17 - 99 - BURNS Flashcards
involve only the epidermis
SUPERFICIAL BURN (FIRST-DEGREE BURN)
Like a sunburn, the skin is warm, erythematous, painful, blanching, and dry without blisters or eschar (Fig. 99-1).
The epithelium remains intact, but will begin to slough within 7 to 14 days.
They are self-limited and have no potential for scar.
Partial thickness burns involve
epidermis and penetrate to the dermis, but do not completely penetrate through the dermis or down to the subcutaneous tissue
These burns appear wet, weeping, and erythematous, and are exquisitely painful, with blisters or sloughing epidermal remnant (Fig. 99-2).
Superficial partial thickness burn involves
epidermis and papillary dermis
Blanching, more painful, hyperemic and erythematous, typically heal in approximately 2 weeks with appropriate wound care, low risk of scar and pigment change.
These can be managed conservatively with dressing changes or xenograft.
Deep partial-thickness burn involves
epidermis, papillary dermis, and reticular dermis
nonblanching, less painful, pink or pale, require more than 3 weeks to heal, high risk of hypertrophic scar and pigment change, outcomes may be improved by excision and grafting
These typically require debridement and grafting.
Full-thickness burns involvement
penetrate to the subcutaneous tissue and beyond, affecting all dermal layers.
These burns are dry, leathery, waxy, nonblanching, insensate, and eschar is frequently shades of brown, white, gray, or black. The transition from adjacent partial-thickness burn is clear by the lack of tissue edema.
They will not heal without surgical excision with skin grafting or tissue transposition. Sequela, such as contractures and hypertrophic scars, are common.
Zones of injury in burn
Full-thickness burn of the back demonstrating zones of injury according to Jackson’s thermal wound theory.
A, Zone of hyperemia (cells that will recover from injury);
B, zone of stasis (cell injury that can either recover or transform into zone of coagulation);
C, zone of coagulation (cell death)
“fourthdegree burn” has been used to refer to burn injuries that penetrate to and/or expose deep structures (eg, bone, muscle, tendon) (Fig. 99-3). Skin grafting alone is not adequate treatment for burns of this severity, and limb loss may occur.
Third-degree burns should be debrided within the first _____ days to avoid cellulitis and wound infections.
3 to 5 days
excess resuscitation can cause abdominal compartment syndrome, which is defined as bladder pressure
> > 30 mm Hg
most common cause of death in burn patients
infection and sepsis
highest risk of death and complications compared to all other burn etiologies
Thermal injuries
most common mechanism of burns in the pediatric population
SCALD BURN
Type of burns included to calculate TBSA
Only partial-thickness and full-thickness burns are totaled to calculate TBSA.
Parkland Formula
- It is extremely important to note that the original timing of the injury is what is used in the calculation, not the time of initial presentation.
- Half of this volume is administered in the first 8 hours after the injury and the second half is administered over the next 16 hours.
type of fluid recommended to avoid complications associated with metabolic acidosis with normal saline or abnormal fluid shifts with colloid fluids.
Lactated Ringer Solution
urine output goal for adults
0.5 mL/kg/h
urine output goal for children
1 mL/kg/h
adult rule-of-nines
- head and neck is given 9%,
- each lower extremity is given 18%,
- each upper extremity is given 9%,
- anterior and posterior torso are each given 18%
pediatric rule-of-nines
- head and neck is given 18%,
- each lower extremity is given 15%
- each upper extremity is given 10%,
- anterior and posterior torso are each given 16%
several steps that can optimize a burn scar
Although hypertrophic scarring often cannot be avoided, there are several steps that can optimize a burn scar:
- Wound closure of a burn that is likely not to heal on its own in 3 weeks;
- Avoidance of sun contact of the scar during the first 6 months;
- Compression garments for those who can tolerate treatment for up to 1 year; and
- Keeping the scar moist.
Type of burn with highest risk of death and complications?
a. Flame burn
b. Scalp burn
c. Electrical burn
d. Chemical burn
A
Burn most common in children.
a. Flame burn
b. Scalp burn
c. Electrical burn
d. Chemical burn
B
In chemical burns, which is/are correctly paired?
a. Acid: liquefactive necrosis
b. Alkali: coagulation necrosis
c. Both
d. Neither
D
Burns: it is considered as the most painful degree?
a. First
b. Second
c. Third
d. Fourth
B
Which is not true regarding full thickness burn?
a. In extends up to subcutaneous tissue and beyond affecting all dermal layers
b. Dry, leathery, waxy, non-blancing
c. Skin grafting not adequate
d. It will not heal without surgical excision (skin grafting/tissue transposition)
C
a. Burn >20% TBSA
b. Burn >40% TBSA
Inflammatory mediator release triggers a systemic inflammatory response - A
A
a. Burn >20% TBSA
b. Burn >40% TBSA
Bacterial load becomes large without intervention.
