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Section II General Surgery P203Surgical Recall Sixth > Burns, C39 P246-254 > Flashcards

Burns, C39 P246-254 Flashcards

1
Q

Define:
TBSA
P246

A

Total Body Surface Area

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2
Q

Define:
STSG
P246

A

Split Thickness Skin Graft

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3
Q

Are acid or alkali chemical burns are more burns more serious?
P246

A

In general, ALKALI burns are more serious because the body cannot buffer
the alkali, thus allowing them to burn for
much longer

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4
Q

Why are electrical burns so dangerous?

P246

A 
Most of the destruction from electrical
burns is internal because the route of
least electrical resistance follows nerves,
blood vessels, and fascia; injury is
usually worse than external burns at
entrance and exit sites would indicate;
cardiac dysrhythmias, myoglobinuria,
acidosis, and renal failure are common
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5
Q

How is myoglobinuria treated?

P247

A 
To avoid renal injury, think “HAM”:
    Hydration with IV fluids
    Alkalization of urine with IV
      bicarbonate
    Mannitol diuresis
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6
Q

Define level of burn injury:
First-degree burns
P247

A

Epidermis only

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7
Q

Define level of burn injury:
Second-degree burns
P247

A

Epidermis and varying levels of

dermis

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8
Q

Define level of burn injury:
Third-degree burns
P247

A

A.k.a. “full thickness”; all layers of the
skin including the entire dermis (Think:
“getting the third degree”)

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9
Q

Define level of burn injury:
Fourth-degree burns
P247

A

Burn injury into bone or muscle

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10
Q

How do first-degree burns present?

P247

A

Painful, dry, red areas that do not form blisters (think of sunburn)

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11
Q

How do second-degree burns present?

P247

A

Painful, hypersensitive, swollen, mottled

areas with blisters and open weeping surfaces

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12
Q

How do third-degree burns present?

P247

A

Painless, insensate, swollen, dry, mottled
white, and charred areas; often described
as dried leather

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13
Q

What is the major clinical difference between second- and third-degree burns?
P247

A

Third-degree burns are painless, and

second-degree burns are painful

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14
Q

By which measure is burn
severity determined?
P247

A 
Depth of burn and TBSA affected by
    second- and third-degree burns
TBSA is calculated by the “rule of
    nines” in adults and by a modified
    rule in children to account for the
    disproportionate size of the head and
    trunk
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15
Q

What is the “rule of nines”?

P248 (picture)

A 
In an adult, the total body surface area
that is burned can be estimated by the
following:
Each upper limb = 9%
Each lower limb = 18%
Anterior and posterior trunk = 18% each
Head and neck = 9%
Perineum and genitalia = 1%
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16
Q

What is the “rule of the palm”?

P248

A

Surface area of the patient’s palm is 1%
of the TBSA used for estimating size of
small burns

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17
Q

What is the burn center referral criteria for the following?
Second-degree burns
P248

A

>20% TBSA

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18
Q

What is the burn center referral criteria for the following?

Third-degree burns

A 
>5% TBSA
Second degree >10% TBSA in children
    and the elderly
Any burns involving the face, hands, feet,
    or perineum
Any burns with inhalation injury
Any burns with associated trauma
Any electrical burns
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19
Q

What is the treatment of first-degree burns?

P249

A

Keep clean, ± Neosporin®, pain meds

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20
Q

What is the treatment of
second-degree burns?
P249

A 
Remove blisters; apply antibiotic
    ointment (usually Silvadene®) and
    dressing; pain meds
Most second-degree burns do not require
    skin grafting (epidermis grows from
    hair follicles and from margins)
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21
Q

What are some newer
options for treating a
second-degree burn?
P249

A
  1. Biobrane® (silicone artificial
    epidermis—temporary)
  2. Silverlon® (silver ion dressings)
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22
Q

What is the treatment of
third-degree burns?
P249

A

Early excision of eschar (within first week

postburn) and STSG

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23
Q

How can you decrease
bleeding during excision?
P249

A

Tourniquets as possible, topical

epinephrine, topical thrombin

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24
Q

What is an autograft STSG?

