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Emergency/surg > E3: Burns > Flashcards

E3: Burns Flashcards

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1
Q

What is the clinical presentation of a superficial burn (AKA first degree)?

A
  • Confined to the epidermal layer
  • red, dry, and painful
  • Blanches with pressure
  • Pain and erythema resolve in 2-3 days and injured epithelium peels around day 4
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2
Q

What is the management of a superficial burn?

A
  • Remove clothing and debris
  • cool with water that is room temp or slightly cooler
  • gentle cleansing
  • topical calamine or aloe
  • topical polysporin
  • OTC Tylenol and NSAIDs PRN
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3
Q

What is the clinical presentation of a superficial partial thickness burn?

A
  • Extends into the dermis
  • pink, moist, blusters
  • painful and blanches
  • Most heal in 7-21 days
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4
Q

What is the clinical presentation of a deep partial thickness burn?

A
  • Mottled color from patchy white to red
  • non blanching, pain with pressure, blisters
  • most heal in 2-9 weeks
  • hypertrophic scarring is common
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5
Q

What is the treatment of a superficial partial thickness burn?

A
  • petroleum based moisturizer vs bacitracin

- occlusive dressing such as xeroform

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6
Q

What is the treatment of a deep partial thickness burn?

A
  • Same as superficial partial thickness burn, unless eschar is present
  • If eschar is present, silver sulfadiazine cream on 4x4 covered with roll gauze
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7
Q

What is the clinical presentation of a full thickness burn?

A

Epidermis and full thickness dermis

  • Eschar (skin charring)
  • dry and non blanching
  • hard, leathery texture
  • painless
  • will not heal spontaneously and requires surgical repair and skin grafting
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8
Q

What is the treatment of a full thickness burn?

A
  • Wash with mild soap and water
  • silver sulfadiazine cream
  • change dressing twice daily
  • surgical debridement and wound closure
  • opioids
  • tetanus booster
  • restoration and close follow up
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9
Q

If a burn involves muscle, tendon, bone, blood vessels, and/or nerves, what kind of burn is it?

A

Beyond full thickness (4th degree

-Life threatening

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10
Q

What physical exam findings are present if a patient was struck by lightning?

A

Lichtenberg figures

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11
Q

If a patient has a circumferential burn, what are they at increased risk for?

A

Compartment syndrome (6Ps: pain, paresthesias, pallor, paralysis, poikilothermia, and pulselessness)

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12
Q

What are the two procedures often performed if there is a circumferential burn?

A

-Escharotomy or a fasciotomy

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13
Q

What is the number one cause of death related to fires?

A

Smoke inhalation

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14
Q

What is the clinical presentation of cyanide poisoning?

A
  • Headache, AMS
  • Skin may have cherry red appearance
  • hypotension, arrhythmia, shock
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15
Q

What is the treatment of cyanide poisoning?

A
  • Hydroxocobalamin is the preferred treatment

- Heme like molecule with complex cobalt atom that binds to cyanocobalamin

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16
Q

When should you intubate for burns?

A

if history suggests airway compromise:

  • closed space smoke exposure
  • carbonaceous sputum
  • facial burns
  • COHb >5
  • hoarse voice
  • singed facial hair
  • If patient is unable to protect their own airway (trauma, opioids)
17
Q

What are the factors that can influence fluid requirements in burns?

A
  • Burn depth
  • inhalation injury
  • delay in resuscitation
  • compartment syndrome
  • electrical burns
18
Q

When is parkland resuscitation required?

A

If TBSA >20

19
Q

What is the parkland formula?

A

4ml LR x kg x TBSA = 24 hours post burn total

-half volume given in first 8 hours post burn and rest given in the remaining 16

20
Q

What are the symptoms of under-resuscitation in burns?

A
  • Intravascular volume depletion

- suboptimal tissue perfusion

21
Q

What are the symptoms of over-resuscitation in burns?

A
  • Results in resuscitation morbidity
  • Abdominal compartment syndrome
  • compartment syndrome
  • pulmonary edema
22
Q

What is the benefit on enteral nutritional support for burns?

A
  • Reduces burn related increase in secretion of catabolic hormones
  • Helps maintain gut mucosal integrity
23
Q

Is TPN recommended for burns?

A

No, it does not prevent the catabolic response to burns, impairs immunity and liver function, and increases mortality

24
Q

What are the protein needs for burn patients?

A

1.5 to 2.0 grams/kg

**vs 0.8 g/kg in a healthy adult

25
Q

What is the clinical presentation of abdominal compartment syndrome?

A

-Decreased urine output, elevated bladder pressure, increased peak expiratory rate, and poor ventilation

26
Q

What is the treatment of abdominal compartment syndrome?

A

If unable to reverse, Decompressive laparotomy

27
Q

What kinds of wounds are prone to tetanus?

A
  • Wounds present for longer than 6 hours
  • Deep (>1cm wounds)
  • grossly contaminated wounds
  • exposed to saliva or feces
  • avulsions, punctures, or crush injuries
  • burns
  • complication of chronic condition (gangrene)
28
Q

What are the chronic complications of burns?

A

-Chronic ulceration, scar contracture, and hypertrophic scarring

29
Q

What is the major concern associated with chronic ulcerations from burns?

A

The development of a marjolin ulcer, a rare and aggressive skin CA

Emergency/surg (9 decks)

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