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Burns Flashcards

1
Q

1st degree

A

sunburn (epidermis)

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2
Q

2nd degree

A 
superficial dermis (papillary): painful to touch; blebs and blisters; hair follicles intact; blanches 
deep dermis (reticular): decreased sensation; loss of hair follicles (need skin grafts)
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3
Q

3rd degree

A

leathery feeling (charred parchment); down to subcutaneous fat

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4
Q

4th degree

A

down to bone, into adjacent adipose or muscle tissue

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5
Q

Scald burns

A

most common

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6
Q

Body surface burned

A 
head 9
arms 18 (9 and 9) 
chest 18
back 18
legs 36 (18 and 18)
palm = 1%
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7
Q

Parkland formula

A

give 4cc/kg x % burn in first 24 hours; give 1/2 in first 8 hours
use LR in first 24 hours
*can grossly underestimate volume requirements with inhalational injury, ETOH, electrical injury, postescharotomy

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8
Q

Escharotomy

A

perform within 4-6 hours

  • circumferential burns
  • low temperature; weak pulse; decrease cap refill, decrease pain sensation, and decrease neurologic function in extremity; may need fasciotomy if compartment syndrome suspected
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9
Q

child abuse

A

accounts for 15% of burn injuries in children

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10
Q

Lung injury

A

caused by carbonaceous materials and smoke, not heat

*risk factors for airway injury - ETOH, trauma, closed space, rapid combustion, extremes of age, delayed extrication

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11
Q

Pneumonia

A

most common infection in burn wound patients; also most common cause of death after inhalation injury

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12
Q

Acid and alkali burns

A

copious water irrigation

  • alkalis produce deeper burns than acid due to liquefaction necrosis
  • acid burns produce coagulation necrosis
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13
Q

Hydrofluoric acid burns

A

spread calcium on wound

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14
Q

Powder burns

A

wipe away before irrigation

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15
Q

Tar burns

A

cool, then wipe away with lipophilic solvent

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16
Q

Electrical burns

A

caridac monitoring

*can cause rhabdomyolysis and compartment syndrome

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17
Q

Lightning

A

cardiopulmonary arrest secondary to electrical paralysis of brainstem

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18
Q

1st week - early excision of burned areas

A

try to excise burn wounds in < 72 hours

*skin grafts are contraindicated if culture is positive for beta-hemolytic strep or bacteria > 10^5

19
Q

Cardiac output 1st week

A

first have decrease CO for 24-48 hours then have increase CO (ebb and flow phases following burn)

20
Q

Burn caloric needs

A

25 kcal/kg/day + (30 x % burn)

21
Q

Burn protein need

A

1 g / kg / day + (3 g x % burn)

22
Q

Glucose in burn patients

A

best source of nonprotein calories in patients with burns; burn wounds use glucose in an obligatory fashion

23
Q

Autografts

A

best; full thickness or split thickness grafts (should be 12-15 mm, include epidermis and part of dermis); decrease infection, desiccation, protein loss, pain, water loss, heat loss, and RBC loss; increase granulation tissue and improve survival

24
Q

Homografts

A

allografts; cadaveric skin; not as good as autografts; can be good temporizing material; last 2-4 weeks; allografts vascularize and are eventually rejected at which time they must be replaced

25
xenografts
porcine; not as good as homografts; last 2 weeks; these do not vascularize
26
wounds to face, palms, soles, genitals
deferred for 1st week
27
most common reason for skin graft loss
seroma or hematoma formation under graft | *need to apply pressure dressing (cotton balls)
28
STSGs
more likely to survive; graft not as thick so easier for imbibition and subsequent revascularization to occur
29
FTSGs
have less wound contraction; good for areas such as palms and back of hands
30
burn wound infections
usually apply bactracin or neosporin immediately after burns * no role for prophylactic IV antibiotics * pseudomonas is most common organism in burn wound infection, followed by staph, e. coli, enterobacter * more common in burns > 30% BSA * topical agents have decreased incidence of burn wound bacterial infections
31
Silvadene (silver sulfadiazine)
can cause neutropenia and thrombocytopenia; dont use in pts with sulfa allergy; limited eschar penetration; effective for Candida
32
Silver nitrate
can cause electrolyte imbalances; hyponatremia, hypochloremia, hypocalcemia, hypokalemia; discoloration; limited eschar penetration
33
Sulfamylon (mafenide sodium)
painful application * metabolic acidosis due to carbonic anhydrase inhibition (decrease renal conversion of H2CO3 --> H20 + CO2) can cause hypersensitivity reactions * good eschar penetration * good for burns overlying cartilage * broadest spectrum against Pseudomonas and GNRs
34
Burn wound sepsis
usually from Pseudomonas
35
HSV
most common viral infection in burn wounds
36
< 10^5 organisms
not a burn wound infection
37
best way to detect burn wound infection
biopsy of wound
38
Complications after burns
* seizures - usually iatrogenic and related to Na concentration; can also be benzo withdrawal * peripheral neuropathy - 2/2 small vessel injury and demyelination * ectopia - from contraction of burned adnexa; tx: eyelid release * eyes - fluorescein staining to find injury; tx: topical fluoroquinolone or gentamycin * corneal abrasion - tx: topical abx * symblepharon - eyelid stuck to conjunctiva; tx: release with glass rod * heterotopic ossification of tendons - tx: PT; may need surgery
39
Curling's ulcer
gastric ulcer that occurs with burns
40
Marjolin's ulcer
highly malignant squamous cell CA that arises in chronic nonhealing burn wounds or unstable scars
41
Hypertrophic scar
usually occurs 3-4 months after injury 2/2 increase neovascularity * more likely to be deep thermal injuries that take > 3 weeks to heal, heal by contraction and epithelial spread, or heal across flexor surfaces * wait 1-2 years before scar modification * tx: grafting, steroids, silicone, compression
42
Toxic epidermal necrolysis (TEN) and staphylococcal scalded skin syndrome
epidermal-dermal separation seen * caused by variety of drugs (dilantin, bactrim, PCN) and viruses * tx: supportive, need to prevent wound desiccation with topical antimicrobials and xenografts * abx if due to staph aureus * no steroids
43
Steven Johnson syndrome (erythema multiforme)
less severe form of TEN * hypersensitivity reaction - subepidermal bullae, epidermal cell necrosis, dermal edema * caused by variety of drugs (dilantin, bactrim, PCN) and viruses tx: supportive; need to prevent wound desiccation with topical antimicrobials and xenografts * no steroids

Burns (1 decks)

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