General Surgery - Burns Flashcards
(64 cards)
# Define: TBSA
Total Body Surface Area
Define STSG
Split Thickness Skin Graft
Are acid or alkali chemical
burns more serious?
In general, ALKALI burns are more
serious because the body cannot buffer
the alkali, thus allowing them to burn for
much longer
Why are electrical burns so
dangerous?
Most of the destruction from electrical
burns is internal because the route of
least electrical resistance follows nerves,
blood vessels, and fascia; injury is
usually worse than external burns at
entrance and exit sites would indicate;
cardiac dysrhythmias, myoglobinuria,
acidosis, and renal failure are common
How is myoglobinuria
treated?
To avoid renal injury, think “HAM”:
Hydration with IV fluids
Alkalization of urine with IV
bicarbonate
Mannitol diuresis
Define level of burn injury:
First-degree burns: Epidermis only
Second-degree burns: Epidermis and varying levels of
dermis
Third-degree burns: A.k.a. “full thickness”; all layers of the
skin including the entire dermis (Think:
“getting the third degree”)
Fourth-degree burns: Burn injury into bone or muscle
How do first-degree burns
present?
Painful, dry, red areas that do not form blisters (think of sunburn)
How do second-degree burns
present?
Painful, hypersensitive, swollen, mottled areas with blisters and open weeping
surfaces
How do third-degree burns
present?
Painless, insensate, swollen, dry, mottled white, and charred areas; often described
as dried leather
What is the major clinical
difference between second-
and third-degree burns?
Third-degree burns are painless, and second-degree burns are painful
By which measure is burn
severity determined?
Depth of burn and TBSA affected by second- and third-degree burns
TBSA is calculated by the “rule of
nines” in adults and by a modified
rule in children to account for the
disproportionate size of the head and
trunk
What is the “rule of nines”?
In an adult, the total body surface area
that is burned can be estimated by the
following:
Each upper limb = 9%
Each lower limb = 18%
Anterior and posterior trunk = 18% each
Head and neck = 9%
Perineum and genitalia = 1%
What is the “rule of the palm”?
Surface area of the patient’s palm is ~1%
of the TBSA used for estimating size of
small burns
What is the burn center referral
criteria?
Second-degree burns: >20% TBSA
Third-degree burns: >5% TBSA
Second degree >10% TBSA in children
and the elderly
Any burns involving the face, hands, feet,
or perineum
Any burns with inhalation injury
Any burns with associated trauma
Any electrical burns
What is the treatment of
first-degree burns?
Keep clean, _+_Neosporin®, pain meds
What is the treatment of
second-degree burns?
Remove blisters; apply antibiotic ointment (usually Silvadene®) and
dressing; pain meds
Most second-degree burns do not require
skin grafting (epidermis grows from
hair follicles and from margins)
What are some newer
options for treating a
second-degree burn?
- Biobrane® (silicone artificial epidermis—temporary)
- Silverlon® (silver ion dressings)
What is the treatment of
third-degree burns?
Early excision of eschar (within first week postburn) and STSG
How can you decrease
bleeding during excision?
Tourniquets as possible, topical epinephrine, topical thrombin
What is an autograft STSG?
STSG from the patient’s own skin
What is an allograft STSG?
STSG from a cadaver (temporary
coverage)
What thickness is the STSG?
10/1000 to 15/1000 of an inch (down to
the dermal layer)
What prophylaxis should the
burn patient get in the ER?
Tetanus
What is used to evaluate the
eyes after a third-degree burn?
Fluorescein
