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Q4 EM Surg > Burns > Flashcards

Flashcards in Burns Deck (27):
1

1° Burn is?

Signs?

Heals?

Tx?

superficial, no dermis

Red, painful, NO blisters

Heals 1-7 days, no scar

aloe, moisturize, open to air, (P) Bacitracin

2

2° Burn is?

Signs?

Heals?

partial thickness dermis:
superficial or deep thickness

Superficial: wet, pink, painful, blister (scald)
Deep: dry, white, +/- pain, (flame)

(P) grafting, scaring

3

3° Burn is?

Signs?

Heals?

full thickness dermis

hard, leathery, no feeling

almost always needs surgery

4

4° Burn is?

beyond skin and subQ into mm, tendon, bv, nn, bone

5

ABA Burn Center Referral when?

1) 2° > 10% total SA
2) Face, hands/feet, genitalia/perineum, major joints
3) 3° all ages
4) Electrical, including lightening
5) Chemical
6) Inhalation
7) Pts w/ morbidities that may interfere w/ recovery
8) Burns w/ concomitant trauma
9) Children
10) Anyone needing special social, emotional, rehab

6

Burn wound tx?

Debridement
Topicals
Mgmt during healing

7

Acute burn care?

Resuscitation
Initial wound care
Operative mgmt

8

Need for Burn Resuscitation depends on?

Depth/extent of burn
Pre-exist illness
Inhalation burn

9

Burn shock pathophysio?

(>20% TBSA = highest risk for shock)

Rapid edema (peak 12 hrs) ->
↑ perfusion to burn ->
↑ cap permeability (histamine/PGs/kinins, ↑ edema in non-burned tissue) ->
↓ oncotic pressure (proteins into interstit) ->
↓ cell memb potential (cells swell for influx of Na+)

10

Zones of burn wound? (3)

1) Zone of coagulation (non-viable)
2) Zone of ischemia (risk of becoming non-viable)
3) Zone of hyperemia (not burned but affected by vasodial)

11

Goal of Resuscitation?

Maintain tissue perfusion to end organs

End point measured by urine output (thru foley)

Adults = 0.5 mL/kg/hr
Kids = 1
Eleictrical burns = 1-2

12

Fluid needs determined how?

Burn depth
Delay in resusc
Compartment synd
Electrical (myoglobinuria)
Inhalation (30-50% more)

13

Over-resuscitation causes?

Morbidity
Compartment Synd: Abd or extremity
Airway obstr
Pulmonary edema

14

Extremity Compartment Synd:

Most at risk?

Signs?

Tx?

Circumferentially burned extremities

6 Ps:
Pain
Paresthesia
Pallor
Paralysis
Poikliothermia
Pluselessness

Escharotomy (incision into subQ)
Fasciotomy (incision into mm fascia)

15

Abdominal Compartment Synd:

Signs?

Monitor?

Tx?

↓ urine output
↓ vent
↑ bladder pressure
↑ peak expiratory pressure

Hrly bladder pressure

↓ IV fluids
(P) continuous renal replacement therapy
(P) intraperitoneal catheter or decomp laparotomy

16

Topical burn meds: 2° Superficial? (2)

Xeroform:
petroleum gauze w/ Bismuth Tribromophenate
+ bacitracin,
Change QD

Aquacel Ag:
Soduim carboxy-methylcellulose w/ silver,
Keep dry,
Change outer dressing QD

17

Topical burn meds: 2° Deep or 3°? (2)

Silver sulfadiazine:
Cover w/ gauze
Change BID
NOT for ears/nose

Thick Eschar:
Mafenide Cream (sulfonamide -> anti-pauedo)
(P) painful
Yes for ears/nose

18

Management of healed burns? (4)

Moisturize
Sunscreen
ROM
Scar massage

19

Burn wound infection, signs?

(colonize 3-5 days, U G+)
+/- fever
↑ edema/erythema
↑ pain

20

Burn scars? (4)

1) Pigment ∆s
2) Keloid (beyond area of injury)
3) Hypertrophic (not beyond injury)
4) Contractures (fibrotic tissue replaces CT)

21

Post-burn neuropathy more (C) when?

Adults
Electrical burns
Full thickness burns
>20% TBSA

22

Staph Scalded Skin Synd:

Etiology?

Presentation?

Tx?

Staph toxins
(U) < 5yo

Skin peels away in sheets

IV abx

23

Necrotising Soft Tissue Infections:

Etiology?

Presentation?

Tx?

(U) polymicrobial

Pain/edema ->
Widespread necrosis of fascia and subQ

Emergency debridement

24

Exfoliative Skin Dz a/w <10% TBSA is?

Steven-Johnson Synd

25

Exfoliative Skin Dz a/w >30% TBSA is?

Toxic Epidermal Necrolysis

26

Exfoliative Skin Dz: Etiology?

(U) caused by abx, anticonvlu, NSAIDs

Microbes (U) mycoplasma, Herpes (CMV, EBV, varicella)

27

Exfoliative Skin Dz: Presentation?

Fever/malaise prodrome ->
Sudden skin burning, vesicle formation ->
Skin and muc memb involvement ->
dermal/epiderm separation