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Burns

Surgery

QuestionAnswer
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