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