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*OldSurgery > Burns > Flashcards

Burns Flashcards

1
Q

3 layers of skin

A

Epidermis, dermis and subcutaneous tissue

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2
Q

what part of the epidermis is metabolically active

A

inner

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3
Q

A barrier that prevents loss of fluid by evaporation and loss of body heat

A

Dermis

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4
Q

layer of skin w/ blood vessels, nerves, sweat glands, appendages (allow you to regrow skin)

A

dermis

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5
Q

layer of skin that is mostly fat but also has skin appendages, blood vessels, and nerves

A

Subcutaneous layer

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6
Q

what happens w/ a first degree burn

A

Involves only the epidermis
Epidermal barrier remains intact
No blistering

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7
Q

2 types of second degree burns

A

superficial

deep

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8
Q

upper 1/3 of dermis is invovled

A

superficial 2nd degree burn

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9
Q

lower 2/3 of dermis is involved

A

deep 2nd degree burn

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10
Q

if there fluid loss w/ a superficial 2nd degree burn?

A

not, most barrier intake

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11
Q

how long does it take for a superficial partial-thickness burn to heal

A

10-14 days

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12
Q

dry and thickened burn that is red or white

can have high fluid loss and can get infected

A

deep second degree burn

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13
Q

healing time w/ 2nd degree burn (deep)

A

heal in 4-8 weeks on their own

better outcome w/ skin grafting

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14
Q

May look unburned skin
Can be white and waxy to completely black
Can be dark red, but dry and non-blanching
Leathery texture
non-painful

A

3rd degree (full-thickness) burn

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15
Q

tx for 3rd degree burn

A

full thickness skin grafts

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16
Q

a 3rd degree burn where Dermal proteins coagulate and contract is called what
causes skin to be tight

A

eschar

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17
Q

what is an Escharotomy

A

making an incision for skin to expand so

a person can breathe or save a limb

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18
Q

what are respiratory injuries

A 
inhalation
aspiration from unconscious patients 
bacterial pneumonia
pulmonary edema
post-traumatic pulmonary insufficiency 
ARDS
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19
Q

are inhalation injuries more common outside or in an enclosed area?

A

enclosed area

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20
Q

what scenarios should you suspect an inhalation injury

A 
History of closed space exposure
Perioral burns
Intraoral burns
Carbonaceous material in the oropharynx
Progressive hoarseness
Singed facial and nose hairs
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21
Q

when should you suspect CO posioning

A

Suspect in same patients that you suspect of inhalation injury + HA and mental status change

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22
Q

can pulse ox and PaO2 be normal in CO poisoning

A

yes

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23
Q

symptoms w/ CO poisoning

A

Asymptomatic – HA – dizziness – syncope – coma - death

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24
Q

treatment w/ CO poisoning

A

100% oxygen

may need intubation or hyperbaric chamber

25
what do you need to determine if CO poisoning
send off blood for CO levels
26
In trauma what do you want for fluid resuscitation?
2 large bore IV's | 14 or 16 gages
27
when do you need to do a urinary cath for burns?
>20% TBS
28
what burns are used to determine total body surface area?
only 2nd (deep) and 3rd degree burns
29
what are considered major burns
``` partial thickeness >25% body adults >20% peds full thickness burns >10% TBSA 2nd or 3rd involving- hands, feet, fact, perineum, genitalia, major joints associated w/ inhalation injury burns + fractures electrical/ lightning/ chemical circumferential burns really young or old ```
30
what is the consensus formula
2-4 mLs X %TBSA (2nd and 3rd degree) x wt in kgs give 1/2 of volume in first 8 hours giver other 1/2 in remainder 16 hours
31
when does "time" for treatment start for burns?
at time of burn | need to make up those fluids once they get to you
32
what directs you fluid rate (consensus formula only duies)
BP | pulse rate
33
what should you add to the %TBSA for an inhalation injury
20-30%
34
what can make ARDS worse?
over-resuscitation (too much fluid)
35
how do you tx a superficial partial thickness burn
occlusive dressing to minimize air exposure | no need for topical abx
36
how to you tx a facial superficial partial thickness burn
topical abx
37
what abx do you not want to use on the face?
Silver sulfadiazine, if used more than a few days, can cause blue/gray discoloration
38
how should nutrients be administered to a burn victim
enterally- reduces risk of infection
39
best topical abx for burns
silver sulfadiazine
40
ADR w/ silver sulfadiazine
transient luekopenia
41
ABX that Penetrates eschar better than silver sulfadiazine | Can induce metabolic acidosis
mafenide
42
why do you mesh the skin for a graft?
to cause epithelialization can cover a large wound (partial thickness skin graft)
43
when wouldn't you use a mesher for a burn?
on face, joints, etc
44
ulcers that people get in their stomach due to severe burns
curling ulcers
45
how do you prevent curling ulcers
put them on PPI for prophylaxis
46
what can you put on a burn for a fungal infection
nystatin
47
do burns from alkalis or acid penetrate deeply?
alkalis
48
what type burn forms an eschar but doesn't penetrate as deeply
acid
49
what do burns by organic compounds (petroleum products, phenols) do?
dissolve cell membranes
50
tx for chemical burns
brush off dry powders | copiously irrigate w/ water
51
what are low resistance tissues w/ electrical injuries?
nerves blood vessels muscles
52
what rhythms can someone w/ an electrical burn go into?
v fib and asystole
53
what is the minimum a person needs to be on telemetry for w/ an electrical burn?
24 hours
54
patients w/ electrical burns are at risk for what
rhabdomyolysis (breakdown of muscle) | compartment syndrome
55
how do you treat rhabdomyolysis
lots of fluids
56
how to determine compartment syndrome?
pain w/ passive movement | lack on sensation between first and second toe
57
how do you diagnose compartment syndrome
put a needle in a muscle compartment to determine pressure
58
tx for frostbite
rewarm in water bath at 40-42.2 degrees for 20-30 minutes
59
what will dead tissue from frost bite do?
become demarcated and usually sough on own

*OldSurgery (22 decks)

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