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Surgery > Fiser ABSITE Ch. 17 Burns > Flashcards

Fiser ABSITE Ch. 17 Burns Flashcards

1
Q

Name the degree of burn:

Sunburn (epidermis)

A

1st

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2
Q

Name the degree of burn:

Painful to touch; blebs and blisters; hair follicles intact; blanches

A

2nd - Superficial dermis (papillary)

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3
Q

Name the degree of burn:

Decreased sensation; loss of hair follicles (need skin grafts)

A

3rd

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4
Q

Name the degree of burn:

Down to bone, into adjacent adipose or muscle tissue

A

4th

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5
Q

Admission criteria for burns:

2nd and 3rd degree burns >10% BSA in pts with what age range?

A

Less than 10 or >50 yrs

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6
Q

Admission criteria for burns:

2nd and 3rd degree in any age with > what % BSA?

A

> 20%

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7
Q

Admission criteria for burns:
2nd and 3rd degree burns in any age, any % BSA with significant portions of hands, feet, face, genitalia, perineum or what other area?

A

overlying major joints

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8
Q

Admission criteria for burns:

3rd degree in any age group with > what BSA %?

A

> 5%

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9
Q

What do the following burn pts share in common?:
electrical and chemical burns, concomitant inhalational injury, mechanical traumas, preexisting medical condition, suspected child abuse or neglect

A

meet admission criteria

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10
Q

What type of burns is most common (flame, scald, chemical, electrical, etc)?

A

Scald

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11
Q

Name the percentage of BSA in burn pt:

Head

A

9

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12
Q

Name the percentage of BSA in burn pt:

Arms

A

18

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13
Q

Name the percentage of BSA in burn pt:

Chest

A

18

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14
Q

Name the percentage of BSA in burn pt: Back

A

18

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15
Q

Name the percentage of BSA in burn pt: Legs

A

36

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16
Q

Name the percentage of BSA in burn pt: Perineum

A

1

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17
Q

Name the percentage of BSA in burn pt: palm (can use to estimate injury)

A

1

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18
Q

What is the Parkland formula?

A

For burns ≥ 20% - give 4 cc/kg × % burn in first 24 hours; give ½ in first 8 hours

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19
Q

Which fluid do you use in burn pts in first 24 hrs?

A

Lactated Ringer’s

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20
Q

What is the best measure of resuscitation in burn pts (with formula in adults and children)?

A

urine output, 0.5-1 cc/kg/hr in adults;

2-4 cc/kg/hr in children

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21
Q

Split-thickness grafts should be ___ mm (include epidermis and part of the dermis)

A

12-15

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22
Q

Homografts (allografts; cadaveric skin) - not as good as autografts • Can be a good temporizing material; last___ weeks • Allografts vascularize and are eventually rejected at which time they must be replaced

A

2-4

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23
Q

Xenografts (porcine) - not as good as homografts; last __ weeks; these do not vascularize

A

2

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24
Q

Wounds to face, palms, soles, and genitals should be deferred for how long?

A

1 week

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25
Q

For each burn wound incision – less than ___ blood loss, less than ___% of skin excised, less than___ hours in OR • Patients can get extremely sick if too much time is spent in OR

A

1 L, 20, 2

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26
Q

What is the most common reason for skin graft loss and what can be done to prevent?

A

seroma or hematoma formation under graft, need to apply pressure dressing (cotton balls) to the skin graft to prevent

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27
Q

Why are split-thinkness grafts better and why are full thickness grafts better

A

STSGs more likely to survive (thinner so easier for imbibition and subsequent revascularization to occur);
FTSGs have less wound contraction and are good for areas such as the palms and back of hands

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28
Q

Burn scar hypopigmentation and irregularities can be improved with ___ thin split-thickness grafts.

A

dermal abrasion

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29
Q

Face and genital burns get topical abx for ___ weeks.

A

2

30
Q

Hand burns:
• Superficial - ROM exercises, splint in functional position if too much ____
• Deep - immobilize for ___ days after operation, then physical therapy. May need wire fixation of joints if unstable or open. Treat with full-thickness grafts

A

Edema;

7

31
Q

Palm burns - try to preserve specialized palmar attachments. Splint hand in extension for how long? Graft in week 2 with full-thickness nonmeshed autograft graft

A

1 week

32
Q

Is there a role for prophylactic IV abx in burns?

A

no

33
Q

What is the most common organism in burn wound infections?

A

pseudomonas

34
Q

Silvadene should not be used in pts with what type of allergy? or in pts with what other condition?

