Burns Flashcards
Describe the 4 degrees of burn wounds
1st degree: To epidermis (sunburn)
2nd degree: To dermis: Superficial-papillary (blebs/blister-painful) & Deep-reticular (loss of hair follicles-loss of sensation)
3rd degree: To subcutaneous (leathery)
4th degree: Down to bone, adipose or muscle
How do 1st degree and 2nd degree (superficial) heal?
Epithelialization: primary site of epithelial cells are in the hair follicles. Loss of hair follicles such as in 2nd degree deep to 4th degree require skin graft
Describe initial volume resuscitation
Parkland Formula: 4cc/kg x% burn over 24 hours.
Give 1/2 in first 8 hrs, other 1/2 in the next 16hrs.
Use LR 1st 24hrs, then D5 1/2NS
When does Parkland formula resuscitation apply?
Only for greater or equal to 2nd degree that are greater than equal to 20% BSA
What risk increases with albumin resuscitation in severe burns?
PNA
Indication for escharotomy
- Circumferential deep burns with decreased temp, pulse, capillary refill, pain sensation.
- Trouble ventilating pt’s w/significant torso burns
When to initiate escharotomy?
within 4-6 hours to prevent myonecrosis
What are the types of escharotomy?
- Medial and lateral sides of limbs
- Dorsum of hands
- Fingers (avoid lateral incicisions due to nerves)
- Chest lateral, sub-clavicular and above costal margin
What electrolyte imbalance is due to Burns
HyperK released from dead tissue
What is the treatment for myoglobinuria?
volume resuscitation ad HCO3 to alkalinize urine
What specific initial blood test should be ordered when a burn patient is admitted?
carboxyhemoglobin
How to dress burns?
Silvadene, telfa and loosely wrapped gauze
How to dress burns over cartilaginous area?
Sulfamylon (mafenide) anti-microbial
When to excise burned area
within 48-72 hrs
How to excise burned areas for deep 2nd degree and 3rd degree
Use dermatome patterns
What determines residual skin viability?
color, texture, punctate bleeding
What is the best method of suspected burn wound infection?
Biopsy
When is auto-graft indicated?
if Cx pos for beta-hemolytic strep or bacteria greater than 10 to the 5th
What are the types of skin graft?
Auto-graft and Homograft
Types of auto graft
STSG and FTSG
What layers does STSG include?
epidermis and part of dermis
Advantages of STSG
- Better Survival: easier imbibition and re-vascularization
2. Can re-use donor site
Advantages of FTSG
- Less wound contraction
- Better skin color match: good for face, palms back of hands, genitals
(Not good for large areas, Not as many donor sites)
Donor sites for FTSG
- Behind the ear
- Above Clavicle
- Above groin
How to manage STSG donor site?
- Hemostasis w/epi soaked gauze
2. Op-site
How does STSG donor site heal
Epithelial appendages (epithelium migrates from hair follicles)
What is most common cause of skin graft failure
Seroma or hematoma
Skin needs to be compressed with xeroform and cotton balls
What parameters need to be followed for each burn wound excision session
- Less than 1L blood loss
- Less than 20% skin excised
- Less than 2 hours in the OR
Contraindication of homografts
Pregnant women: reported fetal deaths with HLA mismatch
Physiology of graft survival
- Imbibition: 0-3 days (osmotic nutrient and O2)
2. Neovascularization: 3+ days
Areas with high risk of skin graft failure
tendons, tendons, bone w/o periosteum, radiated skin
Reasons to delay auto-grafting
- Infection
- Not enough skin donor site
- septic or hemodynamically unstable
- wounds to face, palms, soles and genitals - deferred 1st week
Best source of calories for burn patients
Glucose
What is the caloric need of a burn patient?
25 kcal/kg/day + (30 kcal/day x %burn)
Don’t exceed 3000 kcal/day
What is the protein need of a burn patient?
1 g/kg/day + (3g/d x %burn)
What burn areas are treated at the 2nd week of management?
Hands, Feet, Face, Genital Areas
