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Derm > Burny Stuff > Flashcards

Burny Stuff Flashcards

1
Q

Pathophysiology from burns

A

Localized and Systemic inflammatory responses

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2
Q

What is happening at the cellular level tissue after a burn?

A

thermal energy denatures and coagulates proteins

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3
Q

Systemic responses from a burn

A

Typically occur with >20% BSA burns. Inflammatory mediators are released from burned tissue. Systems include Cardio, Resp, Metabolic rate, immune

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4
Q

Systemic effects (cardio)

A

Capillary permeability increased-> fluid is lost into interstitial spaces (edema). Myocardial contractility decreases->hypotension, shock

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5
Q

Systemic effects (resp)

A

inhalation/inflammation induces bronchoconstriction. Can lead to resp failure or ARDS

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6
Q

Systemic effects (metabolic)

A

Basal metabolic rate increases which leads to high nutritional demands

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7
Q

Different types of burns

A

Heat, electrical, friction, chemical, radiation

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7
Q

Systemic effects (immune)

A

Down regulation of immune responses, which can lead to infection

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8
Q

How is burn size estimated and why is it important?

A

Extent of burns is estimated as % off TBSA (Does not include superficial burns). Accurate estimation is important to guide therapy and determining transfer to a burn center

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9
Q

3 Methods to estimate TBSA

A

Lund-Browder chart (Children)
Rule of Nines (Fastest for adults)
Palm Method (1 Palm = 0.5% of TBSA, Palm w/ fingers = 1%)

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10
Q

Rule of 9s

A

Head 4.5F, Chest 9F, Abdomen 9F, Arms 4.5F (each), Legs 9F (each), Groin 1

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11
Q

Use the rule of nines to estimate the TBSA of a burn that covers the abdomen, chest, and front of the right arm.

A

22.5% (9 Abdomen + 9 Chest + 4.5 R Arm)

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12
Q

Lund-Browder Chart

A

Adjusted Rule of 9s for children. Head 9F, Torso 18F, Arms 4.5F (each), Legs 7F (each)

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13
Q

Name some suspicious features of burns that may indicate abuse (especially in children)

A
  • Scald burns with sharply demarcated edges and symmetrical
  • shape of an object
  • small circular burns (cigarettes)
  • perineal area
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14
Q

Burn classifications by depth

A

1st: Superficial
2nd: Partial thickness (superficial or deep); blistering
3rd: Full thickness
4th: involves muscle or bone (loss of burned part)

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15
Q

Superficial burns

A

Involves epidermis only
No blistering
Painful, dry, erythematous, and blanching
typical heal time is 3-5 days
No scarring generally
Ex: Sunburns

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16
Q

Treatment for superficial burns

A

Immediate: remove clothing/jewelry. Cool the burn (no ice)
Expectations: self limiting
Symptom management: Room temp/cool tap water. Gently clean with mild soap and water. Oral NSAIDs. No Ice directly to the skin. No topical corticosteroids, cool showers

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17
Q

Spectrum of light that causes sunburn

A

UVA and UVB wavelengths cause burn. Most effective at inducing erythema are in the UVB range.

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18
Q

Sunburn differential Dx

A

Phytophotodermatitis

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19
Q

Sunburn prevention and treatment

A

Reduce exposure, protective clothing
Keep infants out of direct sunlight
Suncreen SPF 30 or higher
Treat with cool compresses or soaks. Stay hydrated

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20
Q

SPF

A

Sun Protection Factor. The ability of a sunscreen to protect against a sunburn reaction from UVB light

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21
Q

What populations would benefit from sunscreen use

A

Everyone (regardless of skin tone). AAD recommends SPF 30+ with water/sweat resistance. Avoid with infants <6months

22
Q

Proper use (qty) of sunsecreen

A

Teaspoon rule: 1tsp face and neck, 2 tsp to front and back torso, 1 tsp each upper extremity, 2 tsp each lower extremity.

Apply 15-30 minutes before sun exposure, reapply every 2 hours

23
Q

Superficial partial thickness burns

A

Epidermis and papillary dermis.
Yes Blisters
Painful, erythematous, moist skin, weeping and blanchable.
Healing time: 1-3 weeks. No scarring but may alter pigment
Increased infection risk

24
Q

Superficial partial thickness burn treatment

A

cool (room temp or cool tap H2O)
AVOID direct ice/ice water
Pain management (Acetaminophen and NSAIDs)
Clean with mild soap and tap water
debridement (before dressing)
Wet dressing (saline infused, individual wrapping)
topical ABx
Tetanus update (if needed)

wet gauze

25
Q

What is the different in Tx between superficial and superficial partial thickness burns?

A

When burns enter the dermis there is an increased risk for infection and topical ABx are indicated.

26
Q

Examples of topical ABx for superficial and partial thickness burns

A

Bacitracin zinc-Polymyxin B sulfate, Neomycin.

Easier to apply and remove than silver containing agents.

Neomycin is associated with allergic reactions

27
Q

+/- of silver containing agents as an antimicrobial

A

It can work! Silver Sulfadiazine

Contras:
Can’t use of the face (yellowing of the skin)
No pregnant or breastfeeding people
Sulfa allergies
impedes reepithelialization

28
Q

When is Bismuth-impregnated Petroleum Gauze indicated?

