17 Burns

Question 1

Name the degree of burn:

Sunburn (epidermis)

Answer 1

1st

Question 2

Name the degree of burn:

Painful to touch; blebs and blisters; hair follicles intact; blanches

Answer 2

2nd - Superficial dermis (papillary)

Question 3

Name the degree of burn:

Decreased sensation; loss of hair follicles (need skin grafts)

Answer 3

2nd - deep dermis (reticular)

Question 4

Name the degree of burn:

Leather feeling (charred parchment); down to subcutaneous fat

Answer 4

3rd

Question 5

Name the degree of burn:

Down to bone, into adjacent adipose or muscle tissue

Answer 5

4th

Question 6

Admission criteria for burns:

2nd and 3rd degree burns >10% BSA in pts with what age range?

Answer 6

50 yrs

Question 7

Admission criteria for burns:

2nd and 3rd degree in any age with > what % BSA?

Answer 7

> 20%

Question 8

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?

Answer 8

overlying major joints

Question 9

Admission criteria for burns:

3rd degree in any age group with > what BSA %?

Answer 9

> 5%

Question 10

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

Answer 10

meet admission criteria

Question 11

What type of burns is most common (flame, scald, chemical, electrical, etc)?

Answer 11

scald

Question 12

Name the percentage of BSA in burn pt:

Head

Answer 12

9

Question 13

Name the percentage of BSA in burn pt:

Arms

Answer 13

18

Question 14

Name the percentage of BSA in burn pt:

chest

Answer 14

18

Question 15

Name the percentage of BSA in burn pt:

back

Answer 15

18

Question 16

Name the percentage of BSA in burn pt:

legs

Answer 16

36

Question 17

Name the percentage of BSA in burn pt:

perineum

Answer 17

1

Question 18

Name the percentage of BSA in burn pt:

palm (can use to estimate injury)

Answer 18

1

Question 19

What is the Parkland formula?

Answer 19

For burns ≥ 20% – give 4 cc/kg × % burn in first 24 hours; give ½ in first 8 hours

Question 20

Which fluid do you use in burn pts in first 24 hrs?

Answer 20

Lactated Ringer’s

Question 21

What is the best measure of resuscitation in burn pts (with formula in adults and children)?

Answer 21

urine output, 0.5-1 cc/kg/hr in adults

2-4 cc/kg/hr in children < 6 months

Question 22

Name 4 other factors that can cause the Parkland formula to grossly underestimate volume requirements of a burn pt.

Answer 22

inhalation injury, ETOH, electrical injury, postescharotomy

Question 23

Using colloid (albumin) in 1st 24 hrs in burn pt shown to increase what type of complications (can use after 24 hrs)?

Answer 23

pulmonary/respiratory

Question 24

What is the timeframe for escharotomy?

Answer 24

within 4-6 hrs

Question 25

circumferential burns think ___

Answer 25

escharotomy

Question 26

Problems ventilating pt with significant chest torso burns. Consider ___

Answer 26

escharotomy

Question 27

Scald burn in child with absence of splash marks, consider what?

Answer 27

abuse

Question 28

Is lung injury in burns caused by carbonaceous materials and smoke or heat?

Answer 28

carbonaceous materials and smoke

Question 29

Facial burns, wheezing and carbonaceous sputum are all signs and symptoms of what?

Answer 29

lung injury

Question 30

Most common infection in burn wound patients. Also most common cause of death after inhalation injury.

Answer 30

pneumonia

Question 31

Alkalis produce deeper burns than acid due to ____ necrosis. Acid burns produce ___ necrosis.

Answer 31

liquefaction, coagulation

Question 32

What is the main tx in acid and alkali burns?

Answer 32

copious water irrigation

Question 33

In hydrofluoric acid burns, spread ____ on wound.

Answer 33

calcium

Question 34

In powder burns, ___ before irrigation.

Answer 34

wipe away

Question 35

Tx for tar burns is to cool, then wipe away with what type of solvent?

Answer 35

lipophilic

Question 36

What is important to monitor in electrical burns?

