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Surgical Recall > SR 39 - Burns > Flashcards

SR 39 - Burns Flashcards

1
Q

Define TBSA

A

Total Body Surface Area

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2
Q

Define STSG

A

Split thickness skin graft

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3
Q

Are acid or alkali chemical burns more serious?

A

ALKALI

Body cannot buffer it - they burn for longer

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4
Q

Why are electrical burns so dangerous?

A 
Internal destruction along areas of least resistance - nerves, blood vessels, fascia
Cardiac dysrhythmias
Myoglobinuria
Acidosis
Renal failure
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5
Q

How do you treat myoglobinuria?

A

To avoid renal injury - HAM

  • Hydration with IV fluids
  • Alkalization with IV bicarbonate
  • Mannitol diuresis
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6
Q

Define first-degree burn

A

Epidermis only

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7
Q

Define second-degree burn

A

Epidermis and varying levels of dermis

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8
Q

Define third-degree burn

A

Full thickness

All the layers, including the dermis

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9
Q

Define fourth-degree burn

A

Burn injury into bone or muscle tissue

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10
Q

How do first-degree burns present?

A

Painful, dry, red - no blisters

Sunburn

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11
Q

How do second-degree burns present?

A

Painful, hypersensitive, swollen, mottled areas with blisters, open weeping

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12
Q

How do third-degree burns present?

A

Painless, insensate, swollen, dry mottled white, charred area
Described as dried leather

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13
Q

How do you determine burn severity?

A

Depth of burn and TBSA

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14
Q

What is the rule of nines?

A 
TBSA determination
Each upper limb = 9%
Each lower limb = 18%
Anterior and posterior trunk = 18% each
Head and neck = 9%
Perineum and genitalia = 1%
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15
Q

What is the rule of the palm?

A

Palm of hand = 1% TBSA

Good for smaller burns

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16
Q

Burn center referral criteria for second-degree burns?

A

> 20% TBSA

>10% in children and elderly

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17
Q

Burn center referral criteria for third-degree burns?

A

> 5% TBSA

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18
Q

Burn center referral criteria for any burns?

A

On the face, hands, feet perineum
Associated with inhalation injury
Associated with trauma
Any electrical burn

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19
Q

Treatment of first-degree burns?

A

Keep clean
Neosporin
Pain meds

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20
Q

Treatment of second-degree burns?

A

Remove blister
Antibiotic ointment (Silvadene) and dressing
Pain meds

Generally do not need skin grafting (epidermis grows from hair follicles and from margins)

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21
Q

What are some newer options for treating a second-degree burn?

A

Biobrane (silicone artificial epidermis - temporary)

Silverlon (silver ion dressing)

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22
Q

What is the treatment of third-degree burns?

A

Early excision of eschar (Within first week postburn)

STSG

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23
Q

How can you decrease bleeding during excision?

A

Tourniquests as possible
Topical epinephrine
Topical thrombin

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24
Q

What is the thickness of the STSG?

A

10/1000 to 15/1000 of an inch (down to dermal layer)

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25
Q

What prophylaxis should the burn patient get in the ER?

26
Q

What is used to evaluate the eyes after a third-degree burn?

A

Fluorescein

27
Q

What do you monitor during initial assessment and resuscitation of the burn patient?

A

ABCDEs
Urine output
Check for eschar
Monitor for compartment syndrome

28
Q

What are the signs of smoke inhalation?

A 
Smoke and soot in sputum/mouth/nose
Nasal/facial hair burns
Carboxyhemoglobin
Throat/mouth erythema
History of LOC/explosion/fire in enclosed area
Dyspnea
Low O2 saturation
Confusion
headache
Coma
29
Q

Diagnostic imaging for smoke inhalation?

A

Bronchoscopy

30
Q

What lab value assess smoke inhalation

A

Carboxyhemoglobin
>60% associated with 50% mortality
Treat with 100% O2 and time

31
Q

How do you manage the airway in a burn patient with an inhalation injury?

