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Integ Exam 1 > Burns Lecture > Flashcards

Burns Lecture Flashcards

1
Q

Function of skin

A

Protection from external trauma
Resists temperature variation (insulation/cooling)
Blocks entry of microorganisms
Prevents moisture loss from underlying tissues
Immune surveillance function
Decreases penetration of some types of radiation
Aids metabolism
Produces lubes and mositurizes
Touch!

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2
Q

Three zones of injury

A

Hyperemia
Stasis
Coagulation

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3
Q

Zone of Hyperemia

A

Outermost or most peripheral area to the site of wound or injury
Tissue is characterized by inflammatory changes and minimal damage

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4
Q

Zone of Stasis

A

Extends towards the central site of injury
Tissue is ischemic
Vessel endothelial damage –> thrombosis
Drying and infection –> deepen injury
24-48 hours post injury, progressive degeneration can be seen

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5
Q

Zone of Coagulation

A

Central-most area, where most energy causing the burn was absorbed
Thrombotic vessels and necrotic tissue
Minor burns lack this

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6
Q

Body Surface Area

A

Severity is proportional to the percent of BSA damage + depth

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7
Q

First degree burn

A

Injury to the superficial cells of the skin
Mild sunburn
Blisters are NOT seen
Some erythema and mild pain
Partial thickness burn that heals within 3-4 days with no scarring

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8
Q

Second Degree Burn: Superficial

A

** If damage to dermis is minimal
Involves tissue damage to both epidermis and dermis
Erythematous, blistered, weeping and painful
Blanch with pressure
Spared glands
Within 3 weeks, little or no scarring

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9
Q

Second Degree Burn: Deep

A

** Deeper damage of dermis
Difficult to distinguish from 3rd degree burns
Burn surface is pale and may be hardened or boggy
Less painful than more superficial burns
Slowly heals over 4-6 weeks
Permanent loss of hair follicles and glands

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10
Q

Third Degree Burns

A

Destruction of full thickness of skin
Pearly white, gray or brown and is dry and inelastic
Deep pressure = pain
Small: months to heal
Scarring and contracture formation
Excision and grafting to prevent contractures

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11
Q

Fourth Degree Burn

A

Well belwo the dermis and into subq tissue, fascia, bone
Blackened and charred
Dry and painless (nerve ending destruction)
Great risk of infection and other complications

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12
Q

Fluid loss bc of burns

A

Capillary damage is widespread and vasoactive mediators are released
Fluid, plasma, and electrolytes move to extravascular compartments
Fall in blood volume, cardiac output and tissue/organ perfusion
Critical in first 24 hours

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13
Q

Infections bc of burns

A

Threat in patients with stable BP/HR/RESP
- Sepsis and pnemonia
- Loss of mechanical protection of skin permits entry of microorganisms
G+: colonize immediately
G-: Day 5

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14
Q

Treatment of infections

A

Systemic antibiotics: Not with poor circulation; high bacteria per gram
Topical antibiotics: local wound care and strict infection control

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15
Q

Inhalation Injury bc of Burn

A

High mortality rate
Bronchospasm, ulceration of membranes, edema and impairment of ciliary clearance of bacteria
24-48 hours before symptoms show: hoarseness, dyspnea, tachypnea, and wheezing
– Needs proper recognition and diagnosis

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16
Q

Diagnosis and therapy of inhalation injury

A

Diagnosis
Management: endotracheal intubation and mechanical ventilation
Maintenance of fluid status is critical
Corticosteroids DO NOT influence survival rates– NOT RECOMMENDED (increase risk of infection and morbidity/mortality

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17
Q

Major burn injury

A

Second-degree burns with >25% BSA in adults, >20% in children
All third degree burns with at least 10% BSA
All burns of hands, face, eyes, ears, feet and perineum
High-voltage electrical injury
Burns complicated by inhalation injury, major trauma, or poor-risk patients

18
Q

Moderate, uncomplicated burns

A

Second degree burns with 15-25% BSA in adults and 10-20% in children
Third degree burns 2-10% BSA
Burn must not have risk to key areas of specialized function

19
Q

Minor burn injury

A

Second degree burns with <3 BSA

Burn must not involve risks to specialized functional or cosmetic areas of the body

20
Q

When is outpatients therapy appropriated?

