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SURGERY > Burns > Flashcards

Burns Flashcards

1
Q

1st deg - Superficial burns

> Skin involvement
Color
Pain/No Pain
Scar/No Scar
Blister/No Blister
Duration of healing

A

> Epidermis
Red
Painful
No scar
No blister
Heals in 7-10 days by desquamation

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2
Q

2nd deg - Superficial Partial Thickness burns

> Skin involvement
Color
Pain/No Pain
Scar/No Scar
Blister/No Blister
Duration of healing
Surgery/No Surgery

A

> Full Epidermis and superficial dermis
Pink
Painful
Scars
Blisters
Heals in 10-14 days by re-epithelialization with minimal to no scarring.
Does NOT require surgery

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3
Q

2nd deg - Deep Partial Thickness burns

> Skin involvement
Color
Pain/No Pain
Scar/No Scar
Blister/No Blister
Duration of healing
Surgery/No Surgery

A

> Full Epidermis and Deep (reticular) Dermis
Mottled white to cherry red
No Pain
Scars
Blisters
Heals in 21-35 days (retarded re-epithelialization) with scarring and possible contractures
Requires surgery: Surgical excision and grafting

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4
Q

3rd deg - Full Thickness burns

> Skin involvement
Color
Pain/No Pain
Scar/No Scar
Duration of healing
Surgery/No Surgery

A

> Full Epidermis and Full Dermis Necrosis
White, Dry, sometimes Brown and Leathery
with Thrombosed blood vessels
No Pain
Scars
Healing by granulation and Secondary intention with substantial scar and contracture
Requires surgery: Surgical excision and grafting
High risk of infection

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5
Q

4th Degree burns

> Skin involvement
Management

A

Penetrates subdermal fat, even muscle and bones.

Require multiple surgeries for debridement and reconstruction

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6
Q

TBSA (Total Burn Surface Area) only takes into account which types of Burns

A

2nd degree (Partial thickness) and 3rd degree (Full thickness) burns

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7
Q

A Patient sustained deep partial thickness burns on the entire bilateral thighs, posterior lower torso, and right anterior arm. What is his %TBSA?

A

31.5%

R Entire thigh - 9
L Entire thigh - 9
Post lower back - 9
R anterior arm - 4.5

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8
Q

A Patient sustained multiple full thickness burns covering the back of his head, his groin, the entire L arm and his posterior lower L leg. What is his %TBSA?

A

19%

Post head - 4.5
Groin - 1
Entire L arm - 9
Posterior L Lower Leg - 4.5

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9
Q

A 3/F patient sustained multiple superficial partial thickness burns due to a scald burn covering her Face, anterior trunk, and entire R leg. What is her %TBSA

A

41%

Face - 9%
Ant trunk - 18%
Entire R Leg - 14%

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10
Q

A 2/M sustained full thickness burns from a flash injury covering his Ant lower trunk, Ant R arm, and Ant R leg. What is his %TBSA

A

20.5%

Ant lower trunk - 9
Ant R arm - 4.5
Ant R leg - 7

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11
Q

A-B-C-D-E-F of Primary Survey

A

Airway and C-spine protection

Breathing and ventilation

Circulation and Compartment syndrome

Disability/Deficits

Exposure & Environmental control

Fluid Resuscitation

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12
Q

Measures for airway control

A

Chin lift
Jaw thrust
Oropharyngeal airway in unconscious px

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13
Q

Endotracheal intubation must be considered in patients with Inhalational injury and what %TBSA

A

≥ 40 % TBSA

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14
Q

Inhalational injury should be suspected in patients with what signs

A

> Burn to face
Sooty phlegm
Singed nostril hairs
Hoarseness or stridor
found uncoscious at scene
Circumferential chest burn

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15
Q

Breathing should be established via administration of high-flow oxugen at ___L/min for patients suspectedof inhalational injury

A

15L/min (100%)

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16
Q

One of the most reliable gauge of adequate circulation

A

Urine output

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17
Q

Allowable heart rate elevation in burn patients.

A

100-120bpm

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18
Q

An additional ECG is done for patients with what type of burn

A

Electrical burn

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19
Q

Management of compartment syndrome

A

Escharotomy and Fasciotomy

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20
Q

6Ps of Compartment syndrome

A

Pain
Pallor
Pulselessness
Paralysis
Paresthesia
Poikilothermia

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21
Q

AVPU method of assessing patient’s level of consciousness

A

A - Alert
V - Responds to Verbal stimuli
P - Responds to Painful stimuli
U - Unresponsive

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22
Q

Prolonged application of cold compresses poses a risk of:

A

Wound and body hypothermia

23
Q

Fluid resuscitation should be started in adult patients with burns > ___%TBSA and children (<16yo) with burns > ___%TBSA

A

Adults: >20% TBSA
Children: >10% TBSA

24
Q

Solution used for Burn Resuscitation

A

Plain Lactated Ringer’s solution (PLR)

