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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
What prophylaxis should the burn patient get in the ER?
Tetanus
26
What is used to evaluate the eyes after a third-degree burn?
Fluorescein
27
What do you monitor during initial assessment and resuscitation of the burn patient?
ABCDEs Urine output Check for eschar Monitor for compartment syndrome
28
What are the signs of smoke inhalation?
``` 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
Diagnostic imaging for smoke inhalation?
Bronchoscopy
30
What lab value assess smoke inhalation
Carboxyhemoglobin >60% associated with 50% mortality Treat with 100% O2 and time
31
How do you manage the airway in a burn patient with an inhalation injury?
Low threshold for intubation due to risk of oropharyngeal swelling 100% O2 until carboxyhemoglobin is ruled out
32
What burns qualify for the parkland formula?
>20% TBSA | Second and third degree only
33
What is the Brooke formula for burn resucitation?
V = TBSA burn % x Wt (kg) x 2cc
34
How is crystalloid given?
Two large-bore peripheral venous catheters
35
Can you place an IV or central line through burned skin?
Yes
36
What is the adult urine output goal?
30-50cc (titrate IVF)
37
Why is glucose-containing IVF contraindicated in burn patients in the first 24 hours?
Due to stress response - glucose levels are already elevated
38
What fluid is used the after first 24 hours postburn?
Colloid D5W and 5% albumin 0.5cc/kg/%BSA
39
Why should D5W IV be administered after 24 hours postburn?
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
Minimal urine output for burn patients?
Adults - 30cc | Children - 1-2cc/kg/hr
41
How is the volume status monitored in the burn victim?
``` URINE OUTPUT* BP HR Peripheral perfusion Mental status ```
42
Why do severely burned patients require nasogastric decompression?
>20% TBSA burns --> paralytic ileus --> vomitting --> aspiration risk --> pneumonia
43
What stress prophylaxis must be given to the burn patient?
H2 blocker to prevent burn stress ulcer (Curling's)
44
What are signs of burn wound infection?
``` 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
Is fever a good sign of infection in burn patients?
NO
46
Common organisms found in burn wound infections?
Staph aureus Pseudomonas Strep Candida albicans
47
How is a burn wound infection diagnosed?
Quantitative burn wound bacterial count >10^5/gram --> infection IV antibiotics
48
How are minor burns dressed?
Gentle cleaning with nonionic detergent Debridement of loose skin and broken blisters Dressed with topical antibacterial and sterile dressing
49
How are major burns dressed?
Cleansing and application to topical antibacterial agent
50
Why are systemic IV antibiotics CI in fresh burns?
Bacteria live in the eschar which is avascular | Therefore, use topical
51
+/- for Silver sulfadiazine (SIlvadene)?
``` Painless Little eschar penetration Misses Psudomonas Idiosyncratic neutrpenia CI - sulfa allergy ```
52
+/- for Mafenide acetate (Sulfamylon)?
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
+/- Polysporin (polymyxin B sulfate)?
Painless Clear Used for facial burns Narrow antimicrobial spectrum
54
Do you give prophylactic systemic antibiotics to burn patients?
No - they do not reduce incidence of sepsis and increase resistance
55
Are prophylactic antibiotics administered for inhalation injury?
No
56
Circumferential, full-thickness burns to the extremities are at risk for what complication?
Distal neurovascular impairment
57
How do you treat distal neurovascular impairment?
Eschartomy
58
What is the major infection complication (other than wound infection) in burn patients?
Pneumonia | Central line infection (Change ever 3-4 days)
59
What electrolyte must be closely followed acutely after a burn?
Sodium
60
How are STSGs nourished in the first 24 hours?
Imbibition | fed from wound bed exudate

Surgical Recall (32 decks)

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