Pramod Pulliantla

78 statements · 2 topics

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I think most importantly, that if you suspect in any way, shape or form that this is part of, uh, non-accidental trauma, then that patient should definitely be transferred to a tertiary care center where they can provide the appropriate care to that patient.

quote · Burns

If you believe that the patient has had incurred an inhalational injury, these patients need to be intubated very quickly because once the edema sets in, it's extremely difficult to intubate these patients sometimes.

quote · Burns

Transfer criteria to a burn center include burns of more than 5% total body surface area, particularly if they involve the face, hands, feet, genitalia, perineum, or major joints.

guideline · Burns

Admission criteria at a burn center include any infant under age 1 with a total body surface area burn greater than 8%.

guideline · Burns

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Pramod's statements about Burns 39 statements

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Pediatric Burns

Statement Burns result in over 300 visits and 2 deaths per day in pediatric patients. Open

Quotation Burns, one of the most common causes of pediatric injury, resulting in over 300 visits and 2 deaths per day. Open

Statement The mechanism of pediatric burns is hot liquids or steam in younger children, and fire in older children. Open

Statement Transfer criteria to a burn center include burns of more than 5% total body surface area, particularly if they involve the face, hands, feet, genitalia, perineum, or major joints. Open

Statement Electrical burns, chemical burns, and inhalational injury should be transferred to a burn center. Open

Statement Patients with significant circumferential burns should be transferred to a burn center. Open

Statement If non-accidental trauma is suspected, the patient should be transferred to a tertiary care center. Open

Quotation I think most importantly, that if you suspect in any way, shape or form that this is part of, uh, non-accidental trauma, then that patient should definitely be transferred to a tertiary care center where they can provide the appropriate care to that patient. Open

Statement Admission criteria at a burn center include any infant under age 1 with a total body surface area burn greater than 8%. Open

Statement Any second-degree burn greater than 10% or any third-degree burn greater than 5% are indications for admission. Open

Statement Before transfer, provide adequate pain control, apply silver sulfadiazine, and wrap wounds lightly with gauze, possibly adding Bactigras to prevent sticking. Open

Statement Ensure bandages are not too tight to avoid compromising distal perfusion of extremities. Open

Statement Patients with smaller burns can be treated with oral rehydration therapy and do not necessarily require intravenous fluids. Open

Statement At the speaker's center, IV resuscitation is initiated for patients with greater than 10% total body surface area burns or teenagers with greater than 15%. Open

Statement The Lund-Browder chart is the best chart for estimating burned surface area in children because it accounts for body shape variations. Open

Statement The palm of the patient can be used as an estimate of 1% body surface area burn if the Lund-Browder chart is unavailable. Open

Statement The Parkland formula uses Ringer's lactate at 3 cc per kg per percentage body surface area burn. Open

Statement The speaker prefers the Cincinnati or Galveston formulas because they are more pediatric-specific. Open

Statement Dextrose-containing solutions should be added as maintenance fluids for any patient under 30 kg. Open

Statement A prospective study by Dietrich showed that colloid use results in statistically less fluid use overall, shorter lengths of stay, and reduced incidence of fluid creep. Open

Statement Fluid creep is the phenomenon of giving too much fluid without accounting for previously given boluses or miscalculating total volume. Open

Statement Fluid overload can lead to respiratory compromise and difficulty ventilating the patient. Open

Statement If fluid creep occurs, proceed with controlled diuresis and potentially add colloid to remove excess fluid. Open

Statement A Foley catheter should be placed in patients with extensive burns, multiple trauma, or electrical burns where rhabdomyolysis may occur. Open

Statement All patients should receive at least a tetanus booster if their vaccination card is not available. Open

Statement The speaker does not give antibiotics until there is a proven infection, as prophylactic use leads to development of resistant organisms. Open

Quotation I personally do not give antibiotics until I have a proven infection. I think, in fact, leads to the, uh, development of resistant or uh infection with resistant organisms. Open

Statement Carbon monoxide levels should be checked in any patient with suspected closed-space fire or inhalational injury. Open

Statement Carbon monoxide poisoning can be measured on blood gas with cooximetry by measuring oxyhemoglobin. Open

Statement Patients with carbon monoxide poisoning will have normal transcutaneous oxygen saturation because all hemoglobin is saturated, but will present with low PaO2 on blood gas. Open

Statement Burns evolve over time, and what initially appears superficial may become second-degree requiring surgical debridement and grafting. Open

Statement Wounds should be reassessed every 24 hours for the first 48 hours. Open

Statement Patients with suspected inhalational injury need to be intubated very quickly because once edema sets in, intubation becomes extremely difficult. Open

Quotation If you believe that the patient has had incurred an inhalational injury, these patients need to be intubated very quickly because once the edema sets in, it's extremely difficult to intubate these patients sometimes. Open

Statement Superficial burns can be debrided immediately and treated on an outpatient basis with longer-acting silver-containing dressings changed in a week. Open

Statement Patients with inhalational injury likely require bronchoscopy to assess airway injury extent and perform pulmonary toilet for shed mucosa and casts. Open

Statement Resuscitation endpoints must be reached before surgical procedures, with urine output as the primary endpoint: 1 cc/kg/hr for children under 30 kg and 0.5 cc/kg/hr for those over 30 kg. Open

Statement If a patient with chest burns is desaturating without good chest rise, an escharotomy may be needed with incisions in the anterior axillary lines bilaterally and an oblique chevron incision connecting them. Open

Statement Half of the calculated fluid should be given in the first 8 hours and the remainder over the next 16 hours. Open