P249

A

STSG from the patient’s own skin

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25
Q

What is an allograft STSG?

P249

A

STSG from a cadaver (temporary

coverage)

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26
Q

What thickness is the STSG?

P249

A

10/1000 to 15/1000 of an inch (down to

the dermal layer)

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27
Q

What prophylaxis should the
burn patient get in the ER?
P249

A

Tetanus

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28
Q

What is used to evaluate the
eyes after a third-degree burn?
P249

A

Fluorescein

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29
Q

What principles guide the
initial assessment and
resuscitation of the burn patient?
P249

A

ABCDEs, then urine output; check for

eschar and compartment syndromes

30
Q

What are the signs of
smoke inhalation?
P249

A

Smoke and soot in sputum/mouth/nose,
nasal/facial hair burns, carboxyhemoglobin,
throat/mouth erythema, history of loss of
consciousness/explosion/fire in small
enclosed area, dyspnea, low O(2) saturation,
confusion, headache, coma

31
Q

What diagnostic imaging is
used for smoke inhalation?
P250

A

Bronchoscopy

32
Q

What lab value assesses
smoke inhalation?
P250

A

Carboxyhemoglobin level (a carboxysmoke-
hemoglobin level of >60% is associated
with a 50% mortality); treat with 100%
O(2) and time

33
Q

How should the airway be
managed in the burn patient
with an inhalational injury?
P250

A 
With a low threshold for intubation;
oropharyngeal swelling may occlude the 
airway so that intubation is impossible;
100% oxygen should be administered
immediately and continued until significant
carboxyhemoglobin is ruled out
34
Q

What is “burn shock”?

P250

A 
Burn shock describes the loss of fluid
from the intravascular space as a result
of burn injury, which causes “leaking
capillaries” that require crystalloid
infusion
35
Q

What is the “Parkland formula”?

P250

A

V = TBSA Burn (%) x Weight (kg) x 4
Formula widely used to estimate the
volume (V) of crystalloid necessary for
the initial resuscitation of the burn
patient; half of the calculated volume
is given in the first 8 hours, the rest
in the next 16 hours

36
Q

What burns qualify for the
Parkland formula?
P250

A

≥20% TBSA second- and third-degree

burns only

37
Q

What is the Brooke formula
for burn resuscitation?
P250

A

Replace 2 cc for the 4 cc in the Parkland

formula

38
Q

How is the crystalloid given?

P250

A

Through two large-bore peripheral

venous catheters

39
Q

Can you place an IV or central
line through burned skin?
P250

A

YES

40
Q

What is the adult urine output goal?

P250

A

30–50 cc (titrate IVF)

41
Q 
Why is glucose-containing
IVF contraindicated in burn
patients in the first 24 hours
postburn?
P251
A

Patient’s serum glucose will be elevated

on its own because of the stress response

42
Q

What fluid is used after the

first 24 hours postburn?

A

Colloid; use D5W and 5% albumin at

0.5 cc/kg/% burn surface area

43
Q

Why should D5W IV be
administered after 24 hours
postburn?
P251

A 
Because of the massive sodium load in
the first 24 hrs of LR infusion and
because of the massive evaporation of
H(2)O from the burn injury, the patient
will need free water; after 24 hours, the
capillaries begin to work and then the
patient can usually benefit from albumin
and D5W
44
Q

What is the minimal urine
output for burn patients?
P251

A

Adults 30 cc; children 1–2 cc/kg/hr

45
Q

How is volume status
monitored in the burn
patient?
P251

A 
Urine output, blood pressure, heart
rate, peripheral perfusion, and mental
status; Foley catheter is mandatory and
may be supplemented by central venous
pressure and pulmonary capillary wedge
pressure monitoring
46
Q

Why do most severely
burned patients require
nasogastric decompression?
P251

A

Patients with greater than 20% TBSA
burns usually develop a paralytic ileus →
vomiting → aspiration risk → pneumonia

47
Q

What stress prophylaxis must
be given to the burn patient?
P251

A

H2 blocker to prevent burn stress ulcer

Curling’s ulcer

48
Q

What are the signs of burn
wound infection?
P251

A 
Increased WBC with left shift,
discoloration of burn eschar (most
common sign), green pigment, necrotic
skin lesion in unburned skin, edema,
ecchymosis tissue below eschar, seconddegree
burns that turn into third-degree
burns, hypotension
49
Q