Answer 36

cardiac monitoring

Question 37

What are two complications to consider with electrical burns?

Answer 37

rhabdomyolysis and compartment syndrome

Question 38

In lightening strikes, you can see ___ secondary to electrical paralysis of brainstem.

Answer 38

cardiopulmonary arrest, do cpr

Question 39

Cardiac output in severely burned patients – first have ↓ CO for ___ hours, then have ↑ CO (ebb and flow phases following burn)

Answer 39

24–48

Question 40

What is the formula for caloric needs in a burn pt

Answer 40

25 kcal/kg/day + 30 kcal x % burn

Question 41

What is the formula for protein need in a burn pt?

Answer 41

1 g/kg/day + 3 g x % burn

Question 42

What is the best source of nonprotein calories in a burn pt?

Answer 42

glucose (burn wounds use glucose in an obligatory fashion)

Question 43

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

Answer 43

72

Question 44

In a burn pt, skin grafts contraindicated if culture is positive for ___ or bacteria >10^5

Answer 44

beta-hemolytic strep

Question 45

Split-thickness grafts should be ___ mm (include epidermis and part of the dermis)

Answer 45

12–15

Question 46

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

Answer 46

2–4

Question 47

Xenografts (porcine) – not as good as homografts; last __ weeks; these do not vascularize

Answer 47

2

Question 48

Wounds to face, palms, soles, and genitals should be deferred for how long?

Answer 48

1 week

Question 49

For each burn wound incision – < ___ blood loss, <___ hours in OR • Patients can get extremely sick if too much time is spent in OR

Answer 49

1 L, 20, 2

Question 50

What is the most common reason for skin graft loss and what can be done to prevent?

Answer 50

seroma or hematoma formation under graft, need to apply pressure dressing (cotton balls) to the skin graft to prevent

Question 51

Why are split-thinkness grafts better and why are full thickness grafts better

Answer 51

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

Question 52

Burn scar hypopigmentation and irregularities can be improved with ___ thin split-thickness grafts.

Answer 52

dermal abrasion

Question 53

Face and genital burns get topical abx for ___ weeks.

Answer 53

2

Question 54

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

Answer 54

edema

7

Question 55

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

Answer 55

1 week

Question 56

Is there a role for prophylactic IV abx in burns?

Answer 56

no

Question 57

What is the most common organism in burn wound infections?

Answer 57

pseudomonas

Question 58

Silvadene should not be used in pts with what type of allergy? or in pts with what other condition?

Answer 58

sulfa, G6PD (methemoglobinemia)

Question 59

What is the major side effect of silver nitriate in burns?

Answer 59

electrolyte imbalances

Question 60

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?

Answer 60

metabolic acidosis due to carbonic anyhdrase inhibition, best for burns overlying cartilage, has good eschar penetration

Question 61

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?

Answer 61

burn wound infection

Question 62

What is the most common viral infection in burn wounds?

Answer 62

HSV

Question 63

What is the best way to detect a burn wound infection and differentiate from colonization (<10^5 organisms)?

Answer 63

bx of wound

Question 64

What is the usual cause of seizures in a burn pt?

Answer 64

iatrogenic related to Na concentration or benzo withdrawal

Question 65

What is symblepharon?

Answer 65

eyelid stuck to conjunctiva, can be a complication after burn, tx: release with glass rod

Question 66

What is the tx for heterotopic ossification of tendons in a burn pt?

Answer 66

physical therapy, may need surgery

Question 67

Gastric ulcer that occurs with burns?

Answer 67

curling’s ulcer

Question 68

What is the highly malignant squamous cell CA that arises in chronic nonhealing burn wounds or unstable scars?

Answer 68

Marjolin’s ulcer

Question 69

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

Answer 69

3–4 months,

1–2 years

Question 70

Epidermal–dermal separation seen with what condition?

Answer 70

Toxic epidermal necrolysis

Question 71

Do you give steroids to a pt with Toxic epidermal necrolysis or Stevens-Johnson syndrome (erthema multiforme)?

Answer 71

NO