5.2I-K Burns Sunburn, Oral Burns, Escharatomy Em

Front 1

Regarding escharotomy: Dunn 1224
1. the incision should be through which layers?
2. post escharotomy the appearance of the wound should be...
3. which type of burns require?

Back 1

1. epidermis and dermis through to FAT
2. incision with FAT bulging from wound
3. full thickness e.g. white/charred, insensate

Front 2

Which is NOT an indication for escharotomy?
1. all circumferential limb injuries
2. chest wall injuries with impaired ventilation
3. all circumferential neck injuries

Back 2

1 - only those with distal neurovascular dysfunction

Indications for escharotomy include:
1 circumferential burns of the chestthat increase chest wall rigidity and impair ventilation (e.g. increased peak airway pressures in the ventilated patient).children may have predominantly diaphragmatic breathing so an escharotomy may be required even if the burn is limited to the anterior chest and abdomen (non-circumferential).

2constrictive circumferential neck burns that threaten the airway.
3 circumferential burns of the extremitiesresulting in circulatory embarrassment/ compartment syndrome.The escharotomy should be permed once there is evidence of decreased circulation to the extremity, but before there pulses are lost (e.g. using doppler ultrasound, or SaO2<90% on pulse oximetry of the affected limb)).

Front 3

Escharotomy incision lines - T/F
1. Truncal incisions should be along the mid or posterior axillary lines
2. Truncal incisions should be connected via concave upwads transverse incisions below clavicles across upper chest, and across upper abdomen
3. Long incisions should extend along the mid axial lines e.g. between flexor and extensor surfaces
4. Medial incision of LL should pass in front of the medial malleolus to avoid the saph nn and long saph vein
5. Lateral incisions of LL should avoid the common peroneal n at neck of fibula
6. UL medial incision should pass posterior to medial epicondyle to avoid ulnar nn
7. Sometimes only one side of a limb will need incising

Back 3

1 FALSE should be ANTERIOR axillary line
2 FALSE CONVEX upwards
3 T
4 F - BEHIND malleolus
5 T
6 F in FRONT of epicondyle
7 T


Trunk
Longitudinal incisions along the anterior axillary lines to the costal margins, or upper abdomen if also burnt.
These longitudinal incisions are connected by convex upwards transverse incisions below the clavicles across the upper chest, and across the upper abdomen.

Limbs
Longitudinal incisions along the mid-axial lines between the extensor and flexoral surfaces. Incisions along the flexural creases of joints are avoided.
Lower limbs —
The medial incision should pass behind the medial malleolus to avoid the long saphenous vein and saphenous nerve. Lateral incisions are made in the midlateral line, avoiding the common peroneal nerve at the neck of the fibula.
Upper limbs —
The medial incision should pass anterior to the medial epicondyle to avoid the ulnar nerve at the elbow. On the medial aspect of the hand the incision may progress as far as the base of the little finger. On the lateral aspect of the hand the incision can progress to the proximal phalanx of the thumb. Sometimes an incision along one side of a limb is sufficient to preserve circulation.

Front 4

Treatment for severe sunburn may include (which is incorrect)
1. systemic steroids
2. systemic NSAIDs
3. topical steroids
4. topical NSAIDS

Back 4

As per Dunn 1063 3. is INCORRECT