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Surgical Skills > Burns > Flashcards

Burns Flashcards

1
Q

What age range is at the highest risk of burns?

A

18-35 y/o

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2
Q

Are males or females more likely to have a burn? At what ratio?

A

Males, 2:1

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3
Q

What age range is at the highest risk of scalds from hot liquids?

A

1-5 y/o

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4
Q

Burn injury historically carries a (good/poor) prognosis

A

Poor

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5
Q

Advances in ____ ____ and early excision of wounds has greatly increased survival. Early ____ ____ is very important and referral to _____ is key!

A

fluid resuscitation; fluid resuscitation; specialized burn center

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6
Q

What are the two specialized burn centers in NC?

A

NC Burn Centers: Wake Forest and UNC Chapel Hill

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7
Q

What are the four types of burns? How are they acquired?

A

Thermal: Scald and Fire injuries, Hot water/grease, smoke inhalation
Electrical: Lightning, household electricity
Chemical: Acids and Alkalis
Radiation: Sunburns

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8
Q

What are four crucial assessments that must be made on every burn victim?

A

Airway management
Evaluation of other injuries
Estimation of burn size (Burn Depth and %BSA)
Dx of CO and cyanide poisoning (Look for soot in the airway, etc)

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9
Q

You should have a low threshold for intubation when it comes to burn victims. Some indications that you should intubate a burn victim include ____, ____, and ____.

A

Suspect airway injury, full thickness burns to face/mouth, circumferential chest burns

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10
Q

Direct thermal injury to the upper airway (smoke inhalation) can cause rapid and severe _____ _____ (as a reaction to foreign particles). ____ ____ and ________ are signs of this. Also, be sure to note any presence of a ____ voice, _____/_____, or _____.

A

airway edema; Perioral burns and singed nasal hairs are signs of this
Note hoarse voice, wheezing/stridor, dyspnea

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11
Q

Should you consider burn patients as trauma patients?

A

Yes!

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12
Q

In a burn victim, you should place ______ and begin _____ as soon as possible.

A

2 large bore IVs

Fluids

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13
Q

If a pt has burns all over their arms, you may need to place a _______

A

central line to establish IV access

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14
Q

(Hypothermia/Hyperthermia) is common in pre-hospital pts

A

Hypothermia

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15
Q

T/F You should transfer a burn victim in clean, damp, blankets to best protect their skin

A

False, they should be clean and DRY

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16
Q

In a stable burn victim, what are we most concerned about treating?

A

their pain and anxiety

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17
Q

Is there a need for prophylactic abx tx in burn victims?

A

No

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18
Q

In burn victims, it is important to administer a ______

A

tetanus booster

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19
Q

If a topical abx were needed for better burn protection, what would be a good option?

A

Cephalexin

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20
Q

Why do burn victims suffer increased fluid losses?

A

Burns cause increased fluid losses due to heat and loss of a protective skin barrier
The burn or inhalation drives an inflammatory response that leads to capillary leakiness and thus intravascular fluid loss

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21
Q

Define a thermal burn

A

Type ofburnresulting from making contact w/ heated objects
Ex: boiling water, steam, hot cooking oil, fire, and hot objects
Related to structural fires and associated inhalation/CO poisoning

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22
Q

What is the most common type of burn in pediatric pts?

A

Scalding, which could be a signifier of abuse (also hot bathtub water)

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23
Q

What is the most common cause for hospital burn admissions?

A

Flames

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24
Q

Match the following descriptions of burns with their names (Superficial/1st degree, Partial-thickness/2nd degree, Full thickness/3rd degree, 4th degree)

A. Life-threatening: may extend into tissue, fascia, muscle bone, organs; multiple surgeries usually required.
B. Painless, non-blanching, does NOT spontaneously heal; Skin grafts.
C. Only epidermal layer. Dry, red, painful, blanching. Typically heals in 3-6 days. NO blisters.
D. Takes ~3-8 weeks to heal. Blisters.

A

4th degree = Life-threatening: may extend into tissue, fascia, muscle bone, organs; multiple surgeries usually required.

3rd degree = Painless, non-blanching, does NOT spontaneously heal; Skin grafts.

1st degree = Only epidermal layer. Dry, red, painful, blanching. Typically heals in 3-6 days. NO blisters.

2nd degree = Takes ~3-8 weeks to heal. Blisters.

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25
Q

Burns typically evolve over ___-___ hours after injury which complicates ability to predict healing

A

48-72 hours

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26
Q

How long does it typically take for a 1st degree burn to heal? Superficial 2nd degree? Deep 2nd degree? 3rd? 4th?
Scar or no scar?

A

1st degree: 7 days, no scar
2nd degree (superficial): 14-21 days, no scar
2nd degree (deep): 3-8 weeks, scar
3rd degree: months, severe scar
4th degree: months, multiple surgeries required

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27
Q

What is the first triage tx that should be performed in pts?

