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Surgery > Burn Management > Flashcards

Burn Management Flashcards

1
Q

Burns can cause?

A

Coagulative Necrosis

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2
Q

If a burn is chemical or electrical in origin, what can it do to the body in addition to “heat transfer?”

A

Direct Injury to cell membranes

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3
Q

What can cause a burn?

A
  1. Flame
  2. Scald
  3. Contact
  4. Chemical
  5. Electricity
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4
Q

What factors are taken into account for the depth of a burn?

A
  1. Temperature
  2. Time exposed
  3. Specific Heat of the substance.
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5
Q

When you are burned, what is released?

A

Inflammatory Mediators

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6
Q

With a burn, there is an increased capillary permeability. What is the consequence of this?

A
  • Lead proteins into interstitium

- Get edema into burned and non-burned skin

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7
Q

T/F: There are large fluid loss due to fluid shifts in the body and also losses from exposed burned skin.

A

True

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8
Q

Characteristics of Burn

A
  1. Low metabolism/Cardiac Output
  2. Decreased Temp
    Then!!!
  3. Hypermetabolism
  4. High Cardiac Output
  5. Hyperglycemia
  6. Increased Heat Production
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9
Q

This occurs when too much fluid moves from the intravascular space (blood vessels) into the interstitial.

A

Third Spacing

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10
Q

This is a type of burn that is localized to the epidermis (sunburn).

A

1st Degree Burn

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11
Q

This is a type of burn that is injury to both the dermis and epidermis

A

2nd Degree Burn

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12
Q

This type of burn is typically red, painful, blister, “wet” appearing. Regeneration usually occurs in 7-14 days from the hair follicles/sweat glands.

A

Superficial 2nd degree burn (Papillary Dermis)

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13
Q

This type of burn is typically more pale/mottled, dry and decreased sensation.

A

Deep 2nd degree burn (Reticular Dermis)

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14
Q

This is a type of burn that full covers the epidermis and dermis. It is commonly hard and leathery eschar. This is PAINLESS! (Goes into SQ fat)

A

Third Degree Burn

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15
Q

This type of burn involves muscle, bone, etc.

A

Fourth Degree Burn

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16
Q

When should you go to a burn center?

A
  1. Partial Thickness >10% if less than 10 yo, or greater than 50 yo
  2. Partial Thickness >20%
  3. Face, Hands, Feet, Genital/Perineum, Joints
  4. Full thickness >5%
  5. Electrical Injury
  6. Chemical Burn
  7. Inhalation Injury
  8. Comorbidities like CHF
  9. Concomitant Trauma
  10. Children
  11. Special, emotional, social, or rehab needs
17
Q

What do you do when someone comes in with a burn? (ABCDE)

A
  1. Airway – give O2, put on pulse ox, pre-emptively intubate as needed
  2. Breathing - sounds and chest rise
  3. Circulation
  4. Disability - GCS < 8 = Intubate
  5. Exposure - remove clothing
18
Q

Airway complications with housefires

A
  1. Direct injury from heated air/smoke –> Edema
  2. Edema from inflammatory response to burns
  3. Edema from the resuscitation fluids
19
Q

What does progressive hoarseness indicate?

A

Impending Airway Obstruction

20
Q

When do you pre-emptively intubate anyone?

A
  • Respiratory Distress
  • Inhalation Injury (Bronch helps dx this)
  • Large burns (due to edema)
21
Q

Things to do with circulation in a burn victim:

A
  1. 2 large bore IV
  2. Start burn resuscitation with Lactated Ringers
  3. PLace patient on continuous EKG/monitor
  4. Palpate or doppler extremity signals with circumferential Burns
22
Q

Initial Assessment of Burn victims after the ABCDE! (AMPLE)

A

A-Allergies
M-Medications (also ask about last tetanus)
P-PMH (CHF = careful with fluids)
L-Last meal
E-Events regarding the injury (how did it start, how long where you exposed, what type?)

