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Skin - Derm/Plastics > Burns management > Flashcards

Burns management Flashcards

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Dermatology Board Prep flashcards
1
Q

How can you predict burns severe mortality?

A

Age + % body surface area burned

and if >10 then = severe mortality predictor

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2
Q

Define a burn

A

Coagulative destruction of the surface layers of the body

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3
Q

What is a superficial partial thickness burn?

A

predominantly epidermal loss

- the majority of adnexal structures e.g. in dermis are preserved (they are fine)

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4
Q

What type of burn does this describe: bright red, moist, BLISTERS, blanches on pressure, V painful?

A

Superficial partial thickness burn

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5
Q

What is a deep dermal/deep partial thickness burn?

A

more adnexal structures are damaged e.g. into the dermis

epitheliasation TF is slower…

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6
Q

What type of burn does this describe: leathery and insensate (no sensation),
scarring, contractures, needs skin grafting?

A

Full thickness burn

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7
Q

What type of burn does this describe: white/red with fixed staining, no blanching on pressure (is coagulated), prolonged healing, risk of hypertrophic scarring - may need graft?

A

Deep dermal/deep partial thickness

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8
Q

What is a full thickness burn?

A

loss of entire dermis

all skin constituents are damaged

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9
Q

How long do superficial partial thickness vs dermal / deep partial thickness take to heal?

A

Deep dermal/deep partial thickness = ~6 wks

Superficial partial thickness = ~ 2-3 wks

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10
Q

What kind of burns are flame burns, prolonged contact burns and corrosive chemicals likely to cause?

A

full thickness

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11
Q

What kinds of burns are flash burns, sunburn, some hot water scalds likely to cause?

A

superficial partial thickness

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12
Q

What kinds of burns are some hot water scalds, hot fat, contact burns likely to cause?

A

deep dermal / deep partial thickness

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13
Q

What is the rules of 9’s in body surface area for burns?

A

rules of 9 - head and arms = 9
front/back = 18
legs front & back = 18
genitals = 1%

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14
Q

What is the ruled of 9’s in children?

A

it is the rules of 10 in children
TF head and arm = 10 (5 each side)
legs = 20 (10 each side)

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15
Q

What different categories of burn deliveries can you get?

A 
1 - Thermal
2 - Chemical
3 - Electrical
4 - Radiation
5 - Cold
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16
Q

What types of thermal burns are there?

A

Thermal = 90% of all burns –> severity related to temperature and duration

Wet heats - scalds - most common & tend to be partial thickness

Dry heat - flame, contact, radiant heat - contact burns tend to be deep

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17
Q

What types of chemical burns are there and how do you test?

A

Chemical is 5% of all burns and severity depends on chemical:

Acid burns: damage by coagulative necrosis - local and short lived
Alkali e.g. cement: progressive liquefactive necrosis, deep and prolonged

Rx: remove clothing - “dilution is solution to pollution”
Ix - use litmus paper

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18
Q

What types of electrical burns are there?

A

Electrical burns = 5% of all

  • wide variation in severity,
  • entry & exit points mark the path of current
  • -> low voltage <1,000V = household electricity
  • -> high voltage >1,000
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19
Q

How do you monitor high voltage (>1,000V) electrical burns?

A

ECG monitoring & serial cardiac enzymes

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20
Q

What can monitor high voltage (>1,000V) electrical burns lead to?

A

Extensive tissue damage
– Rhabdomyolysis
—> Renal failure
– Compartment syndrome (movement exacerbates pain & pain is out of proportion to injury)
Asystole & arrhythmias (hence: cardiac enzymes and ECG)

21
Q

What may cause a radiation burn?

A

superficial radiotherapy –> local erythema

anything due to radiation exposure

22
Q

There are 3 zones involved in a burn (pathophysiology) what are they?

A

zone of coagulation
zone of stasis
zone of hyperaemia

23
Q

What zone does this describe: tissue NECROSIS due to destruction by injury?

A

the zone of coagulation AKA the CENTRE

necrosis = dead

24
Q

What zone does this describe: ISCHAEMIA - can progress & increase the area/depth of injury?

A

the zone of stasis

ischaemia = dying

25
Q

What zone does this describe: INFLAMMATION - manifested by increased vascular permeability?

A

zone of hyperaemia

-aemia means subst. is present in blood

26
Q

What effect do local release of inflammatory mediators have?

A

increased microvascular permeability
oedema formation
microvascular stasis
thrombosis

27
Q

at what BDSA % do you get systemic release of mediators into circulation?

A

> 25-30%

28
Q

What does systemic release of mediators into circulation cause?

