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Clinical Medicine Lecture - Professor Kramer > Burns > Flashcards

Burns Flashcards

1
Q

First degree histology ?

A

epidermis

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2
Q

First degree anatomy ?

A

no blisters

painful

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3
Q

First degree durn depth ?

A

Superficial thickness

  • *1 = does not blanch
  • *
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4
Q

Superficial second degree or superficial partial thickness burn depth ?

A

Superficial partial

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5
Q

Superficial second degree or superficial partial thickness anatomy ?

A

Blisters

very painful

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6
Q

Superficial second degree or superficial partial thickness histology ?

A

Epidermis and superficial dermis

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7
Q

Deep second degree or deep partial thickness burn depth ?

A

Deep partial

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8
Q

Deep second degree or deep partial thickness Histology ?

A

Epidermis and deep dermis

sweat glands

hair follicles

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9
Q

Deep second degree or deep partial thickness anatomy?

A

Blisters

very painful

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10
Q

Third degree burn depth ?

A

full thickness

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11
Q

Third degree Histology/anatomy ?

A

Entire epidermis and dermis charred

pale

leathery

no pain

** 3 - epi and dermis are toast , no pain = worse in severity **

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12
Q

Fourth degree histology/anatomy ?

A

Entire epidermis and dermis

bone

fat

muscle

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13
Q

Rule of 9’s: entire head ?

A

9 = front and back

front = 4.5
back= 4.5
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14
Q

Rule of 9’s: entire arm ?

A

9 front and back

front = 4.5
back = 4.5
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15
Q

Rule of 9’s: entire trunk ?

A

36

front = 18
back = 18
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16
Q

Rule of 9’s: entire leg ?

A

18

posterior = 9 
anterior = 9
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17
Q

Rule of 9’s: genital s?

A

1

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18
Q

First degree clinical presentation ?

A

Damage to the epidermal later only

painful, erythematous

heals spontaneously within several days

no scarring

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19
Q

Second degree clinical presentation ?

A

Damage to the dermis

erythematous, painful

blisters

pink/red/shiny to pale/mottled

heals by reepithelization from structures within dermis

may lead to sign. scarring based on level of dermal involvement

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20
Q

Third degree/full thickness clinical presentation ?

A

Damage through the dermis

hard, dry eschar

painless

heals by skin grafting surgery

significant scarring

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21
Q

Fourth degree clinical presentation ?

A

Damage to structures and tissue below the skin

charred the bone

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22
Q

Burns DS minor ?

A

none

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23
Q

Burns DS severe ?

A

CBC

electrolytes

BUN/Cr

Glucose

**severe - 10% plus **

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24
Q

Burns DS if inhalation injury ?

A

ABG

carboxyhemoglobin level

CXR

EKG ( also for electric burn)

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25
Q

Complications related to ?

A

age and % burned

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26
Q

Complications of smoke inhalation ?

A

ARDS

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27
Q

Complication of circumferential burn?

A

Compartment syndrome

** this tissue cant stretch anymore + inflammatory response ( CS from the inside out)**

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28
Q

Burns Tx: wound care ?

A

Debridement as appropriate

Topical antibiotics (silver sulfadiazine)

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29
Q

Burns Tx: severe burns?

A

Fluid resuscitation

Skin grafts

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30
Q

Burns Tx: CS ?

A

Escharotomy

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31
Q

Burns Tx: Hydrofluoric acid ?

A

Topical calcium gluconate

Consider IV calcium gluconate

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32
Q

Burns Tx: Lye ?

A

brush off before irrigating - powder brush it off first ,

if water first then you just spread it and activated it

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33
Q

Burns Tx: Major burns?

A

ABCA

airway
breathing
circulation
adjuncts

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34
Q

Minor burn tx plan ?

A

Provide appropriate analgesics before burn care and for outpatient use

Cleanse burn with mild soap and water or dilute antiseptic solution

Debride wound as needed

Apply topical antimicrobial

**pour bedaine on it = NO! cause it stops growth ? **

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35
Q

Burns debridement ?

A

Remove tissue that is open

Decreases wound infections

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36
Q

Burns topical ABS ?

A

Silver sulfadiazine

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37
Q

Why Silver sulfadiazine ?

A

Great for infection prophylaxis

Also has soothing effect

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38
Q

Silver sulfadiazine concerns ?

A

Destroys skin graft sites

May slow partial thickness wound healing

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39
Q

Topical antibiotics other options ?

A

Bacitracin

Neomycin

Polymixin B

Silver dressings

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40
Q

Burns IV fluid resuscitation formula ?

