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FD9 > 99 - Burns > Flashcards

99 - Burns Flashcards

1
Q

Two independent systems of describing the depth of burn injury exist

A
  1. Degrees

2. Thickness

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2
Q

Involve only the epidermis

Painful, dry burn with no blisters or eschar formation, blanching

A

First-degree burn (superficial)

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3
Q

Involves epidermis and papillary dermis

Exquisitely painful, wet, weeping burn, blanching

A

Second-degree burn (superficial partial thickness)

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4
Q

Involves epidermis, papillary dermis, and reticular dermis

Less painful, pale, nonblanching

A

Second-degree burn (deep partial thickness)

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5
Q

Penetrate to the subcutaneous tissue and beyond

Insensate, dry, waxy, nonblanching with eschar formation

A

Third-degree burn (full thickness)

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6
Q

Self-limited with sloughing within 7-14 days

No risk of scarring

A

First-degree burn (superficial)

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7
Q

Heals in 2 weeks with proper wound care

Low risk of scarring

A

Second-degree burn (superficial partial thickness)

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8
Q

> 3 weeks to heal
Debridement and grafting may be necessary
High risk for scarring and pigmentary changes

A

Second-degree burn (deep partial thickness)

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9
Q

Surgical excision with skin grafting necessary for healing

Contractures, hypertrophic scars are common

A

Third-degree burn (full thickness)

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10
Q

Burns of this degree are the most painful

A

Partial-thickness burn

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11
Q

The transition to full-thickness from adjacent partial-thickness burn is clear by the lack of

A

Tissue edema

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12
Q

Has been used to refer to burn injuries that penetrate to and/or expose deep structures (eg, bone, muscle, tendon)

A

“Fourth-degree burn”

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13
Q

Breadth of injury is described as

A

A percentage of total body surface area

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14
Q

Zones of injury according to Jackson’s thermal wound theory

A

Zone of hyperemia
Zone of stasis
Zone of coagulation

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15
Q

Zone: cell death

A

Coagulation

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16
Q

Zone: cell injury that can either recover to or transform into zone of coagulation

A

Stasis

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17
Q

Zone: cells that will recover from injury

A

Hyperemia

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18
Q

Third-degree burns should be debrided within _____ to avoid cellulitis and wound infections

A

3 to 5 days

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19
Q

Burns sustained in structural fires have a high incidence of _____, wherein the pulmonary epithelium sustains direct thermal injury with ensuing edema and airway obstruction

A

Smoke inhalation injury

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20
Q

Highly suspicious for smoke inhalation injury

A

Perioral burns

Presence of ashes and soot around or within the mouth and oropharynx

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21
Q

Circumferential burns of the extremities are at risk for the development of

A

Compartment syndrome

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22
Q

Excess resuscitation can cause abdominal compartment syndrome, which is defined as a bladder pressure over

A

30 mmHg

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23
Q

Patients with abdominal compartment syndrome often present with

A

Oliguria

Abdominal distension

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24
Q

May develop in the gastric or duodenal mucosa as a result of intravascular volume depletion

A

Acute stress gastritis (Curling ulcer)

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25
Q

May occur following inadequate resuscitation or thermal injury to muscle as a consequence of massive myoglobulinuria, particularly in electrical burns

A

Acute renal failure

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26
Q

May develop in patients with large TBSA burns
Most commonly occurs in the elbow
More frequent if the burn injury includes the upper extremity

A

Ectopic bone formation

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27
Q

Most common cause of death in burn patients

A

Infection and sepsis

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28
Q

The pathophysiology of burn injury can be appreciated by considering 2 paradigms

A
  1. Loss of skin organ function

2. Production of an inflammatory response

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29
Q

In burns greater than _____% TBSA, the initial insult from inflammatory mediator release triggers a systemic inflammatory response

A

20

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30
Q

In burns greater than _____% TBSA, bacterial load becomes so large that without intervention, sepsis and death are imminent

A

40

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31
Q

Most common burn etiology

A

Thermal injuries, caused by fire or flames

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32
Q

Associated with the highest risk of death and complications compared to all other burn etiologies

A

Thermal injuries, caused by fire or flames

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33
Q

Flame burns most commonly occur

A

At home

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34
Q

Second leading cause of burn injuries

A

Scald burn

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35
Q

Most common mechanism of burns in the pediatric population

A

Scald burn

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36
Q

Third leading cause of burns in children

A

Contact burns

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37
Q

Scalp burns then to cause a (lesser/greater) inflammatory response than flame burns

