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Plastic Surgery > Burns > Flashcards

Burns Flashcards

1
Q

What are some common complications associated with burn injuries?

A

Cellulitis, osteomyelitis, sepsis

These complications can arise due to the impaired skin barrier and increased risk of infection.

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2
Q

What are the main causal conditions for burn injuries?

A
  • Thermal (flame contact, scald)
  • Chemical
  • Radiation (UV, medical/therapeutic)
  • Electrical

Each type of burn has different mechanisms and potential impacts on the body.

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3
Q

Which type of burns is most common in children?

A

Scald burns

Children are often more susceptible to scald burns due to hot liquids.

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4
Q

Which type of burns is most common in adults?

A

Flame burns

Adults are more likely to experience flame burns due to occupational or recreational activities.

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5
Q

What is a consequence of burn injury related to thermoregulation?

A

Prone to lose body heat

Burn injuries can disrupt the body’s ability to maintain a stable temperature.

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6
Q

What is essential for controlling fluid loss in burn patients?

A

Must keep patient covered and warm

This helps to prevent hypothermia and excessive fluid loss.

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7
Q

What is the zone of hyperemia in burn injuries?

A

Vasodilation from inflammation; entirely viable, cells recover within 7 days

This zone contributes to systemic consequences seen with major burns.

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8
Q

What happens in the zone of stasis in burn injuries?

A

Decreased perfusion; microvascular sludging and thrombosis of vessels results in progressive tissue necrosis + cellular death in 24-48 hours without proper treatment

Early intervention can help prevent further damage in this zone.

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9
Q

What factors favor cell survival in burn injuries?

A
  • Moist, aseptic environment
  • Rich blood supply

These conditions are critical for promoting healing and minimizing tissue loss.

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10
Q

What is the zone of coagulation in burn injuries?

A

No blood flow to tissue; irreversible cell damage + cellular death/necrosis

This zone is the most severely affected area in a burn injury.

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11
Q

Fill in the blank: The amount of tissue destruction in burn wounds is based on _______.

A

[temperature, time of exposure, specific heat of the causative agent]

These factors influence the severity of burn injuries.

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12
Q

What intervention is required for burn injuries to prevent infection?

A

Antimicrobial dressings and systemic antibiotics if signs of specific infection present

Infection control is crucial in burn management.

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13
Q

True or False: Tetanus prophylaxis is not necessary if it has been administered previously.

A

True

Tetanus prophylaxis should be reviewed in burn patients, especially if the burn is severe.

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14
Q

What factors determine the amount of tissue destruction in burn wounds?

A

Temperature, time of exposure, and specific heat of the causative agent

These factors are critical in assessing the severity of burns.

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15
Q

What is the zone of hyperemia in burn wounds?

A

Vasodilation from inflammation; entirely viable, cells recover within 7 days

This zone contributes to systemic consequences seen with major burns.

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16
Q

What is the consequence of the zone of stasis in burn wounds?

A

Decreased perfusion leading to microvascular sludging and thrombosis, resulting in progressive tissue necrosis

Cellular death can occur within 24-48 hours without proper treatment.

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17
Q

What factors favor cell survival in burn injuries?

A

Moist, aseptic environment and rich blood supply

These conditions are crucial for promoting healing in burn wounds.

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18
Q

What characterizes the zone of coagulation in burn wounds?

A

No blood flow to tissue, irreversible cell damage, and cellular death/necrosis

This zone represents the most severe damage in burn injuries.

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19
Q

What is the best method for determining prognosis in burn injuries?

A

Percentage of total body surface area (TBSA) burned

The Rule of 9s is used for 2nd and 3rd degree burns to estimate TBSA.

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20
Q

What is the Rule of 9s used for?

A

Estimating the percentage of TBSA burned in adults

For children under 10 years, the Lund-Browder chart is preferred.

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21
Q

What is the significance of age in burn prognosis?

A

More complications if the patient is under 3 years or over 60 years

Age can significantly impact recovery and outcomes in burn cases.

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22
Q

How can circumferential burns affect a patient?

A

Can restrict respiratory excursion and/or blood flow

Circumferential burns can restrict respiratory movement and/or blood fow to extremities and require escharotomy ; a small incision in the burned skin to relieve the pressure

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23
Q

What is the impact of inhalation injury on burn patients?

A

Can severely compromise the respiratory system and affect fluid requirement estimation

It can also lead to increased mortality secondary to ARDS.

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24
Q

What is the approximate percentage of TBSA represented by the surface area covered by a patient’s palm?

A

Approximately 1% of TBSA

This is useful for estimating burn size for patchy burns.

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25
Q

What areas are considered critical for burn care?

A

Face and neck, hands, feet, perineum

These areas require special care in a burn unit due to their importance.

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26
Q

What does burn size not include?

