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ABSITE > 17 Burns > Flashcards

17 Burns Flashcards

1
Q

First degree burn

A

Epidermis

Sunburn

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2
Q

Superficial dermis burn (second degree)

A

Papillary dermis
Painful to touch, blebs and blisters, hair follicles intact, blanches
Does NOT need skin grafts

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3
Q

Deep dermis burn (second degree)

A

Reticular dermis
Decreased sensation, loss of follicles
Requires skin grafts

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4
Q

Third degree burn

A

Leathery (charred parchment)

Down to subcutaneous fat

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5
Q

Fourth degree burn

A

Down to bone

Into adjacent adipose or muscle tissue

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6
Q

Admission criteria for a burn center

A

Only relates to 2/3rd degree burns:
- >10% BSA (<10, >50yo)
- >20% BSA anyone
- Hands, face, feet, genitalia, perineum or major joints
3rd degree > 5%
Electrical and chemical burns
Concomitant inhalation injury, mechanical traumas, pre-existing medical conditions
Special social, emotional or long-term rehab needs
Suspected child abuse/neglect

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7
Q

Most common type of burn?

A

Scald

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8
Q

Most common type of burn to present to ED and be admitted?

A

Flame

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9
Q

Parkland formula

A

Burns >20%; only 2nd degree and greater
4cc x kg x % burn

Give 1/2 in first 8 hours, next 1/2 over 16 hours

Underestimates in patients with inhalation injury, ETOH, electrical injury, post-escharotomy

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10
Q

What fluid do you use in the first 24hrs after a burn?

A

Lactated ringers

Colloid (albumin) within the first 24 hours increases pulmonary/respiratory complicaitons

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11
Q

Indications for escharotomy

A

Perform within 4-6 hours

  • Circumferential deep burns
  • Low temp, weak pulse, decreased capillary refill, decreased pain sensation or decreased neurological functioning extremity
  • Problems ventilating patient with significant chest torso burns

If concern for compartment syndrome after escharotomy - perform fasciotomy

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12
Q

Risk factors for burn injuries

A 
Alcohol or dug use
Age (very young/very old)
Smoking
Low SES
Violence
Epilepsy
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13
Q

What is the cause of lung injury in burn patients?

A 
Carbonaceous materials and smoke
NOT heat (protective closing)
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14
Q

Risk factors for airway injury in a burn patient?

A 
ETOH
Trauma
Closed space
Rapid combustion
Extremes of age
delayed extrication
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15
Q

Signs and symptoms of possible airway injury in burn patients?

A

Facial burns
Wheezing, stridor
Carbonaceous sputum

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16
Q

Indications for intubation in burn patients?

A

Upper airway stridor or obstruction
Worsening hypoxemia
Massive volume resuscitation can worsen symptoms

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17
Q

Most common infection in patients with >30% burns? Most common cause of death?

A

Pneumonia

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18
Q

Treatment of acid and alkali burns?

A

Water irrigation

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19
Q

Type of burn that causes liquefaction necrosis?

A

Alkali

Deeper burn

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20
Q

Type of burn that causes coagulation necrosis?

A

Acid

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21
Q

Treatment of hydrofluoric acid burns?

A

Spread calcium on the wound

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22
Q

Treatment of tar burns?

A

Cool

Wipe away with lipophilic solvent (adhesive remover)

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23
Q

Complications of electrical burns

A 
Rhabdomyolysis
Compartment syndrome
Polyneuritis
Quadriplegia
Transverse myelitis
Cataracts
Liver necrosis
Intestinal perforation
Gallbladder perforation
Pancreatic necrosis
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24
Q

Caloric need in first week of burn?

A

25kcal/kg/day + (30kcal x %burn)

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25
Q

Protein need in first week of burn?

A

1g/kg/day + (3g x %burn)

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26
Q

What is the best source of non-protein calories in burn patients?

A

Glucose

Burn wounds use glucose in an obligatory fashion

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27
Q

When do you excise burn wounds? Exceptions?

A

Within 72 hours, but AFTER appropriate fluid resuscitation
Used in deep 2nd, 3rd and 4th degree burns
Exception - face, palms, soles, genitals - defer for 1 week

28
Q

Limitations/goals for burn surgery?

A

< 1L blood loss
< 20% of skin excised
< 2hrs in OR

29
Q

When are skin grafts contraindicated?

A

Positive B-hem strep

Bacterial > 10^5

30
Q

Benefits of Autografts

A

Decreased - infection, desiccation, protein loss, pan, water loss, heat loss and RBC loss

31
Q

What are donor skin sites regenerated?

A

From hair follicles and skin edges

32
Q

Imbibition

A

Osmotic nutrition

Blood supply to skin graft for days 0-3

33
Q

Neovascularization

A

Starts around day 3

34
Q

Where are skin grafts unlikely to do well?