A

Minor burns if: no other trauma, no circumferential burns, able to comply
- Many require initial evaluation by a health care provider

21
Q

Hospital admission?

A

Major burns or moderate, uncomplicated burns

  • Surgical referral: second or third-degree burns covers 3% BSA
  • Possible transfer to burn patients
22
Q

Age-related recommendations

A

Less than 2 years old
Frail and eldery
More than two burn sites
Varying stages of healing

23
Q

Candidates to be alert for?

A 
Diabetes mellitus
Cardiovascular disease
Immune deficiency disorders
Immuno suppressants
Renal disease, alcoholism, obesity
24
Q

Electrical burns

A

Appear superficial
Extensive damage to underlying tissues and organs without obvious outer damage
REFER

25
Q

Goals of treatment

A 
Relieve pain
Prevent desiccation and deepening
Prevent infection
Provide a protective environment for healing
Need for more extensive measures?
26
Q

Skin substitutes

A 
Human cadaver skin 
Epidermal substitutes (grown on a culture sheet; lack mechanical stability)
Animal substitutes (adheres well, lower cost, covers nerve endings)
Dermal substitutes (cadaver or bovine collagen fibers)
27
Q

Biobrane

A

Sheet of silicone bonded to a nylon mesh, with collagen peptides protruding downward from the nylon underlayer to promote adherence

28
Q

Tissue -engineered biological dressings

A

Repeated application to the injury site of a special mesh/preparation of skin cells

29
Q

Silver sulfadiazine (silvadene)

A

Broad spectrum
Lack good water solubility
Some penetration of eschar tissue
Painless
Effective when applied immediately after injury
Adverse effects: neutropenia and rare hypersensitivity
Avoid skin near eyes and mouth, patients with known hypersensitivity or pregnancy/nursing

30
Q

Mafenide Acetate (Sulfamylon)

A

Water soluble, diffuses easy, penetrates eschar areas
Best with contaminated burn would, delayed treatment, or dense bacterial growth
Adverse effects: Hypersensitivity, pain upon application, inhibition of carbonic anhydrase

31
Q

How are topical agents applied?

A

1/8 inch layer applied to the entire burn witha sterile gloved hand immediately after initial debridement and emergency care
May be covered with gauze and wrapped
Another application 12 hours later
Cleanse and inspect daily and meds reapplied

32
Q

Wet dressings

A

Multi layered occlusive gauze dressing are moistened with agent every 2 hours and changed 2-4 times a day
- Silver nitrate, aluminum acetate (burow’s solution), potassium permanganate and acetic acid

33
Q

Silver nitrate

A

Good germicidal and astringent activity
Immediately after injury
Precipitates upon contact with proteins - do not penetrate into eschar
Stains clothes and sometimes painful

34
Q

Aluminum acetate (Burrow’s Solution)

A

Mild germicidal and astringent activity

Easy dilution of tablet or packet in water to prepare

35
Q

Potassium Permanganate

A

Moderate germicidal activity
NOT astringent
Stains skin and clothes

36
Q

Acetic acid

A

Good germicidal and astringent activity

Unpleasant, strong odor and irritating

37
Q

Topical antibiotics

A

Topical or systemic

Depends on the nature of the organism, presence of blood circulation to the burn, whether the infection has spread

38
Q

Analgesics

A

Oral OTC products
Less pain
Severe pain: upgrade to opiates depending on the patient and status

39
Q

Topical protectants

A 
Palliative preparation (allantoin, calamine, white petrolatum, or zinc oxide) are safe and effective for first and minor second degree burns
Sooth and prevent excessive drying and protect from mechanical friction and rubbing
40
Q

Post wound and follow up

A

Ensure adequate would healing as well as psychological support with regard to cosmetics and presence of scaring

Moisturize regularly
Pruritis: antihistamines and moisturizers
Protect from sun
Aware of surface changes

Integ Exam 1 (7 decks)

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