A

Areas with 1st degree burns

Only 2nd and 3rd degree burns are included in TBSA calculations.

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27
Q

True or False: Comorbid factors can exacerbate the extent of burn injuries.

A

True

Factors like concurrent disabilities, alcoholism, and chronic conditions can worsen outcomes.

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28
Q

What determines the prognosis/ severity of burns?

A
  1. Prognosis best determined by burn size (TBSA).
  2. Age of patient (< 3 years or more > 60 years => more severe).
  3. Presence/ absence of inhalation injury.
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29
Q

How to asses the depth of the burn ?

A

difcult to assess initially – history of etiologic agent and time of exposure helpful.

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30
Q

What is the traditional name for a first degree burn?

A

Erythema/Superficial burn (it affects the outer most layer of the skin => epidermis).

First degree burns affect only the epidermis.
Redness and pain
No blisters
Heals quickly
Eg: sunburn

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31
Q

What depth of burn is characterized by painful sensation, erythema, and blanchable skin?

A

First degree

This type of burn involves only the epidermis.
Blanchable skin: with pressure its white and then when you release the pressure it becomes red which indicates normal circulation

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32
Q

What are the clinical features of a second degree superficial-partial thickness burn?

A

Painful, sensation intact, erythema, blisters with clear fluid, blanchable, hair follicles present

This type of burn affects the superficial dermis.

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33
Q

What does a deep-partial thickness second degree burn affect?

A

Into deep (reticular) dermis

This type may be difficult to distinguish from full thickness burns.

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34
Q

What are the characteristics of a full thickness third degree burn?

A

Injury to underlying tissue structures (e.g. muscle, bone) and dermis, insensate, hard leathery

Nerve endings are destroyed in this type of burn.

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35
Q

What is a fourth degree burn?

A

Injury to underlying tissue structures

This type involves eschar that can be black, grey, white, or cherry red in color.

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36
Q

Fill in the blank: A second degree burn can be classified as _______.

A

Superficial-Partial or Deep-Partial Thickness

Second degree burns can vary in depth and severity.

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37
Q

True or False: Second degree deep-partial thickness burns are insensitive and do not blanch.

A

True

These burns may still have some hair follicles attached.

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38
Q

What color can eschar be in a fourth degree burn?

A

Black, grey, white, or cherry red

The presence of thrombosed veins may also be observed.

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39
Q

What is a key distinguishing feature of a third degree burn?

A

Insensate (nerve endings destroyed)

Full thickness burns affect all layers of the skin.

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40
Q

What happens to hair follicles in a fourth degree burn?

A

Hairs do not stay attached

The destruction of underlying tissue structures is evident.

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41
Q

What are the criteria for transfer to a burn center according to the American Burn Association?

A

Patients with partial or full-thickness burns that involve:
* hands
* feet
* genitalia
* face
* eyes
* ears
* major joints
* perineum

These criteria ensure that patients with burns in critical areas receive specialized care.

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42
Q

What is the minimum percentage of total body surface area (TBSA) for partial thickness burns in patients aged 10-50 years that requires transfer to a burn center?

A

≥20% TBSA

This threshold indicates a significant burn injury that may require specialized treatment.

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43
Q

What is the TBSA threshold for partial thickness burns in children ≤10 years or adults ≥50 years that necessitates transfer to a burn center?

A

≥10% TBSA

This criterion highlights the increased vulnerability of younger and older patients.

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44
Q

What is the TBSA threshold for full thickness burns that requires transfer to a burn center?

A

≥5% TBSA in patients of all ages

Full thickness burns are severe and can lead to significant complications.

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45
Q

What types of burns are included in the criteria for transfer to a burn center?

A

Electrical burns, chemical burns, and inhalation injuries

These types of burns often require specialized management due to their complexity.

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46
Q

True or False: Inhalation injury is considered a high risk for mortality.

A

True

Inhalation injuries can lead to respiratory distress and require immediate attention.

47
Q

What should be done for patients with burn injuries who also have medical comorbidities?

A

They should be transferred to a burn center due to potential complications in management and recovery.

Comorbid conditions can affect healing and treatment outcomes.

48
Q

What is the protocol for patients who have both trauma and burns?

A

Stabilize for trauma first, then triage to burn center

This approach prioritizes life-threatening conditions before addressing burn injuries.

49
Q

What type of patients with burn injuries may require special emotional, social, and rehabilitation intervention?

A

Any patients with burn injury

These interventions are crucial for holistic recovery.

50
Q

Why should children with burns be transferred to a burn center equipped with pediatric care specialists?

A

Because they require specialized care tailored to their unique needs

Pediatric patients often have different physiological responses and healing processes.

51
Q

What protocol should be adhered to in the acute care of burn patients?

