17 Burns Flashcards
Name the degree of burn:
Sunburn (epidermis)
1st
Name the degree of burn:
Painful to touch; blebs and blisters; hair follicles intact; blanches
2nd - Superficial dermis (papillary)
Name the degree of burn:
Decreased sensation; loss of hair follicles (need skin grafts)
2nd - deep dermis (reticular)
Name the degree of burn:
Leather feeling (charred parchment); down to subcutaneous fat
3rd
Name the degree of burn:
Down to bone, into adjacent adipose or muscle tissue
4th
Admission criteria for burns:
2nd and 3rd degree burns >10% BSA in pts with what age range?
50 yrs
Admission criteria for burns:
2nd and 3rd degree in any age with > what % BSA?
> 20%
Admission criteria for burns:
2nd and 3rd degree burns in any age, any % BSA with significant portions of hands, feet, face, genitalia, perineum or what other area?
overlying major joints
Admission criteria for burns:
3rd degree in any age group with > what BSA %?
> 5%
What do the following burn pts share in common?:
electrical and chemical burns, concomitant inhalational injury, mechanical traumas, preexisting medical condition, suspected child abuse or neglect
meet admission criteria
What type of burns is most common (flame, scald, chemical, electrical, etc)?
scald
Name the percentage of BSA in burn pt:
Head
9
Name the percentage of BSA in burn pt:
Arms
18
Name the percentage of BSA in burn pt:
chest
18
Name the percentage of BSA in burn pt:
back
18
Name the percentage of BSA in burn pt:
legs
36
Name the percentage of BSA in burn pt:
perineum
1
Name the percentage of BSA in burn pt:
palm (can use to estimate injury)
1
What is the Parkland formula?
For burns ≥ 20% – give 4 cc/kg × % burn in first 24 hours; give ½ in first 8 hours
Which fluid do you use in burn pts in first 24 hrs?
Lactated Ringer’s
What is the best measure of resuscitation in burn pts (with formula in adults and children)?
urine output, 0.5-1 cc/kg/hr in adults
2-4 cc/kg/hr in children < 6 months
Name 4 other factors that can cause the Parkland formula to grossly underestimate volume requirements of a burn pt.
inhalation injury, ETOH, electrical injury, postescharotomy
Using colloid (albumin) in 1st 24 hrs in burn pt shown to increase what type of complications (can use after 24 hrs)?
pulmonary/respiratory
What is the timeframe for escharotomy?
within 4-6 hrs
circumferential burns think ___
escharotomy
Problems ventilating pt with significant chest torso burns. Consider ___
escharotomy
Scald burn in child with absence of splash marks, consider what?
abuse
Is lung injury in burns caused by carbonaceous materials and smoke or heat?
carbonaceous materials and smoke
Facial burns, wheezing and carbonaceous sputum are all signs and symptoms of what?
lung injury
Most common infection in burn wound patients. Also most common cause of death after inhalation injury.
pneumonia
Alkalis produce deeper burns than acid due to ____ necrosis. Acid burns produce ___ necrosis.
liquefaction, coagulation
What is the main tx in acid and alkali burns?
copious water irrigation
In hydrofluoric acid burns, spread ____ on wound.
calcium
In powder burns, ___ before irrigation.
wipe away
Tx for tar burns is to cool, then wipe away with what type of solvent?
lipophilic
What is important to monitor in electrical burns?
cardiac monitoring
What are two complications to consider with electrical burns?
rhabdomyolysis and compartment syndrome
In lightening strikes, you can see ___ secondary to electrical paralysis of brainstem.
cardiopulmonary arrest, do cpr
Cardiac output in severely burned patients – first have ↓ CO for ___ hours, then have ↑ CO (ebb and flow phases following burn)
24–48
What is the formula for caloric needs in a burn pt
25 kcal/kg/day + 30 kcal x % burn
What is the formula for protein need in a burn pt?
