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DERMATOLOGY > BURNS > Flashcards

BURNS Flashcards

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Dermatology Board Prep flashcards
1
Q

What is a burn?

A

An injury caused by exposure to thermal, electrical, chemical or radiation energy

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2
Q

What is a scald?

A

A burn caused by contact with a hot liquid or steam

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3
Q

What is a non-complex burn?

A

A ‘minor burn’
Include any partial-thickness thermal burn covering up to 15% of total body surface area in adults or 10% in children, that does not affect a critical area
Includes a deep partial-thickness burn covering up to 1% of the body

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4
Q

What is a critical area for a burn?

A

Face
Hands
Feet
Perineum
Genitalia
Crossing joints
Circumferential burn

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5
Q

What is a circumferential burn?

A

When the entire circumference of a limb (or trunk, neck, digits) is burned
Has the potential to constrict underlying tissues as skin is inelastic

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6
Q

What is a complex burn?

A

A ‘major burn’
Includes:
- all electrical & chemical burns
- all thermal burn injuries affecting critical areas
- any thermal burns covering >15% of the total body surface area in adults or >10% in children

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7
Q

What is included in ‘thermal burns’?

A

Scalds
Flame injuries
Contact burns

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8
Q

What are electrical burns?

A

When electricity flows through the body from an entry point to an exit point
Heat energy from the electrical current damages tissue along its path of flow
Extent of tissue damage is determined by the voltage of the current

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9
Q

What are chemical burns?

A

Contact with corrosive agents
Such as acids, alkalis, and organic products

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10
Q

Which people are at increased risk of burn injury?

A

Elderly people
People with reduced mental capacity or those who may not recognise or react to a dangerous situation
People with reduced mobility
People with sensory impairment which may prevent a quick response to injury

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11
Q

How long do superficial epidermal burns typically take to heal?

A

7 days with conservative management
Dont result in scarring

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12
Q

How long do superficial dermal burns typically take to heal?

A

14 days with conservative management
Do not result in scarring

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13
Q

Examining to assess burn severity?

A

Location and size of burn
Extent of burn - expressed as total body surface area
Depth of burn - may increase with time so reassess after 24-72 hours
Skin - Colour changes, blisters, CRT, pain

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14
Q

Methods for estimating total body surface area?

A

The Lund and Browder method
Wallace’s rule of Nines
Rule of Palm

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15
Q

What is the Lund and Browder method for assessing burns?

A

This is a chart with an outline of a person divided into several regions, each represented by a number.

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16
Q

What is Wallace’s Rule of Nines method for assessing burns?

A

This estimates the adult’s total body surface area using multiples of 9 representing different areas of the body

Head & neck - 9%
Each lower extremity - 18%
Each upper extremity - 9%
Anterior torso - 18%
Posterior torso - 18%
Palmar surface of hand - 1%

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17
Q

What is the rule of palm method for assessing burns?

A

This assumes that the palm of the person who is burned is about 1% of the body
It can be used as a guide for small or scattered burns

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18
Q

What are the 3 types of superficial partial-thickness burns?

A

Superficial epidermal burns
Superficial dermal burns
Deep dermal burns

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19
Q

What are full-thickness burns?

A

Burns that extend through all the layers of the skin and into the subcutaneous tissues
(I.e. third degree burns)

20
Q

What are “fourth-degree burns”?

A

Severe full thickness burns - burns that extend into muscle and bone

21
Q

Skin examination in superficial epidermal burns?

A

Skin is red and painful
No blisters
Cap refill blanches but rapidly refills

22
Q

Skin examination in superficial dermal burns?

A

Skin is red or pale pink
Painful
Blistering
Cap refill blanches but regains colour slowly

23
Q

Skin examination in deep dermal burns?

A

Skin is dry, blotchy or mottled, red
Painful
May be blisters
Cap refill does not blanch

24
Q

Skin examination in full thickness burns?

