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Clin Specialties - Surgery > Burn and Wound Care > Flashcards

Burn and Wound Care Flashcards

1
Q

Wounds heal in a ____environment

A

warm, moist

warm allows for more vascularization - dilation

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2
Q

Why is smoking a risk factor for poor wound healing?

A

smoking decreases the capillaries that lead to wounds

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3
Q

What is the first stage of wound healing?

A

hemostasis (immediate)

constriction of blood vessels after injury
platelet aggregation, clotting cascade, fibrin matrix

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4
Q

What is the second stage of wound healing?

A

inflammation (0-4d)

capillary dilation allows inflammatory cells to reach wound, release histamine, and PGs

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5
Q

What is the 3rd stage of wound healing?

A

epithelialization (5-21d)

migration of basal cell proliferation, angiogenesis, collagen deposition, laid down by fibroblasts

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6
Q

What is the 4th stage of wound healing?

A

fibroplasia

fibroblast proliferation and collagen production stimulating angiogenesis

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7
Q

What is the last stage of wound healing?

A

Maturation (22-60 days)

collagen crosslinking
wound contraction
repigmentation

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8
Q

Epitheliaization budding

A

each bud of the epidermis is arising from a single hair follicle

these buds will coalesce with layer of healed tissue

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9
Q

Primary wound healing

A

primary closure, or healing by primary intention

closing a wound immediately

ex. laceration stitch closure, laparotomy incision closure, closure of C-section

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10
Q

Delayed Primary Wound Healing

A

irrigate contaminated wounds, pack, and close later

edges are closed at a LATER time

ex. dog bite wound that require surgical washing out, debridement, then later closed

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11
Q

Secondary wound healing

A

wound heals slowly on own or eventually with surgical adjunct

heals by contracting from edges to close
may involve formation of granulation tissues
scarring and wound contracture common

ex. assisted closure with wound vac
small contracted healed in wounds

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12
Q

hypertrophic scar vs keloid scars

A

hypertrophic can be raised and discolored and ugly but it remains within the border of the wound

keloids extend beyond the wound borders

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13
Q

What can you do for hypertrophic scars to try and improve them?

A

compression garments
steroid injections
silicone gel sheeting

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14
Q

What ABX would you use for MRSA infected wounds?

A 
vanco 
linezolid
Bactrim 
clinda 
mupirocin
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15
Q

What ABX would you use for pseudomonas aeruginosa?

A 
Zosyn (piperacillin-tazo) 
ceftrazidime
gentamycin
cipro
tobramycin
levofloxacin
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16
Q

Goal of wound vac? When can you use it?

A

can only be used if the wound is NOT infected

goal is the constant suction is trying to promote revascularization

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17
Q

What dressing options do you have for infected open wounds?

A

wet - to-dry
Dakin’s solution (diluted bleach)
ABX impregnated solutions

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18
Q

Stage 1 pressure ulcer

A

no blistering
non blanchable erythema
intact dermis

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19
Q

Stage 2 pressure ulcer

A

partial thickness

entered the dermis –blister

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20
Q

Stage 3 pressure ulcer

A

full thickness skin loss

subq fat or slough may be present withOUT bone or tendon exposure

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21
Q

Stage 4 pressure ulcer

A

full thickness TISSUE loss WITH tendon or bone exposure, often includes tunneling or undermining

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22
Q

What makes a ulcer “unstageable”?

A

if you can’t see the base of the ulcer but maybe you have a dry, black eschar covering it

leave the eschar in place (biological bandaid)

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23
Q

What is the biggest complication of burns?

A

PNA because you are probably intubated

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24
Q

If you are confused between 2nd and 3rd degree burn, what can you do?

A

if you push on it and it doesn’t blanch or hurt then it is NOT 2nd degree

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25
Q

Do we put burn pts on prophylactic IV ABX?

A

NO

because they might not even get infected but if they do you need your ABXs to be effective

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26
Q

4th degree burn

A

tendon
muscle
bone
commonly needs amputation

27
Q

When do you start massive fluid resuscitation for a burn pt?

A

if their TBSA >20%

parkland formula

using LR

28
Q

Rule of 9s

A

only for 2nd and 3rd degree burns because these ones cause fluid shifts

entire 1 leg (posterior and anterior) 18 
entire 1 arm (posterior and anterior) 9 
anterior chest 18 
entire head (front and back) 9 
groin 1
29
Q

Parkland formula

A

4cc x TBSA burn x wt (kg) = total fluid amount

replace 1/2 of that in the first 8 hours
replace second 1/2 over the next 16 hours
(watch the pt response and adjust accordingly)

30
Q

What is the urine output for a resuscitation pt?