25
Q

Modified Brooke Formula for fluid resuscitation for the first 24 hours

A

2mL/kg/TBSA burned

26
Q

Parkland Formula for fluid resuscitation for the first 24 hours

A

4mL/kg/TBSA burned

27
Q

Half of the computed Fluid requirements should be given in the first __ hours AFTER injury, and the remaining half over the next __ hours

A

8 hours; 16 hours

28
Q

International Society of Burn Injuries (IBSI) recommended fluid resuscitation for adults

A

PLR at 2-4ml x Wt (kg) x TBSA

29
Q

International Society of Burn Injuries (IBSI) recommended fluid resuscitation for children

A

PLR at 3-4mL x Wt (kg) x TBSA

30
Q

International Society of Burn Injuries (IBSI) recommended fluid resuscitation for infants and children < 30kg

A

D5LR or Glucose containing fluid added as a side drip calculated using Holiday-Segar formula

31
Q

Holiday-Segar formula for infants and children <30kg

A

0-10kg: 100mL/kg

11-20kg: 1000mL + 50mL/kg for each kg in excess of 10kg

> 20kg: 1500mL + 20mL/kg for each kg in excess of 20kg

32
Q

Reason behind administering the 1st half of fluids in the 1st 8 hours after injury

A

First 8 hours after injury: time of greatest capillary permeability and intravascular volume loss

33
Q

Complications of over resuscitation

A

Pulmonary congestion and compartment syndrome

34
Q

Reason behind addition of Glucose containing maintenance fluid to the resuscitation of children < 30kg

A

Lower hepatic glycogen stores, depleted in the first 12-14 h of fasting

35
Q

Fluid of choice in the first 24 hours of fluid resuscitation

A

Crystalloid fluid (e.g., LR)

Approximates intravascular solute content

36
Q

Fluid to be administered in the second 24 hours Post burn

A

Shift to 5% Dextrose in Water (D5LR) at the rate of 1cc/kg/%burn

37
Q

Adequate urine output for Adults undergoing Fluid Resuscitation

A

0.5mL/kg/hour

38
Q

Adequate urine output for Children < 30kg undergoing Fluid Resuscitation

A

1mL/kg/hour

39
Q

Adequate urine output for Children > 30kg up to age 17 undergoing Fluid Resuscitation

A

0.5mL/kg/hour

40
Q

Adequate urine output for Adults patients with high voltage electrical burns/myoglobinuria undergoing Fluid Resuscitation

A

1-1.5mL/kg/hour

41
Q

AMPLET History in the Secondary Survey

A

A - Allergies
M - Medications
P - Past medical history or Pregnancy
L - Last meal/drink
E - Events/ Environment related to injury
T - Tetanus and childhood immunization

42
Q

Tetanus administration for all burn patients

A

0.5mL Tetanus Toxoid

+ 250u Tetanus immunoglobulin/3000U anti-tetanus serum (ATS)
if absent/unknown prior immunization or if booster > 10 y ago)

43
Q

Initial laboratory studies for Burn injury patients

A

> CBC w/ PT
Electrolytes
BUN, Crea, eGFR
Urinalysis
CXR

44
Q

Toxic effect of 1% Silver Sulfadiazine

A

Transient Leukopenia

45
Q

Wound dressing the provides a moist environment by trapping water in the matrix, thereby promoting wound healing. Works better than 1% SSD in pain reduction and number of dressing changes.

A

Hydrocolloid Dressings

46
Q

Dressing that contains the highest amount of silver. Releases silver ions over a long period.

A

Silver Nanocrystalline dressings

47
Q

Tangential excision of Eschar is usually done ____ days after burn injury

A

5-7 days

48
Q

Burn Center Referral Criteria

A
  1. > 10% TBSA
  2. Burns involving the face, hands, feet, genitalia, perineum, or major joints
  3. 3rd degree (full thickness) burns in all ages
  4. Electric burns
  5. Chemical burns
  6. Inhalational injury
  7. Burn in patients with pre-existing medical conditions that can complicate management/prolong recovery/affect mortality
  8. Burns with concomitant trauma (fractures) in which burn poses the greatest risk
  9. Burned children in hospitals without qualified personnel or equipment
  10. Burn in patients who will require special social, emotional, or rehabilitative intervention
49
Q

Jackson Zones of Burn Injury

A
  1. Coagulation
  2. Stasis
  3. Hyperemia
50
Q

Jackson Zone of burn injury where there is ongoing inflammation and vasodilation

A

Zone of Hyperemia

51
Q

Jackson Zone of burn injury with no capillary blood flow

A

Zone of Coagulation

52
Q

Jackson Zone of burn injury that is salvageable with appropriate resuscitation

A

Zone of Stasis

53
Q

Most common cause of death in burns

A

Burn wound sepsis

54
Q

Adverse effect of Silver Nitrate

A

Hyponatremia
Methemoglibinemia

SURGERY (13 decks)

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