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Surgery Rotation > Derm part 2: burns > Flashcards

Derm part 2: burns Flashcards

1
Q

Are acid or alkali chemical burns more serious?

A

In general, alkali burns are more serious because the body cannot buffer the alkali, thus allowing them to burn for much longer

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2
Q

How is myoglobinuria treated?

A

Hydration with IVF
Alkalization of urine with IV bicarb
Mannitol diuresis

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3
Q

Superficial burns

A

Epidermis only

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4
Q

Partial-thickness burns

A

Epidermis and varying levels of dermis

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5
Q

Full-thickness burns

A

All layers if the skin, including the entire dermis

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6
Q

How do superficial burns present?

A

Painful, dry, red areas that do not form blisters

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7
Q

How do partial thickness burns present?

A

Painful, hypersensitive, swollen, mottled areas with blisters and open weeping surfaces

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8
Q

How do full thickness burns present?

A

Painless, insensate, swollen, dry mottled white, and charred areas

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9
Q

What is the major clinical difference between partial and full-thickness burns?

A

Full thickness burns are painless, and partial thickness burns are painful

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10
Q

By which measure is burn severity determined?

A

Depth of burn and TBSA affected by partial and full thickness burns
TBSA is calculated by the rule of nines in adults and by a modified rule in children

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11
Q

What is the rule of nines?

A 
In an adult the TBSA that is burned can be estimated by the following:
Each upper limb= 9%
Each lower limb= 18%
Anterior and posterior trunk= 18% each
Head and neck=9%
Perineum and genitalia = 1%
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12
Q

What is the rule of the palm?

A

Surface area of the pt’s palm is ~1% of the TBSA used for estimating size of small burns

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13
Q

What is the burn center referral criteria for partial thickness burns?

A

> 20% TBSA

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14
Q

What is the burn center referral criteria for full thickness burns

A

> 5% TBSA
Partial thickness >10% TBSA in children and the elderly
Any burns involving the face, hands, feet, or perineum
Any burns with inhalation injury
Any burns with associated trauma
Any electrical burns

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15
Q

What is the tx of superficial burns?

A

Keep clean
+/- Neosporin
Pain meds

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16
Q

What is the tx of partial thickness burns?

A

Remove blisters: apply antibiotic ointment and dressing
Pain meds
Some use silver bandages
Most partial-thickness burns do not require skin grafting

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17
Q

What is the tx of full thickness burns?

A

Early excision of eschar (within first week postburn) and STSG

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18
Q

How can you decrease bleeding during excision of full thickness burns?

A

Tourniques as possible
Topical epinephrine
Topical thrombin

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19
Q

What prophylaxis should the burn pt get in the ER?

A

Tetanus

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20
Q

What principles guide the initial assessment and resuscitation of the burn pt?

A

ABCDEs, then urine output

Check for eschar and compartment syndromes

21
Q

What are the signs of smoke inhalation?

A 
Smoke and soot in sputum/mouth/nose
Nasal/facial hair burns
Throat/mouth erythema
Hx of loss of consciousness/explosion/fire in small enclosed area
Dyspnea
Low O2 saturation
Confusion
HA
Coma
22
Q

What diagnostic imaging in used for smoke inhalation?

A

Bronchoscopy

23
Q

What lab value assesses smoke inhalation?

A

Carboxyhemoglobin level

Treat with 100% O2 and time

24
Q

How should the airway be managed in the burn pt with an inhalational injury?

A

With a low threshold for intubation
Oropharyngeal swelling may occlude the airway so that intubation is impossible
100% O2 should be administered immediately and continued until significant carboxyhemoglobin is ruled out

25
Q

What is burn shock?

A

Describes the loss of fluid from the intravascular space as a result of burn injury, which causes leaking capillaries that require crystalloid infusion

26
Q

What is the Parkland formula?

A

V= TBSA Burn (%) x weight (kg) x 4

Half of the calculated volume is given in the first 8 hrs, the rest in the next 16 hrs

27
Q

What burns qualify for the Parkland formula?

A

Greater than or equal to 20% TBSA partial and full thickness burns only

28
Q

What is the Brooke formula for burn resuscitation?

A

Replace 2 cc for the 4 cc in the Parkland formula

29
Q

What is the rule of 10s?

A

For determining hourly IVF rate: TBSA x 10 (pts 40-80 kg)

30
Q

How is the crystalloid given?

A

Through two large-bore peripheral venous catheters

31
Q

Can you place an IV or central line through burned skin?

A

Yes

32
Q

What is the adult urine output goal?

A

30-50 cc (titrate IVF)

33
Q

Why is glucose containing IVF contrainidcated in burn pts in the first 24 hours postburn?

A

Pt’s serum glucose will be elevated on its own because of the stress response

34
Q

What fluid is used after the first 24 hrs postburn?

A

Colloid

Use D5W and 5% albumin at 0.5 cc/kg/% burn surface area

35
Q

What is the minimal urine output for burn pts?

A

Adults 30 cc

Children 1-2 cc/kg/hr

36
Q

What is the most important for volume status monitroing in the burn pt?

A

Urine output

37
Q

Why do mostl severely burned pts require nasogastric decompression?

A

Pts with >20% TBSA burns usually develop a paralytic ileus, which leads to vomiting, which leads to aspiration risk, which leads to pneumonia

38
Q

What stress prophylaxis must be given to the burn pt?

A

PPI to prevent burn stress ulcer

39
Q

What are the signs of burn wound infection?

A 
Increased WBC with left shift
Discoloration of burn eschar
Green pigment
Necrotic skin lesion in unburned skin
Edema
Ecchymosis tissue below eschar
Partial-thickness burns that turn into full thickness burns
Hypotension
40
Q

What are the common organisms found in burn wound infections?

A

S. aureus
Pseudomonas
Streptococcus
C. albicans

41
Q

How is a burn wound infection diagnosed?

A

Send burned tissue in question to the lab for quantitative burn wound bacterial count
If the count is >10 to the fifth/gram, infection is present and IV abx should be administered

42
Q

Why are systemic IV abx contraindicated in fresh burns?

A

Bacteria live in the eschar, which is avascular

Thus apply topical antimicrobial agents

43
Q

Advantages and disadvantages of silver sulfadiazine

A

Painless, but little eschar penetration
Misses Pseudomonas and has idiosyncratic neutropenia
Sulfa allergy is a contraindication

44
Q

Advantages and disadvantages of mafenide acetate

A 
Penetrates eschars
Broad spectrum (that misses Staph)
Causes pain on application
Triggers allergic reaction in 7% of pts
May cause acid-base imbalances
Agent of choice for ear burns
45
Q

Advantages and disadvantages of polysporin

A 
Polymyxin B sulfate
Painless
Clear
Used for facial burns
Does not have a wide antimicrobial spectrum
46
Q

Circumferential, full thickness burns to the extremities are at risk for what complication?

A

Distal neurovascular impairment

47
Q

How are circumferential, full thickness burns to the extremities treated?

A

Escharotomy: full thickness longitudinal incision through the eschar with scalpel or electocautery

48
Q

How is carbon monoxide inhalation overdose treated?

A

100% O2 (+/- hyperbaric O2)

49
Q

Which electrolyte must be closely followed acutely after a burn?

A

Sodium

Surgery Rotation (19 decks)

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