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Block F -- Defense > Burns Case Conference > Flashcards

Burns Case Conference Flashcards

NOTE: Includes facts that seem important enough, but especially quizzes facts on the slides that the professor starred (i.e. will probably be on the exam). Left out much of the powerpoint.

1
Q

% TBSA of burn when systemic response is triggered

A

30%

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2
Q

3 cardiovascular effects

A
  • Increased capillary permeability
  • Peripheral and splanchnic vasoconstriction
  • Decreased myocardial permeability
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3
Q

Respiratory effect

A

Bronchoconstriction

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4
Q

Metabolic effect

A

Increased metabolic rate (up to 3x)

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5
Q

Immunological effect

A

Non-specific down-regulation of the immune response (both cell-mediated and humoral)

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6
Q

5 steps in initial burn management

A 
Trauma primary survey
Secondary survey (history)
Estimate TBSA of burn
Estimate depth of burn
Burn fluid resuscitation
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7
Q

Primary survey: ABCDE meaning

A 
Airway
Breathing
Circulation
Disability (neurologic evaluation)
Exposure
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8
Q

Jackson’s Burn Zones

A
  • Zone of coagulation
  • Zone of stasis
  • Zone of hyperaemia
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9
Q

Define zone of coagulation

A

Point of maximum damage (initial point of burn) = irreversible tissue loss due to coagulation of constituent proteins

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10
Q

Define zone of stasis

A

Zone of decreased tissue perfusion that is potentially salvageable at the periphery of the site of direct trauma

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11
Q

Define zone of hyperaemia

A

Outermost zone where tissue perfusion is acutally increased and where tissue will invariably recover

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12
Q

Define adequate and inadequate burn resuscitation based on Jackson’s burn zones

A

Adequate = zone of stasis preserved

Inadequate = zone of stasis lost

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13
Q

Parkland Formula for fluid resuscitation

A

4 cc / kg / % TBSA = total fluid to be administered in the first 24 hours

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14
Q

Purpose of Parkland Formula

A

ESTIMATION of fluid requirements in burn victim; should also monitor clinically

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15
Q

Fluid administered in burn victims

A

Ringer’s lactate

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16
Q

Reason for not using NS for burn victims

A

Risk of inducing a hyperchloremic acidosis

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17
Q

How to clinically monitor fluid requirements

A

Monitor urine output by means of a Foley catheter and titrate fluids to achieve a specific urine output

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18
Q

What % TBSA burns can be treated with oral fluids only?

A

<10 - 15% in children

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19
Q

How to administer fluids to burn victims based on Parkland Formula

A
  • 1/2 of fluid given in first 8 h

* 1/2 of fluid given in next 16 h

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20
Q

Goal urine output in adults and in children burn victims

A 
Adult = 30 cc/h
Children = 1 cc/kg/h
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21
Q

2 goals of fluid resuscitation in burn management

A

1) Increase tissue perfusion in the zone of stasis in order to prevent irreversible tissue damage
2) Achieve enough volume to ensure end-organ perfusion while avoiding intracompartmental edema and join stiffness

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22
Q

AMPLE trauma history meaning

A 
Allergies
Medications
Past medical history
Last meal
Events
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23
Q

Mechanisms of burn injury

A 
Thermal (scals, flame, contact)
Electrical
Chemical
Cold exposure (frostbite)
Radiation burns
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24
Q

Mechanism of injury often associated with inhalation injury

A

Flame

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25
Q

Method to assess burn size

A

Standardized Lund-Bower diagram for 2nd and 3rd degree burns (NOTE: Do not include any 1st degree burns in calculation)
May also use rule of 9’s, but less accurate

26
Q

%TBSA estimated by patient’s palm + fingers

A

1%

27
Q

%TBSA of head and neck (rule of 9’s)

A

9%

28
Q

%TBSA of trunk (rule of 9’s; anterior AND posterior)

A

36% total (18% each side)

29
Q

%TBSA of arms (rule of 9’s)

A

9% each

30
Q

%TBSA of legs (rule of 9’s)

A

18% each

31
Q

%TBSA of genitalia and perineum

A

1%

32
Q

Pathology of 1st degree burns

A

Involvement of epidermis only

33
Q

Appearance of first degree burns

A

Dry, red and warm. Blanches to pressure. No blisters, no scarring once healed.

