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Fiser absite > Chapter 17 - Burns > Flashcards

Chapter 17 - Burns Flashcards

1
Q

What is a first degreen burn?

A

sunburn- epidermis only

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2
Q

What is are the two types of second degree burns?

A 
superficial dermis (papillary)- painful to touch; blebs and blisters; hair follicles intact; blanches
-Deep dermis (reticular) - Decreased sensation; loss of hair follicles (need graft)
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3
Q

What are 3rd degree burns?

A

Leathery feeling (charred parchment); down to subcutaneous fat

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4
Q

What are 4th degree burns?

A

Down to bone, into adjacent adipose or muscle tissue

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5
Q

What are admission criteria for 2nd and 3rd degree burns?

A
  • > 10% BSA in pts 50yo
  • > 20% in all other pts
  • burns to significant portions of hands, face feet, cock and balls, perineum, or skin on joints
  • 3rd degree in >5% any age
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6
Q

Other than the criteria for 2nd and 3rd degree burns, what are some criteria for burn admission?

A 
electrical and chemical
concomitant inhalation injury
trauma
social/emotional issues
child abuse or neglect
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7
Q

Why are kids and elderly highest mortality

A

bitches cant get away

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8
Q

what are most common types of burns?

A

scalds

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9
Q

what are the most common types of burns to cum to hospital and get admitted?

A

flamers

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10
Q

What is the rule of 9’s?

A
  • Head 9
  • arms 9/9
  • chest 18
  • back 18
  • legs 18/18
  • Taint, cock and balls, lady junk 1%
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11
Q

What is the parkland formula?

A

For burns >20% give 4cc/kg x %burn in first 24 hours; give have in the first 8 (LR)
-can grossly underestimate in inhalation injury, etoh, electrical, post escharotomy

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12
Q

Indications for escharotomy?

A
  • circumferential burns
  • low temperature, weak pulse, low cap refill, low pain sensation, decreased neuro function in extremity
  • problems ventilating with chest torso burns
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13
Q

Lung injury from smoke caused by what?

A

carbonaceous materials and smoke, not heat

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14
Q

What are the risk factors for airway injury? What are the signs and symptoms of possible airway injury?

A

Risks: etoh, trauma, closed space, rapid combustion, delayed extrication

signs: facial burns, wheezing, carbonaceous sputum

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15
Q

What are the indications for intubation in smoke lung injury?

A

upper airway stridor or obstruction, worsening hypoxemia

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16
Q

What is the most common infection in burn patients?

A

Pneumonia. Also most common cause of death

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17
Q

What do you do with acid and alkali burns?

A

copious water irrigation.

  • alkalis produce deeper burns than acid due to liquefaction necrosis
  • acud burns produce coagulation necrosis
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18
Q

What do you do with hydrofluoric acid burns?

A

spread calcium on wound

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19
Q

What do you do with powder burns?

A

wipe away before irrigation

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20
Q

What do you do with tar burns?

A

cool, then wipe away with a lipophilic solvent

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21
Q

What do you do with electrical burns?

A
  • cardiac monitoring
  • can cause rhabdo and compartment syndrome
  • polyneuritis
  • polyneuritis
  • intestinal/gallbladder perf, pancreatic nec.
  • liver necrosis
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22
Q

How do smiting lightning bolts kill you?

A

cardiopulmonary arrest secondary to electrical paralysis of brainstem

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23
Q

In the first week of early excision burns

  • what happens to CO
  • what is caloric need
  • protein need
A
  • CO decreased for 24-48h then increases
  • 25kcal/day + 30kcal x %burn
  • protein 1g/kg + 3g x %burn
  • need glucose- obligatory
  • excise in first 72 hours- viability based on color, texture, punctate bleeding after removal
24
Q

When is skin graft contraindicated (bacteria)?

A

beta hemolytic strep + or bacteria >10^5

25
Q

What is best type of skin graft?

A

split thickness/full thickness

  • decrease infection, desiccation, protein loss, pain, water loss, heat loss, rbc loss
  • increases granulation and improves survival
26
Q

how thick should stsg be?

A

12-15mm- include epidermis include epidermis and part of dermis

27
Q

homografts used when?

A

temporizing- last 2-4wks

28
Q

how long do xenografts last?

A

2 wks, do not vascularize

29
Q

when do you fraft wounds to face, palms, soles, dick, balls, lady junk?