A

ATLS protocol

52
Q

What formula is used for resuscitation to treat fluid loss in burn patients?

A

Parkland formula

4ml x TBSA x kg

53
Q

What are the conditions that may require extra fluid administration in burn patients?

A
  • burn >80% TBSA
  • 4° burns
  • associated traumatic injury
  • electrical burn
  • inhalation injury
  • delayed start of resuscitation
  • paediatric burns
54
Q

What is the best measure to monitor resuscitation in burn patients?

A

urine output

55
Q

What is the target urine output for adults and children <12 years during resuscitation?

A
  • adults: >0.5 cc/kg/h
  • children <12 yr: 1.0 cc/kg/h
56
Q

What are the vital signs to maintain during resuscitation of burn patients?

A
  • clear sensorium
  • HR <120/min
  • MAP >70 mmHg
57
Q

What procedure is indicated for circumferential extremity burns?

A

escharotomy

58
Q

What is the purpose of inserting a Foley catheter in burn patients?

A

to monitor urine output

59
Q

What immediate life-threatening conditions should be identified and treated in burn patients?

A
  • inhalation injury
  • CO poisoning
60
Q

What should be determined first when assessing burn injuries?

A

TBSA affected

61
Q

What is the tetanus prophylaxis requirement for patients with burns >10% TBSA?

A

0.5 cc tetanus toxoid

62
Q

What additional treatment is needed if prior immunization is absent or unclear for tetanus?

A

250 U of tetanus Ig

63
Q

What baseline laboratory studies should be conducted for burn patients?

A
  • Hb
  • U/A
  • BUN
  • CXR
  • electrolytes
  • Cr
  • glucose
  • CK
  • ECG
  • cross-match if traumatic injury
  • ABG
  • carboxyhemoglobin
64
Q

What is the standard care for treating burn injuries?

A

cleanse, debride, and treat with antimicrobial dressings

65
Q

What is important for the outcome in burn care?

A

early excision and grafting

66
Q

What are the three major causes of respiratory problems in burn patients?

A
  • burn eschar encircling chest
  • CO poisoning
  • smoke inhalation
67
Q

What immediate action should be taken for burn eschar encircling the chest?

A

perform escharotomy

68
Q

What treatment is used for CO poisoning in burn patients?

A

100% O2 by facemask

69
Q

How does 100% O2 treatment affect the half-life of carboxyhemoglobin?

A

decreases from 210 to 59 min

70
Q

What is the risk associated with smoke inhalation in burn patients?

A

pulmonary insufficiency and pulmonary edema

71
Q

What should be monitored for after smoke inhalation injury?

A

secondary bronchopneumonia

72
Q

What action should be taken for patients showing signs of inhalation injuries?

A

intubate patient

73
Q

How to manage burn/ mention the steps to manage burn?

A
  1. ATLS protocol
  2. Determine TBSA
  3. Asses vital signs MAP > 70, HH<120
  4. Asses for CO poisoning and inhalation injury.
  5. escharotomy in circumferential extremity burns, including digits.
  6. IV fluid resuscitation through parkland formula (4 ml x kg x TBSA).
  7. insert Foley catheter to monitor urine output.
  8. tetanus prophylaxis if needed.
  9. cleanse, debride, and treat the burn injury (antimicrobial dressings).
  10. early excision and grafing are standard of care and important for outcome.
74
Q

What are the three major causes of respiratory problems?

A
  1. Burn eschar encircling chest
  2. Inhalation injuries
  3. Smoke inhalation
75
Q

What is the immediate treatment for burn eschar encircling the chest?

A

Escharotomy to relieve constriction

76
Q

What are indicators of inhalation injury?

A
  1. CO poisoning
  2. Injury in a closed space
  3. Facial burn
  4. Singed nasal hair/eyebrows
  5. Soot around nares/oral cavity
  6. Hoarseness
  7. Conjunctivitis
  8. Tachypnea
  9. Carbon particles in sputum
  10. Elevated blood CO levels
77
Q

What is the treatment for facial burns due to inhalation injury?

A

100% O2 by facemask until carboxyhemoglobin <10%

78
Q

True or False: Signs of inhalation injury may present immediately or later.

A

True

79
Q

What is the risk associated with smoke inhalation leading to pulmonary injury?

A

Risk of pulmonary insufficiency and pulmonary edema

80
Q

What is the time frame for monitoring potential pulmonary insufficiency after inhalation injury?

A

Up to 48 hours for insufficiency and 48-72 hours for pulmonary edema

81
Q

What should be done with a patient showing signs of inhalation injuries?

A

Intubate the patient

82
Q

What can failure to diagnose inhalation injury lead to?

A

Airway swelling and obstruction, potentially leading to death

83
Q

What are the components of the Parkland Formula for burn shock resuscitation?

