Chapter 17 - Burns Flashcards
What is a first degree burn?
epidermis only, ie sunburn
What are the two types of second-degree burns?
- superficial dermis (papillary) - painful to touch; blebs and blisters; hair follicles intact; blanches; no intervention needed
- deep dermis (reticular) - decreased sensation; loss of hair follicles; needs excisional debridement and likely graft
What are 3rd-degree burns?
through dermis, down to subcutaneous fat; leathery feeling (charred parchment); requires surgical debridement and graft
What are 4th-degree burns?
Down to bone, adjacent adipose tissue, or muscle tissue
What are admission criteria for 2nd and 3rd-degree burns?
- >10% BSA in pts 50yo (higher risk)
- >20% in all other pts (needs burn resuscitation)
- burns to significant portions of hands, face, feet, perineum, or skin on joints (may cause loss of fct if not treated in hospital)
- 3rd degree in >5% any age
Other than the dimensional/locational criteria for 2nd and 3rd-degree burns, what are some etiological/associated-injury criteria for burn admission?
- electrical and chemical
- concomitant inhalation injury
- trauma
- child abuse or neglect
Why are kids and elderly highest mortality?
difficulty escaping fire - longer exposure
What are most common types of burns?
scalds
What are the most common types of burns to come to the hospital and get admitted?
flame-burns
What is the rule of 9’s?
- head 9
- arms 9/9
- chest 18
- back 18
- legs 18/18
- perineum 1
What is the Parkland formula?
- for burns >20%
- 4cc/kg x %burn in first 24 hours
- give half in the first 8 (LR)
- can grossly underestimate in inhalation injury, EtOH, electrical, post escharotomy
Indications for escharotomy?
- circumferential burns
- extremity w/low temperature, weak pulse, low cap refill, low pain sensation, decreased neuro function
- problems ventilating with chest/torso burns
Lung injury from smoke caused by what?
carbonaceous materials and smoke, not heat
What are the risk factors for airway injury?
What are the signs and symptoms of possible airway injury?
Risks: EtOH, trauma, closed space, rapid combustion, delayed extrication
Signs: facial burns, wheezing, carbonaceous sputum
What are the indications for intubation in smoke lung injury?
upper airway stridor or obstruction, worsening hypoxemia
What is the most common infection in burn patients?
Pneumonia. Also most common cause of death
What do you do with acid and alkali burns?
What is the difference in the pathology of alkali vs acid burns?
- copious water irrigation
- alkalis produce deeper burns than acid due to liquefaction necrosis
- acid burns produce coagulation necrosis
What do you do with hydrofluoric acid burns?
spread calcium gluconate gel on wound
What do you do with powder burns?
wipe away before irrigation
What do you do with tar burns?
cool, then wipe away with a lipophilic solvent (Neosporin works)
What do you do with electrical burns?
- cardiac monitoring
- watch for:
- compartment syndrome
- polyneuritis
- intestinal/gallbladder perf
- pancreatic necrosis
- liver necrosis
How does lightning kill you?
cardiopulmonary arrest secondary to electrical paralysis of brainstem
In the first week of early excision burns…
- What happens to CO?
- What is caloric need?
- What is protein need?
- CO decreased for 24-48h then increases
- 25kcal/day + 30kcal x %burn
- protein 1g/kg + 3g x %burn
- need glucose
- excise in first 72 hours
- viability based on color, texture, punctate bleeding after removal
When is skin graft contraindicated (bacteria)?
beta hemolytic strep + or bacteria >10^5