A

Greater

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38
Q

Pose the greatest diagnostic, therapeutic, and prognostic challenge among burn mechansims

A

Electrical burn

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39
Q

Electrocution injuries are classified as

A 
Low voltage (<1000 V)
High voltage (>1000 V)
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40
Q

It is the _____ of the electricity and its direction of travel that ultimately determine ensuing tissue damage and lethality

A

Current (amperage)

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41
Q

_____ milliamperes (mA) are required to paralyze respiratory muscles

A

20

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42
Q

_____ milliamperes (mA) are required to induce ventricular fibrillation

A

100

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43
Q

During electric shock by alternating current, both flexor and extensor muscles are stimulated, by the strength of the flexors is greater than that of extensors, causing the “_____” phenomenon

A

No let-go

44
Q

Primary electrical injury is greatest in areas with

A

The least cross-sectional area, such as digits, wrist, and toes

45
Q

Has the greatest resistance of all body tissues, and therefore generates the most heat as current flows through it

A

Bone

46
Q

If compartment pressures are greater than _____ mmHg, then fasciotomies should be performed

A

30

47
Q

Long-term complications of high-voltage electrical injury also includes _____, and these patients should followup with ophthalmology as an outpatient

A

Cataracts

48
Q

(Alkalis/Acids) induce burn damage through binding of hydrogen ions to proteins, inducing coagulation

A

Acids

49
Q

(Alkali/Acid) burns are typically deeper and more serious as hydroxide ion saponification of fats induces liquefactive necrosis and permits further depth of chemical penetration

A

Alkali

50
Q

_____ burns are unique in that they will continue to progress after the initial insult until the offending agent is eliminated

A

Chemical

51
Q

It is advisable for _____ to be removed by brushes or dusting, as wetting with irrigation may provoke injuries in some cases

A

Solids or powders

52
Q

Y/N: Attempts at neutralizing pH with a complementary chemical should be undertaken

A

No - should not be

53
Q

Hydrofluoric acid is toxic because of the fluoride ion that binds calcium, but can be neutralized with

A

Topical calcium gel (1 ampule of calcium gluconate in 100g of lubricating jelly)

54
Q

Treatment of phenol exposure includes copious water irrigation and cleansing with

A

Polyethylene glycol or ethyl alcohol

55
Q

Can be considered if there are no other burns oustide of the inhalation injury

A

Systemic steroids

56
Q

Symptoms of carbon monoxide poisoning typically begin with _____ at levels of approximately 10%

A

Headaches

57
Q

CO in the blood becomes toxic at levels of approximately

A

50% to 70%

58
Q

Half-life of CO

A

4 hours

59
Q

Delivery of _____ reduces the half-life of CO to 30 to 90 minutes

A

100% O2

60
Q

Most important initial step in the management of a burn patient

A

Prompt and aggressive evaluation and maintenance of the airway

61
Q

For superficial burns, treatment of the burn wound oftentimes requires

A

Topical antimicrobial agents and corticosteroids

62
Q

Totaled to calculate the TBSA

A

Partial-thickness and full-thickness burns

63
Q

Regions on the adult that constitutes 9% of the TBSA

A

Head

Each arm

64
Q

Regions on the adult that constitutes 18% of the TBSA

A

Each leg
Anterior trunk
Posterior trunk

65
Q

Regions on children that constitutes 9% of the TBSA

A

Each arm

66
Q

Regions on children that constitutes 14% of the TBSA

A

Each leg

67
Q

Regions on children that constitutes 18% of the TBSA

A

Head and neck
Anterior trunk
Posterior trunk

68
Q

Patients who have burns of more than _____% TBSA commonly require IV fluid resuscitation

A

20

69
Q

Most commonly used to calculate fluid requirements within the first 24 hours of burn injury

A

Parkland formula

70
Q

Parkland formula

A

4mL x %TBSA x weight (kg)

71
Q

Half of the volume is administered in the first _____ after the injury and the second half is administered over the next _____

A

8 hours

16 hours

72
Q

Recommended fluid resuscitation to avoid complications associated with metabolic acidosis with normal saline or abnormal fluid shifts with colloid fluids

