Plastics Flashcards
What are systemic complications of burns?
Systemic inflammatory immune response , which leads to third spacing and hypovolaemia, hypotension, organ dynfunction.
+/- Sepsis
TSS: group A strep or staph
respiratory comromise from hypoventilation
hypothermia
compartment syndrome
What are some specific organ injuries from burns?
kidneys: myoglobinuria, SIRS, hypotension
Lungs: smoke inhalation and ARDS
endocrine: all electrolytes are low except hyper natraemia
GIT: ileus, curlings ulcer.
What is the initial management for a chemical burn
irrigation
What is the initial concerns for an electrical burn
there will be an entry and exit wound
arrythmia is common (need ECG)
myoglobin uria is common from rhabdomysis (test CK)
What is the difference between a flap and graft ?
flap brings its own blood supply but a graft receives blood supply from the reciepent site.
What are some signs of graft failure?
pallor or discoloration at the site, graft non adherant to the bed, evidence of infection systemic features and necrosis
When would full thickness and split thickness sking grafts be used
split thickness would be harvested from a large area which is too large to close primarily so some granulation tissue is left to regenerate the skin at the the donor site.
which is more concering for a skin flap failure , arterial or venous?
arterial, need to go back to theatre immediately
What is involved in an A-E assessment of someone with burns?
A: directly visualise the airway for any swelling , may require intubation.
B: start 02 via Hudson mask and test blood with ABG for carboxyhaemoglobin to test for carbon monoxide poisioning. If there is a burn across the circumference of the chest may need to perfrom escharotomy if ventilation is impaired.
C: get 2 PIVC in , IVH agressive and IDC for fluid monitoring.
D: temp, risk of hypothermia
E: estimate total body surface burn and tetanus booster , analgesia
when should the burns patient be transferred to the burs centre?
> 40% TBSA or inhalational injuries
Whn is negative pressure wound therapy indicated?
to encourage blood supply to the wound, reduce wound oedema
What are risk factors for melanoma?
Age > 30
family history
previous melanoma
UV exposure
Skintone: fitspatrick 1 and 2
predisposing conditions: immunosupression, ie organ transplant
when examining a skin lesion what is the A-E approach
Asymmetry
Border irregularity
Colour uneven
Diameter >6mm
Evolving lesion
When excising a melanoma what must you excise ?
a 2 mm margin around and below in the fatty tissue
What is the follow up post inital resection adn disgnosis of a melanoma?
send to an MDT
book for wide local resection (even if negative resection margins)
the margin will be dictated by the breslow thickness.
sentinal node biopsy if breslow thickness is > 1 mm
complete staging TNM with CT PEt
What are the consequences of leaving an abscess untreated?
sepsis, nec fasc, cellulits.
What is the initial management of a bite injury
A- E
examine the wound and provide tetanus injection
broad spectirm antibiotic
X-ray for fracture or foriegn body
treat the wound
surgical washout if deep or near the joint
What would be some signs of nec fasc ?
pain out of proportion to the wound
oedema beyond the wound
crepitus (inpolymocrobial cases)
grey dishwater like discharge
focal skin gangrene is a late sign
What are the two types of nec facs?
there is a mono microbial one from clostridium and it causes gas gangreen. and purely strep pyogenes
the other is poly mocrobial and can be commonly staph aureua, sprep pyogenes. gram negs also include E.Coli, bacteroides, pseudomonas.
there is also a vibrio one from marine contamination
What is necrotising fascitiis ?
rapidly progressing
life threatening infectionof the soft tissues
which tracks along the fascial layer
involving the fat and subcutaneous tissues fulminant destruction.
