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SB82 Burns

SB82 Burns - loosely taken from Fiser's ABSITE review

QuestionAnswer
Sensory difference between superficial and deep second degree burns Superficial is painful, deep has decreased sensation
Admission criteria for burned patients 2nd/3rd degree > 10% in ages <10 and > 50; 2nd/3rd degree >20% otherwise; 2nd/3rd degree burns to hands / feet / face / genitalia / perineum / major joints; 3rd degree burns > 5%; electrical; chemical; inhalational injury; suspected child abuse/neglect
Most common type of burn ___________ Scald
Use of colloid within the 1st 24 hours after burn can cause complications in this organ system __________ Pulmonary
How quickly after burn should an escharotomy be performed, if indicated? Within 4-6 hours
Child abuse accounts for what percentage of burns in children? ____________ Fifteen
Lung injury from burn is NOT caused by heat but by ________________ Carbonaceous materials and smoke
Risk factors for airway injury with burn include ___________ Alcohol use, enclosed space, trauma, rapid combustion, extremes of age, delayed extrication
Signs / symptoms of possible airway injury Facial burns, wheezing, carbonaceous sputum
The most common infection in burn patients ____________ Pneumonia
Most common cause of death after inhalational injury ______________ Pneumonia
Which produce deeper burns, acid or alkali solutions, and how? Alkali, through liquefaction necrosis
What effect do acid burns produce? ___________ Coagulation necrosis
Treatment for hydrofluoric acid burns ______________ Topical calcium
A patient with an electrical burn has decreased UOP, increased creatinine, and normal CVP. What is the likely cause of his renal failure? _________ Rhabdomyolysis
What is the cause of cardiopulmonary arrest after a lightning strike? Electrical paralysis of the brainstem
Equation for the daily CALORIC need of burn patients 25 kcal/kg/day + (30 kcal x %burn)
Equation for the daily PROTEIN need for burn patients 1g protein / kg / day + (3g x %burn)
What is the best source of non-protein calories in burn patients? __________ Glucose
How quickly should burn wounds be excised? Within 72 hours
What electrolyte abnormality may occur during burn surgery, and what medication used by anesthesia may potentiate it? Hyperkalemia, potentiated by succinylcholine
Skin grafts to a burn wound are contraindicated if a culture swab of the wound is positive for what? Beta-hemolytic strep or bacteria > 10^5
Allografts undergo what process prior to rejection? _________ Vascularization
How long can allografts last? 2-4 weeks
How long can xenografts last? 2 weeks
What are the goals during each burn surgery for blood loss, percentage of skin excised, and number of hours in the OR? < 1 L blood loss, < 20% skin excised, and < 2 hours in the OR
Most common reason for skin graft loss ____________ Seroma or hematoma
Treatment for facial burns Topical antibiotics for 2 weeks, followed bu full-thickness skin grafts for non-healed areas (unmeshed)
Treatment for superficial hand burns ROM exercises, with splinting in a functional position if there is too much edema
Treatment for deep hand burns Immobilization for 7 days, full-thickness skin grafts, physical therapy
Treatment for palmar burns Splint in extension for 1 week; week 2 place full-thickness non-meshed autograft
Treatment for genital burns Antibiotics for 2 weeks, meshed grafts
Most common organism in burn infections __________ Pseudomonas
Burn infections are more common with burn wounds greater than __________ % Thirty
Immune problems found in burn patients Impaired granulocyte chemotaxis and impaired cell-mediated immunity
Side effects of silvadene in burn wounds Neutropenia and thrombocytopenia
Silvadene is contraindicated in patients with G6PD deficiency due to risk of ____________ Methemoglobinemia
Silvadene is effective for treatment of this organism ____________ Candida
Silvadene is INEFFECTIVE for treatment of this organism _____________ Pseudomonal (and other Gram-negative rods)
Side effects of silver nitrate use __________ Electrolyte imbalances
Silver nitrate is INEFFECTIVE against what organisms? ____________ Pseudomonas (and other Gram-negative rods)
Sulfamylon may cause metabolic acidosis through what mechanism? _________ Inhibition of carbonic anhydrase
Which topical burn wound medication has good eschar penetration? _____________ Sulfamylon
Which topical burn wound medication is good for burned areas overlying cartilage? _______________ Sulfamylon
Burn wound sepsis is usually due to this organism _____________ Pseudomonas
Another name for sulfamylon _____________ Mafenide sodium
Most common VIRAL infection in burn wounds ____________ HSV
Gastric ulcer that occurs with burns __________ Curling’s ulcer
Highly-malignant squamous cell carcinoma that arises in chronic, non-healing burn wounds or unstable scars ______________ Marjolin’s ulcer
Hypertrophic scars usually occur in what time frame after a burn? 3-4 months
What is the cause of hypertrophic scars? _____________ Neovascularity
Hypertrophic scars are more likely to occur under what conditions? Deep thermal injuries that take >3weeks to heal, contraction and epithelial spread or across flexor surfaces
How long should you wait before operating on hypertrophic scars? _________ 1-2 years
Treatment for TEN Prevent wound dessication with topical antimicrobials and xenografts
What medication should you avoid in patients with TEN or Stevens-Johnson syndrome? ___________ Steroids
Created by: StudyBug82
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