A

Parkland formula is a general guideline

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41
Q

Burns IV fluid resuscitation effective resuscitation has ?

A

MAP >60 mmHg

Urinary output

** no urine production then they are so dehydrated that the kidney is absorbing everything **

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42
Q

What is the parkland formula ?

A

Helps determine the volume of LR solution:

4ml x BSA(%) x weight (kg)

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43
Q

For the parkland formula you want to give half of the determined solution for the first ___ hours ?

A

8

** 8,400 ml ( liter back times 8) and in first 8 hours they need 4.2 L**

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44
Q

For the parkland formula you want to give the other half of the solution over the next ___ hours

A

16

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45
Q

Burns tx: transfusion ?

A

Debated among literature

Concensus is to treat for physiologic need– significant blood loss

  • -Do not transfuse for all burns
  • –Have higher risk of infection and mortality
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46
Q

Guidelines for referral to burn center ?

A

partial thickness > 10% TBSA

involving face, hands, feet, genitailia, perineum, major joints

3rd degree at any age

electrical burns (lightning)

chemical

inhalation injury

pre-existing medical disorders

if current location does not have qualified personnel

if tx requires social, emotional or rehab intervention

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47
Q

Crystalloids examples ?

A

ECF

LR

0.9 Nacl

D5 = 0.45 NaCL

D5w

3% NaCL

48
Q

ECF electrolyte composition ?

A

Na - 142

CL - 103

K - 4

Bicarb - 27

Ca - 5

Mg - 3

mOsm - 280-310

49
Q

LR electrolyte composition ?

A

Na - 130

CL - 109

K - 4

Bicarb - 28

Ca - 3

mOsm - 273

volume depleted and low Na then no LR

50
Q

0.9% NaCL electrolyte composition ?

A

Na - 154

CL - 154

mOsm - 308

51
Q

D5 0.45% NaCL electrolyte composition ?

A

Na - 77

CL - 77

mOsm - 407

52
Q

D5w electrolyte composition ?

A

mOsm - 253

53
Q

3% NaCL electrolyte composition ?

A

Na - 513

CL - 513

54
Q

LR indications ?

A

Volume replacement

post surgical and burns

55
Q

NL saline indications ?

A

Volume replacement

Hyponatremia

Hypochloremia

metabolic alkalosis

56
Q

D5 Half normal (Dextrose 5%, 0.45% sodium chloride)

indications ?

A

Postoperative maintenance

57
Q

Hypertonic saline (3% sodium chloride) indications ?

A

Severe hyponatremia ( Na at 120 )

Cerebral edema

58
Q

Volume deficit: generalized hx. ?

A

weight loss

decreased skin turgor

59
Q

Volume deficit: cardiac hx. ?

A

Tachy

Orthostasis/hypoTN

Collapsed neck veins

60
Q

Volume deficit: Renal hx. ?

A

Oliguria

Azotemia

61
Q

Volume deficit: GI hx. ?

A

Ileus

62
Q

Volume deficit: Pulm hx. ?

A

N/A

63
Q

Volume excess: Generalized hx. ?

A

weight gain

peripheral edema

64
Q

Volume excess: cardiac hx. ?

A

increased CO

increased central venous pressure

Distended neck veins

Murmur

65
Q

Volume excess: Renal hx. ?

A

N/A

66
Q

Volume excess: GI hx. ?

A

Bowel edema

67
Q

Volume excess: Pulm hx. ?

A

Pulmonary edema

68
Q

Complications: LR ?

A

Lactate may initiate inflammatory response and induce apoptosis

69
Q

Complications: NL saline ?

A

No significant

70
Q

Complications: D5 half NL saline ?

A

Cerebral edema

71
Q

Complications: Hypertonic saline 3% ?

A

Hemorrhage

72
Q

Fluid management monitoring ?

A

Blood pressure

Pulse

Electrolytes

73
Q

Hyperkalemia tx ?

A

Kayexalate

oral/rectal sorbitol

Dialysis

glucose D50 & insulin

Bicarb.

calcium glutinate - cardiac

albuterol

74
Q

Hyperkalemia monitoring ?

A

Interventions are temporary, lasting 1-4 hours

Continue to check potassium levels

75
Q

Hypokalemia tx. Asymptomatic, tolerating enteral nutrition ?

A

KCl 40 mEq per enteral access × 1 dose

76
Q

Hypokalemia tx. Asymptomatic, not tolerating enteral nutrition ?

A

KCl 20 mEq IV q2h × 2 doses

77
Q

Hypokalemia tx. Symptomatic ?

A

KCl 20 mEq IV q1h × 4 doses

78
Q

Hypokalemia monitoring ?