A

sulfa, G6PD (methemoglobinemia)

35
Q

What is the major side effect of silver nitriate in burns?

A

electrolyte imbalances

36
Q

Sulfamylon (mafenide sodium) in burn pts has a painful application and what is the major side effect and what type of burns is best for?

A

metabolic acidosis due to carbonic anyhdrase inhibition, best for burns overlying cartilage, has good eschar penetration

37
Q

Burn would with peripheral edema, 2nd- to 3rd-degree burn conversion, hemorrhage into scar, erythema gangrenosum, green fat, black skin around wound, rapid eschar separation, focal discoloration. These are all signs of what?

A

burn wound infection

38
Q

What is the most common viral infection in burn wounds?

A

HSV

39
Q

What is the best way to detect a burn wound infection and differentiate from colonization (

A

bx of wound

40
Q

What is the usual cause of seizures in a burn pt?

A

iatrogenic related to Na concentration or benzo withdrawal

41
Q

What is symblepharon?

A

eyelid stuck to conjunctiva, can be a complication after burn, tx: release with glass rod

42
Q

What is the tx for heterotopic ossification of tendons in a burn pt?

A

physical therapy, may need surgery

43
Q

Gastric ulcer that occurs with burns?

A

curling’s ulcer

44
Q

What is the highly malignant squamous cell CA that arises in chronic nonhealing burn wounds or unstable scars?

A

Marjolin’s ulcer

45
Q

Hypertrophic scar • Usually occurs ___ after injury secondary to ↑ neovascularity • More likely to be deep thermal injuries that take >3 weeks to heal, heal by contraction and epithelial spread, or heal across flexor surfaces • Wait ___ before scar modification • Tx: grafting, steroids, silicone, compression

A

3-4 months; 1-2 years

46
Q

Epidermal-dermal separation seen with what condition?

A

Toxic epidermal necrolysis

47
Q

Do you give steroids to a pt with Toxic epidermal necrolysis or Stevens-Johnson syndrome (erthema multiforme)?

A

NO

48
Q

Name 4 other factors that can cause the Parkland formula to grossly underestimate volume requirements of a burn pt.

A

inhalation injury, ETOH, electrical injury, postescharotomy

49
Q

Using colloid (albumin) in 1st 24 hrs in burn pt shown to increase what type of complications (can use after 24 hrs)?

A

pulmonary/respiratory

50
Q

What is the timeframe for escharotomy?

A

within 4-6 hrs

51
Q

circumferential burns think ___

A

escharotomy

52
Q

Problems ventilating pt with significant chest torso burns. Consider ___

A

escharotomy

53
Q

Scald burn in child with absence of splash marks, consider what?

A

abuse

54
Q

Is lung injury in burns caused by carbonaceous materials and smoke or heat?

A

carbonaceous materials and smoke

55
Q

Facial burns, wheezing and carbonaceous sputum are all signs and symptoms of what?

A

lung injury

56
Q

Most common infection in burn wound patients. Also most common cause of death after inhalation injury.

A

pneumonia

57
Q

Alkalis produce deeper burns than acid due to ____ necrosis. Acid burns produce ___ necrosis.

A

liquefaction, coagulation

58
Q

What is the main tx in acid and alkali burns?

A

copious water irrigation

59
Q

In hydrofluoric acid burns, spread ____ on wound.

A

calcium

60
Q

In powder burns, ___ before irrigation.

A

wipe away

61
Q

Tx for tar burns is to cool, then wipe away with what type of solvent?

A

lipophilic

62
Q

What is important to monitor in electrical burns?

A

cardiac monitoring

63
Q

What are two complications to consider with electrical burns?

A

rhabdomyolysis and compartment syndrome

64
Q

In lightening strikes, you can see ___ secondary to electrical paralysis of brainstem.

A

cardiopulmonary arrest, do cpr

65
Q

Cardiac output in severely burned patients - first have decreased CO for ___ hours, then have increased CO (ebb and flow phases following burn)

A

24-48

66
Q

What is the formula for caloric needs in a burn pt

A

25 kcal/kg/day + 30 kcal x % burn

67
Q

What is the formula for protein need in a burn pt?

A

1 g/kg/day + 3 g x % burn

68
Q

What is the best source of nonprotein calories in a burn pt?

A

glucose (burn wounds use glucose in an obligatory fashion)

69
Q

Try to excise burn wounds in

A

72

70
Q

In a burn pt, skin grafts contraindicated if culture is positive for ___ or bacteria >10^5

A

beta-hemolytic strep

Surgery (33 decks)

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