SKIN & BURNS W3 Flashcards
Skin consist of which 4 components
- Skin
- Hair
- Sweat glands
- Oil glands
What is the function of the skin?
- Protection
- Temperature regulation
- Waste elimination
- Absorb vitamin D
- Sensation
- Blood reservoir
What are the 3 layers of the skin?
Epidermis
Dermis
Subcutis
The functions of the epidermis are?
- Protect the body
- Keep fluids inside the body
Which components do we find in the dermis?
- Nerves
- Sweat glands
- Hair follicles
- Large Capillary beds
What are the primary functions of subcutis?
- Isolation (fat)
- Blood supply (vessels)
Jaundice is a sign of…
Lever failure (eyes and skin turn yellow due to excessive bilirubin levels)
What are the primary function of Melanin (pigments)
- Protect against UV-Radiation
Urticaria is a sign/symptom of
Systemic allergic reaction (analphylaxia)
An incision is typically…
Longer than deep
Name the 3 phases of wound healing
- Hemostatic phase
- Inflammatory phase
- Proliferative phase
Wound healing can be disturbed by…
- Infection
- Suboptimal surgical technique
- Dead tissue
- Smoking (bad perfusion)
- Leakage of plasma protein
Important steps in wound management
- Hemostasis
- Pain control
- Remove foreign objects
- Cleaning of wound
- Keep wound moist
- Inspect for infection
- Change dressing (every 24-48h)
What should you consider especially with large, dirty, crush or bite wounds?
Keep them open and clean
What are the impaired skin functions caused by burns?
- Fluid balance (barrier function lost)
- Thermoregulation (evaporation)
- Protection (against microbes)
Signs & symptoms of inhalation injury?
- Swelling of tongue
- Burns in mouth/nose
- Stridor/altered voice
How do we classify severity of burns?
- Degree (superficial)
- Degree (partial thickness)
- Degree (full thickness
- Degree (underlying organs etc.)
What are the three zones of a burn injury?
- Zone of coagulation/necrosis
- Zone of stasis
- Zone of hyperemia
Considering the rule of 9 how many percentages covers the whole torso?
36% Front and back combined
Considering the palmar rule how many percentages can you cover with your hand?
Approximately 1%
- Degree burns is minor tissue damage to the…
Epidermis
- Degree burn is damage to…
Epidermis + variable part of dermis
What are the charateristiscs of 2. degree burns?
- Blisters
- Swelling
- Pain
- Detachment of hair
Dense or waxy burns with damage to all layers of the skin are classified as…
- Degree burns
In a 3. degree burn were can you expect painful 2. degree burns?
Most commonly around the edges of the 3. degree burn
What is delayed necrosis?
The progression of a burn wound over the duration of 3-5 days
Why are infections (sepsis) one of the most common complications of burn injuries?
The protective epidermis is damaged/gone so bacteria and other microbes can easily enter the body
Name some of the burns sites that suggests the CAX needs a hospital specialised in burn injuries?
Hands
Feet
Face
Genitalia
TBSA >20%
Deep joint near burns
Inhalation injuries
Circumferencial burns
Signs & symptoms of CO poisoning?
- Confusion
- Headache
- Tachycardia, arrhythmia
- Vomiting
- Dilated pupils
- Cyanosis
- Seizure
- Bounding pulse (patient feels his pulse harder)
What is the ISR rule of 10?
Fluid resuscitation rate = % TBSA x 10ml/hr for adults 40-80kg
For every 10kg above 80kg, increase flow rate by 100ml/hr
What is the fluid resuscitation rate (ISR) for an adult weighting 100kgs with a 25% TBSA?
450ml/hr
25% TBSA x 10ml/hr + 200ml/hr =450ml/hr
Electrical discharge to the body can cause the following 3 things
- Acute renal failure
- Cardiac arrythmias
- Compartment syndrome to extremities
Name the 4 different mechanisms of burn injuries
- Thermal
- Chemical
- Electrical
- Radiation
In chemical burns what does acid do?
Causes coagulation necrosis of tissue
In chemical burns what does alkaline substances do?
Causes liquefaction necrosis of tissue
What are the 3 stages of radiation burns
- Intense burning/tingeling
- Symptom free interval
- Red skin (erythema)
CASE:
CAX has been in a burning building and now presents with:
M: No massive bleeds
A: Patent, singed nostril hairs, rusty voice
R: Tachypnea, bilateral respiration, cyanosis on nails
C: Tachycardia, bounding pulse
H: Dialated pupils, nausea, confusion, headache
O: 1.degree burns on both arms and in the face
P: Does not express pain.
What is your FIRST concern?
You need to consider the possibility of the airway becoming obstructed soon -> Find CRIC set and be ready…
Reassess airway frequently
Per TCCC what are the preferred type of fluid for burn injury resuscitation?
- Lactated ringers
- Isotonic NaCl (saline)
What are the resuscitation goal in fluid therapy for burn injuries?
Urine output of 30-50ml/h
What are one of the cons of using prefabricated burn shields for burn injuries?
They might cause hypothermia
What might be the issue with putting bandage/cling film circumflexial on burn injuries?
Tissue may expand/swell and circumflexial bandage might be too tight
A puncture wound is typically…
Deeper than wide
A patient with a TBSA >30% is likely to have…
Systemic/globalised edeema