A

4 cc x mass in kg x % TBSA

84
Q

How is the total volume calculated in the Parkland Formula distributed over time?

A

1/2 in the first 8 hours and 1/2 in the next 16 hours from the time of injury

85
Q

What is the treatment for suspected CO poisoning?

A

Monitor for signs like headache, confusion, coma, arrhythmias

86
Q

What should be added to the resuscitation after 30 hours?

A

D5W at a rate to maintain normal serum sodium

87
Q

Fill in the blank: Direct bronchoscopy is now used for _______.

A

[diagnosis of inhalation injury]

88
Q

What is the time frame for administering the second part of the Parkland Formula?

A

Hour 24-30

89
Q

What can be observed in sputum that indicates inhalation injury?

A

Carbon particles

90
Q

What is the healing characteristic of a First Degree burn?

A

No scarring; complete healing

First Degree burns affect only the epidermis and heal completely without scars.

91
Q

How long does it take for a Second Degree (superficial partial) burn to re-epithelialize?

A

7-14 days from retained epidermal structures

These burns may leave residual skin discoloration and rarely require grafting.

92
Q

What is a common outcome for hypertrophic scarring in Deep Second Degree burns?

A

Hypertrophic scarring frequent

Grafting is recommended to expedite healing in these cases.

93
Q

What is required for healing in Third Degree (full thickness) burns?

A

Grafting/flap necessary to replace dermal integrity and limit hypertrophic scarring

These burns do not heal spontaneously and require surgical intervention.

94
Q

What is a potential consequence of a Fourth Degree burn?

A

Often results in amputations

If amputation is not required, flap coverage after debridement is necessary as these burns do not re-epithelialize.

95
Q

Fill in the blank: Second Degree (superficial partial) burns can spontaneously re-epithelialize in _______ days.

A

7-14

96
Q

True or False: Hypertrophic scarring is uncommon in Second Degree (superficial partial) burns.

A

True

97
Q

What is the primary source of re-epithelialization for Third Degree burns?

A

Wound edge

This is a critical factor as these burns do not heal from within.

98
Q

What are the three stages of burn treatment?

A
  1. Assessment 2. Management 3. Rehabilitation

Assessment involves determining the depth of the burn; management is specific to the depth and associated injuries; rehabilitation focuses on recovery.

99
Q

What is the risk factor associated with patient age in burn infections?

A

Higher risk with very young and very old patients

Age can significantly affect the body’s ability to heal and respond to infections.

100
Q

What is the extent of burn that indicates a higher risk for complications?

A

> 30% Total Body Surface Area (TBSA)

Larger burn areas increase the risk for infection and other complications.

101
Q

What treatment is aimed at comfort for first-degree burns?

A

Topical creams, oral NSAIDs

Topical creams help keep the skin moist and provide pain control.

102
Q

What are the common organisms responsible for burn infections?

A
  • S. aureus * P. aeruginosa * C. albicans

These organisms are often involved in infection, especially in the early days post-burn.

103
Q

What is the typical microbial profile of burn wounds on day 1-3?

A

Gram-positive organisms

The microbial profile changes as the wound heals; Gram-negative organisms appear later.

104
Q

What are the characteristics of deep second-degree and third-degree burns?

A

Full thickness and deep partial thickness

These types of burns require more intensive treatment and are more prone to complications.

105
Q

What is the purpose of daily dressing changes with topical antimicrobials?

A

To prevent infection and promote healing

Keeping the wound moist and protected is crucial for recovery.

106
Q

What is a significant complication and cause of death in burn patients?

A

Infection and sepsis

Prompt treatment is essential to prevent these serious outcomes.

107
Q

What are the adverse effects of Silver Sulfadiazine (cream)?

A
  • Slowed healing * Leukopenia * Mild inhibition of epithelialization

It is important to wash off pseudoeschar before each application.

108
Q

Fill in the blank: The treatment for deep/full thickness burns primarily involves _______.

A

[early excision and grafting]

This approach is crucial for optimal recovery and minimizing complications.

109
Q

What is the role of surgical debridement in burn treatment?

A

Remove dead tissue and excise to viable tissue

This helps prevent infection and promotes healing.

110
Q

What does a density greater than 10^5 organisms per gram of tissue indicate?

A

Infection risk

High organism density suggests a higher likelihood of infection.

111
Q

True or False: Topical antimicrobials are only used on superficial burns.

A

False

Topical antimicrobials are used to treat colonized wounds regardless of burn depth.

112
Q

What is the main concern with wound temperature in burn care?

A

Preventing wound dryness and infection

Maintaining an appropriate temperature is vital for healing.

113
Q

What is one key factor that can impair blood flow to a burn wound?

A

Secondary impairment

Factors such as swelling or pressure can reduce blood flow.

Plastic Surgery (5 decks)

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