A

Areas of poor vascularized beds

Tendons, bone without periostomy, radiation areas

35
Q

How thick are split-thickeness grafts?

A

12-15mm

Includes epidermis and part of dermis

36
Q

Homografts

A

Cadaveric skin
Temporizing material - last 2-4 weeks
They vascularize and are eventually rejected

37
Q

Xenografts

A

Porcine
Last 2 weeks
Do NOT vascularize

38
Q

Reasons to delay autografting

A

Infection
Not enough skin donor sites
Patient septic or unstable
Do not want to create any more donor sites with concomitant blood loss

39
Q

Most common cause for skin graft loss?

A

SEroma/hematoma

40
Q

STSGs are more likely to:

A

Survive

Easier for imbibition and revascularization due to being thinner

41
Q

FTSGs have less:

A

Wound contraction

Good for palms and back of hands

42
Q

Treatment of facial burns?

A

Topical antibiotics for 1 week

FTSG for unhealed areas (non-meshed)

43
Q

Treatment of hand burns?

A

Superficial - ROM exercise, splint in extension if too much edema
Deep - Immobilize in extension for 7 days after FTSG, then physical therapy

44
Q

Treatment of palm burns?

A

Try to preserve specialized palmar attachments

Splint hand in extension for 7 days after FTGS

45
Q

Treatment of genital burns?

A

Use STSG (meshed)

46
Q

Most common organisms in burn wound infections?

A

Pseudomonas*
Staph
E. coli
Enterobacter

47
Q

Silvadene (silver sulfadiazine)

A 
AE: neutropenia, thrombocytopenia
CI: sulfa allergy
Negative:
- Limited eschar penetration
- Can inhibit epithelialization
- Ineffective against pseudomonas

Good for Candida

48
Q

Silver nitrate

A 
AE: electrolyte imbalance (hyponatremia, hypochloremia, hypocalcemia, hypokalemia), methemoglobinemia
Negative:
- Discoloration
- Limited eschar penetration
- Ineffecetive against pseudomonas, GPCs
49
Q

Sulfamylon (mafenide sodium)

A 
AE: painful application, metabolic acidosis
Positives:
- Good eschar penetration
- Good for burns overlying cartilage
- Broadest spectrum (peudomonas, GNRs)
50
Q

Mupirocin

A

Good for MRSA

Very expensive

51
Q

Signs of burn wound infection?

A 
Peripheral edema
2-3rd degree burn conversion
Hemorrhage into scare
Erythema gangrenosum
Green fat
Black skin around wound
Rapid eschar separation
Focal discoloration
52
Q

Most common cause of burn wound sepsis?

A

Pseudomonas

53
Q

Most common viral infection in burn wound?

A

HSV

54
Q

Best way to detect a burn wound infection (and differentiate from colonization)?

A

Biopsy of burn wound

<10^5 organisms - NOT an infection (just colonization)

55
Q

Complications after burns:

Seizures

A

Iatrogenic - sodium concentrations

56
Q

Complications after burns:

Peripheral neuropoathy

A

Secondary to small vessel injury and demyelination

57
Q

Complications after burns:

Ectopia

A

From contraction of burned adnexa

Tx: Eyelid release

58
Q

Complications after burns:

Corneal abrasions

A

Topical antibiotics

59
Q

Complications after burns:

Symblepharon

A

Eyelids stuck to conjunctiva

Tx: Release with glass rod

60
Q

Complications after burns:

Heterotopic ossification of tendons

A

Tx: Physical therapy, may need surgery

61
Q

Complications after burns:

Fractures

A

Tx: external fixation to allow for treatment of burns

62
Q

Complications after burns:

Curling’s ulcer

A

Gastric ulcer that occurs with burns

63
Q

Complications after burns:

Marjolin’s ulcer

A

Squamous cell CA that occurs in chronic non-healing wounds or unstable scars

64
Q

Complications after burns:

Hypertrophic scar

A

Occurs 3-4 months after injury
Secondary to neovascularity
Increased risk: deep thermal injurys that take >3wks to heal, heal by contraction and epithelial spread, heal across flexor surfaces
Tx: Steroid injection to lesion*, silicone, compression, wait 1-2 years before scar modification surgery

65
Q

Erythema multiforme > Stevens-Johnson syndrome > Toxic epidermal necrolysis

A

EM - least severe, self-limited, target lesions
SJS - More serious, <10% BSA
TEN - most severe

Epidermal-dermal separation
Caused by drugs/viruses
Tx:
- Fluid resuscitation and support
- Prevent wound desiccation with homografts/xenograft wraps
- Topical antibiotics
- IV abx if Staph
- NO steroids
66
Q

Scalded skin syndrome

A

Caused by staph aureus

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