A

defer for first week

30
Q

For each burn wound incision, how much blood loss, skin excised, time in OR?

A

<2 hrs in OR

31
Q

What are reasons to delay autografting?

A 
infection
not enough skin
septic
unstable
do not want to create more blood loss with donor sites
32
Q

Most common reason for skin graft loss?

A

seroma or hematoma formation under graft

-apply pressure dressing to skin graft

33
Q

why are stsg good compared to ftsg?

A

more likely to survive

not as thick, so easier for imbibition and subsequent neovascularization

34
Q

why are ftsg good compared to stsg?

A

less wound contraction

good for palms and back of hands

35
Q

How can burn scar hypopigmentation and irregularities be improved?

A

dermal abration thin split thickness grafts

36
Q

Weeks to five what to do with the face?

A

Topical antibiotics for two weeks, full thickness grafts for unhealed areas – nonmeshed

37
Q

What to do with hand burns for weeks 2-5?

A

– Superficial – ROM exercises, splint in functional position if too much edema
– deep – immobilize for seven days after operation, then physical therapy. May need wire fixation if joints unstable or open. Treat with full thickness graft

38
Q

What to do with palm burns for weeks 2 to 5?

A

Try to preserve specialized Palmer attachments. Splinted hand in extension for one week. Graft in week two with full thickness non-meshed autograft graft

39
Q

How do you prevent burn wound infections?

A

Apply Neosporin immediately after burns

no role for prophylactic IV antibiotics

40
Q

What are the most common bacteria in burn infections?

A

Pseudomonas is most common organism in Burn infection, followed by Staphylococcus, E coli, and Enterobacter

41
Q

What are side effects of Silvadene? What allergy cat it not be used with?

A

Can cause neutropenia and thrombocytopenia.
Cannot use with sulfa allergy
Ineffective against Pseudomonas and GNRs
Can cause methemoglobinemia

42
Q

What are the side effects of silver nitrate?

A

Can cause electrolyte imbalances – hyponatremia, hypochloremia, hypocalcemia and hypokalemia
-Discoloration
-Limited eschar penetration
Ineffective against some Pseudomonas species and GPCs

43
Q

What are the problems with Sulfamylon?

A

Painful application

  • Metabolic acidosis due to carbonic anhydrase inhibition
  • Good eschar penetration; good for burns overlying cartilage
  • Broadest spectrum against pseudomonas and GNRs
44
Q

What are signs of burn wound infection?

A

Peripheral edema, second to third degree burn conversion, hemorrhage into scar, Erythema gangrenosum, Green fat, black skin around wound, rapid eschar separation

45
Q

What is burn wound sepsis usually caused by?

A

Pseudomonas

46
Q

What is the most common viral infection in burn wounds?

A

Hsv

47
Q

What is the best way to detect burn wound infection?

A

Biopsy the wound

48
Q

What are seizures after burns usually caused by?

A

Usually iatrogenic and related to sodium concentration; can also be benzodiazepine withdrawal

49
Q

What is peripheral neuropathy after burns caused by?

A

Secondary to small vessel injury and demyelination

50
Q

What is Ectapia caused by after Burns?

A

Burned adnexa. Treatment is eyelid release.

51
Q

What is a symblepharon after a burn?

A

Eyelid stuck to conjunctiva. Treat with Eyelid release with a glass rod

52
Q

What is a curlings ulcer?

A

Gastric ulcer that occurs with Burns

53
Q

What is a marjolin’s ulcer?

A

Hey highly malignant squamous cell carcinoma that arises in chronic nonhealing burn wounds or unstable scars

54
Q

What is a hypertrophic scar, and when does it occur?

A
  • Usually occurs 3 to 4 months after injury secondary to increased neo vascularity
  • More likely to be deep thermal injuries that take more than three weeks to heal
  • Wait 1 to 2 years before scar modification
  • Treat with grafting, steroids, silicone, compression
55
Q

What is toxic epidermal necrolysis Caused by?

A

Caused by a variety of drugs including Dilantin, Bactrim, penicillin and viruses

  • Epidermal dermal separation
  • Treatment is supportive. Need to prevent wound desiccation with topical antimicrobials and xenograft
56
Q

What is seen with Stevens Johnson syndrome?

A

Subepidermal bullae, epidermal cell necrosis, dermal edema

-Hypersensitivity reaction

Fiser absite (58 decks)

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