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68 Cards in this Set

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What is the zone of coagulation?
Nonviable, irreversibly injured tissue
What is the zone of stasis?
initially - dilated blood vessels and capillary diffusion, after 24-48 hours dilated capillaries become occluded with resultant conversion to zone of coagulation. Injury to this zone may be reversible.
What is the zone of hyperemia?
viable, edematous tissue
When is edema formation greatest after a burn?
8-12 hours
Should glucose be used in fluid resuscitation of a burn patient?
No - burn patients are frequently glucose intolerant and hyperglycemic (stress response)
What are the criteria for admission to a burn center for a 10-40 year old patient? (in terms of TBSA)
>15% TBSA second degree burns, or >3% TBSA 3rd degree burns
What are the criteria for admission to a burn center for a patient under 10 or over 40 years old? (in terms of TBSA)
>10%TBSA 2nd or 3rd degree burns
Burns on what areas of the body always necessitate admission to a burn center (regardless of TBSA)?
face, hands, feet, perineum and circumferential extremity burns
What type of burn (chemical, electrical, flame) always necessitates admission to a burn center (regardless of TBSA)?
electrical
What are the signs/symptoms of an inhalation burn injury?
history of burn in a closed space, presence of facial burns and/or oral carbon deposits, singed facial hair/nares, hoarseness, wheezing, unconsciousness
What are the signs/symptoms of CO poisoning?
Cherry red skin, hypoxemia, mental status changes or history of LOC, persistent acidosis in presence of normovolemia
Is pulse oximetry a reliable way to diagnose CO poisoning?
No
What CO level is associated with severe neurologic symptoms?
20-40%
At what level is CO commonly fatal?
60%
What is the treatment for CO poisoning?
100% oxygen (to displace CO from hemoglobin), hyperbaric therapy
When should you consider hyperbaric therapy?
If patient is at risk for CO exposure and has mental status changes.
What is the rule of 9s for an adult?
Arm, anterior/posterior legs, head = 9% each. Anterior/posterior torso = 18% each
A patient's palm is what % of TBSA?
1%
First degree burns are confined to what layer of the skin?
Epidermis
When does the pain resolve after 1st degree burns?
48-72 hours
What are the physical findings of a 1st degree burn?
Skin is mildly erythematous
2nd degree burns involve what layer(s) of the skin?
epidermis and varying levels of dermis
What are the skin findings after a 2nd degree burn?
Painful, red, edematous and blistering
Why is it important to distinguish between superficial and deep partial thickness burns?
Excision and grafting is performed for deep, but usually not for superficial.
What layer(s) of skin are involved in a 3rd degree burn?
epidermis and dermis are destroyed, there are no remaining dermal appendages
What are the skin findings in a 3rd degree burn?
No pain, leathery, waxy, charred. Thrombosis of vessels.
According to the Parkland formula, what are a patient's fluid requirements in the first 24 hours?
4 cc x %TBSA x pt wt (kg)
What is the best indicator of adequacy of fluid resuscitation?
Urine output
There is a high risk for myoglobin-induced acute tubular necrosis with which type of burn?
High-voltage electrical burns
What is goal urine output after a high voltage electrical burn?
2 mL/kg/hr
What can be added to fluids to protect high-voltage electrical burn patients from ATN due to rhabdomyolysis?
Sodium bicarbonate (50 mEq/L)
Should colloids be used in the first 24 hours after a burn?
No - increased capillary leak causes colloid trapping in interstitial space leading to increased 3rd spacing.
What metabolic derangements are common after a burn?
Hyponatremia and hyperkalemia
What is the leading cause of death after a burn?
Bronchopneumonia
Other than pneumonia, what are common infections in burn patients?
Burn wound sepsis, septic thrombophlebitis, bacterial endocarditis
What organisms are frequently found in burn patients' infections?
Pseudomonas, enterococcus, MRSA
What are potential side effects of silvadene?
leukopenia, corneal damage
What is the best topical antimicrobial agent for exposed cartilage?
sulfamylon
What are the adverse effects of sulfamylon?
Painfus, can cause acidosis (inhibits carbonic anhydrase)
Avoid use of sulfamylon in burns greater than what %TBSA?
20%
What is a side effect of silver nitrate
hyponatremia
What topical antimicrobial is commonly used on the face?
Bacitracin zinc ointment
What is tangential excision?
Thin-layer sequential excision of all nonviable tissue until a viable layer is reached
Why is it hard to skin graft on fat?
Fat has a poor blood supply and it is hard to delineate a healthy tissue level.
What is the recommended limit for excision in a single session?
10-20% TBSA
What thickness graft should be used on the face?
16 to 20/1000th inch
What are the advantages and disadvantages of thin grafts?
The thinner the graft the more likley the take, but there is more significant secondary contraction
Why are grafts meshed?
To increase the surface area that can be covered and decrease hematoma/seroma formation under the graft.
What is the usual meshing ratio for a graft?
1:1.5
Should facial grafts be meshed?
No
When should facial grafting be performed?
Within 2 weeks from time of injury to reduce scarring
What are common risks after burns to the eye?
keratitis and corneal abrasion
What percent of palmar burns require resurfacing?
20%
There is a high risk for myoglobin-induced acute tubular necrosis with which type of burn?
High-voltage electrical burns
What is goal urine output after a high voltage electrical burn?
2 mL/kg/hr
What can be added to fluids to protect high-voltage electrical burn patients from ATN due to rhabdomyolysis?
Sodium bicarbonate (50 mEq/L)
Should colloids be used in the first 24 hours after a burn?
No - increased capillary leak causes colloid trapping in interstitial space leading to increased 3rd spacing.
What metabolic derangements are common after a burn?
Hyponatremia and hyperkalemia
How do you prevent paraphimosis after a burn to an uncircumcised penis?
Replace burned foreskin to its normal position.
What is the Harris-Benedict equation and what is it used for?
Used to calculate 25 hour caloric requirement. 24 hour caloric requirement = (25 kcal x kg body wt)+ (40 kcal x %TBSA)
How much protein does an adult require after a burn?
2.5-3 g/kg/day
How much protein does a child require after a burn?
3 to 4 g/kg/day
What lab can be checked to monitor nutritional progress in patients with large burns?
Prealbumin
What is the key to management of chemical burns?
Dilution
What compound is used to treat hydrofluoric acid burns?
10% calcium gluconate
What compound is used to treat phenol burns?
Wash with polyethylene glycol
What can occur after systemic absorption of phenol?
arrhythmias
What compound is used to treat white phosphorous burns?
Copper sulfate