A

Lukewarm sterile water irrigation, administer pain medications as necerssary (i.e. Tramadol)

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28
Q

If a pediatric burn victim has ____% BSA affected, they should be referred

A

> 10%

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29
Q

How do you estimate burn size? (hint: it is a ‘rule’)

A

The Rule of Nines

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30
Q

In adults, anterior and posterior trunk account for ___% BSA, each lower extremity ___%, each upper extremity ___%, and head ___%.
In peds ____ y/o the head accounts for larger surface area.

A

In adults anterior and posterior trunk account for 18%, each lower extremity 18%, each upper extremity 9%, and head 9%.
In peds < 3 y/o the head accounts for larger surface area.

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31
Q

______ burns are NOT included in the rule of nines, so make sure to thoroughly clean the skin to avoid confusion.

A

Superficial/1st degree

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32
Q

Data suggests inexperienced providers (underestimate/overestimate) size of small burns and (underestimate/overestimate) large burns

A

Data suggests inexperienced providers overestimate size of small burns and underestimate large burns

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33
Q

IV fluids typically given for burns ____% BSA

A

> 10% BSA

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34
Q

The tough leathery tissue remaining after a full-thickness burn is called _____

A

Eschar

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35
Q

Describe an escharotomy. What can it be used for?

A

An escharotomy is performed by making an incision through the eschar to expose the fatty tissue below. It can be performed as a prophylactic measure as well as to release pressure, facilitate circulation, and combat burn-inducedcompartment syndrome.

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36
Q

What is the Parkland formula (used in fluid replacement for thermal burn victims)?

A

LR 4cc x wt (kg) x %BSA = amount given in 24 hours

Half over first 8 hours, half over subsequent 16 hours

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37
Q

LR maintains a more stable ______ than NS in long term resuscitation

A

Blood pH

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38
Q

LR contains less ____ and ____ than NS because large amounts of NS could cause _________.

A

Na+ and Cl-; hyperchlorermic acidosis

39
Q 
One liter of Ringer's Lactate solution contains:
\_\_\_ mEq of sodium ion = 130 mmol/L
\_\_\_ mEq of chloride ion = 109 mmol/L
\_\_\_ mEq of lactate = 28 mmol/L
\_\_\_ mEq of potassium ion = 4 mmol/L
\_\_\_ mEq of calcium ion = 1.5 mmol/L
A 
130 mEq of sodium ion = 130 mmol/L
109 mEq of chloride ion = 109 mmol/L
28 mEq of lactate = 28 mmol/L
4 mEq of potassium ion = 4 mmol/L
3 mEq of calcium ion = 1.5 mmol/L
40
Q

In the treatment of thermal burns, are prophylactic abx recommended?

A

No. Prophylactic antibiotics are not given

41
Q

How often should dressings be changed on thermal burns?

A

Dressings should be changed twice daily

42
Q

In a pt with a thermal burn, you should treat their pain and administer what vaccination if not UTD (up to date)?

A

Tetanus

43
Q

T/F Silver sulfadiazine (Silvadene) is the most widely used tx for thermal burns

A

True

44
Q

Silvadene is primarily used as (prophylaxis/tx) for active infection

A

Prophylaxis

45
Q

Silvadene is not significantly absorbed, but you should still use caution in pts with what type of allergy?

A

Sulfa Allergic Patients

46
Q

Can Silvadene be used in pts with skin grafts?

A

No! It DESTROYS skin grafts!

47
Q

In pts with smaller thermal burns, you may use Bacitracin and Neosporin topically, but you should not use Bacitracin or Neosporin in large burns due to what concern?

A

Nephrotoxicity

48
Q

Is wound debridement always recommended?

A

No, it is controversial

49
Q

The antibiotic ______ is considered 1st line for tx of cellulitis

A

Cephalexin

50
Q

Surgery indicated typically for burns not expected to heal within how many weeks?

A

2 weeks

51
Q

Full-thickness burns with a rigid eschar can cause a ______ effect as edema progresses, which may lead to _________, which is most common in burns on the ______, _____, and _____.

A

Tourniquet; Compartment syndrome; extremities; abd; thorax

52
Q

What is the recommended tx for an eschar?

A

Escharotomy, which is performed at bedside

53
Q

The best graft sites include…. What are the best sites for the elderly? For infants/children?

A

Thigh
Thicker skin of back (older pts)
Buttocks (infants/children)
Scalp

54
Q

_________ grafts are the most common type of skin graft

A

Split thickness (autografts)

55
Q

Permanent synthetic skin substitutes are (uncommon/common) and may be used in combination with autografts

A

Uncommon

56
Q

Most chemical burns are caused by _____ and _____

A

Acids and alkalis

57
Q

T/F Never neutralize acid w/base or vice versa

A

True

58
Q

How common are chemical burns in comparison to other types of burns? Are they usually mild/moderate/severe?

A

Less common, but severe

59
Q

____% of all burn center admissions are result of chemical burns

A

10%

60
Q

In order to properly tx a pt with a chemical burn, what should you do?

A

CAREFULLY remove the substance:
Remove clothes and brush away chemical
Copious irrigation with water
Wound care and Tetanus

61
Q

Where are a lot of chemical burns seen? How should you assess this type of chemical burn?