A

Lactated Ringer solution

73
Q

Commonly used as maintenance fluids

A

Dextrose 5% in lactated Ringer solution

74
Q

Proper resuscitation is based on overall fluid status as represented by urine output with the goal of _____ mL/kg/h in adults and _____ mL/kg/h in children

A

0.5

1

75
Q

Aggressive hydration also accounts for potential _____, leading to acute kidney injury

A

Rhabdomyolysis

76
Q

If the organs are perfused, _____ should be observed

A

Decreases in lactate and base deficit
Increases in central venous O2
Normalization of pH

77
Q

Silver-containing cream that has broad-spectrum coverage against both Gram-negative and Gram-positive bacteria
Contraindicated in patients with sulfa allergies and over wounds near the eyes
Possible leukopenia in the acute phase

A

Silvadene

78
Q

Used over cartilaginous areas such as the nose or ear because of increased penetration of the dressing over these areas
Can be used without dressings
Associated with increased pain; risk for hyperchloremic metabolic acidosis; chronic use at risk for fungal infection

A

Suflamylon

79
Q

Typically applied as soak dressings 2 to 3 times a day
Covers fungal species
Can cause leaching of cations causing hyponatremia; stains the skin as well as anything it comes in contact with

A

Silver nitrate

80
Q

Commonly used for facial burns

A

Bacitracin

81
Q

Often used for partial-thickness skin graft donor sites

A

Xenograft

82
Q

Consists of silver-impregnated sheets
Mainly used in partial-thickness injuries
Only needs to be changed every 5 days

A

Acticoat

83
Q

Acticoat is activated with

A

Water

Not normal saline as the sodium can leech out with the silver

84
Q

Early intubation is recommended for patients with

A

Severe airway involvement or
Patients with large TBSA burns (>20% deep partial or full thickness) that will require Parkland large fluid resuscitation

85
Q

A _____ vaccine should be given to all burn patients with partial-thickness or full-thickness burns

A

Tetanus toxoid

86
Q

Tetanus immunoglobulin should also be administered in

A

Very young children
Persons with high-risk tetanus wound (ie, burn older than 6 hours at presentation, immunodeficiency, or soil contamination in wound)

87
Q

Tetanus should not be given in

A

Children younger than age 4 years

88
Q

First-line medications for the management of outpatient burn pain

A

Scheduled narcotics

89
Q

Analgesics that should play a secondary role in management

A

Acetaminophen

Nonsteroidal antiinflammatory drugs

90
Q

Pulsing or throbbing pain accompanied by warmth at the wound site may be associated with

A

Inflammatory progression

91
Q

Inflammatory progression may be managed with

A

Nonsteroidal antiinflammatory drugs

92
Q

The infection rate of burns managed in the outpatient setting is _____%, which increases to _____% in diabetic patients

A

5

11 to 15

93
Q

Usual culprits in infections developing in the first 7 to 10 days

A

Normal flora organisms, such as Staphylococcus

94
Q

Infections developing in the first 7 to 10 days have good response to

A

First-generation cephalosporins

95
Q

Infections occurring after the first 10 days are more likely caused by

A

Gram-negative rods

96
Q

Patients with infections occurring after the first 10 days benefit from

A

Wound culture

Empiric coverage with ciprofloxacin

97
Q

Risk factors for developing chronic pruritus

A 
Female gender
Young age
Skin grafting
Raised or thick scars
Dry skin
98
Q

Evidence of treatment of burn pruritus is limited to 3 categories

A

Topicals
Antihistamines
Neuropathic agents

99
Q

Y/N: Cetirizine, a selective H1-blocker, is more effective than general antihistamines such as diphenhydramine

A

Yes

100
Q

Risk factors that contribute to the development of hypertrophic scarring

A

Localization of the burn injury
Burn depth
Time to heal
Skin color

101
Q

Steps that can optimize a burn scar:

Wound closure of a burn that is likely not to heal on its own in

A

3 weeks

102
Q

Steps that can optimize a burn scar:

Avoidance of sun contact of the scar during the first

A

6 months

103
Q

Steps that can optimize a burn scar:

Compression garments for those who can tolerate treatment for up to

A

1 year

104
Q

Steps that can optimize a burn scar:

Keeping the scar

A

Moist

105
Q

The most important step in rejuvenating the scar

A

Release of tension

106
Q

Traditional treatment for hypertrophic scarring

A

Surgical manipulation to remove the excess skin

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