A

0.5cc/kg/hr (1 cc/kg/hr for kids and electrical injuries)

FOLEY

31
Q

If you suspect a pt has an inhalation injury, when do you intubate?

A 
decrease LOC
stridor, retraction, respiratory distress
progressive hoarseness
frothy sputum 
high CO
clue: enclosed space injury
32
Q

How do you treat CO poisoning?

A

100% oxygen

get ABG

33
Q

How do you treat cyanide poisoning?

A

100% oxygen

antidote (Cyanokit-hyperoxycobalamin IV)

34
Q

3rd spacing

A

NOT DONE HERE

35
Q

Compartment Syndrome

A 
Pain 
Pallor
Pulselessness (last sign to go) 
Paresthesias
Paralysis 
Poikliothermia
36
Q

What is the most common infection of burns?

A

pseudomonas

37
Q

What fluids are ped burns getting?

A

D5W in addition to the Parkland formula (LR)

38
Q

For kids with leg burns from a bathtub what secondary injury are you looking for?

A

tib fib fx

forcefully pushing the kid into the hot water

39
Q

Granulation tissue

A

angiogenesis

40
Q

How do you treat an SSI with suspected MSSA?

A

kelfex, augmentin, nafcillin

PCN allergy? clindmycin

41
Q

How do you treat an SSI with suspected MSSA for a pt with PCN allergy?

A

clindmycin

42
Q

How do you treat an SSI with suspected MRSA?

A

Vancomycin, linezolid, Bactrim, clindamycin, mupirocin

43
Q

How do you treat an SSI with suspected strep?

A

Cerftriaxone, nafcillin

PCN allergy? erythromcyin

44
Q

How do you treat an SSI with suspected strep with a PCN allergy?

A

erythromcyin

45
Q

How do you treat an SSI with suspected pseudomonas?

A

Zosyn (pip/tazo), gentamycin, ciprofloxacin, ceftazidime

46
Q

What are surgical methods of debridement?

A

curettes
scissors
Versajet

47
Q

Negative Pressure Wound therapy

A

Wound vac with porous foam and occlusive film

keeps environment moist while aiding in revascularization via suctioning

NOT FOR INFECTED WOUNDS

48
Q

Which layer of skin is responsible for thermoregulation?

A

Dermis

49
Q

Which layer of skin is responsible for neurosensory?

A

epidermis

50
Q

With which type of burn are you more likely to see Nikolsky’s sign?

A

second degree

51
Q

How long does it take for a second degree burn to heal?

A

4 weeks +/-

52
Q

When are you calculating the TBSA for a burn pt?

A

Immediately after you do ABCs

because you need to know if you are going to do massive fluid resuscitation

53
Q

What do you worry about most when transferring a burn pt to a burn center?

A

Keeping the pt WARM

54
Q

Is pulse ox appropriate to measure CO?

A

NO
you could have a normal O2 sat and still have tissue hypoxia

get ABG

55
Q

Which nueromuscular agent will you use to intubate a burn pt?

A

succinylcholine

56
Q

What are the typical causes of inhalation injury ABOVE the glottis?

A

thermal or chemical

57
Q

What are the typical causes of inhalation injury BELOW the glottis?

A

chemical
steam
smoke
(like from household stuff burning)

58
Q

A pt comes in with lethargy, HA, and confusion that started “all of the sudden”, what kind of poisoning should you be suspicious of?

A

Cyanide at low levels

at high levels this pt is probably already dead (death within 15 min)

59
Q

Escharotomy

A

trying to release the pressure of possible compartment syndrome by cutting into the fascia and leaving it open

60
Q

What should you do if abdominal pressures are greater than 30mmHg?

A

decompressive laparotomy for abdominal compartment syndrome to relieve pressure and prevent bowel ischemia
but if intestines fall out the risk of death is SUPER DUPER HIGH

61
Q

What is the goal calorie and protein needs for a burn pt?

A

30 cal/kg

1.5/kg protein

62
Q

Why do we give burn peds pts D5W in addition to LR?

A

They dont have as much glycogen reserve d/t immature liver

63
Q

What is the urine output goal for burn pts pts?

A

1cc/kg/hr

64
Q

What pts get transferred to burn centers?

A

partial thickness burns >10% TBSA if it involves sensitive areas of the body like face or groin

3rd degree burn in any age group

inhalation injury

children

chemical/electrical burns

Clin Specialties - Surgery (11 decks)

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