OnlineMedEd: Surgery: Trauma - "Burns"

Question 1

Review the degrees of burns.

Answer 1

1st:
- Epidermis intact but erythematous, warm, and tender
- Classic example: sunburn

2nd: also called partial thickness
- Epidermis is destroyed and blisters

3rd: also called full thickness
- Epidermis and dermis are destroyed
- Will appear white and charred
- Painless at the site because nerves are destroyed

Question 2

Which is worse, alkali or acid burn?

Answer 2

Alkali

Question 3

The way to treat chemical burns, whether alkali or acid, is _____________.

Answer 3

through irrigation and observation (with x-rays for peritoneal signs or EGD for examining how destroyed the esophagus is)

Don’t buffer (causes thermal injury due to exothermic reaction), induce emesis (second pass of chemicals will harm esophagus), or place an NG (can induce emesis).

Question 4

Why are inhalational burns dangerous?

Answer 4

The person with an inhalational injury might later compromise their airway due to the delayed inflammatory response to the burn.

Question 5

How can you work up inhalational burns?

Answer 5

You want to monitor their ventilation status, so get ABGs, peak flow, and maybe bronchoscopy. If any of these show poor ventilatory status or compromisation of the airway, then intubate.

Question 6

Review the two mechanisms of injury after a lightning strike.

Answer 6

• Heart: arrhythmia secondary to electrical shock

* Muscles: rhabdomyolysis secondary to bones that heat up and burn surrounding muscle

Question 7

With any thermal burns of the extremity, you need to ask if it is ______________.

Answer 7

circumferential

Circumferential burns are rigid and inflexible. The edema that occurs with a burn will press down on blood vessels due to not being able to push outward. Thus, circumferential burns need to be surgically resected with an escharotomy.

Question 8

Explain the rule of 9s.

Answer 8

• Head: 9%
• Chest: 9% front, 9% back
• Abdomen: 9% front, 9% back
• Right leg: 9% front, 9% back
• Left leg: 9% front, 9% back
• Right arm: 9% total
• Left arm: 9% total
• Genitals: 1%

Question 9

Give the Parkland formula.

Answer 9

(% body surface area burned) x (kg body weight) x 4 = amount to be replaced in 24 hours

Give half over the first 8 hours and half over the next 16.

Question 10

Aside from fluids, you need to treat burn patients with _______________.

Answer 10

early movement and early grafting; infection prophylaxis (topical mupirocin or silver sulfadiazine); pain control