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Senior - Surgery 3 > 7 - Burns > Flashcards

7 - Burns Flashcards

1
Q

Epithelialization

A

Starts within one day

Skin grows in from the wound edges and up from hair follicle

If full thickness - no hair follicles, no epithelialization

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2
Q

Calculating burn surface area (TBSA)

A

Patient’s palm is appx 1%

Rule of 9’s (picture on slide 4)

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3
Q

Superficial burns (aka 1st degree burns)

A

Injury limited to the dermis

Manage the pain with APAP/NSAIDs

Hydrating lotions (avoid alcohol-based lotions)

Rarely long-term sequelae

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4
Q

Partial thickness (aka 2nd degree)

A

Injury extends into the dermis

Initially cover and protect

Debride and clean with warm water an soap

UPDATE TETANUS

Painful - may need narcs

If small, heals from outside -> in

Topical ABX (silvadine)

If large (follicle destroyed) will need skin graft

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5
Q

What’s preferred for partial thickness - cream or ointment?

A

Cream is preferred - easier to remove

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6
Q

How long should you protect the skin from sunlight with a partial thickness?

A

A year

Also, keep moisturized with hydrating lotion

Avoid vigorous debridement - gentle debridement of devascularized tissue

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7
Q

Primary care responsibilities for partial thickness burns:

A 
Clean it
Debride blisters 
Cover with silvadine (ABX) cream
Apply dressings
Ensure tetanus is up to date
Patient education (sunlight protection, dressing changes)
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8
Q

Full thickness (aka 3rd or 4th degree)

A

Extends into SQ fat, muscle, tendon, or bone

Nerves destroyed - mostly no sensation

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9
Q

What to do with full-thickness?

A

Admit to burn unit for:

IV ABX
Fluids
Pain control
Serial debridements
Escharotomy 
Skin grafting
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10
Q

Initial txt for full-thickness

A

Rinse with clean water
Dress
Elevate
ABX cream

Ensure bandaging between digits - do not impede circulation

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11
Q

Fluid resuscitation for full thickness?

A

Aggressive

2-4mL (TBSA)(body weight in Kg)

1/2 that volume in the first 8 hrs, the remainder of 16 hrs

Adjust UOP to 0.5ml/kg/hr (adult)
-if it goes over, decrease IVF rate

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12
Q

Airway considerations?

A

Full-thickness burn patients usually need ET-tube

Tale that airway before it closes up

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13
Q

Heat considerations for burn victims?

A

Room needs to be kept really warm

Loss of skin barrier leads to inability to thermoregulate, which can lead to metabolic acidosis

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14
Q

Ways to monitor fluid status

A

ABG
Lactate
Central venous pressure monitoring (Swan-Ganz catheters)(via central line)

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15
Q

Circumferential burns typically need:

A

Escharotomy

Prevents tourniquet effect

Pain out of proportion

Especially chest or limbs

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16
Q

Silver-impregnated dressing

A

Soak in water

Apply directly overtop of burned area

Apply moisture dressing over top silver dressing

Rinse off daily and can reuse bandage

17
Q

Splinting

A

Splint extremity in position of function (not comfort)

Accomplished with specialized splints

If left in position of comfort, may result in wound contraction -> disability (may be amenable to z-plasty after healed)

18
Q

Autograft

A

From self

19
Q

Allograft

A

Same species

20
Q

Xenograft

A

Another species

21
Q

Full thickness (sheet graft)

A

Only skin (no fenestration like STSG)

Covers smaller area

Reserved for covering bone, tendon, vessels

22
Q

Definitive skin graft comes from:

A

The patient (autograft)

23
Q

Split thickness skin graft (STSG)

A

Covers other surfaces

Healthy skin grafted from donor site

Meshed to maximize surface area

24
Q

Electrical burns

A

Often worse than they outwardly appear

Electricity traverses bones, nerves

Txt - admit to burn unit
Cardiac monitoring 2/2 increased cellular damage and leaking K+ (worrisome for arrhythmias)
Aggressive fluids (UOP 0.5-1mL/Kg/hr)
CMP, CK Q14-6hs
Serial evals of long bones
25
Q

Cord biting

A

Normally no surgery or debridement needed immediately

Splint to avoid contracture

Reconstruction of the mouth after healed

26
Q

Chemical burns

A

Acids - coagulation necrosis

Alkaline - liquefaction necrosis

Remove clothing from burned area

Irrigate with copious amounts of running water

Elevate and dress

Splint in position of function

Send em off to the specialists

27
Q

Evacuate to burn unit if:

A

> 20% TBSA

Any exposed tendon, bone

Face, genitalia, hands, feet, mouth

Inhalation injury

28
Q

Target UOP for burn victims

A

Around 0.5mL/Kg/hr (but no more than 1 - if above 1, back the fluid off)

Remember parkland - 2-4ml x TBSA x weight in kg)

Prevent hypothermia

29
Q

Fluid for burn victimes

A

LR

If you use NS, you may create an acidosis

30
Q

ADC-VAN-DISMAL

A

Slide 22 for explanations

Admit
Diagnosis
Condition
Vitals
Activity
Nursing
Diet
IVF
Special tests
Meds
Allergies
Labs
31
Q

Burn unit team

A 
1:1 nursing
Attending surgeons/intensivists/PAs
Resp-therapy
OT/dietician
BHT
Social workers
Discharge planners
32
Q

What lies at the bottom of the ocean and twitches?

A

A nervous wreck

Senior - Surgery 3 (12 decks)

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