Burns and Thermal Injuries Flashcards
First degree
only the epidermis. Erythema and minor microscopic changes.
Second degree/partial thickness
all of the epidermis and some of the corium or dermis.
Third degree/full thickness burns
white, dry, waxy appearance. May look unburned to untrained eye. Prolonged exposure to heat may be brown, red, or black. No sensation or cap refill, and has a leathery texture
Topical antibacterial agents (good for what, which ones)
lowers incidence of sepsis. Treatment of choice = silver containing product because silver has superior antimicrobial properties. Ex: Silver sulfadiazine, silver release dressings
Exposure therapy (what, why, why not)
no dressings. Usually over face or head. Disadvantages= increased pain, heat loss, and cross-contamination
Closed method (what, why not)
occlusive dressing. Preferred method. Usually changed twice a day. Disadvantages= increased bacterial growth if not changed frequently enough.
skin substitutes
alternative to topical agents for partial thickness or clean excised wounds. Reepithelialization is accelerated and pain is better controlled
Homografts
human skin. Better on large excised wounds but is difficult to obtain.
immersion hydrotherapy
use of this treatment has decline. Studies show an infection rate increase with immersion in a tub because of generalized inoculation of a previously local infection.
hydrotherapy on a slant board
useful once the wounds are in the process of being debrided and closed.
Showering as hydrotherapy
great at wound cleansing for stable patients
Operative debridement and grafting
Within the first several days post burn. Varies from an extensive burn excision and grafting within several days of injury to limiting debridements to less than 15% of the burned area. Excision can be carried down to fascia or to viable remaining dermis or fat. Excision to fascia is more commonly used when the burn extends well into the fat. A meshed skin graft can be covered with a biologic dressing to avoid desiccation of the uncovered wound.
Sepsis syndrome (from current surgery)
occurs in all major burns. Fever, hypermetabolism, catabolism, and leukocytosis are typical characteristics, the result of local burn and total body inflammation. (Infection is often not present according to Current Surg, various websites state the syndrome is due to infection)
Continued deterioration of a wound is likely due to _______. A more common cause of infection today is a ________. __________ is the third most common cause of infection.
Continued deterioration of a wound is likely due to invasive infection. A more common cause of infection today is a pulmonary complication (pneumonia). Catheter sepsis is the third most common cause of infection.
Circumferential burns of an extremity or trunk
Swelling beneath the unyielding eschar may act as a tourniquet to blood and lymph flow, and the distal extremity may become swollen and tense. Swelling may compromise the arterial supply. Tx: escharotomy must be performed before arterial ischemia develops.
Constriction involving the chest or abdomen may severely restrict ventilation.
