Burn/Wound/PRS Flashcards
Most commonly used burn drug?
Silver sulfadiazine
Which burn drug causes transient leukopenia?
Silver sulfadiazine
Burn drug that’s an anhydrase inhibitor. Side effect?
Mafenide acetate
Side effect metabolic acidosis
Which burn drug cause hyponatremia?
Silver nitrate
Which burn drug causes methemoglobinemia?
Silver nitrate
treatment for methhemoglobinemia: methylene blue
treatment for cyanide toxicity: sodium nitrite, sodium thiosulfate
Which stage of frostbite has numbness and edema?
Superficial stage. Stage I
Which stage of frostbite has milky white blisters?
Hemorrhagic blisters?
What do you do about these blisters?
Stage 2. Partial thickness. Drain the milky white blusters
Hemorrhagic blisters: stage 3. You leave these alone
Car mechanic found down under a car, no evidence of trauma. Treatment?
Hyperbaric oxygen chamber. Carbon monoxide poisoning.
Hypothermia is body temp under what?
How is hypothermia classified?
35C, 95F
Mild hypo: 90-94F (32-34) - shiver, mental status, tachy
Moderate hypo: 84-89F (29-32) - agitated, combative, slowed respirations
Severe: 70-84 (<29) - prolonged qt, Osborn waves
CPR and active rewarming in hypothermic asystole pt should be continued until what?
Until T is 90F and K > 12 mmol/L
Meshed split thickness vs. full thickness skin graft
Which one has better cosmetic results?
What does meshing do?
Which one gets worse pigmentation?
Which one has higher rate of engraftment?
Full thickness has better cosmetic results
Meshing reduceds seroma/hematoma formation. doesn’t improve imbibition
Split thickness gets worse pigmentation
Split thickness higher rate of engraftment because they have less dermis and require lower metabolism
Which burn drug can cause methemoglobinemia?
Silver nitrate
What’s primary contraction vs. secondary contraction?
Split thickness graft has more or less primary/secondary contraction?
Primary contraction: how much it contracts after harvesting and before grafting
Secondary contraction: how much it contracts after grafting
Split thickness - less primary contraction, more secondary contraction
Full thickness - more primary contraction, less secondary contraction
Predominant cells in 24-48hr after surgery
Neutrophils
What timeframe do macrophages show up in the wound after surgery?
48-96hr after surgery
When do lymphocytes show up to wound after surgery?
3 day Mark
When do fibroblasts show up at the wound after surgery?
Within 24hrs then predominate @ ~10 days
Wound healing. When is there maximum amount of collagen accumulation?
On what day do the fibroblasts dominate?
21 days
Fibroblasts dominate at 10 days. Collagen is maxed at 21 days
Mafenide acetate is used for what degree burns? Why?
Full thickness
Excellent eschar penetration
Which topical hurts when you apply?
Mafenide acetate
AKA
Sulfamylon
What is the other name for silver sulfadiazine?
what is its side effect?
Silvadene
leukopenia
Most commonly used burn drug for partial thickness burn?
Silver sulfadiazine/silvadene
Singed hair has high or low sensitivity to predict inhalation injury?
Airway damage from inhalation damage is primarily from the heat?
Singed hair is not that sensitive
No the heat of inhalation injury mostly dissipates in the upper airway. Damage is mostly from INHALED TOXINS
For burn pts, urinary output of how much is appropriate for adults and children?
Adults: 0.5 - 1 cc/kg
Children: 1 - 1.5 cc/kg
What is primary and secondary contraction and which one is more pertinent to split thickness vs full thickness skin grafts?
Primary contraction: how much the graft contracts after harvesting
Secondary contraction: how much the graft contracts after grafting over time
Split thickness: less primary contraction, more secondary contraction
Full thickness: more primary contraction, less secondary contraction
Which type of skin graft is better for flexor surface of the elbow?
Full thickness
Burn drug that causes hyponatremia?
Silver nitrate
Which burn drug causes transient neutropenia?
Silvadene. Or silver sulfadiazine
Cell type in a healing wound:
- first to show up
- predominant type in the first 24-48hrs
- predominant type in the first 48-96 hrs
- predominate around 10d mark
- when do fibroblasts and lymphocytes show up?
- first to show up: platelet
- predominant type in the first 24-48hrs: neutrophils
- predominant type in the first 48-96 hrs: macrophages
- predominate around 10d mark: fibroblasts
- when do fibroblasts first show up? Within the first 24 hrs
- arrive around 3 day mark: lymphocytes
Which interleukin is secreted by macrophages?
IL-1
Interleukin 2 is secreted by what cells?
T Lymphocytes
Treatment for hydrofluoric acid burn includes copious washing and what?
Calcium gluconate cream. If systemic toxicity: IV calcium gluconate
Hydrofluoric acid binds calcium
Collagen synthesis in wound begins in what day?
Collagen accumulates to the max on what day of wound healing?
when to fibroblasts come? when are the predominant?
When does type III collagen start converting to type I?
Begins within 10 hrs of injury
Accumulates to the max at 21 days
fibroblasts show up at 24 hrs. predominate at 10 days
Day 7
What cell type secretes tumor necrosis factor?
Macrophages
Interferons are released by what cells?
What do they do?
By lymphocytes.
They promote production of new cellular RNA and proteins. To activate immune reponse
Burn drug for MRSA infection
Mupirocin
Most common electrolyte abnormality in burn patients
Hyperkalemia because of tissue necrosis and loss of intracellular potassium
Which burn drug is associated with methemoglobinemia?
Silver nitrate
What stimulates the fibroblasts in a healing wound?
Macrophages
What is the greatest risk factor to developing keloids or hypertrophic scars?
extends beyond scar boundary
does not extend beyond boundary
Genetics
extends beyond scar boundary: keloid
does not extend beyond boundary: hypertrophic scar (triamcinolone injection)
What is marjolin’s ulcer?
Treatment?
More aggressive or less aggressive compared to UV skin cancers?
Radiation?
Cancer that develops from chronic non healing wound
Treatment: WLE with 5-20mm margin
More aggressive than basal or sq
Chemo/radiation usually not effective. Only radiation if pt refuses other treatment