A
  • Burn oedema - the protein loss = oedema even in non burnt tissue
  • Impaired microvascular integrity - leaky endothelium, vasoactive substance (PG, LT, free radicals, histamine)
  • Hypovolaemia
  • Myocardia depression
  • RBC destruction
  • Glucose intolerance
29
Q

What do you need to ask in a burns history?

A

causative agent
Time & duration of insult
First aid applied

30
Q

What Ssx of burns are there?

A

pain
plasma loss (leaky endothelium systemic release >30% BSA)
anaemia (RBC destruction in skin capillaries; toxic inhibition of bone marrow)
pharyngeal/laryngeal oedema
stress reaction
toxaemia

31
Q

What complications may occur at the burn site?

A 
Wound sepsis (strep or pseudomonas)
Wound contracture
Scarring
Sepsis
Curling ulcers (in stomach, stress response)
Seizures (electrolyte imbalance)
Renal failure (hypovolaemia, plasma loss)
Psychological
32
Q

Other indications of severity are there for burns?

A

1) Location: hands (1%), feet, genitalia
2) Age
3) Co-morbidities and medications
4) Presence of multisystems trauma
5) Inhalation injury

33
Q

What should be examined on someone with a burn?

A

Distribution consistent with history? (hand =1% BSA)
Capillary refill - absent in deep burns
Sensation = absent in deep burns
Estimation of depth
Other indications of depth: location, age, co-morbs, multi-system trauma, inhalation

34
Q

What are these criteria for?
burns on:
- Face, hands, feet, genitalia, perineum, major Joints
- Circumferential burns (risk compartment syndrome)
- Electricity burns
- Inhalation injury
- Significant pre-existing medical conditions
- Co-existing trauma
- NAI
>10% BSA in children
> 15 % in adults

A

these are the criteria for the BURNS UNIT

35
Q

The burns unit management will use the Parkland formula. What is this?

A

the parkland formula for the total fluid requirement in 24 hours is:
4ml x TBSA (%) x body weight (Kg)
50% given in first 8 hours, 50% in next 16

36
Q

What is the management of burns in the burns unit?

A 
obs
bloods (FBC, Hct, Gp &amp; save, U&amp;Es, COHb, ABG)
Pt weight
burn area estimation
IV access and fluid resuscitation
catherterise
analgesia, NG feeding, H2 antagonists (dc leaky endothelium), tetanus prophylaxis
photograph, dressings
phystiotherapy (if burns on chest/limbs)
37
Q

What is an fasciotomy?

A

cutting in the fascia to relieve pressure in compartment

- avoids necrosis and renal failure

38
Q

What is a Escharotomy?

A

cutting into tissue
used in full thickness circumferential burns
the tough leathery tissue remaining after a full thickness burn = eschar

39
Q

What is the pathophysiology & Rx of inhalation injury?

A

Airway oedema - Give O2, fluids

Bronchospasm - salbutamol (for dilation)

Depression of ciliary function – Mucosal plugging (= lung casts –> nebs of heparin, acetyl choline = mucolytic too)

:oss of surfactant

Rx also: lavage, physio

40
Q

What is it important to intubate early in inhalation injury?

A

as inflammation /swelling can severely compromise airway

41
Q

What ix can you do for inhalation injury?

A

COHb (carbon monoxide poisoning)
ABG - metabolic acidosis
CXR
fibreoptic bronchoscopy w/lavage

42
Q 
What do these represent:
renal dysfunction
haemoglobinuria
over-transfusion
infection
pulmonary damage
burn encephalopathy
toxic shock syndrome (children- fever, rash, BP  drop, myalgia, )
malnutrition?
A

the complications of inhalation injury

43
Q

What are these:

paraffin, flamazine, Ag?

A

1ry dressings (covers wound, absorbent and non-adehering)

44
Q

What are these:

jelonet, mepital?

A

2ry dressings (covers the 1ry dressing)

45
Q

what are these:

gauze, J-cloths, wool, crepe?

A

3ry dressings (covers 1ry and 2ry)

46
Q

What is the surgical managment of burns?

A

1) excision and grafting
2) scar release - as late stage of wound healing = contraction of the scar
3) reconstruction

47
Q

What is the benefits of each meshed vs sheet grafts?

A

meshed = larger area

sheet grafts = better cosmetic

48
Q

What is an alternative to autograft?

A

allograft = cadaveric - leave on for ~2 weeks as temporary measure

49
Q

What skin substitutes are there?

A

pig skin, skin cultures

biobrane - silicon/nylon mesh and contains porcine demal collagen peptides

Skin - Derm/Plastics (5 decks)

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