Flashcards in Burns Deck (27):
1° Burn is?
superficial, no dermis
Red, painful, NO blisters
Heals 1-7 days, no scar
aloe, moisturize, open to air, (P) Bacitracin
2° Burn is?
partial thickness dermis:
superficial or deep thickness
Superficial: wet, pink, painful, blister (scald)
Deep: dry, white, +/- pain, (flame)
(P) grafting, scaring
3° Burn is?
full thickness dermis
hard, leathery, no feeling
almost always needs surgery
4° Burn is?
beyond skin and subQ into mm, tendon, bv, nn, bone
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
7) Pts w/ morbidities that may interfere w/ recovery
8) Burns w/ concomitant trauma
10) Anyone needing special social, emotional, rehab
Burn wound tx?
Mgmt during healing
Acute burn care?
Initial wound care
Need for Burn Resuscitation depends on?
Depth/extent of burn
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+)
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)
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
Fluid needs determined how?
Delay in resusc
Inhalation (30-50% more)
Compartment Synd: Abd or extremity
Extremity Compartment Synd:
Most at risk?
Circumferentially burned extremities
Escharotomy (incision into subQ)
Fasciotomy (incision into mm fascia)
Abdominal Compartment Synd:
↓ urine output
↑ bladder pressure
↑ peak expiratory pressure
Hrly bladder pressure
↓ IV fluids
(P) continuous renal replacement therapy
(P) intraperitoneal catheter or decomp laparotomy
Topical burn meds: 2° Superficial? (2)
petroleum gauze w/ Bismuth Tribromophenate
Soduim carboxy-methylcellulose w/ silver,
Change outer dressing QD
Topical burn meds: 2° Deep or 3°? (2)
Cover w/ gauze
NOT for ears/nose
Mafenide Cream (sulfonamide -> anti-pauedo)
Yes for ears/nose
Management of healed burns? (4)
Burn wound infection, signs?
(colonize 3-5 days, U G+)
Burn scars? (4)
1) Pigment ∆s
2) Keloid (beyond area of injury)
3) Hypertrophic (not beyond injury)
4) Contractures (fibrotic tissue replaces CT)
Post-burn neuropathy more (C) when?
Full thickness burns
Staph Scalded Skin Synd:
(U) < 5yo
Skin peels away in sheets
Necrotising Soft Tissue Infections:
Widespread necrosis of fascia and subQ
Exfoliative Skin Dz a/w <10% TBSA is?
Exfoliative Skin Dz a/w >30% TBSA is?
Toxic Epidermal Necrolysis
Exfoliative Skin Dz: Etiology?
(U) caused by abx, anticonvlu, NSAIDs
Microbes (U) mycoplasma, Herpes (CMV, EBV, varicella)