Surgery
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Burn epidemiology | Adult: flame burns/clothing ignition; kids: scalds
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1st degree burns heal within: | 3-6 days
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Superficial 2nd degree | due to flame, scalding, chem. Edema; skin pink/ red, often blisters; hypersensitivity; healing 10-21 days
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Deep 2nd degree | More destruction than superficial; involves some skin appendages; large blisters or bullae, often ruptured, skin red or pale; decreased sensation/ circulation, may be pale; healing >21 days
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3rd degree | d/t prolonged exposure to heat or severe exposure; extensive edema; skin moist/ weeping, charred skin or pale; no sensation, circulation; will not heal spontaneously, requires grafting
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Laryngeal edema d/t smoke inhalation usually occurs: | within 24 hours of the injury (but poss any time); intubate pre-emptively
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Baseline labs: | ABG, CBC, electrolytes, glucose, UA, carbon monoxide level; determine tetanus status
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Pt's hand is ___% of BSA | 1%
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BSA chest + abdomen | 9 + 9 = 18%
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BSA head | 2 X 4.5 = 9%
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BSA: arms | 2 X 4.5 = 9% each arm; 18% for both arms
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BSA: lower extremities | 2 x 9 = 18% each leg; 36% both legs
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Major burns: disposition | transfer to the nearest regional burn center
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Definition of major burns | Partial thickness >25% BSA; Full thickness >10% BSA; burns of the face, eyes, ears, hands, feet or perineum
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Moderate burns | Partial thickness of 15-25% BSA; Full thickness burns of 2-10% of BSA (except if it includes critical areas); excludes high voltage electrical injury, inhalational injury, high risk-patients, or a multi-trauma burn pt
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Parkland formula | 4 mL/kg x % total BSA (kids: 3mL). Half given over 1st 8 hrs, 2nd half given over next 16 hrs
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Smoke inhalation | 33% of pts admitted to burn ctr; d/t toxic damage to resp epithelium; inflammation/ necrosis
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Most common cause of morbidity in smoke inhalation patients | Pneumonia
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To dx smoke inhalation injury: | Fiberoptic bronchoscopy
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Smoke inhalation injury: tx | Humidified O2 (100% if CO tox); mucolytics; pulmonary physiotherapy; consider intubation; usu heal in 2-3 wks
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Electrical injury | may be worse than it looks; may need fasciotomy; poss extensive mx damage & cardiac arrhythmias; 1/3 of pts need amputation
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Monitor electrical burn pts for: | myoglobinuria
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Escharotomy/Fasciotomy may be needed for: | Electrical burns; circumferential full-thickness burns; chest wall involvement impairing resp; compartment syndrome
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Chemical burns | Wash thoroughly, copious amounts water to decontaminate; get pH to 7.0 (litmus paper)
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Alkali vs acid burns | Alkali cause more damage than acid
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conjunctival pallor is due to: | severe ocular injury from alkali
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Most common pathogens in burns: | S. Aureus and Pseudomonas (topical Abx prevent invasion)
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Which topical antimicrobial agent has the ability to penetrate eschar? | Mafenide acetate
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Topical Abx | Ag NO3, Ag sulfadiazine; Mafenide acetate
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If systemic Abx are indicated (discolored, erythema, edema, high temp): | Broad spectrum: PCN, ceph, macrolides
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skin grafting is indicated for: | 3rd degree and deep 2nd degree
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Biologic dressings | Gold standard: Human allograft; also porcine xenografts, synthetics
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Burn type: erythema, mild discomfort | 1st degree: outer dermis layer
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Burn type: blister formation, tissue edema, plasma leakage | 2nd degree: Superficial (upper dermis portion) or Deep (involving most but not entire dermis). Often caused by short flash / scalding liquid
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Burn type: painless, leathery, charred appearance | 3rd degree: full thickness. Often due to high electrical current, prolonged fire exposure, immersion in scalding liquid or chemicals
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