BURNS, WOUND HEALING AND WOUND CARE Flashcards
1.PMNs are the first infiltrating cells to enter the wound site
a. True
b. False
A] TRUE. Polymorphnuclear (PMN) Leukocytes are the first infiltrating cells to enter the wound sites and peaking at about 24-48 hours then increase vascular permeability and local prostaglandin release as well as the presence of your chemotactic substances which will all stimulate neutrophil migration
- Which is the initial matrix in healing wounds?
a. Glycosaminoglycan
b. Proteoglycans
c. Collage Type III
d. Collagen Type I
[C] COLLAGE TYPE III. The principal function of collagen is to act as a scaffold in connective tissues, mostly in its Type I, II and III forms. In early healing wounds, TYPE III is laid down first, with the proportion of type I increasing as scar formation progresses and is remodeled
- Once a biofilm colony forms, it will continuously shed bacteria to uncolonized areas
a. True
b. False
[A] TRUE. The presence of biofilms protects bacteria from host defenses. So, once a biofilm colony forms, it will continuously shed bacteria to colonized areas, causing more biofilm colonies to form. Thus, presume its function.
- Components in myofibroblasts responsible for contraction
a. cytoskeletal structure
b. stress fibers
c. smooth muscle myosin
d. aandbonly
e. all of the above
[E] ALL OF THE ABOVE. Normal fibroblasts in possesses a cytoskeletal structure, typically the cells contain alpha-smooth muscle actin in the thick bundles called the stress fibers which give myofibroblasts contractile capability. So, the a-smooth muscle actin is undetectable until 6th day.
- Ischemia is the greatest contributor to diabetic foot ulcer formation
a. True
b. False
[B] FALSE. Major contributors are neuropathy (60-70%), ischemia (15-20%) and a combination of both (15-20%).
- As scar matures, the content proteoglycans gradually increases
a. True
b. False
[B] FALSE. As scar matures, the content proteoglycans gradually decreases.
- Which kind of skin graft is taken from a nonidentical donor or cadaver?
a. autograft
b. heterograft
c. xenogeneic graft
d. allograft
[D] ALLOGRAFT. Allogeneic grafts (allografts, homografts) are transplants from one individual to another of the same species not identical to the donor. May it be from a cadaver.
- Which is false about epithelialization?
a. Final step is establishing tissue integrity
b. The process begins within day 3 of injury
c. It is characterized by proliferation and migration of
epithelial cells adjacent to the wound
d. Cell movement is in a leapfrog fashion
e. none of the above
[B] THE PROCESS BEGINS WITHIN DAY 3 OF INJURY. It usually begins within 1 day of injury and is seen as thickening of the epidermis at the wound edge.
- Which chronic wound presents with dryness of skin, shallow ulcer with a pale base?
a. arterial ulces
b. venous ulcer
c. pressure ulcer
d. diabetic ulcer
[A] ARTERIAL ULCER. These wounds are commonly present at the most distal portions of the extremities such as the interdigital clefts, although more proximal locations are also encountered. It shows dryness of skin, hair loss, scaling and pallor. It is mostly shallow with smooth margins, with a pale base and surrounding skin.
- Which is not part of an effective therapy to combat biofilm?
a. effective removal of biofilm
b. unimodal therapy
c. antimicrobial eradication of bacteria
d. prevention of biofilm recurrence
[B] UNIMODAL THERAPY. To achieve effective therapy to combat biofilm, it may need repetition to multiple times.
1.Burn dressing that confers autolytic debridement
a. Hydrocolloid Dressings
b. Silver Sulfadiazine
c. Silver Nitrate
d. Mafenide Acetate
A] HYDROCOLLOID DRESSINGS. Duoderm/Hydrocolloid Dressings are wafer type of dressing with gel-forming agents, water resistant outer layer, adherent. That provides a moist healing environment and can promote fibrinolysis, angiogenesis and wound healing without softening or breaking down the tissue. It enables autolytic debridement and insulation
- The following are important prognostic factors for burn mortality and morbidity, except;
a. age
b. % TBSA
c. weight
d. inhalational injury
e. NOTA
[C] WEIGHT. Revised Baux Score which accounts for age, burn size and inhalation injury has been found independently associated with mortality and morbidity
- A burn patient was treated with Mafenide acetate. What possible side effect should we watch out for?
a. Methemoglobinemia
b. Metabolic acidosis
c. Electrolyte Extravasation
d. Metabolic Alkalosis
- A burn patient was treated with Mafenide acetate. What possible side effect should we watch out for?