A

Check potassium levels 2 hours after infusion

Caution should be exercised when oliguria or impaired renal function is coexistent

79
Q

Hypernatremia tx. ?

A

Volume correction (Normal saline)

Electrolyte correction (Hypotonic solutions)
-if they are not volume depleted
80
Q

Hypernatremia monitoring ?

A

Hypotonic solutions can induce cerebral edema

Correct no more than 1 mEq/hr or 12 mEq/ day

81
Q

Hyponatremia tx. hypervolemic ?

A

Fluid restriction

CHF folks

82
Q

Hyponatremia tx. hypovolemic ?

A

NL saline

83
Q

Hyponatremia tx. Neurologic sxs. ?

A

Hypertonic saline

84
Q

Hyponatremia monitoring ?

A

Correct no more than 0.5 mEq/hr (12 mEq/ day)

85
Q

Hyponatremia, rapid correction can cause ?

A

pontine myelinolysis which includes ?

Seizures
Weakness
Paresis
akinetic movements
Unresponsiveness
permanent brain damage
death

**sheds axonal sheaths and radioopaqueness in the PONS

they are there but they cannot do anything - Locked in syndrome **

86
Q

Skin graft types ?

A

Split thickness

Full thickness

Composite tissue

87
Q

Split thickness description thin ?

A

Thiersch-Ollier

88
Q

Split thickness description intermediate ?

A

Blair-Brown

89
Q

Split thickness description thick ?

A

Padgett

90
Q

Full thickness description ?

A

Entire dermis (Wolfe-Krause)

91
Q

Composite tissue description ?

A

Full-thickness skin with additional tissue

SubQ, fat, cartilage, muscle

92
Q

Split thickness benefits ?

A

Better take

More availability

93
Q

Split thickness negatives ?

A

Less durability

hypopigmentation

94
Q

Full thickness benefits ?

A

Lower take

95
Q

Full thickness negatives ?

A

Higher durability

Better cosmesis

96
Q

Composite benefits ?

A

Used only for special cases

97
Q

Composite negatives ?

A

N/A

98
Q

Split thickness may be ____________ to increase surface area x1.5-1.6

A

meshed (or fenestrated)

99
Q

Graft take phases ?

A
  1. Imbibition
  2. Inosculation
  3. Revascularization
100
Q

Imbibition ?

A

thin film of fibrin separate wound from graft (24-48 hours)

101
Q

Inosculation ?

A

fine vascular network begins in fibrin film (about 48 hours)

102
Q

Revascularization ?

A

vessels invade dermis creating vascular channels–

pink hue develops (2-6 days)

103
Q

Skin grafts indications ?

A

Burns

Large wounds

**DM folks with large infections and debridement **

104
Q

Skin grafts complications ?

A

infections

105
Q

Skin grafts procedure ?

A

Clean site

Place graft

Apply nonadherent dressing

-petroleum type things so it doesn’t move

106
Q

Skin grafts procedure- Large burn ?

A

Fenestrated grafts best for high surface area

May not need to suture (decrease general anesthesia time)

107
Q

Skin grafts monitoring ?

A

General wound care (see Patient Evaluation)

108
Q

Burn thermal types ?

A

Flame

Contact

Scalding

109
Q

Flame burn ?

A

Most common for hospital admission

Highest mortality

Risk of smoke inhalation injury and carbon monoxide poisoning

110
Q

Burn types ?

A

thermal

electrical

chemical

111
Q

Electrical burns are high risk of ?

A

Cardiac arrhythmia

Rhabdomyolysis

Neurologic dysfunction

  • Look for entry and exit on exam
  • Only 4% of hospital admissions

**heart spine and nerves use electricity and it can coarse down these areas

looking for entry and exit ( and it toasted things in between) - if exit would it can cause arrhythmias, and rhadbo - over stimulation of the muscles and to much contraction(tetany) over use and yeah rhabdo

it is better if there is no exit wound**

112
Q

Chemical acid burns ?

A

Hydrofluoric acid - common industrial cleaning agent

Formic acid - preservative

113
Q

Chemical basic burns ?

A

Lye- used to make soap and oven cleaner

114
Q

What burn can cause hypocalcemia ?

A

Hydrofluoric acid

**Absorption of HF may cause hypocalcemia due to HF’s fixation of blood calcium.

HFA can bind the calcium - hypo calcium = seizures ( we treat the burn in this case but also give them calcium supplementation)
**

115
Q

What burn can cause hemolysis and hemoglobinuria ?

A

Formic acid

Clinical Medicine Lecture - Professor Kramer (28 decks)

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