burns and HCAI

Question 1

Most common cause in burn

Answer 1

cutaneous thermal burns

Question 2

acidic chemical burn

Answer 2

coagulative necrosis

Question 3

alkaline chemical burn

Answer 3

liquefactive necrosis

Question 4

types of inhalation injury

Answer 4

smoke: pharynx
sting: epiglottis
chemical: further airway

Question 5

radiation burn

Answer 5

photo-energy and DNA damage

Question 6

non-accidental burn

Answer 6

abuse

Question 7

factors determining burn tissue response

Answer 7

1. degree of temp elevation
2. rate of temperature change
3. duration of contact
4. thickness of skin

Question 8

degree of burn

Answer 8

1. superficial epidermal
2. superficial dermal
3. deep dermal
4. full thickness
5. 4th degree burn

Question 9

would you see nay lister in full thickness burn?

Answer 9

No

Question 10

which burn will destroy blood vessel and not blanch?

Answer 10

deep dermal and full thickness

Question 11

which burn will have anaesthesia or hypo- anaesthesia?

Answer 11

deep dermal and full thickness

Question 12

Jackson burn wound model 3 zones?

Answer 12

1. zone of coagulation
2. zone of stasis
3. zone of hyperaemia

Question 13

what level of burn will only have regeneration not repair?

Answer 13

only superficial epidermal

Question 14

stages of wound healing?

Answer 14

1. haemostats
2. finalisation
   3, repair( reepithelilizatoin, angiogenesis, firbogenesis)
3. remodelling( vessel regression dan collagen deposition)

Question 15

superficial epidermal

Answer 15

no blister, pain, dry, red, blanchable, no necrosis,no scarring +/- inflammation, vasodilation, oedema

Question 16

superficial dermal

Answer 16

blisters, pain, red, sweeping blanch able, exudate and necrosis

Question 17

deep dermal

Answer 17

blister, no blanching, minimal pain

Question 18

full thickness

Answer 18

loss of cells structure, eschar on granulation tissue, anaesthesia

Question 19

4th degree

Answer 19

fasciae, muscle and bone affected

Question 20

complication of wound healing

Answer 20

wound dehiscence and ulceration ( deficient scar)
excessive repair( keloids, exuberant granulation, proud flesh)
infection and sepsis, contracture

Question 21

when will wound contraction happen

Answer 21

within 6 wk

Question 22

what hormones increased after burn

Answer 22

cortisol, glucagon, glucose

Question 23

what decreased in burn

Answer 23

immune response, myocardial contractility, Na, electrolytes albumin, muscle mass

Question 24

common causes of burn in adults and kids

Answer 24

kids: Scald>contact>flame
adults: scald>flame>contact

Question 25

common place of burn

Answer 25

home for both adults and kids( then work place and outdoor)

Question 26

CVS responses to burn

Answer 26

capillary permeability increased --> loss of intravascular proteins and fluid into intersitium

Question 27

resp responses to burn

Answer 27

bronchoconstriction | severe burns can cause rep distress syndrome

Question 28

what happens after burn

Answer 28

systemic responsive to burn: release of cytokines or inflammatory mediators at site of injury

Question 29

metabolic response to burn

Answer 29

BMR increased by 3X increased glucose turnover -->hyperglycemia increase catabolic hormone; adrenaline, cortisol, glucagon - increased rate of gluconeogensis, glyocgenolysis and muscle proteolysis - temp set point raised increased protein turnover and synthesis metabolic acidosis: loss of water causing PH imbalance

Question 30

immunologic response to burn

Answer 30

down regulation of immune response

Question 31

SIRS if burn>20% TBSA causing

Answer 31

``` bronchconstriction increased cap permeability reduced immune response increased BMR peripheral and splanchnic vasoconstrction( hypoperfusion) ```

Question 32

inhalational injury

Answer 32

``` increase mortality - above larynx( inhale hot gases or steam) - onset 4-24hr below larynx - chemical burn - immediate to 5d systemic intoxication - systemic absorptio nof CO, HCN ```

Question 33

how to treat hypermetabolic response

Answer 33

propranolol | oxandrolone

Question 34

where does epidermal keratinocytes regeneration from

Answer 34

``` skin appendages ( hair sheath cell, bulge stem cells, basaloid cells of sebaceous glands) - speed of regeneration of depend on depth of injury ```

Question 35

risk factors for hypertrophic scar

Answer 35

``` >2-3wk healing time depth of burn time to heal genetics/ skin types - mixed depth burns so need grafting ```

Question 36

how to treat burn

Answer 36

epidermal: moisture superficial dermal: dressing deep dermal and full thickness: surgery and grafting

Question 37

features of superficial dermal burn

Answer 37

1. necrosis confined to upper 1/3 of dermis 2. zone of necrosis lifted off viable wound by edema 3. small zone of injury

Question 38

features of mid dermal burn

Answer 38

1. necrosis to mid dermis 2. large zones of injury 3. eschar separated from viable tissue by edema layer

Question 39

features of deep dermal burn

Answer 39

1. necrosis involving majority of skin layers 2. zone of necrosis adherent to zone of injury 3. smaller edema layer

Question 40

full thickness burn features

Answer 40

no remaining viable dermis

Question 41

how to assess burn severity

Answer 41

1. wallace rule of nines 2. Lund and Browder chart 3. palm= 1% TBSA