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3. E Med & Surgery > 3- Burns > Flashcards

3- Burns Flashcards

1
Q

75% of burn related deaths result from what?

A

House fires

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2
Q

Pt presents with painful burn that appears red, dry, blanches with presssure, and does NOT have blisters. What type of burn is this and what skin layer is affected?

A

Superficial, epidermal layer

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3
Q

Sunburns, mild scalds, and mild electrical burns are what type of burn?

A

Superficial

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4
Q

What is included in the wound care for a superficial burn?

A

Remove clothing/ debris

Topical calamine/ aloe vera

Topical polysporine (infection)

Dressing not usually needed

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5
Q

Pt presents with painful burn that appears pink, moist, blanches with presssure, and has blisters. What type of burn is this and what skin layer is affected?

A

Partial thickness, superficial

Partially extends into dermis

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6
Q

Pt presents with burn that is mottled in color from patchy white to red, is non-blanching, has blisters, and is painful with pressure. What type of burn is this and what skin layer is affected?

A

Partial thickness, deep

Partially extends into dermis

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7
Q

What is the difference in healing between a superficial and deep partial thickness burn?

A

Superficial: 1-3 weeks, scars not typical

Deep: 2-9 weeks, hypertrophic scarring common

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8
Q

What is included in the wound care for a partial thickness burn?

A

Keep wound moist + debridement (re-epithelialization)

Do not pop blisters

Petrolium moisturizer/ Bacitracin

Occlusive dressing

If deep w/ eschar: silver sulfadiazine cream + PT

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9
Q

Pt presents with painless burn that appears dry, non-blanching, hard, and has a leathery texture. What type of burn is this and what skin layer is affected?

A

Full thickness, epidermis + full thickness dermis

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10
Q

What is included in the wound care for a full thickness burn?

A

Surgical repair + skin grafting

Silver sulfadiazine cream

Opioids

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11
Q

What tissues are involved in a fourth degree/ beyond full thickness burn?

A

Muscle, tendon, bone, blood vessel, nerve

(life threatening)

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12
Q

What is the management for chemical burns?

A

Copious irrigation with water, monitor progress with litmus paper

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13
Q

What is the greatest concern with electrical burns?

A

Damage may be hidden under good skin (current follows path of least resistance)

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14
Q

What is an associated risk of electrical burns?

A

Rhabdomyolysis

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15
Q

What is the management for electrical burns?

A

Fluid resuscitate (1-2 cc urine/kg/hr)

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16
Q

Pt presents with feathering skin and Lichtenberg figures. What type of burn are you concerned for?

A

Lightning burn

(often have permanent injury)

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17
Q

What are the 6 P’s of compartment syndrome and what type of burn are they a/w?

A

Pain, paresthesia, pallor, paralysis, poikilothermia, pulselessness

A/w circumferential burns

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18
Q

What surgical procedures are used in the management of circumferential burns to relieve pressure?

A

Escharotomy, fasciotomy

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19
Q

How is breathing managed in a burn pt? (ABCs)

A

100% oxygen non-rebreather

20
Q

How is circulation managed in a burn pt? (ABCs)

A

2 large bore IVs, unburned skin

Calculate TBSA involved (Parkland resuscitaion if ≥ 20%)

21
Q

What is the #1 cause of death related to fires?

A

Smoke inhalation

22
Q

What measurement is NOT reliable for pts with carbon monoxide poisoning?

A

Pulse ox

23
Q

Elderly pt with prolonged exposure to carbon monoxide may present with a symptomatic initial clinical picture and are at risk for what complication?

A

Delayed neurologic sequelae

24
Q

Pt presents with inhalation injury and skin has “cherry red” appearance. You suspect cyanide (CN)/ hydrogen cyanide poising. What is the tx?

A

Cyanokit

25
Q

Hoarseness, stridor, and substernal retractions are sxs of upper or lower airway inhalation injuries?

A

Upper

26
Q

Tachypnea, decreased breath sounds, wheezing/ rales/ rhonchi, and accessory muscle use are sxs of upper or lower airway inhalation injuries?

A

Lower

27
Q

What is included in the tx for inhalation injuries?

A

Mechanical ventilation

Aggressive pulmonary toilet

Pneumonia prevention/ tx

Supplemental nutrition

28
Q

Pt should be intubated if hx suggests airway compromise or they are unable to protect their airway (trauma, opioids). What hx is suggestive of compromise? (6)

A
  • Closed space smoke exposure
  • Carbonaceous sputum
  • Facial burns
  • COHb > 5
  • Hoarse voice
  • Singed facial hair
29
Q

What are the goals of circulation resuscitation in burn pts?

A

Maintain perfusion to end organs

Monitor I+O

Diuretics not indicated in acute setting

30
Q

What is the Parkland formula for TBSA for burn pts?

(used if ≥ 20%)

A

4mL LR x kg x TBSA = 24 hr post burn total

Half of volume given in first 8 hrs post burn

Rest given in remaining 16 hrs

31
Q

Burn pts who have a delay in receiving care can experience under-resuscitation and are at risk for what?

A

Intravascular volume depletion

Suboptimal tissue perfusion

32
Q

Burn pts who are over resuscitated are at risk for what?

A

Abdominal compartment syndrome

Compartment syndrome

Pulmonary edema

33
Q

When/ why is nutritional support recommended for burn pts?

A

25% TBSA

Losses exceeding 10% body weight a/w poorer outcome

34
Q

What nutritional support is recommended for burn pts?

A

High carb, low fat diet

Protein needs ~1.5-2 g/kg

Vitamins A, E, D, C, + selenium/ zinc

TPN NOT recommended (increases mortality)

35
Q

According to ABA referral criteria, who is transferred to a burn center for care?

A
  • Partial thickness > 10% TBSA
  • 3rd degree burns, any age group
  • Face, hands, feet, genitalia, perineum, major joints
  • Electrical/ chemical/ inhalation
  • Concomitant trauma
36
Q

Infection is the leading cause of morbidity/ mortality a/w burns. Wounds that become colonized in 3-5 days typically involve what type of organisms?

A

G (+), S. aureus

37
Q

What type of grafts are used as a temporary skin covering in a staging graft procedure?

A

Allograft, xenograft

38
Q

What is the only definitive grafting for large or deep burn wounds?

A

Autograft (pts own skin)

Requires donor site (painful and takes time to heal)

39
Q

Pt presents with decreased urine output, elevated bladder pressure > 25 mmHg, increased peak expiratory pressure, and poor ventilation. What burn complication are you concerned about and what is the treatment?

A

Abdominal compartment syndrome

Tx: decompressive laparotomy (if unable to reverse)

40
Q

Pt presents with trismus (lockjaw) and subsequent descending muscle rigidity within 24-48 hours. What burn complication are you concerned for?

A

Tetanus

41
Q

In what circumstances is a wound prone to tetanus?

A
  • Present > 6 hours
  • > 1 cm deep
  • Exposed to saliva/ feces
42
Q

What complications are a/w tetanus?

A

Abscess, gangrene

43
Q

What is the major concern with chronic ulcerations (complication of burn)?

A

Marjolin ulcer

44
Q

What type of burn scar is an overgrowth of scar tissue that extends beyong the area of injury?

A

Keloid

45
Q

What type of burn scar is thick, raised, red, and does not extend beyond original injury?

A

Hypertrophic

46
Q

What type of burn scar is connective tissue replaced with fibrotic tissue and is a/w decreased ROM that leads to shortening of the muscle?

A

Scar contractures

3. E Med & Surgery (19 decks)

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