B
Among the wound dressing options, leukopenia is a known side effect.
a. Silvadene
b. Silver nitrate
c. Bacitracin
d. Sulfamylon
A
most common mechanism of burn injury in the outpatient setting
scald burns
majority of inpatient burns are secondary to what type of burn?
flame burns
Painful, dry burn with no blisters or eschar formation, blanching
FIRST-DEGREE BURN (SUPERFICIAL)
Exquisitely painful, wet, weeping burn, blanching
SECOND-DEGREE BURN (SUPERFICIAL PARTIAL THICKNESS)
Less painful, pale, nonblanching
SECOND-DEGREE BURN (DEEP PARTIAL THICKNESS)
Insensate, dry, waxy, nonblanching with eschar formation
THIRD-DEGREE BURN (FULL THICKNESS)
Surgical excision with skin grafting necessary for healing
THIRD-DEGREE BURN (FULL THICKNESS)
contractures, hypertrophic scars are common
THIRD-DEGREE BURN (FULL THICKNESS)
more than 3 weeks to heal
SECOND-DEGREE BURN (DEEP PARTIAL THICKNESS)
debridement and grafting may be necessary
SECOND-DEGREE BURN (DEEP PARTIAL THICKNESS)
high risk for scarring and pigmentary changes
SECOND-DEGREE BURN (DEEP PARTIAL THICKNESS)
Heals in 2 weeks with proper wound care
SECOND-DEGREE BURN (SUPERFICIAL PARTIAL THICKNESS)
low risk of scarring
SECOND-DEGREE BURN (SUPERFICIAL PARTIAL THICKNESS)
Self-limited with sloughing within 7-14 days
FIRST-DEGREE BURN (SUPERFICIAL)
no risk of scarring
FIRST-DEGREE BURN (SUPERFICIAL)
Superficial burns involve what part og the skin
epidermis only
Superficial partial thickness burn involves what part of the skin?
epidermis and papillary dermis
Deep partial-thickness burn involves what parts of the skin?
epidermis, papillary dermis, and reticular dermis
Full-thickness burns penetrate until what part of the skin?
subcutaneous tissue and beyond, affecting all dermal layers
zone in burned skin where there are cells that will recover from injury
Zone of hyperemia
zone in burned skin where cell injury can either recover or transform into zone of coagulation
zone of stasis
zone in burned skin where there is already cell death
zone of coagulation
has been used to refer to burn injuries that penetrate to and/or expose deep structures (eg, bone, muscle, tendon)
“fourth-degree burn”
Third-degree burns should be debrided within the first how many days to avoid cellulitis and wound infections?
3 to 5 days
Circumferential burns of the extremities are at risk for the development of what syndrome?
compartment syndrome as the underlying tissues becomes increasingly swollen and edematous and constricted by the eschar
Ectopic bone formation known as heterotopic ossification may develop in patients with large TBSA burns causing severe pain, contractures, and restricting range of motion. 10 This most commonly occurs in what area?
elbow
more frequent if the burn injury includes the upper extremity
excess resuscitation can cause abdominal compartment syndrome, which is defined as bladder pressure of what?
over 30 mm Hg
- Patients often present with oliguria and abdominal distension. In these patients, first steps include escharotomy of the abdominal full-thickness burns, as well as paralysis and laying the patient flat.
- Fluids should be immediately decreased and diuresis or continuous renal replacement therapy should be considered to avoid a decompressive laparotomy.
- If these noninvasive measures fail to relieve the abdominal compartment syndrome, then a laparotomy might be required.
most common cause of death in burn patients
infection and sepsis
Unprotected from ultraviolet radiation, melanin-deficient burn scars are prone to squamous cell carcinoma development. What do you call this ulcer?
Marjolin ulcer
associated with the highest risk of death and complications compared to all other burn etiologies
Thermal injuries, caused by fire or flames
second leading cause of burn injuries and are the most common mechanism of burns in the pediatric population.
SCALD BURN
pose the greatest diagnostic, therapeutic, and prognostic challenge among burn mechanisms
ELECTRICAL BURN
ultimately determine ensuing tissue damage and lethality
current (amperage) of the electricity and its direction of travel
has the greatest resistance of all body tissues, and therefore generates the most heat as current flows through it
Bone
Bone heating leads to severe thermal injury of deep invested muscles and tendon insertions which can cause swelling and compartment syndrome
. If compartment pressures are greater than how many mm Hg, fasciotomies should be performed.
30 mmHg
T/F
Acid burns are typically deeper and more serious than alkali burns, as hydroxide ion saponification of fats induces liquefactive necrosis and permits further depth of chemical penetration
FALSE
Alkali burns are typically deeper and more serious than acid burns, as hydroxide ion saponification of fats induces liquefactive necrosis and permits further depth of chemical penetration
what types of burns are totaled to calculate TBSA?
Only partial-thickness and fullthickness burns
patients who have burns of more than how many % TBSA commonly require IV fluid resuscitation?
more than 20%
Silvadene
Sulfamylon
Silver nitrate
Bacitracin
Xeroform
Acticoat
most important factors to consider in the assessment of a burn
depth, location, size, and duration of the burn injury
tetanus toxoid vaccine should be given to all burn patients with what type of burns?
partial-thickness or full-thickness burns
- In very young children and persons with high-risk tetanus wounds (ie, burn older than 6 hours at presentation, immunodeficiency, or soil contamination in wound), tetanus immunoglobulin should also be administered (tetanus toxoid is not given in children younger than age 4 years)
first-line medications for the management of outpatient burn pain
Scheduled narcotics
Infections occurring after the first 10 days, however, are more likely caused by what spp of bacteria?
Gram-negative rods
patients benefit from wound culture and empiric coverage with ciprofloxacin
Usually these infections develop in the first 7 to 10 days, and normal flora organisms, such as what spp, are usually the culprits.
Staphylococcus
most important step in rejuvenating the scar
release of the tension
