Burns

Question 1

1° Burn is?

Signs?

Heals?

Tx?

Answer 1

superficial, no dermis

Red, painful, NO blisters

Heals 1-7 days, no scar

aloe, moisturize, open to air, (P) Bacitracin

Question 2

2° Burn is?

Signs?

Heals?

Answer 2

partial thickness dermis:
superficial or deep thickness

Superficial: wet, pink, painful, blister (scald)
Deep: dry, white, +/- pain, (flame)

(P) grafting, scaring

Question 3

3° Burn is?

Signs?

Heals?

Answer 3

full thickness dermis

hard, leathery, no feeling

almost always needs surgery

Question 4

4° Burn is?

Answer 4

beyond skin and subQ into mm, tendon, bv, nn, bone

Question 5

ABA Burn Center Referral when?

Answer 5

1) 2° > 10% total SA
2) Face, hands/feet, genitalia/perineum, major joints
3) 3° all ages
4) Electrical, including lightening
5) Chemical
6) Inhalation
7) Pts w/ morbidities that may interfere w/ recovery
8) Burns w/ concomitant trauma
9) Children
10) Anyone needing special social, emotional, rehab

Question 6

Burn wound tx?

Answer 6

Debridement
Topicals
Mgmt during healing

Question 7

Acute burn care?

Answer 7

Resuscitation
Initial wound care
Operative mgmt

Question 8

Need for Burn Resuscitation depends on?

Answer 8

Depth/extent of burn
Pre-exist illness
Inhalation burn

Question 9

Burn shock pathophysio?

Answer 9

(>20% TBSA = highest risk for shock)

Rapid edema (peak 12 hrs) ->
↑ perfusion to burn ->
↑ cap permeability (histamine/PGs/kinins, ↑ edema in non-burned tissue) ->
↓ oncotic pressure (proteins into interstit) ->
↓ cell memb potential (cells swell for influx of Na+)

Question 10

Zones of burn wound? (3)

Answer 10

1) Zone of coagulation (non-viable)
2) Zone of ischemia (risk of becoming non-viable)
3) Zone of hyperemia (not burned but affected by vasodial)

Question 11

Goal of Resuscitation?

Answer 11

Maintain tissue perfusion to end organs

End point measured by urine output (thru foley)

Adults = 0.5 mL/kg/hr
Kids = 1
Eleictrical burns = 1-2

Question 12

Fluid needs determined how?

Answer 12

Burn depth
Delay in resusc
Compartment synd
Electrical (myoglobinuria)
Inhalation (30-50% more)

Question 13

Over-resuscitation causes?

Answer 13

Morbidity
Compartment Synd: Abd or extremity
Airway obstr
Pulmonary edema

Question 14

Extremity Compartment Synd:

Most at risk?

Signs?

Tx?

Answer 14

Circumferentially burned extremities

6 Ps:
Pain
Paresthesia
Pallor
Paralysis
Poikliothermia
Pluselessness

Escharotomy (incision into subQ)
Fasciotomy (incision into mm fascia)

Question 15

Abdominal Compartment Synd:

Signs?

Monitor?

Tx?

Answer 15

↓ urine output
↓ vent
↑ bladder pressure
↑ peak expiratory pressure

Hrly bladder pressure

↓ IV fluids
(P) continuous renal replacement therapy
(P) intraperitoneal catheter or decomp laparotomy

Question 16

Topical burn meds: 2° Superficial? (2)

Answer 16

Xeroform:
petroleum gauze w/ Bismuth Tribromophenate
+ bacitracin,
Change QD

Aquacel Ag:
Soduim carboxy-methylcellulose w/ silver,
Keep dry,
Change outer dressing QD

Question 17

Topical burn meds: 2° Deep or 3°? (2)

Answer 17

Silver sulfadiazine:
Cover w/ gauze
Change BID
NOT for ears/nose

Thick Eschar:
Mafenide Cream (sulfonamide -> anti-pauedo)
(P) painful
Yes for ears/nose

Question 18

Management of healed burns? (4)

Answer 18

Moisturize
Sunscreen
ROM
Scar massage

Question 19

Burn wound infection, signs?

Answer 19

(colonize 3-5 days, U G+)
+/- fever
↑ edema/erythema
↑ pain

Question 20

Burn scars? (4)

Answer 20

1) Pigment ∆s
2) Keloid (beyond area of injury)
3) Hypertrophic (not beyond injury)
4) Contractures (fibrotic tissue replaces CT)

Question 21

Post-burn neuropathy more (C) when?

Answer 21

Adults
Electrical burns
Full thickness burns
>20% TBSA

Question 22

Staph Scalded Skin Synd:

Etiology?

Presentation?

Tx?

Answer 22

Staph toxins
(U) < 5yo

Skin peels away in sheets

IV abx

Question 23

Necrotising Soft Tissue Infections:

Etiology?

Presentation?

Tx?

Answer 23

(U) polymicrobial

Pain/edema ->
Widespread necrosis of fascia and subQ

Emergency debridement

Question 24

Exfoliative Skin Dz a/w <10% TBSA is?

Answer 24

Steven-Johnson Synd

Question 25

Exfoliative Skin Dz a/w >30% TBSA is?

Answer 25

Toxic Epidermal Necrolysis

Question 26

Exfoliative Skin Dz: Etiology?

Answer 26

(U) caused by abx, anticonvlu, NSAIDs

Microbes (U) mycoplasma, Herpes (CMV, EBV, varicella)

Question 27

Exfoliative Skin Dz: Presentation?

Answer 27

Fever/malaise prodrome ->
Sudden skin burning, vesicle formation ->
Skin and muc memb involvement ->
dermal/epiderm separation