A

Chemical burns are commonly seen in the eye; you should stain it and look for damage

62
Q

Electrical burns make up ___% of admissions

A

4%

63
Q

Electrical burns are typically seen at what areas?

A

Areas of electrical contact

64
Q

T/F Electrical burns need admission and care by burn specialist

A

True

65
Q

What are potential complications of electrical burns?

A

Cardiac arrhythmias, compartment syndrome, and rhabdomyolysis

66
Q

If a pt presents with entry and exit wounds, you would expect that this injury was obtained via (AC/DC) current. If a pt presents with contact wounds c/o sustained muscle spasms, you would expect for this injury to have been obtained via (AC/DC) current.

A

DC; AC

67
Q

Electrical burns often cause extensive deep tissue damage to what type of tissues? Examples?

A

electrically conductive; such as muscles, nerves, and blood vessels

68
Q

Do patients with electrical burns typically have copious or minimal cutaneous injury?

A

minimal

69
Q

______ injury increases mortality in burn patients

A

Inhalation

70
Q

In a pt with an inhalation injury, how would we expect the pt obtained an upper airway injury? Lower airway injury?

A 
Direct heat (upper airway)
Inhalation of combustible products (lower airway)
71
Q

What are some examples of signs and sx of smoke inhalation?

A

Cough, wheezing, nares with singed hair, soot in mouth/nose, hoarseness, HA

72
Q

What is the recommended tx for pts with inhalation injury?

A

Fluids and supportive care (oxygen, possible intubation, bronchodilators, etc)

73
Q

T/F Inhalation injury is commonly obtained via a fire in an open space

A

False; Fire in an enclosed space

74
Q

Direct inhalation injury causes swelling that is generally worse in the first ___-___ hrs

A

24-48 hours

75
Q

Combustibles can cause what types of injuries/complications if inhaled?

A

mucosal injury, bronchoconstriction, obstruction

76
Q

What is a potential consequence of smoke inhalation injury?

A

CO poisoning

77
Q

T/F CO poisoning contributes to early mortality from smoke inhalation

A

True

78
Q

CO has an affinity for hemoglobin that is ___-___ times (lower/higher) than that of oxygen, which can lead to _____.

A

200-250 times higher; anoxia/death

79
Q

What are potential signs and sx of CO poisoning?

A

Headache, lightheadedness, dizziness, confusion, tachypnea, hypoxia

80
Q

If you suspect a pt has CO poisoning, what PE should be performed? Labs/imaging?

A

Neuro exam very important

Consider CXR and CO levels

81
Q

How do you tx a pt with CO poisoning?

A

High flow O2 administration of 100% O2

82
Q

How do you tx a pt with CO poisoning?

A

High flow O2 administration of 100% O2

83
Q

_________ toxicity is also a risk of smoke inhalation, and has been described as being mostly odorless, but with a slight _____ odor.

A

Hydrogen cyanide; burnt almond

84
Q

Hydrogen cyanide poisoning should be considered with a pt has sx of CO poisoning but has a normal _______ level

A

carboxyhemoglobin

85
Q

High flow O2 reduces the half life of CO from _____ mins to ___-___ mins

A

250 minutes; 40-60 minutes

86
Q

Children ____ y/o and adults ____ y/o are considered high risk burn patients and should be referred to and admitted to a burn center right away

A

Children <10 y/o and Adults >50 y/o are considered high risk patients

87
Q

There are many guidelines for when to refer a pt to a burn center. Some of them include the following:

Partial-thickness burns ____% TBSA
Burns involving the ____, ____, ____, ____, ____ or major ____
____-degree burns in any age group

A

Partial-thickness burns >10% TBSA
Burns involving the face, hands, feet, genitalia, perineum or major joints
Third-degree burns in any age group

88
Q

There are many guidelines for when to refer a pt to a burn center. Some of them include the following:

______ burns (including _____ injury), _____ burns, _____ injury
Burns in pts with complicated _______
Circumferential burns of _____ or _____
______ pt in hospital without qualified ______ specialists
Burn pts requiring special ____/_____ rehab

A

Electrical burns (including lightning injury), Chemical burns, Inhalation injury
Burns in pts with complicated comorbidities
Circumferential burns of chest or extremity
Peds pt in hospital without qualified peds specialists
Burn pts requiring special social/emotional rehab

89
Q

What are the most important indicators for mortality in burn pts?

A

Age, burn size and inhalation injury

90
Q

Recent study of >68,000 burn patients found the highest predictors of mortality to be ____, ____, ____, ____, and ____.

A 
Age
% TBSA
Inhalation injury
Co-existent trauma
PNA
91
Q

____ and/or ____ are recommended to burn patients to prevent functional loss

A

PT; OT

92
Q

_______ of the hand are a huge complication and liability in burn patients

A

Contractures

93
Q

What type of scarring is common in burn patients?

A

Hypertrophic

94
Q

What type of rehab is extremely important in burn pts? Why?

A

Psychological; Depression, PTSD, body image concerns, return to work…

Surgical Skills (8 decks)

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