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Surgery > Burn > Flashcards

Burn Flashcards

1
Q

Depth of injury is proportional to

A

Temperature applied
Duration of contact
Thickness of skin

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2
Q

Type of burn wounds

A

Scald
Flame burns
Flash burns
Contact burns

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3
Q

Most common cause of burn from a hot water

A

Scald

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4
Q

Scald temperature

A

> 140 f
60 c in 3 secs

> 156 f
69 c in 1 secs

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5
Q

Thin skin in children and elderly

A

Deeper burns

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6
Q

2nd most common mechanism of thermal injury

A

Flame burns

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7
Q

Flame burns usually victims of

A

House fires associated with respiratory injury

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8
Q

Due to explosion of natural gas and electrical arch

A

Flash burns

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9
Q

Flash burns depth depends on the

A

Amount and kind of fuel that explodes

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10
Q

Flash burns often full thickness that require

A

Grafting

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11
Q

Contact with hot metals, plastic, glass or hot coals

A

Contact burns

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12
Q

Severity of burn is related to

A 
Burn size (>20%)
Burn depth (deep partial thickness to stage 4)
Part of the body burned (face, hands and perineum)
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13
Q

Epidermis thickest

Epidermis thinness

A

0.5 cm on palm and sole
1mm back

Eyelid and genitalia

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14
Q

Adult and children same thickness, but ______________ thickness in each specific area may be less than one half that of adult skin

A

Infant skin

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15
Q

All areas of skin become thin in elderly patients, and the skin appendages are far less active.

A

50 years of age, dermal atrophy

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16
Q

When dead dermal tissue is removed, epithelial cells swarm from the surface if each appendages to meet swarming cells from neighboring appendages forming

A

New fragile epidermis

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17
Q

The less dermis remains

A

The longer the burns takes to heal
The greater the inflammatory response
The more severe the scarring

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18
Q

Burns that heal within 3 weeks usually do so

A

Without hypertrophic scarring
No functional impairment
With long term pigmentary changes are common

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19
Q

Shallow burns

Epidermal burn

A 
1st degree 
No blister
Erythema due to dermal vasodilation 
Quite painful
4th day injured epithelium desquamate (peeling)
Sunburn
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20
Q

Shallow burns

Superficial partial thickness

A

2nd degree
Includes upper layer of dermis
Blisters(between epi and dermi)
Heals spontaneously 3 weeks without functional impairment

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21
Q

If blisters are removed in superficial partial thickness

A

Wound is pink, wet, painful and blanch with pressure

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22
Q

Deep burns

Deep partial thickness (second degree)

A

Extend to reticular layer
With blisters but wound surface mottled pink and white color
Discomfort rather than pain

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23
Q

Deep burns

Deep partial thickness (second degree) 2

A

Pressure applied capillary refill is slow or absent
If not excised and grafted heals in 3 to 9 weeks with scarring
Ji paired joint function

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24
Q

Deep burns

Full thickness (3rd degree burn)

A

All layers
White, cherry red or black
May or may not have blisters
Insensate

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25
Q

Deep burns

Full thickness (third degree) 2

A

Burn eschar
Intact dead and denatured dermis that separate after days or weeks
Heal only by wound contracture and skin grafting

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26
Q

Deep burn

Fourth degree

A 
Subcutaneous fat and deeper structures
Charred appearance
Electrical burns
Contact burns
Immersion burns
Unconscious at time of burn.
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27
Q

Those that will heal within 3 weeks

A

Better treated by non operative wound care

Shallow burn

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28
Q

State of the art burn care involves early excision and grafting of all burns

A

That will not heal within 3 weeks

Deep burns

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29
Q

Ability to detect dead cells or denatured collagen

A

Biopsy
Ultrasound
Vital dyes

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30
Q

Assessment of changes in blood flow

A

Flurometry
Laser Doppler
Thermography

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31
Q

Analysis of the color of the wound

A

Light reflectance methods

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32
Q

Evaluation physical changes, such as edema

A

MRI

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33
Q

Alterations of the metabolic, cardiovascular, gastrointestinal and coagulation systems resulting to

A

Hypermetabolism
Increase cellular, endothelial and epithelial permeability
Often extensive micro thrombosis

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34
Q

Complex process of circulatory and micro circulatory dysfunction that is not elastic or fully repaired by fluid resuscitation

A

Burn shock

35
Q

Tissue trauma and hypovolemic shock releases local and systemic mediators

A

Increase vascular permeability and microvascular lead to
Hydrostatic pressure lead to
Burn edema

36
Q

Increase permeability

A

Histamine

37
Q

Platelet aggregation increase vascular resistance

A

Serotonin

38
Q

Increase hydrostatic pressure and blood flow

Edema

A

Eicosanoids (arachidonic and prostacyclin)

39
Q

Increase permeability

A

Kinins (bradykinin)

40
Q

Increase vascular pressure

A

Vasoactive amines

41
Q

Burn shock is both

A

Hypovolemic

Cellular etiology

42
Q

Hemodynamic changes in burn shock includes

A

Increased extracellular fluid
Decreased plasma volume
Decreased cardiac output
Oliguria

