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Burns
Surgery
| Question | Answer |
|---|---|
| Burn epidemiology | Adult: flame burns/clothing ignition; kids: scalds |
| 1st degree burns heal within: | 3-6 days |
| Superficial 2nd degree | due to flame, scalding, chem. Edema; skin pink/ red, often blisters; hypersensitivity; healing 10-21 days |
| 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 |
| 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 |
| Laryngeal edema d/t smoke inhalation usually occurs: | within 24 hours of the injury (but poss any time); intubate pre-emptively |
| Baseline labs: | ABG, CBC, electrolytes, glucose, UA, carbon monoxide level; determine tetanus status |
| Pt's hand is ___% of BSA | 1% |
| BSA chest + abdomen | 9 + 9 = 18% |
| BSA head | 2 X 4.5 = 9% |
| BSA: arms | 2 X 4.5 = 9% each arm; 18% for both arms |
| BSA: lower extremities | 2 x 9 = 18% each leg; 36% both legs |
| Major burns: disposition | transfer to the nearest regional burn center |
| Definition of major burns | Partial thickness >25% BSA; Full thickness >10% BSA; burns of the face, eyes, ears, hands, feet or perineum |
| 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 |
| Parkland formula | 4 mL/kg x % total BSA (kids: 3mL). Half given over 1st 8 hrs, 2nd half given over next 16 hrs |
| Smoke inhalation | 33% of pts admitted to burn ctr; d/t toxic damage to resp epithelium; inflammation/ necrosis |
| Most common cause of morbidity in smoke inhalation patients | Pneumonia |
| To dx smoke inhalation injury: | Fiberoptic bronchoscopy |
| Smoke inhalation injury: tx | Humidified O2 (100% if CO tox); mucolytics; pulmonary physiotherapy; consider intubation; usu heal in 2-3 wks |
| Electrical injury | may be worse than it looks; may need fasciotomy; poss extensive mx damage & cardiac arrhythmias; 1/3 of pts need amputation |
| Monitor electrical burn pts for: | myoglobinuria |
| Escharotomy/Fasciotomy may be needed for: | Electrical burns; circumferential full-thickness burns; chest wall involvement impairing resp; compartment syndrome |
| Chemical burns | Wash thoroughly, copious amounts water to decontaminate; get pH to 7.0 (litmus paper) |
| Alkali vs acid burns | Alkali cause more damage than acid |
| conjunctival pallor is due to: | severe ocular injury from alkali |
| Most common pathogens in burns: | S. Aureus and Pseudomonas (topical Abx prevent invasion) |
| Which topical antimicrobial agent has the ability to penetrate eschar? | Mafenide acetate |
| Topical Abx | Ag NO3, Ag sulfadiazine; Mafenide acetate |
| If systemic Abx are indicated (discolored, erythema, edema, high temp): | Broad spectrum: PCN, ceph, macrolides |
| skin grafting is indicated for: | 3rd degree and deep 2nd degree |
| Biologic dressings | Gold standard: Human allograft; also porcine xenografts, synthetics |
| Burn type: erythema, mild discomfort | 1st degree: outer dermis layer |
| 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 |
| 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 |
Created by:
Abarnard
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