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in service ASPS > Burns > Flashcards

Burns Flashcards

1
Q

Parkland Forumla

A

2-4ml/kg x kg x TBSA% = 1st 24hr fluid requirement

1/2 vol 1st 8hrs
1/2 vol over the next 16 hrs
monitor UOP
0.5cc/kg/hr adults, 1cc/kg/hr peds
if not responding to fluid after 8hrs start albumin or FFP

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2
Q

Zone of coagulation

A

point of max damage, irreversible tissue loss

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3
Q

Zone of stasis

A

decreased perfusion, reversible damage dependent on resus

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4
Q

Zone of hyperemia

A

INCREASED perfusion, inflamed, outer most from center of burn

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5
Q

Lund and Browder Chart

A

TBSA chart used in billing

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6
Q

2nd degree - superficial partial thickness

A

epidermis and papillary dermis
blister/weep 12-24hrs
painful, blanching
re-epithelialization in 1-3 weeks
if healing takes >3wks = full thickness
improved result with grafting

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7
Q

3rd degree - full thickness

A

through dermis
white, leathery, non-blanching
insensate
min-no re-ep due to loss of adnexal structures
without grafting will heal by contraction from wound edge

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8
Q

Compartment pressure when escharotomy is needed

A

> 30 mmHg
- increased vent pressures

fasciotomies for electric burns

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9
Q

Tangential excision

A

Weck/Watson blade excises layers until healthy bleeding tissue exposed, use a tourniquet

fascial excision used in large surface area full thickness
- lower risk of blood loss

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10
Q

limit blood loss

A

Epi, tourniquet, elevation

Burn Multicenter Trial Group
TBS >20%
found that mortality is proportional to units transfused
risk of infection 11%/transfusion

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11
Q

temporary skin subs for early large excision of burns

A

integra, biobrane, alloderm, apligraf, surgisis
cadaveric split thickness for temp coverage awaiting CEA

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12
Q

biobrane

A

bilaminate membrane
type 1 porcine collagen
outer silicone film and nylon fabric matrix

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13
Q

apligraf

A

bilayered
cultured neonatal foreskin keratinocytes and fibroblasts
bovine collagen matrix

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14
Q

integra

A

bilaminate membrane
cross linked bovine tendon collagen
shark derived glycosaminoglycans
outer silicone sheet

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15
Q

alloderm

A

cadaveric acellular dermis

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16
Q

surgisis

A

porcine small intestines

17
Q

mesh ratios for STSG

A

increases surface area
1:1 2:1 3:1
4:1 w/ overlying allograft (Alexander technique)

18
Q

Incubation period for Cultured Epidermal Autograft

A

3 weeks

CEA when donor sites are limited - 10,000 fold expansion of keratinocytes

$13,000 / 1% TBSA
Epidermis only
very susceptible to shear

19
Q

What can silver sulfadiazine cause?

A

leukopenia
- dont d/c unless WBC <2,000
- worse in sulfa allergy

silver sulfa
- has poor pentration (used in ppx only)
- causes yellow/grey pseudoeschar

20
Q

where is mafenide (sulfamylon) used?

A

Ears

  • dont excise early
  • can cause met acid (carbonic anhydrase inhibitor)
  • painful
  • good penetration
21
Q

Silver nitrate may cause what electrolyte abnormalities?

A

hyponatremia and hypochloremia due to being hypotonic

can also cause methemoglobinemia

  • requires frequent application to keep moist
  • stains black
22
Q

What is Acticoat antimicrobial against?

A

gram + and - in addition to fungal

  • silver coated mesh dressing
  • moisten w/ sterile water
    change q2-3 days + moisten outer dressing daily
  • painful and can stain
23
Q

When is xeroform/baci best used in burns?

A

initial dressing for 2nd degree burns

24
Q

what is the gold standard evaluation for inhalation injuries?

A

bronchoscopy
- shows carbonaceous deposits and mucosal sloughing below vocal cords

carbon monoxide poisoning when carboxyhgb >15%
- smokers can be up to 10% at baseline

Intubate: stridor, hypoexmia, massive fluid resus

25
Q

what is the major determinant of tissue damage in electrical burns?

A

VOLTAGE

alternating current (AC) is more dangerous then direct which is unidirectional

ohms law: current (I) = voltage (E)/resistance (R)
jules: power (P) = voltage (E)/current(I)

26
Q

What current causes v-fib/resp effects?

A

50-100mA

1mA = perceptible
10-15 = tetany
1000 = mycardial tetany

High voltage = >1000 volts
- throws patients
- can cause deep tissue burn w/o evidence of external burn

27
Q

What type of necrosis does alkali burns cause?

A

liquifactive
- cement, lime, lye

alkali worse than acid burns

Acids cause coagulation necrosis (except for hydrofluoric acid - neutralize with calcium or mag)

  • irrigate until skin pH normalizes
28
Q

what is the antidote to phenol burns?

A

polyethylene glycol

  • phenol causes cardiac and CNS issues
29
Q

what is the antidote to phosphorus burns?

A

copper sulfate

  • phos causes cardiac arrythmias
30
Q

what are the 2 frostbite mechanism of injury?

A

<-2 celcius

direct cellular damage:
- extracellular crystals
- osmotic gradient
- mechanical cell destruction

progressive dermal ischemia:
- like reperfusion injury
- inflam
- microvasc emboli
- arachidonic acid metabolities

31
Q

first degree frostbite

A

numb white plaque w/ surround erythema

32
Q

2nd degree frostbite injury

A

soft fluid filled blister w/ surround erythema and edema

33
Q

3rd degree frostbite

A

hemorrhagic blisters over non-perfused skin

34
Q

4th degree frostbite

A

insensate, woody, mottled/gray skin
irreversible

35
Q

initial treatment for frostbite

A

rapid rewarming 100-104 bath w/ circulating water
- cont until thawing complete
- NO radiant heat

image with tech 99 triple phase bone scan
- not useful in 1st degree
- hypo uptake in 2nd degree
- absent uptake 3rd/4th degree

36
Q

post thawing tx of frostbite

A

thrombolytic therapy
NSAIDS
tetnus
wound care, splint, elevate

  • wait for demarcation prior to surgery
  • if blisters are clear okay to debride (dont if hemorrhagic)
37
Q

what is the most frequent complication of burns?

A

pneumonia

  • no abx ppx
  • > 4 days on vent increases mortality

in service ASPS (3 decks)

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