34
Q

Sensation of first degree burns

A

Maybe painful

35
Q

Healing time of first degree burns

A

Within 7 days

36
Q

5 degrees of burns

A
  • First degree
  • Superficial 2nd degree
  • Deep 2nd degree
  • Third degree
  • Fourth degree
37
Q

Pathology of superficial 2nd degree burns

A

Involvement of epidermis and upper dermis; most adnexal structures intact

38
Q

Appearance of superficial second degree burns

A

Pale pink. Smaller blisters. Wound base blanches with pressure

39
Q

Sensation of superficial second degree burns

A

Increased; very painful and tender

40
Q

Healing time of superficial 2nd degree burns

A

7 - 14 days

41
Q

Scarring of superficial 2nd degree burns

A

Color match defect. Low risk for hypertrophic scarring

42
Q

Pathology of deep 2nd degree burns

A

Involves epidermis and significant part of dermis. Only deeper adnexal structures intact

43
Q

Appearance of deep second degree burns

A

Blotchy red or pale deeper dermis where blisters have ruptured

44
Q

Sensation of deep 2nd degree burns

A

Decreased

45
Q

Healing time of deep 2nd degree burns

A

over 21 days

46
Q

Scarring of deep 2nd degree burns

A

High risk (up to 80%) of hypertrophic scarring

47
Q

Pathology of 3rd degree burns

A

Epidermis, dermis and cell adnexal structures all destroyed

48
Q

Appearance of 3rd degree burns

A

White, waxy, charred. No blisters. No capillary refill.

49
Q

Sensation of 3rd degree burns

A

None

50
Q

Healing time of 3rd degree burns

A

Cannot heal spontaneously

51
Q

Scarring of 3rd degree burns

A

Wound contraction. Heals by secondary intention.

52
Q

Pathology of 4th degree burns

A

Extension through the subcutaneous soft tissue to reach muscle, tendon, or bone. Associated with limb loss or the need for complex reconstruction

53
Q

Burn Center Referral Criteria in terms of burn depth (4)

A
  • 2nd and 3rd degree burns >10% of TBSA in patient 50 y-o
  • 2nd and 3rd degree burns >20% TBSA in other groups
  • 2nd and 3rd degree burns with serious threat of functional or cosmetic impairment that involve face, hands, feet, genitals, perineum, and major joints
  • 3rd degree burns >5% TBSA in any age group
54
Q

Burn Center Referral Criteria in terms of mechanism of injury (2)

A
  • Electrical burns, including lightning injury

* Chemical burns with serious threat of functional or cosmetic impairment

55
Q

Burn Centre Referral Criteria in terms of secondary considerations related to the burn (4)

A
  • Inhalation injury
  • Circumferential burns
  • Patients with preexisting medical disorders that could complication management, prolong recovery, or affect mortality
  • Any patient with concomitant trauma in which the burn injury poses the greatest risk of morbidity or mortality (physician judgment whether trauma or burn priority)
56
Q

Leading cause of death in adult burn victims

A

Inhalation injury

57
Q

Treatment of CO poisoning

A

High flow oxygen via a non-rebreathing mask

58
Q

4 indications of hyperbaric oxygen

A
  • CO level > 25%
  • Loss of consciousness
  • Severe metabolic acidosis
  • Concern for end-organ ischemia
59
Q

Define excharotomy

A

Release of ONLY burned skin

60
Q

Define fasciotomy

A

Release of edematous muscles from their fascial compartments (incision through all involved fascial layers)

Block F -- Defense (4 decks)

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