Is fever a good sign of
infection in burn patients?
P251

A

NO

50
Q

What are the common
organisms found in burn
wound infections?
P252

A

Staphylococcus aureus, Pseudomonas,

Streptococcus, Candida albicans

51
Q

How is a burn wound
infection diagnosed?
P252

A 
Send burned tissue in question to the
laboratory for quantitative burn wound
bacterial count; if the count is >105/gram,
infection is present and IV antibiotics
should be administered
52
Q

How are minor burns dressed?

P252

A 
Gentle cleaning with nonionic detergent
and débridement of loose skin and broken
blisters; the burn is dressed with a topical
antibacterial (e.g., neomycin) and
covered with a sterile dressing
53
Q

How are major burns dressed?

P252

A

Cleansing and application of topical

antibacterial agent

54
Q

Why are systemic IV antibi-otics contraindicated in fresh burns?
P252

A

Bacteria live in the eschar, which is
avascular (the systemic antibiotic will
not be delivered to the eschar); thus,
apply topical antimicrobial agents

55
Q 
Note some advantages and disadvantages of the following topical antibiotic agents:
Silver sulfadiazine (Silvadene®)

P252

A

Painless, but little eschar penetration,
misses Pseudomonas, and has idiosyncratic
neutropenia; sulfa allergy is contraindication

56
Q

Note some advantages and disadvantages of the following topical antibiotic agents:
Mafenide acetate (Sulfamylon®)
P252

A 
Penetrates eschars, broad spectrum (but
misses Staphylococcus), causes pain on
application; triggers allergic reaction in
7% of patients; may cause acid-base
imbalances (Think: Mafenide ACetate 
Metabolic ACidosis); agent of choice in
already-contaminated burn wounds
57
Q

Note some advantages and disadvantages of the following topical antibiotic agents:
Polysporin®
P252

A

Polymyxin B sulfate; painless, clear, used
for facial burns; does not have a wide
antimicrobial spectrum

58
Q

Are prophylactic systemic
antibiotics administered to
burn patients?
P253

A 
No—prophylactic antibiotics have not
been shown to reduce the incidence
of sepsis, but rather have been shown to
select for resistant organisms; IV
antibiotics are reserved for established
wound infections, pneumonia, urinary
tract infections, etc.
59
Q

Are prophylactic antibiotics
administered for inhalational
injury?
P253

A

No

60
Q

Circumferential, full-thickness burns to the
extremities are at risk forwhat complication?
P253

A

Distal neurovascular impairment

61
Q

How is it treated?

P253

A

Escharotomy: full-thickness longitudinal
incision through the eschar with scalpel
or electrocautery

62
Q 
What is the major infection
complication (other than
wound infection) in burn
patients?
P253
A

Pneumonia, central line infection (change
central lines prophylactically every 3 to
4 days)

63
Q

Is tetanus prophylaxis
required in the burn patient?
P253

A

Yes, it is mandatory in all patients except
those actively immunized within the past
12 months (with incomplete immunization:
toxoid x 3)

64
Q

From which burn wound is
water evaporation highest?
P253

A

Third degree

65
Q

Can infection convert a
partial-thickness injury into
a full-thickness injury?
P253

A

Yes!

66
Q

How is carbon monoxide
inhalation overdose treated?
P253

A

100% O(2) ( ± hyperbaric O(2))

67
Q

Which electrolyte must be
closely followed acutely after a burn?
P253

A

Na⁺ (sodium)

68
Q

When should central lines be
changed in the burn patient?
P254

A

Most burn centers change them every

3 to 4 days

69
Q

What is the name of the
gastric/duodenal ulcer
associated with burn injury?
P254

A

Curling’s ulcer (Think: CURLING iron

burn = CURLING’s burn ulcer)

70
Q

How are STSGs nourished
in the first 24 hours?
P254

A

IMBIBITION (fed from wound bed

exudate)

Section II General Surgery P203Surgical Recall Sixth (33 decks)

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