A

Skin graft donor sites, covering fresh skin grafts.

29
Q

Benefits of Mafenide Acetate as topical antimicrobial

A

Alternative to silver sulfa, although pain when applied, metabolic acidosis can also occur in addition to allergic reactions and tachypenea

30
Q

Benefits of Chlorhexidine as topical antimicrobial

A

Long lasting
does not interfere with re-epithelialization like silver sulfa

31
Q

What are the components of a basic burn dressing?

A

Topical ABx, nonadherent gauze, dry gauze, elastic gauze roll

32
Q

Considerations during dressing changes

A

Individually wrap all toes or fingers to prevent adherence and maceration. Adequate pain control is essential. Topical ointment and nonadherent gauze should be changed at least 1x per day

33
Q

Deep partial thickness burn

A

Epidermis and reticular dermis involved. Damages hair follicles and glandular tissues
Yes blisters
Painful to pressure only, waxy, dry, red yellow or pale skin. Non blanchable (no capillary refill)
Healing time: 2-9 weeks and hypertrophic scarring is expected. Joint involvement leads to chronic joint impairment

34
Q

Tx for deep partial thickness burn

A

No cooling or submerging
Pain management, tetanus update
Wound excision and burn wound closure
Dry, nonstick gauze only if transferring to a burn center
Early burn excision and coverage is essential
Admission to ICU (1/2 – 1 day per % TBSA)
Management includes nutritional support, management of contractures, and psych support

35
Q

Full thickness burn

A

Destroys dermis and enters hypodermis
No blistering
painless, waxy white/grey skin, charred, dry, leathery, non-blanchable
Eschar will be present
severe scarring and contractures is expected w/o surgery

36
Q

Tx for full thickness burn

A

Trauma ABCs eval (airway, breathing, circulation)
Same mgmt as deep partial thickness.
Pain control (high doses of opiods may be needed)
Increased severe infection risk–but use of prophylactic ABx is controversial

37
Q

4th Degree burn

A

Dermis and subcute destroyed–burn extends into fat, muscle, and bone.
No sensation and non-blanchable (nerves destroyed)
Damage is often permanent (amputation indicated)

38
Q

Dx testing for major burns

A

CBC (Hematocrit increased initially)
BMP (hyperkalemia)
Creatinine Kinase (CK) with UA and myoblobin to eval for Rhabdomyolysis
Carboxyhemoglobin (CO poisoning)
Serum lactate (cyanide poisoning)
Arterial blood gas (O2, CO2, pH in serum)
Chest Xray

Monitor end-tidal CO2 (EtCO2) and pulse ox
ECG

Blood typing and cross matching in anticipation of need for transfusion

39
Q

Burn center referral criteria

A

Importance of preserving hands and feet
aggresive PT and OT is vital
minor burns but with underlying health conditions (DM, PVD, immunosuppresion, age)
3rd degree burns

40
Q

Indications for an escharotomy

A

deep partial and full thickness burns that cover >20 % TBSA. Release of compression that could relate to compartment syndrome

41
Q

General approach to burn tramtment

A

A (Airway): Signs of significant smoke inhalation injury (leading cause of death in adult burn victims) and need for potential intubation. Supplemental O2 prn, listen to lungs. upper airway edema is a major concern

B (Breathing): look for signs of breathing impairment (mental status, hypoxia, tachypnea, accessory muscle use). Use bronchodilators for bronchospasms. No corticosteroids

C (Circulation): Risk of Burn Shock, maintain aggressive fluid resuscitation (but not too much). use PARKLAND Formula, monitor urine output

D (Disability and exposure): Neuro status, core body temp (hypothermia risk), tetanus immunization, topical ABx

42
Q

What severity of burn indicates formal fluid resuscitation?

A

> 15% TBSA non-superficial

43
Q

PARKLAND Formula

A

most common method for calculating initial fluid resuscitation.

44
Q

Management of chemical burns

A

Remove individual from exposure area, copious irrigation (especially alkali substances). Monitor pH. Don’t irrigate dry lime, phenols, or elemental metals.

45
Q

common cause of alkalotic burns

A

wet cement

46
Q

Considerations for hydrofluoric acid burns

A

it’s highly corrosive and can cause hypocalcemia and hypomagnesemia (cardiotoxic). Manage with copious water irrigations and topical Ca gluconate gel

47
Q

Treatment for tear gas exposure

A

remove clothing and wash with lots of soap and water

48
Q

What type of electrical injury has the highest morbitiy

A

Low voltage; AC

49
Q

Does skin have high or low resistance? (in regards to electrical burns)

A

high resistance (compared to underlying tissue). Parkland formula not used since skin appearance masks damage to underlying tissue

50
Q

Frostnip

A

1st stage of frostbite; reversible. Localized paresthesia that resolves with rewarming

51
Q

Frostbite

A

freezing of tissue (classified as grade 1-4)

52
Q

Non-freezing cold injuries

A

trench and immersion foot. 2-3 days of cold exposure

Derm (13 decks)

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