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Clin Med - II (Surgery) > Burns > Flashcards

Burns Flashcards

1
Q

Skin

A

Largest organ of the body
Consists of 2 layers
- Epidermis
- Dermis

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2
Q

Epidermis

A

Outermost layer is dead, yet it is a protective barrier

Inner cells are metabolically active

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3
Q

Dermis

A

Connective tissue
Contains blood vessels, nerve ending which mediate pain and sweat glands
Helps maintain body temperature - controlling amount of water that evaporates

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4
Q

First Degree burns

A

Superficial
Involves only the epidermis
Erythema, tissue damage and edema is minimal
Protective function are intact and systemic effects are rare
Usually resolves in 48-72h
Peeling in 5-10 days
Example - sunburn

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5
Q

Second Degree burns

A

Partial thickness
Deeper
Involve the epidermis and some of the dermis
Systemic severity and healing of burn directly related to the amount of undamaged dermis
Pain, hypersensitive swollen, dry, mottled
May blister - Superficial burn
Deeper dermal partial thickness burns - reddish or layer of whitish, nonviable tissue

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6
Q

Third Degree burns

A 
Full thickness
White, dry, waxy appearance
Lack of sensation in burned skin
Lack of capillary refill
Leathery texture
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7
Q

Second degree - superficial burn

A

Blister
Painful
Typically heal in 10-14 days with minimal scarring unless they become infected

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8
Q

Second degree - Deeper dermal partial thickness burns

A

Reddish or layer of whitish
Nonvialble tisuse
Heals over 4-8 weeks
Severe hypertrophic scaring
High evaporative loss
May convert to full-thickness when complicated by bacterial infection
Skin grafting may be needed to improve healing and quality

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9
Q

What type of burns progress and look worse on day 3 than day 1? Could these progress to full thickness?

A

Chemical and grease burns

Yes

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10
Q

Severity

A 
Illness and death are dependent upon
Size (surface area)
Depth
Age
Prior state of health
Location of burn
Associated injuries (lung)
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11
Q

Percentage burned

A

Age-related charts

  • Important b/c burns are often over/under estimated
  • Relates to prognosis
  • Determines who needs inpatient vs. outpatient tx
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12
Q

Rule of 9’s

A 
Head and Neck - 9%
Anterior Trunk - 18%
Posterior Trunk - 18%
Each arm - 9%
Each leg - 18%
Genitalia and perineum - 1%
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13
Q

Who is a greatest risk after a burn?

A

Elderly (>60 yo)
Young (<2 yo)
Burns to the perineum, hands, face or feet
Respiratory, chemical and electrical burns

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14
Q

The zones of pathophysiology

A

Coagulation
Injury or stasis
Hyperemia

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15
Q

Pathophysiology - coagulation

A

Necrosis with irreversible cell death and no capillary blood flow

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16
Q

Pathophysiology - injury or stasis

A

Sluggish capillary blood flow and injured cells (still viable)

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17
Q

Pathophysiology - Hyperemia

A

Inflammatory response of healthy tissue to nonlethal injury

Vasodilation and increased capillary permeability

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18
Q

Pathophysiology - general concerns

A

Volume loss
Inflammation (can be systemic)
Protein loss in the burn
Hemodynamic instability

19
Q

Metabolic response

A

Metabolic rate and oxygen consumption rise
Evaporative water loss
Heat loss
Secretion of hormones, catecholamines, cortisol, glucagon

20
Q

Immunologic Factors in burns

A

Immunologic abnormalities predispose to infection
Decreased serum IgA, IgM, IgG (reflects depressed B-cell function
Cell-mediated immunity or T-cell function depressed
PMN chemotactic activity suppressed

21
Q

Acute management - in general

A 
Adequate airway
Intubate
Fluids
Debridement of loose skin and dirt once stable
Control pain with IV narcotics
Tetanus prophylaxis
22
Q

Acute management - adequate airway

A

Inhalation injury? (may have carbonious sputum)
If so ABG, arterial oxygen saturation of HgB and carboxyhemoglobin
Administer 100% O2

23
Q

Acute management - intubation

A 
If pt is
- Semicomatose
- Deep burns to face / neck
- Otherwise critically injured
Do early (waiting pt may have swelling making it more difficult to intubate)
24
Q

Acute management - fluids

A

Severe burns characterized by large losses of intravascular fluid
Greatest loss is in the first 8-12h
Parkland formula
Lactated ringers is commonly used
Rate dictated by urine output, pulse, state of consciousness and BP

25
Q

Parkland Formula

A

4ml * 80kg * % body burned

26
Q

Post-resuscitation management

A 
Control hypothermia, pain, anxiety
Prevent hypovolemia by giving enough fluid to make up for losses
Prevent pulmonary complications
Nutritional support
Supplement Vit. A, E, C and zinc
Low-dose heparin
27
Q

Care of the burn wound - Superficial partial or second-degree burn

A

Aseptic environment
Occlusive dressing
If no infection, heals spontaneously

28
Q

Occlusive dressing

A

Minimize air exposure
Increase rate of epithelializaiton
Decrease pain (exception is the face)

29
Q

How are burns to the face dressed?

A

Tx ope with antibacterial ointment

30
Q

Care of the burn wound - third degree

A

Prevent infection
Remove dead tissue
Cover wound with skin or skin substitute ASAP
Topical abx retard wound healing - use in deep second or third degree wounds (high-risk infection)

31
Q

Topical Antibacterial Agents

A

Silver containing products
Superior antimicrobial properties
Sulfa sulfadiazine
Silver release dressings

32
Q

Sulfa sulfadiazine

A

Most common topical antibacterial silver containing product

Cream effective against Gram positive and Gram negative organisms

33
Q

Silver release dressings

A

Available in slow-release form that releases ions for several days
Decreases dressing changes
Improves pt comfort

34
Q

Exposure therapy

A

No dressings after application of agent
2-3 times daily
Face and head
Disadvantage - heat loss, increased risk of cross-contamination

35
Q

Closed method

A

Generally preferred
Occlusive dressing over agent and changed BID
Advantage - Less pain,, less heat, less cross-contamination
Disadvantage - Increase in bacterial growth if dressing not changed

36
Q

Skin substitutes

A 
Alternative to topical agents
Partial thickness or clean excised wound
Reepithelialization is accelerated 
Pain better controlled
Homografts (human skin) or engineered skin substitutes
37
Q

Hydrotherapy

A

Use of immersion decreased risk of infection

On slant board - useful once wounds are ready for debridement

38
Q

Debridement and grafting

A

More aggressive than in the past
More rapid debridement and closure of burn wounds
Skin grafts and skin substitutes

39
Q

Function

A

Wound contracture occurs

Maintain motion and function of joints to avoid permanent function loss

40
Q

Complications - in general

A

Infection

Sepsis syndrome

41
Q

Complications - infection

A 
Critical problem
Pulmonary
Wound
- S.aureus
- P. aeruginosa
- C. albicans
42
Q

Complications - children

A

Seizures secondary to electrolyte imbalance
Hypoxemia
Infection
Drugs

43
Q

Complications - sepsis syndrome

A

Occurs in all major burns
Fever, hypermetabolism, catabolism, leukocytosis
Can lead to death from multi-system organ failure
Infection often not present, but bodies response to inflammation

Clin Med - II (Surgery) (10 decks)

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