1 g/kg/day + 3 g x % burn
What is the best source of nonprotein calories in a burn pt?
glucose (burn wounds use glucose in an obligatory fashion)
Try to excise burn wounds in <___ hours • Used for deep 2nd- and 3rd-degree burns • Viability is based on color, texture, punctate bleeding after removal
72
In a burn pt, skin grafts contraindicated if culture is positive for ___ or bacteria >10^5
beta-hemolytic strep
Split-thickness grafts should be ___ mm (include epidermis and part of the dermis)
12–15
Homografts (allografts; cadaveric skin) – not as good as autografts • Can be a good temporizing material; last___ weeks • Allografts vascularize and are eventually rejected at which time they must be replaced
2–4
Xenografts (porcine) – not as good as homografts; last __ weeks; these do not vascularize
2
Wounds to face, palms, soles, and genitals should be deferred for how long?
1 week
For each burn wound incision – < ___ blood loss, <___ hours in OR • Patients can get extremely sick if too much time is spent in OR
1 L, 20, 2
What is the most common reason for skin graft loss and what can be done to prevent?
seroma or hematoma formation under graft, need to apply pressure dressing (cotton balls) to the skin graft to prevent
Why are split-thinkness grafts better and why are full thickness grafts better
STSGs more likely to survive (thinner so easier for imbibition and subsequent revascularization to occur)
FTSGs have less wound contraction and are good for areas such as the palms and back of hands
Burn scar hypopigmentation and irregularities can be improved with ___ thin split-thickness grafts.
dermal abrasion
Face and genital burns get topical abx for ___ weeks.
2
Hand burns:
• Superficial – ROM exercises, splint in functional position if too much ____
• Deep – immobilize for ___ days after operation, then physical therapy. May need wire fixation of joints if unstable or open. Treat with full-thickness grafts
edema
7
Palm burns – try to preserve specialized palmar attachments. Splint hand in extension for how long? Graft in week 2 with full-thickness nonmeshed autograft graft
1 week
Is there a role for prophylactic IV abx in burns?
no
What is the most common organism in burn wound infections?
pseudomonas
Silvadene should not be used in pts with what type of allergy? or in pts with what other condition?
sulfa, G6PD (methemoglobinemia)
What is the major side effect of silver nitriate in burns?
electrolyte imbalances
Sulfamylon (mafenide sodium) in burn pts has a painful application and what is the major side effect and what type of burns is best for?
metabolic acidosis due to carbonic anyhdrase inhibition, best for burns overlying cartilage, has good eschar penetration
Burn would with peripheral edema, 2nd- to 3rd-degree burn conversion, hemorrhage into scar, erythema gangrenosum, green fat, black skin around wound, rapid eschar separation, focal discoloration. These are all signs of what?
burn wound infection
What is the most common viral infection in burn wounds?
HSV
What is the best way to detect a burn wound infection and differentiate from colonization (<10^5 organisms)?
bx of wound
What is the usual cause of seizures in a burn pt?
iatrogenic related to Na concentration or benzo withdrawal
What is symblepharon?
eyelid stuck to conjunctiva, can be a complication after burn, tx: release with glass rod
What is the tx for heterotopic ossification of tendons in a burn pt?
physical therapy, may need surgery
Gastric ulcer that occurs with burns?
curling’s ulcer
What is the highly malignant squamous cell CA that arises in chronic nonhealing burn wounds or unstable scars?
Marjolin’s ulcer
Hypertrophic scar • Usually occurs ___ after injury secondary to ↑ neovascularity • More likely to be deep thermal injuries that take >3 weeks to heal, heal by contraction and epithelial spread, or heal across flexor surfaces • Wait ___ before scar modification • Tx: grafting, steroids, silicone, compression
3–4 months,
1–2 years
Epidermal–dermal separation seen with what condition?
Toxic epidermal necrolysis
Do you give steroids to a pt with Toxic epidermal necrolysis or Stevens-Johnson syndrome (erthema multiforme)?
NO
