Burns, Bacterial Infections and Pressure Ulcers Flashcards
burns
-heat
-over exposure to sun
-friction
-chemical
-electrical- serious
-mild to life threatning
first degree burns
-mild
-effects the epidermis
-redness
-pain
-maybe some tiny blisters
2nd degree burns
-affects epidermis and dermis
-swelling
-red and white splothes
-blisters
-can cause scarring
-also called partial thickness burn
3rd degree burn
-hair follicles disintegrated
-sweat glands disintegrated
-epidermis and dermis
-black, brown, whitish
-leathery
-can destroy nerves
-AKA full thickness burn
-always require skin grafts
4th, 5th, and 6th degree burn
-fat
-muscle
-bone
burns- rule of nines
-used to determine treatments
-TBSA
-different for infants and children
-know adults**
-skin grafts
-fluid replacement
-infection
-how much body SA is involved
-also can be used for psoriasis -> insurance coverage needs high % for jack inhibitors
-first 25 hours after burn are vital -> without body will shut down
burns- parkland formula
-4 mls of fluid X weight in Kg X TBSA (%) = #
-divide that number in half -> give that in the 1st 8 hours
-give the remainder given over the next 16 hrs
rule of nines %
-4.5% - each arm (9%)
-4.5%- head
-18% trunk
-1%- genital
-9% each leg- 18%
impetigo
-honey colored crusts*
-common
-contagious
-superficial
-strep or staph aureus (usually staph) or combo
-after trauma or on normal skin
-bullous and non bullous (Crusted)
-staph can colonize nose
-MRSA- rule out
practice questions
-1. 70kg
-30% of body SA
-what is total fluid volume needed
-4200 in first 8 hours and 262 per 1 hr over next 16hrs
-2. 60kg
-20% body SA
-2400 in first 8 hours and 150 per 1 hr over next 16 hrs
-80kg
-15% body SA
-how much fluid in first 8 hours
-2400 in first 8 hours and 150 per 1 hr over next 16 hrs
impetigo treatment
-mupirocin (bactroban) ointment 2-3x a day
-make sure you cover nose too bc it can keep reoccurring
-oral antibiotics for severe or widespread-cephalexin minocycline, doxycycline
-watch out for post streptococcal
-glomerulonephritis and nephritis
-serious secondary infections (infants)
cellulitis
-non necrotizing inflammation of the skin and subcutaneous tissue
-breach in the skin
-erythema ill defined plaque
-pain
- swelling warmth
-lymphangitic spread-> lymphangitis (streaking)
-spread proximally towards lymph nodes
-tx- cool compresses, elevation (if leg involvement), antibiotics aimed at staph and strep
diagnosis predictive tool a score of 5-7 points = Cellulitis
-unilateral (3 points)
-leukocytosis WBC count > 10,000 (1 point)
-tachycardia HR > 90 bpm (1 point)
-cytokines released -> cause increase HR
-age > 70 years (2 points)
erysipelas
-inflammatory form of cellulitis
-lymphatic involvement (streaking)
-more superficial
-malaise, fever chills
-more superficial** -> epidermis
-well defined margins* abrupt onset
-causative agent is mostly streptococci
-also s. aurius, pneumococcus organisms and klebsiella
-TREAT WITH PENICILLIN
pressure ulcers
-AKA bed sores
-lack of blood flow to skin causes breakdown of tissue
-older adults-bedridden, nursing homes
-start as red, blue, or purplish patches on the body
-warm
-dont blanch, turn white, when touched they get worse over time
-become infected and grow deeper until they reach muscle, bone, or joints
-coccyx, elbows, heels
pressure ulcer prevention
-egg crates- takes pressure off- distributes
-special mattresses
-move pts
-wheelchairs shift position every 2 hrs
-bed ridden turn pts every 2 hrs
-NO REASON FOR PRESSURE ULCERS
-in worst cases, pressure injuries can become life threatening
stages of pressure ulcers
-stage 1- red, blue, purplish area, first appears on skin like bruise -> may feel warm to touch and burn or itch
-stage 2- bruise becomes an open sore -> skin around the wound can be discolored and the area is painful
-stage 3- sore deepens and looks like crater, often with dark patches of skin around the edges
-stage 4- damage extends to muscle, bone, joints and can cause serious infection of bone -> known as osteomyelitis -> SEPSIS
pressure ulcer treatment
-clean wound
-antibiotics- topical and oral
-debridement of dead tissue -> cut dead tissue off
-pain management
-skin grafts
stasis dermatitis
-common for ages 50+
