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Course 2 - Dermatology > Burns > Flashcards

Burns Flashcards

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Dermatology Board Prep flashcards
1
Q

epidemiology of burns

A

69% male
chuldren <5yr old - 20%
seniors >60yr old - 12%
most occur at home

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2
Q

etiology of thermal burns

A

scald
flame
flash
contact

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3
Q

etiology of other burns

A

electrical
chemical
less common than thermal

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4
Q

severity of scald burn depends on:

A

length of contact and temperature
nature of substance (steam, hot water, hot oils)
depth and extent of burn

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5
Q

what may indicate a non-accidental burn in pediatrics

A

symmetrical burns
cigarette burns
mandatory to report

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6
Q

burn severity assessment with depth

A

superficial - 1st degree
partial thickness -2nd degree
full thickness - 3rd degree (epi, dermis, subcut fat)
underlying muscle and bone - 4th degree

don’t underestimate depth

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7
Q

signs of superficial burn

A

only inflammation
no blisters
heal within 2-5days
no scar/pigment changes

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8
Q

signs of superficial partial thickness

A

all of epidermis and into paillary dermis
pink/red, moist, swelling, blisters
7-10 days w/o significant scarring
e.g. scald burns

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9
Q

signs of deep partial thickness

A

all of epidermis and into reticular dermis
red to white, blistered, moist, moderate swelling
painful
longer than 14 days to heal
hypertrophic scarring

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10
Q

signs of full thickness burns

A 
all of epidermis and dermis and into subcut tissue 
white or black, charred, leathery 
does not blanch 
NOT painful 
long time to heal by secondary healing 
e.g. flame burns, electrical burns
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11
Q

how to calculate total body surface area (TBSA) in adults

A 
rule of nines 
head: 9
chest/abd: 18
back: 18
arms: 9+9
legs: 18+18
genitals: 1 
caution over-estimating TBSA
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12
Q

how to calculate total body surface area (TBSA) in children

A

Lund & Browder chart

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13
Q

local effects of burns

A

barrier to evaporation lost

increased cellular vascular permeability in area of burn

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14
Q

zones of thermal injury

A

zone of coagulation (necrosis)
zone of stasis (alive, microvascular damage, can convert to necrosis)
zone of hyperemia (inflammation)

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15
Q

systemic effects of major burns

A

inflammatory mediators (histamine, prostaglandins, cytokines) causes fluid leaks from intravascular space

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16
Q

physiology of burn shock

A 
fluid loss and decreased cardiac output 
increased systemic vascular resitance 
decreased RBCs 
impaired host defense 
decreased perfusion of kidneys
17
Q

what occurs after acute resuscitation

A

hypermetabolic and hypercatabolic response

impaired cellular and humoral immune response (no rejection of graft)

18
Q

mechanism of inhalation injury

A

CO poisoning
direct heat injury (upper airway)
chemical injury (lower airways)

19
Q

pathophysiology of CO poisoning

A

greater affinity for Hb than oxygen, oxygen deprivation

measure carboxyhemoglobin levels (ABGs)

20
Q

presentation of smoke inhalation injury

A 
face and neck burn 
singed facial hair 
soot in sputum 
redness and swelling of oropharynx
increase mortality from burns
21
Q

Tx for smoke inhalation

A

intubate immediately
Bronchoscopy: Dx
therapeutic: clear soot away from lower airways

22
Q

guidelines for fluid resuscitation for burns

A

first 24h
Parkland formula
4cc/kg/%TBSA burn/day
1/2 first 8hrs, 1/2 next 16 hrs from time of burn

for children add isotonic maintenance fluids
first 10kg: 4cc/kg/hr
second 10kg: 2cc/kg/hr
after 20kg: 1cc/kg/hr

23
Q

what to monitor during fluid resuscitation

A 
urine output (0.5-1cc/kg/hr)
mental status
cap refill 
temp of extremities 
lytes, base deficit, serum lactate
24
Q

what is escharotomy

A

checkerboard cuts to release tension on skin

25
Q

wound care for burns

A

pre hospital: stop burning process, clean coverings, warm blanket
ED: warm saline-gauze, dressings, topical antimicrobials
add splint so no joint contractures occur

26
Q

topical antimicrobials for burns

A

silver sulfadiazine
polymyxin B
mupirocin

silver dressings

27
Q

describe sepsis in burns

A

leading cause of death post-resuscitation
larger burns
preexisting disease

28
Q

nutrition requirements in burns

A

high protein, high calories
vitamins and minerals
monitor blood sugar, albumin

29
Q

indications for debridement and skin grafting

A

deep partial thickness burns and full thickness burns

surgery is the ‘conservative’ treatment in severe burns

30
Q

timing of operative burn treatment

A

<20% TBSA: decide bw 7-10 days if it will heal

burns >20%: within first week

31
Q

describe complications with electrical burns

A

cardiac monitoring
compartment syndrome
myoglobinuria
can be unrecognized

Course 2 - Dermatology (11 decks)

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