A

Low threshold for intubation due to risk of oropharyngeal swelling
100% O2 until carboxyhemoglobin is ruled out

32
Q

What burns qualify for the parkland formula?

A

> 20% TBSA

Second and third degree only

33
Q

What is the Brooke formula for burn resucitation?

A

V = TBSA burn % x Wt (kg) x 2cc

34
Q

How is crystalloid given?

A

Two large-bore peripheral venous catheters

35
Q

Can you place an IV or central line through burned skin?

36
Q

What is the adult urine output goal?

A

30-50cc (titrate IVF)

37
Q

Why is glucose-containing IVF contraindicated in burn patients in the first 24 hours?

A

Due to stress response - glucose levels are already elevated

38
Q

What fluid is used the after first 24 hours postburn?

A

Colloid
D5W and 5% albumin
0.5cc/kg/%BSA

39
Q

Why should D5W IV be administered after 24 hours postburn?

A

Due to massive sodium load with the LR infusion during first 24 hours and massive evaporation fo H2O from burn injury
Patient needs free water
After 24 hours, the capillaries work again - patient can benefit from albumin and D5W

40
Q

Minimal urine output for burn patients?

A

Adults - 30cc

Children - 1-2cc/kg/hr

41
Q

How is the volume status monitored in the burn victim?

A 
URINE OUTPUT*
BP
HR
Peripheral perfusion
Mental status
42
Q

Why do severely burned patients require nasogastric decompression?

A

> 20% TBSA burns –> paralytic ileus –> vomitting –> aspiration risk –> pneumonia

43
Q

What stress prophylaxis must be given to the burn patient?

A

H2 blocker to prevent burn stress ulcer (Curling’s)

44
Q

What are signs of burn wound infection?

A 
Increased WBC with left shift
Discoloration of burn eschar*
Green pigment
Necrotic skin lesion in unburned skin
Edema
Echymosis below eschar
Hypotension
Worsening of burn
45
Q

Is fever a good sign of infection in burn patients?

46
Q

Common organisms found in burn wound infections?

A

Staph aureus
Pseudomonas
Strep
Candida albicans

47
Q

How is a burn wound infection diagnosed?

A

Quantitative burn wound bacterial count
>10^5/gram –> infection
IV antibiotics

48
Q

How are minor burns dressed?

A

Gentle cleaning with nonionic detergent
Debridement of loose skin and broken blisters
Dressed with topical antibacterial and sterile dressing

49
Q

How are major burns dressed?

A

Cleansing and application to topical antibacterial agent

50
Q

Why are systemic IV antibiotics CI in fresh burns?

A

Bacteria live in the eschar which is avascular

Therefore, use topical

51
Q

+/- for Silver sulfadiazine (SIlvadene)?

A 
Painless
Little eschar penetration
Misses Psudomonas
Idiosyncratic neutrpenia
CI - sulfa allergy
52
Q

+/- for Mafenide acetate (Sulfamylon)?

A

Penetrates eschars
Misses Staph
Pain on application
7% of patients will have allergic reactions
Acid-base imbalances - metabolic acidosis

Agent of choice in contaminated burn wounds

53
Q

+/- Polysporin (polymyxin B sulfate)?

A

Painless
Clear
Used for facial burns
Narrow antimicrobial spectrum

54
Q

Do you give prophylactic systemic antibiotics to burn patients?

A

No - they do not reduce incidence of sepsis and increase resistance

55
Q

Are prophylactic antibiotics administered for inhalation injury?

56
Q

Circumferential, full-thickness burns to the extremities are at risk for what complication?

A

Distal neurovascular impairment

57
Q

How do you treat distal neurovascular impairment?

A

Eschartomy

58
Q

What is the major infection complication (other than wound infection) in burn patients?

A

Pneumonia

Central line infection (Change ever 3-4 days)

59
Q

What electrolyte must be closely followed acutely after a burn?

60
Q

How are STSGs nourished in the first 24 hours?

A

Imbibition

fed from wound bed exudate

Surgical Recall (32 decks)

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