-causes:
-venous insufficiency- problem with circulation of blood back to heart
-deep venous thrombosis
-surgery such as vein stripping and total knee arthroplasty
-traumatic injury
-being overweight
-heart conditions such as congestive heart failure
-shiny, crinkely
-moisturize
-mostly shins
stasis dermatitis treatment
-wearing compression stockings
-applying petroleum jelly moisturizer or barrier cream
-keeping feet elevated above the heart while sleeping
-avoid standing for long
-keep skin clean
-antibiotics for infection
drug reactions
-mild or life threatening
-hives and morbilliform rashes are most common types
-anaphylaxis most serious (also DRESS)
-can be from a drug itself
-can also be from combination of drugs- interaction
-usual onset 4-14 days
interactions…examples
-two drugs- such as aspirin and blood thinners *
-drugs and food, such as statins* and grapefruit
-drugs and supplements, such as gingko and blood thinners
-drugs and medical conditions, such as aspirin and peptic ulcers*
DRESS syndrome *
-drug reactions with eosinophilia and systemic symptoms
-it is serious drug reaction affecting skin and other organs, with mortality rate of up to 10%
-life threatening over reaction of the immune system
-type 4 hypersensitivity reaction
-happens within 2-6 weeks of persons first exposure to drug
-damage occurs due to overreaction from immune system, involves the activation of t-cells and release of cytokines
-looks red and dry
many culprit drugs of DRESS
-anticonvulsants
-antiviral drugs
-antibiotics
-allopurinol (zyloprim)
-mexiletine (mexitil)
-mood stabilizers and antidepressants
-biologic agents
other things that may cause reaction: DRESS
-genetic predisposition to DRESS syndrome
-inability of liver to metabolize certain drugs
-reactivation of certain viruses, such as epstein barr virus (EBV) or human herpesvirus 6 (HHV6)
symptoms of DRESS
-fever
-sin rashes or eruption
-eosinophilia
-atypical lymphocytosis
-head to toe
-disseminated
-swollen lymph nodes (systemic) *
-inflammation of internal organs
diagnosing DRESS criteria
-hospitalization
-acute rash
-reaction that likely drug-related
-3 out of 4 issues below should be present:
-fever higher than 38C
-enlarged lymph nodes in at least 2 sites
-involvement of at least 1 internal organ
-blood count abnormalities
treatment of DRESS
-supportive
-early systemic corticosteroids (suppress immune)
-STOP DRUG
erythema multiforme
-acute, self limited sometimes recurrent immune mediated mucocutaneous eruption
-90% caused by upper respiratory infections (MC HSV-1)
-presents target like lesions of face, palms extremities and trunk
-vesicles and erosions on oral mucous membranes common
-systemic involvement is not common or notable
-targetoid**
causes of EM
-infections
-immunizations
-radiation
-sarcoidosis
-menstruation
-wise variety of bacteria, viral, fungal and parasitic infections
-MUST ALWAYS THINK ABOUT EVOLVING STEVEN JOHNSONS SYNDROME AND TENS
clinical presentation EM
-abrupt onset of skin lesions
-may or may not have recollection of previous infection
-round well defined targetoid like lesions- 3 concentric rings
-blood work non diganostic
-SKIN BX- severe epidermal necrosis- not diagnostic
-management is supportive- try determine the cause -> if HSV, can be prevented with suppressive therapy anti-virals (not treat)
SJS and TENS
-steven johnson syndrome or toxic epidermal necrolysis
-emergency
-Both are rare idiopathic, life-threatening adverse reactions usually due to medications- rarely infectious
-Necrosis of epidermal cells of the skin and mucosa
-Prodromal 1-3 day influenza like symptoms
-Dusky targetoid plaques evolving into areas of sloughing denuded skin
-Nickolsky Positive
-Differentiated by the % of BSA affected
-Patients usually hospitalized in BURN unit
SJS vs TENS
-SJS:
-< 10% BSA detaches
-commonly face
-TENS:
-> 30% BSA detaches
-read chapter 18
SJS/TENS vs EM
-SJS/TENS:
-commonly drug induced
-atypical target lesions
-start on face and trunk
-mucosal involvement common
-sick pt
-systemic features
-EM:
-commonly associated with infection
-typical or atypical target lesions
-starts distally
-well pt
-lack of systemic features
-EM can progress into SJS or TENS -> follow up