A

Skin is white, brown or black
No blisters
Dry, leathery, waxy
Painless
Cap refill does not blanch

25
Q

Immediate first aid for thermal burns?

A

Stop the burning process
Remove non-adherent clothing and jewellery
Irrigate burn with cool/luke-warm running water 15-30 minutes
Cover burn in clingfilm - lay over burn dont wrap
Elevate area to reduce oedema
Pain relief

26
Q

Immediate first aid for electrical burns?

A

Do not approach a person connected to a high-voltage source
Otherwise switch off power supply if safe to do so
Arrange admission to A&E

27
Q

Immediate first aid for chemical burns?

A

Determine causative chemical where possible
Remove affected clothing
Irrigate burn with copious water for an hour
Arrange admission to A&E

28
Q

Management of superficial epidermal burn when hospital admission is not indicated?

A

Take a cool bath/shower or apply cold compresses
Massage area with an emollient
Simple analgesia
Adequate hydration
Protect skin from sun

Arrange urgent review if signs of infection, blisters, wound not improving etc

29
Q

Management of superficial dermal burn when hospital admission is not indicated?

A

Clean and dress wound.
Reassess wound after 48 hours and then every 3-5 days until wound is healed
Assess need for tetanus prophylaxis
Analgesia
Adequate hydration
Protect from sun

After wound has healed -> massage daily with emollient 3-6 months until burn is no longer dry and itchy to reduce risk of hypertrophic scar

30
Q

Wound cleaning guide

A

Clean technique - lukewarm tap water
Sterile technique - 0.9% normal saline

Genetly irrigate the wound
Wound debridement - surgical or natural with specialist dressings

Leave blisters in tact to reduce risk of infection

31
Q

What is tetanus?

A

An acute disease caused by the action of tetanus toxin released following infection by clostridium tetanus

32
Q

Where are C.tetani spores found?

A

Soil & manure

33
Q

Incubation period of tetanus?

A

3-21 days

34
Q

What are the 3 ways tetanus infection can present?

A

Generalised tetanus
Localised tetanus
Cephalon tetanus

35
Q

How does generalised tetanus present?

A

Lockjaw (trismus)
Tonic contractions
Spasms

This may lead to dysphagia, opisthotonus, rigid abdomen, and in severe cases resp difficulties

36
Q

How does localised tetanus present?

A

Rigidity and spasms confined to the area around the site of infection
Can continue for weeks or may develop into generalised tetanus

37
Q

What is cephalic tetanus?

A

localized tetanus after a head or neck injury, primarily involving the musculature supplied by the cranial nerves.

38
Q

Management of infected burn wounds?

A

Empirical antibiotics

39
Q

Most accurate method for assessing the extent of a burn?

A

Lund and Browder chart

40
Q

Pathophysiology of severe burbs?

A

Following a burn there is a local response with progressive tissue loss and release of cytokines
Systemically fluid loss and sequestration of fluid into the third space causes cardiovascular defects
Marked catabolic response
Immunosuppression -> sepsis is a common cause of death

41
Q

When do burn patients require IV fluids?

A

Children with burns >10% of TBSA
Adults with burns >15% of TBSA

42
Q

Fluid calculation for burns patients?

A

Parkland formula
Volume of fluid = TBSA x weight in kg x 4
Half of fluid should be administered in first 8 hours

43
Q

Which patients should be transferred to a burns unit?

A

Complex burns
Burns involving the hand, perineum, face
Burns >10% in adults and 5% in children

44
Q

What is an escharotomy?

A

Incising through areas of burnt skin to release the constriction and therefore restoring circulation

45
Q

Indications for escharotomies?

A

Circumferential full thickness burns to torso or limbs

46
Q

What is a curling’s ulcer?

A

An acute gastric erosion resulting as a complication from severe burns when reduced plasma volume leads to ischaemia and necrosis of gastric mucosa

DERMATOLOGY (14 decks)

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