43
Q

Pathophysiology of burn shock

The primary goal

A

Restore and preserve tissue

End organ perfusion

44
Q

Pathophysiology of burn shock

Maximal edema formations occurs between

A

8-12 hours in small burns

12-24 hours in major burns

45
Q

Pathophysiology of burn shock

Changes in cellular level

A

> 30% burns

46
Q

Pathophysiology of burn shock

Systemic decrease in cell transmembrane potential

A

Decrease in sodium potassium ATPase activity

Defective adenosine triphosphate metabolism in burn

47
Q

Metabolic response to burn injury

A

Hyper-metabolism

Neuroendocrine response

48
Q

Hyper metabolism

A

Increase catabolism of CHO, Lipids and CHON

2g of protein per kg per day

49
Q

Computation of basal energy expenditure

A

For men

66.47+ 13.75(W) + 5.0(H) - 6.76(A) kcal/day

For women

66.51+ 9.56(W) + 1.85(H) - 4.68 (A) kcal/day

50
Q

Neuroendocrine response

Massively elevated and the major endocrine mediator of hyper metabolism in burn

A

Catecholamines

51
Q

Neuroendocrine response

Giving _______ diminish REE and O2 consumption

A

Propranolol

52
Q

Emergency care at the scene

A

Kept flat and warm wrapped in clean sheet
NPO
Lactated ringers 1L/hr
Applying ice is not advisable

53
Q

Emergency room burn wound not the 1st concern but

A

Airway and breathing

54
Q

Airway and breathing

Signs of potentially serious airway edema or inhalation injury

A

Stridor
Hoarseness
Expiratory wheezes

55
Q

Airway and breathing

A

Inspect mouth and pharynx
Copious mucus production
Carbonaceous sputum
Carb oxyhemoglobin levels

56
Q

Emergency room

Airway

A

Exposed to smoke (CO poisoning)
100% O2 inhalation
If unconscious or respiratory distress - intubate

57
Q

One of the earliest indicators of smoke inhalation

A

Decreased P:F ratio

58
Q

Normal P:F ratio

A

400-500

59
Q

Impending pulmonary problem

A
60
Q

Indication for endo tracheal intubation

A
61
Q

Can accurately assess edema of upper airway

A

Fiberoptic bronchoscopy

62
Q

Circulation
Fluid resuscitation

Burn shock and myocardial injury

LR solution

A

1000ml/hr adults

20ml/kg/hr children

63
Q

Circulation
Fluid resuscitation

Foley catheter placed and urine output monitored hourly the goal

A

30 ml/hr in adults

1.0 ml/kg/hr in children

64
Q

Once the extent of the burn is ascertained, resuscitation should be tailored to the injury using the

A

Parkland formula

65
Q

Consequences of low cardiac output

A

Depress CNS
Heart failure
Acute renal failure
Ischemia of GIT

66
Q

Put 2 large bore IVF, better use upper extremities even if with. Urn than the lower ext. because?

A

For high septic thrombophlebitis

67
Q

Central venous pressure placed

A

Burn is greater than 50%
Have medical problems
Extreme age
Contaminant inhalation injuries

68
Q

Fluid resuscitation after 24 hours

Total maintenance fluid

A

1500ml/m2 + evaporate water loss

69
Q

Fluid resuscitation after 24 hours

Patient will require approximately ________ their normal maintenance fluid following successful resuscitation from a major thermal injury

A

1.5 times

70
Q

Fluid resuscitation after 24 hours

Because of loss of intracellular potassium during burn shock, the potassium requirement in adults with normal renal function is

A

120mEq/d

71
Q

Care of burn wounds

Bed side, observe sterility, (-) local anesthesia, IV opiates, done up to subcutaneous layer

A

Escharotomy

72
Q

Care of burn wounds

Cutting through deep fascia

A

Fasciotomy

73
Q

Fascitotomy

Compartment syndrome can be developed up to

A

72 hours following injuri

74
Q

Fasciotomy location

A

Anterior axillary line and transverse incision along costal margin

75
Q

Fasciotomy done if

A 
Cyanosis
Deep tissue pain
Progressive paresthesia
Progressive decrease or absence of pulse
Cold extremeties
76
Q

To asses arterial flow

A

Doppler

77
Q

Tetanus prophylaxis

Previous immunization within 5 years requires

A

No treatment

78
Q

Tetanus prophylaxis

Immunization within 10 years requires

A

Tetanus toxoid booster

79
Q

Tetanus prophylaxis

Unknown immunization status requires

A

Hyper immune serum

80
Q

Tetanus prophylaxis

If patient had DPT

A

Give passive

81
Q

Many burn centers begin enteral feeding on admission to reduce the risk of

A

Gastric ulceration (curlings ulcer)
Prevent ileus
Blunt catabolism

82
Q

If patient transport is via air ambulance or is going to take more than few hours, the safest course is usually to decompress the stomach with a

A

Nasogastric tube

83
Q

Pain control is best managed with small ______ until analgesia is adequate without inducing hypotension

A

Opiate

84
Q

Cutaneous burns caused by application of

A

Heat
Cold
Caustic chemical
Electricity

Surgery (7 decks)

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