Burns Flashcards
Grade 1 burn?
Painful, does not blister, no scar
2nd degree burn?
2A) Superficial partial (ytlig delhud)
- Red, blister, pain
2B) Deep partial (djup delhud) > require surgery
- Pallor, blister, leathery less painful
3rd degree burn?
To subcutaneous level
White and insensate - heals with contracture
Two % rules?
9% rule
1% rule (palm of patient)
How to determine depth of burn?
Injury mechanism
Colour
Clean wound!
Moist/dry
Skin loss
Capillary refill (needle not needed)
Sensory/pain
Demarcation
Keep blisters?
No. Though low evidence. Take away the whole!
Toxins inside, pressure on the wound.
Can decrease movement.
Impossible to determine depth.
Dead tissue. Only clean wounds heal.
Theretically good biological wound dressing - mainly for small blisters
Surgical treatment of burns?
Escharotomy
Tangential debridement + skin transplant (serial, 3-4h surgery)
Enzymatic treatment
Escharotomy is done how?
From healthy skin to healthy (may not need anesthesia) - long enough
Almost never on fingers because if needed its probably totally necrotic
PS. not radial on index finger
Include web-space on every digit!
Wounddressing?
Polyuretanskum
- Allevyn (good absorption)- large rolls
- Mepilex
- Jelonet …
Mobilize! Dress digits (fingerlindning)
Orthosis MCP 70 degrees between rehab
What direction of split scin graft mesh-holes?
Same as skin “crack direction”
When to do secondary scar correction?
Approx 18-24 months after injury when skin inflammatory process is gone
How to cool burn?
Not to cold
Don’t cool the patient
5-15 min
Fullthickness for palm?
Not necessary but good on smaller wounds when possible.
Partial thickness ok, do not need to be thick.
When do early surgery?
3rd-4th degree <5 days
2nd degree deep <2-3 weeks
