be estimated at 60% total body surface area using the rule of nines
    d- The most sensitive indicator of adequacy of fluid resuscitation is heart rate
    e- The patient should undergo immediate intubation for airway protection and oxygen administration
  2. Lona.

    Lona. Guest

    Answer: e. (Schwartz, 7/e, pp 228-232, 234-238) Aggressive evaluation and treatment of burn victims has led to increased survival of the 2 million patients treated for burns each year in the United States. A systematic approach to the patient with attention to airway/vascular access and aggressive fluid resuscitation has proved essential. In the patient with obvious facial burns who is hemodynamically unstable, airway access is the first priority. Fluid resuscitation is initiated using the Parkland formula, with urine output of 0.5 to 1.0 ml/(kg.h) being the most sensitive indicator of the adequacy of resuscitation. The extent of the burn can be roughly estimated using the rule f nine, in which the head and the upper extremities are each 9% of the total body surface area (TBSA) and the anterior trunk, posterior trunk, and the lower extremities are each 18% of the TBSA. This patient has burns of roughly 40% TBSA (face 4.5%, upper extremities 18%, and anterior trunk 18%). Tetanus prophylaxis is indicated in all patients who have not been immunized within 1 year; prophylactic intravenous antibiotics are not indicated because they have not been shown to be benefit in decreasing early cellulitic infections. Conversely, they have been shown to lead to increased complications secondary to resistant gram-negative organisms.

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