In the first week of early excision burns - what happens to CO - what is caloric need - protein need

- CO decreased for 24-48h then increases - 25kcal/day + 30kcal x %burn - protein 1g/kg + 3g x %burn - need glucose- obligatory - excise in first 72 hours- viability based on color, texture, punctate bleeding after removal

Chapter 17 - Burns Flashcards by Ryan Cohen

What is a first degreen burn?

sunburn- epidermis only

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What is are the two types of second degree burns?

superficial dermis (papillary)- painful to touch; blebs and blisters; hair follicles intact; blanches
-Deep dermis (reticular) - Decreased sensation; loss of hair follicles (need graft)

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What are 3rd degree burns?

Leathery feeling (charred parchment); down to subcutaneous fat

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What are 4th degree burns?

Down to bone, into adjacent adipose or muscle tissue

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What are admission criteria for 2nd and 3rd degree burns?

> 10% BSA in pts 50yo
> 20% in all other pts
burns to significant portions of hands, face feet, cock and balls, perineum, or skin on joints
3rd degree in >5% any age

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Other than the criteria for 2nd and 3rd degree burns, what are some criteria for burn admission?

electrical and chemical
concomitant inhalation injury
trauma
social/emotional issues
child abuse or neglect

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Why are kids and elderly highest mortality

bitches cant get away

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what are most common types of burns?

scalds

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what are the most common types of burns to cum to hospital and get admitted?

flamers

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What is the rule of 9’s?

Head 9
arms 9/9
chest 18
back 18
legs 18/18
Taint, cock and balls, lady junk 1%

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What is the parkland formula?

For burns >20% give 4cc/kg x %burn in first 24 hours; give have in the first 8 (LR)
-can grossly underestimate in inhalation injury, etoh, electrical, post escharotomy

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Indications for escharotomy?

circumferential burns
low temperature, weak pulse, low cap refill, low pain sensation, decreased neuro function in extremity
problems ventilating with chest torso burns

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Lung injury from smoke caused by what?

carbonaceous materials and smoke, not heat

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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

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What are the indications for intubation in smoke lung injury?

upper airway stridor or obstruction, worsening hypoxemia

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What is the most common infection in burn patients?

Pneumonia. Also most common cause of death

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What do you do with acid and alkali burns?

copious water irrigation.

alkalis produce deeper burns than acid due to liquefaction necrosis
acud burns produce coagulation necrosis

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What do you do with hydrofluoric acid burns?

spread calcium on wound

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What do you do with powder burns?

wipe away before irrigation

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What do you do with tar burns?

cool, then wipe away with a lipophilic solvent

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What do you do with electrical burns?

cardiac monitoring
can cause rhabdo and compartment syndrome
polyneuritis
polyneuritis
intestinal/gallbladder perf, pancreatic nec.
liver necrosis

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How do smiting lightning bolts kill you?

cardiopulmonary arrest secondary to electrical paralysis of brainstem

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In the first week of early excision burns

what happens to CO
what is caloric need
protein need

CO decreased for 24-48h then increases
25kcal/day + 30kcal x %burn
protein 1g/kg + 3g x %burn
need glucose- obligatory
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

What is best type of skin graft?

split thickness/full thickness - decrease infection, desiccation, protein loss, pain, water loss, heat loss, rbc loss - increases granulation and improves survival

how thick should stsg be?

12-15mm- include epidermis include epidermis and part of dermis

homografts used when?

temporizing- last 2-4wks

how long do xenografts last?

2 wks, do not vascularize

when do you fraft wounds to face, palms, soles, dick, balls, lady junk?

defer for first week

For each burn wound incision, how much blood loss, skin excised, time in OR?

<2 hrs in OR

What are reasons to delay autografting?

``` infection not enough skin septic unstable do not want to create more blood loss with donor sites ```

Most common reason for skin graft loss?

seroma or hematoma formation under graft | -apply pressure dressing to skin graft

why are stsg good compared to ftsg?

more likely to survive | not as thick, so easier for imbibition and subsequent neovascularization

why are ftsg good compared to stsg?

less wound contraction | good for palms and back of hands

How can burn scar hypopigmentation and irregularities be improved?

dermal abration thin split thickness grafts

Weeks to five what to do with the face?

Topical antibiotics for two weeks, full thickness grafts for unhealed areas – nonmeshed

What to do with hand burns for weeks 2-5?

– Superficial – ROM exercises, splint in functional position if too much edema – deep – immobilize for seven days after operation, then physical therapy. May need wire fixation if joints unstable or open. Treat with full thickness graft

What to do with palm burns for weeks 2 to 5?

Try to preserve specialized Palmer attachments. Splinted hand in extension for one week. Graft in week two with full thickness non-meshed autograft graft

How do you prevent burn wound infections?

Apply Neosporin immediately after burns | no role for prophylactic IV antibiotics

What are the most common bacteria in burn infections?

Pseudomonas is most common organism in Burn infection, followed by Staphylococcus, E coli, and Enterobacter

What are side effects of Silvadene? What allergy cat it not be used with?

Can cause neutropenia and thrombocytopenia. Cannot use with sulfa allergy Ineffective against Pseudomonas and GNRs Can cause methemoglobinemia

What are the side effects of silver nitrate?

Can cause electrolyte imbalances – hyponatremia, hypochloremia, hypocalcemia and hypokalemia -Discoloration -Limited eschar penetration Ineffective against some Pseudomonas species and GPCs

What are the problems with Sulfamylon?

Painful application - Metabolic acidosis due to carbonic anhydrase inhibition - Good eschar penetration; good for burns overlying cartilage - Broadest spectrum against pseudomonas and GNRs

What are signs of burn wound infection?

Peripheral edema, second to third degree burn conversion, hemorrhage into scar, Erythema gangrenosum, Green fat, black skin around wound, rapid eschar separation

What is burn wound sepsis usually caused by?

Pseudomonas

What is the most common viral infection in burn wounds?

Hsv

What is the best way to detect burn wound infection?

Biopsy the wound

What are seizures after burns usually caused by?

Usually iatrogenic and related to sodium concentration; can also be benzodiazepine withdrawal

What is peripheral neuropathy after burns caused by?

Secondary to small vessel injury and demyelination

What is Ectapia caused by after Burns?

Burned adnexa. Treatment is eyelid release.

What is a symblepharon after a burn?

Eyelid stuck to conjunctiva. Treat with Eyelid release with a glass rod

What is a curlings ulcer?

Gastric ulcer that occurs with Burns

What is a marjolin's ulcer?

Hey highly malignant squamous cell carcinoma that arises in chronic nonhealing burn wounds or unstable scars

What is a hypertrophic scar, and when does it occur?

- Usually occurs 3 to 4 months after injury secondary to increased neo vascularity - More likely to be deep thermal injuries that take more than three weeks to heal - Wait 1 to 2 years before scar modification - Treat with grafting, steroids, silicone, compression

What is toxic epidermal necrolysis Caused by?

Caused by a variety of drugs including Dilantin, Bactrim, penicillin and viruses - Epidermal dermal separation - Treatment is supportive. Need to prevent wound desiccation with topical antimicrobials and xenograft

What is seen with Stevens Johnson syndrome?

Subepidermal bullae, epidermal cell necrosis, dermal edema | -Hypersensitivity reaction