[B] METABOLIC ACIDOSIS. Mafenide Acetate is a topical antimicrobial effective even in the presence of escar. It is absorbed systematically and major side effect is known to be metabolic acidosis since it is from carbonic anhydrase inhibition.
- Formula for calculating total caloric needs in adult burn patients that takes into consideration more factors and is thus more preferred in the ICU setting
a. Schofield equation
b. Harris-Benedict equation c. Curreri Formula
d. Toronto Formula
D] TORONTO FORMULA. Curreri’s Formula may overestimate caloric requirements thus resulting to overfeeding to some patients. So, Toronto Formula is said to be more appropriate since titrating caloric needs will be possible avoiding overfeeding to ICU patients.
- The following compromise treatment for inhalational injury except:
a. Pulmonary Toilet
b. Bronchoconstrictors
c. N-acetyl cysteine
d. Heparin
[B] BRONCHOCONSTRICTORS. Nebulized bronchodilators such as albuterol can be used as primary supportive in treating inhalational injuries.
- A 9-year-old is brought to the emergency room after accidentally touching a hot iron with his forearm. On examination, the burned areas have light pinkish skin and is slightly anesthetic. What is the burn depth?
a. First degree
b. Third degree
c. Fourth degree
d. Second degree (superficial partial)
e. Second degree (deep partial)
[E] SECOND DEGREE (DEEP PARTIAL). Deep partial thickness burn is white to pale pink; moist to dry to waxy, slightly anesthetic which are less painful and will heal 3-5 weeks resulting in hypertrophic scarring and potential contractures.
- Colloids must be initiated for massive burns as early as the first 8 hours’ post-burn
a. True
b. False
[B] FALSE. For massive burns, colloid infusion can be started as early as 12 hours’ post-burn. It is to decrease total fluid replacements and lessen edema.
- A 40-year-old flame burn patient is received at the ER approximately 2 hours post injury. He is estimated to weigh around 65 kgs. Upon examination, he is noted to have partial and full thickness burns involving the half of the Left upper extremity, 1⁄3 of the anterior chest and entire Left lower extremity. How will you resuscitate this patient?
a. 7.4 L in six hours, 7.4 L in the next 16 hours
b. 3.7 L in six hours, 3.7 L in the next 16 hours
c. 6.3 L in eight hours, 6.3 L in the next 16 hours
d. 3.8 L in eight hours, 3.8 L in the next 16 hours
e. 2.9 L in six hours, 2.9 L in the next 16 hours
f. none of the above
B] 3.7 L IN SIX HOURS, 3.7 L IN THE NEXT 16 HOURS
1/2 L upper extremity - 4.5%
1/3 of anterior chest - 6%
entire L lower extremity - 18%
TOTAL %BSA - 28.5%
- 4ml x 65 kg (wt) x 28.5 (%BSA) = 7410 / 24 hours
- 1st half first 6hours = 3705 / 6 hours or 618cc / hr
- 2nd half next 16 hours = 3705 / 16 hours or 232cc / hr
6 hours because it was consulted 2 hours post injury.
- Tangential excision is less bloody than fascial excision but
with greater cosmetic defect
a. True
b. False
[B] FALSE. Fascial excision is less bloody than Tangential excision but with greater cosmetic defect.
- Most common cause of mortality in the first 48 hours is inadequate fluid resuscitation
a. True
b. False
[A] TRUE.
- Early excision for burns is defined as within 2 weeks or 14 days’ post-burn.
a. True
b. False
[B] FALSE. – 7 days.
WOUND CARE(PICS)
________is a bad bruise. It happens when an injury causes blood to collect and pool under the skin. The pooling blood gives the skin a spongy, rubbery, lumpy feel. A hematoma usually is not a cause for concern. It is not the same thing as a blood clot in a vein, and it does not cause blood clots.
HEMATOMA
known as a skin tear, it is a deep break to the skin, tearing it away from the underlying tissue.
AVULSION