23
Q

When figuring out the burn size, what is a good rule of thumb?

A

The size of the palm of the hand is roughly 1% or the Rule of 9s (will see the Rule of 9s later)

24
Q

What is the Parkland Formula?

A

4 x weight(kg) x %TBSA = ml to give in 1 day

– Titrate to UOP of 0.5 mL/kg/hr in adults and 1 mL/kg/hr in children

DO NOT GIVE COLLOID IN FIRST 24 HOURS

25
Q

What is the rule of 9s?

A
  • Head and Neck = 9%
  • Upper extremity (Arms) = 9%
  • Each lower extremity (Legs) = 18%
  • Anterior Trunk = 18%
  • Posterior Trunk = 18%
  • Genitalia (perineum) = 1%
26
Q

Burn Wound Management

A
  • Circumferential deep 2nd or 3rd degree extremity burn can compromise circulation
  • Assess for the 6 P’s = Pain, Pallor, Pulselessness, Paresthesias, Paralysis, Poikilothermia
  • Directly Measure tissue pressure (30 mmHg is cutoff)
27
Q

How do you treat burn wounds?

A

Escharotomy (is a surgical procedure used to treat full thickness (third-degree) circumferential burns. Since full thickness burns are characterized by tough, leathery eschar, an escharotomy is used primarily to combat compartment syndrome)

28
Q

Why are burn patients susceptible to infection?

A
  • Due to immunologic insult of large burns

- Dead tissue is easily colonized

29
Q

Treatment for Superficial 2nd degree?

A

Temporary pig skin

30
Q

Treatment for 3rd and most deep 2nd degree burns?

A

Early excision and grafting, except palm/soles/face/genitals.

31
Q

What are topical antimicrobials for burns?

A
  1. Sulfamylon for ears (SE: metabolic acidosis via carbonic anhydrase inhibition)
  2. Bacitracin for face (Few SE)
  3. Silvadene for trunk, neck, extremities (SE: neutropenia, thrombocytopenia)
32
Q

Tell me about electrical burns

A
  1. Most significant injury is within deep tissue
  2. Edema can compromise circulation
  3. Be ready to perform eschar-/fasciotomies
  4. Explore & debride necrotic tissue
  5. May have to re-explore questionable areas
  6. EKG if heart was in conduction path
  7. Follow serial CPK & urine myoglobin due to possibility of rhabdomyolysis
33
Q

Tell me about Chemical Burns

A
  1. Speed is essential
  2. ABCDE – remove all clothing
  3. Irrigate with 15-20L of water (Brush off any dry powder before irrigation)
  4. Alkalis generally cause worse damage
  5. Do not attempt to counteract acid burns using alkali or alkali burns using acid
34
Q

Why is nutrition important in burn surgery victims?

A

Patients with major thermal injury develop a hypermetabolic state characterized by increased basal metabolic rate, increased oxygen consumption, negative nitrogen balance, and weight loss. Subsequently, these patients have increased caloric requirementsto prevent delayed wound healing, decreased immune competence, and cellular dysfunction.

35
Q

In a burn patient, what is the goal of OR treatment?

A

Debridement of devitalized tissue

36
Q

What is a skin graft involving cadaver skin?

A

Allograft

37
Q

How does an allograft help?

A

It VASCULARIZES and engrafts and provides physiologic wound closure for 2 to 4 weeks, at which point it typically is rejected and must be replaced with either new allograft or preferably autograft from reharvested donor sites.

38
Q

What is a skin graft involving pig skin?

A

Xenograft

39
Q

How does a xenograft work?

A

Porcine xenograft can also be used as a cheaper alternative, but it will NOT vascularize and will not engraft. When widely meshed skin grafts are necessary, overlayed sheets of allograft can be used on top of the autografts to protect the wound bed as the meshed interstices epithelialize.

Surgery (12 decks)

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