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Fiser ABSITE Review + Decker + TrueLearn > Chapter 17 - Burns > Flashcards

Chapter 17 - Burns Flashcards

1
Q

What is a first degree burn?

A

epidermis only, ie sunburn

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2
Q

What is are the two types of second-degree burns?

A
  • 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
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3
Q

What are 3rd-degree burns?

A

through dermis, down to subcutaneous fat; leathery feeling (charred parchment); requires surgical debridement and graft

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4
Q

What are 4th-degree burns?

A

Down to bone, adjacent adipose tissue, or muscle tissue

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5
Q

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

A
  • >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
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6
Q

Other than the dimensional/locational criteria for 2nd and 3rd-degree burns, what are some etiological/associated-injury criteria for burn admission?

A
  • electrical and chemical
  • concomitant inhalation injury
  • trauma
  • child abuse or neglect
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7
Q

Why are kids and elderly highest mortality?

A

difficulty escaping fire - longer exposure

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8
Q

What are most common types of burns?

A

scalds

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9
Q

What are the most common types of burns to come to the hospital and get admitted?

A

flame-burns

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10
Q

What is the rule of 9’s?

A
  • head 9
  • arms 9/9
  • chest 18
  • back 18
  • legs 18/18
  • perineum 1
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11
Q

What is the Parkland formula?

A
  • 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
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12
Q

Indications for escharotomy?

A
  • circumferential burns
  • extremity w/low temperature, weak pulse, low cap refill, low pain sensation, decreased neuro function
  • problems ventilating with chest/torso burns
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13
Q

Lung injury from smoke caused by what?

A

carbonaceous materials and smoke, not heat

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14
Q

What are the risk factors for airway injury?

What are the signs and symptoms of possible airway injury?

A

Risks: EtOH, trauma, closed space, rapid combustion, delayed extrication

Signs: facial burns, wheezing, carbonaceous sputum

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15
Q

What are the indications for intubation in smoke lung injury?

A

upper airway stridor or obstruction, worsening hypoxemia

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16
Q

What is the most common infection in burn patients?

A

Pneumonia. Also most common cause of death

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17
Q

What do you do with acid and alkali burns?

What is the difference in the pathology of alkali vs acid burns?

A
  • copious water irrigation
  • alkalis produce deeper burns than acid due to liquefaction necrosis
  • acid burns produce coagulation necrosis
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18
Q

What do you do with hydrofluoric acid burns?

A

spread calcium gluconate gel on wound

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19
Q

What do you do with powder burns?

A

wipe away before irrigation

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20
Q

What do you do with tar burns?

A

cool, then wipe away with a lipophilic solvent (Neosporin works)

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21
Q

What do you do with electrical burns?

A
  • cardiac monitoring
  • watch for:
    • compartment syndrome
    • polyneuritis
    • intestinal/gallbladder perf
    • pancreatic necrosis
    • liver necrosis
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22
Q

How does lightning kill you?

A

cardiopulmonary arrest secondary to electrical paralysis of brainstem

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23
Q

In the first week of early excision burns…

  • What happens to CO?
  • What is caloric need?
  • What is protein need?
A
  • 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
24
Q

When is skin graft contraindicated (bacteria)?

A

beta hemolytic strep + or bacteria >10^5

25
Q

What are the different types of skin graft?

A
  • split thickness/full thickness
  • decrease infection, desiccation, protein loss, pain, water loss, heat loss, RBC loss
  • increases granulation and improves survival
26
Q

How thick should STSG be?

A

12-15mm - include epidermis and part of dermis

27
Q

Homografts used when?

A

temporizing - last 2-4wks

28
Q

How long do xenografts last?

A

2 wks; they do not vascularize

29
Q

When do you graft wounds to face, palms, soles, perineum?

A

defer for first week

30
Q

What are reasons to delay autografting?

A

Skin septic, unstable, do not want to create more blood loss with donor sites

31
Q

Most common reason for skin graft loss?

How do you prevent this?

A

seroma or hematoma formation under graft

apply pressure dressing to skin graft

32
Q

Benefits of STSG compared to FTSG?

A

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

33
Q

Benefits of FTSG compared to STSG?

A

less wound contraction; good for palms and back of hands

34
Q

How can burn scar hypopigmentation and irregularities be improved?

A

Dermal abrasion, thin split thickness grafts

35
Q

What to do with burns to the face?

A

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

36
Q

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

A
  • 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
37
Q

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

A
  • Try to preserve specialized palmer attachments.
  • Splint hand in extension for one week.
  • Graft in week two with full thickness non-meshed autograft graft
38
Q

How do you prevent burn wound infections?

A

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

39
Q

What are the most common bacteria in burn infections?

A

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

40
Q

What are side effects of Silvadene?

What allergy can it not be used with?

A

Can cause neutropenia and thrombocytopenia.

Cannot use with sulfa allergy.

Ineffective against Pseudomonas and GNRs.

Can cause methemoglobinemia.

41
Q

What are the side effects of silver nitrate?

A
  • Can cause electrolyte imbalances – hyponatremia, hypochloremia, hypocalcemia and hypokalemia
  • Discoloration
  • Limited eschar penetration
  • Ineffective against some Pseudomonas species and GPCs
42
Q

What are the problems with Sulfamylon?

A
  • Painful application
  • Metabolic acidosis due to carbonic anhydrase inhibition
  • Good eschar penetration
  • Good for burns overlying cartilage
  • Broadest spectrum against Pseudomonas and GNRs
43
Q

What are signs of burn wound infection?

A
  • Peripheral edema, second to third-degree burn conversion, hemorrhage into scar
  • Erythema gangrenosum
  • Green fat, black skin around wound, rapid eschar separation
44
Q

What is burn wound sepsis usually caused by?

A

Pseudomonas

45
Q

What is the most common viral infection in burn wounds?

A

HSV

46
Q

What is the best way to detect burn wound infection?

A

Biopsy the wound

47
Q

What are seizures after burns usually caused by?

A

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

48
Q

What is peripheral neuropathy after burns caused by?

A

Secondary to small vessel injury and demyelination

49
Q

What is Ectapia caused by after Burns?

A

Burned adnexa. Treatment is eyelid release.

50
Q

What is a symblepharon after a burn?

A

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

51
Q

What is a Curlings ulcer?

A

Gastric ulcer that occurs with burns

52
Q

What is a Marjolin’s ulcer?

A

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

53
Q

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

A
  • Deposits of excessive amounts of collagen which give rise to a raised scar
  • Not outside boundaries of injury
  • Usually occurs 3 to 4 months after injury
  • 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
54
Q

What is toxic epidermal necrolysis Caused by?

A
  • 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
55
Q

What is seen with Stevens-Johnson syndrome?

A

Subepidermal bullae, epidermal cell necrosis, dermal edema

Hypersensitivity reaction

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