NEET trap: Parkland formula uses time of burn, not time of admission — if patient arrives 2 hours after injury, the first 8-hour volume must be given in the remaining 6 hours. Ringer's lactate is preferred (less hyperchloraemic acidosis than NS). Colloid is not given in the first 24 hours (capillary leak). Curling's ulcer = stress ulcer in burns (duodenum); Marjolin's ulcer = SCC arising in chronic burn scar (years later).
Laplace's law explains why larger aneurysms rupture more readily: wall tension = pressure × radius. As diameter doubles, tension doubles — a self-accelerating process. EVAR (endovascular aneurysm repair) has lower 30-day mortality than open repair but requires lifelong surveillance for endoleaks. Open repair is more durable. Ruptured AAA triad: sudden tearing back/flank pain + hypotension + pulsatile abdominal mass — direct to theatre, no CT if haemodynamically unstable.
Morning Rounds · Surgery Series · Round 06
Vascular, Trauma & Burns Pressure, Flow & the Golden Hour