Sbl3: Skin Ulcers And Burns, Cockrell

Front 1

first priorities in treating the burned patient

Back 1

airway, breathing, circulatory management

Front 2

three types of inhalation injury

Back 2

carbon monoxide
upper airway (thermal)
lower airway (chemical)

Front 3

how to manage circulatory function after airway and breathing are taken care of

Back 3

start 1 or more (preferably 2) large bore IV's to initiate fluid resuscitation

Front 4

treatment for carbon monoxide injury

Back 4

humidified 100% oxygen (hyperbaric chamber for best results)

Front 5

indications for referral to burn center

Back 5

partial thickness > 10% of body surface area
burns of face, hands, feet, genitalia, perineum, or over major joints
3rd degree burns in any age group
electrical burns
chemical burns
toxic smoke inhalation
association w/ pre-existing medical conditions
patients requiring social, emotional, or long-term rehabilative intervention

Front 6

three classifications of burns in the current schema

Back 6

superficial (epidermis)
superficial dermal (blanches with pressure, healing w/in 2 weeks)
deep (non-regenerative, excision and grafting)

Front 7

early sepsis (1-3 days post burn) is usually due to ___ (two bugs)

Back 7

Strep and Staph

Front 8

late sepsis is usually due to ___ (3 bugs)

Back 8

Pseudomonas, Acinetobacter, fungi

Front 9

how to treat infection in the burn patient

Back 9

avoid prophylaxis, take cultures, treat as indicated

tetanus toxoid must be given

Front 10

criteria for superficial partial burns

Back 10

upper 1/3 of dermis
blisters common
red, wet, painful, blanching
heals in 7-14 days
minimal scarring

Front 11

criteria for deep burns (partial thickness)

Back 11

deep dermal involvement
blisters possible
slow or absent blanching
deeper red to pink
decreased sensation
healing takes more than 21 days, prone to scarring

Front 12

criteria for full thickness burn

Back 12

dry, leathery, firm
white, brown, or charred
non blanching
insensate
edema may be massive

Front 13

incision of skin to relieve compartment pressures

indications are circumferential 3rd degree burns of chest and extremities

Back 13

escharotomy

Front 14

voltage levels in low and high voltage electrical burns

Back 14

low voltage: 110-220 volts
high voltage: over 1000 volts

Front 15

possible complications of high voltage electrical burns

Back 15

persistent arrhythmias, significant soft tissue injury w/ 25% requiring major amputation, rhabdomyolysis and subsequent renal failure

Front 16

treatment for rhabdomyolysis

Back 16

alkalinization of urine w/ sodium bicarb to prevent crystallization of myoglobin

keep urine output high

Front 17

acid burns typically produce a ___ that limits the penetration of the acid

bases typically produce a more severe injury known as ___, which involves saponification of fats

Back 17

coagulation necrosis

liquefaction necrosis

Front 18

***the acid that is atypical in its ability to produce a liquefaction necrosis

what electrolyte changes does it cause

Back 18

***hydrofluoric acid

***Ca, Mg, K

Front 19

treatment for small, superficial HFl burns

treatment for deeper burns

Back 19

topical calcium or magnesium gels

subcutaneous injections of calcium gluconate

Front 20

acid burn that predisposes patient to renal failure

Back 20

chromic acid

Front 21

special treatment for white phosphorus burns

special treatment for combustible metallic elements

Back 21

irrigate, then cover area w/ moist gauze; keep the area moist at all times

irrigation can worsen the burn; use mineral oil and remove metallic pieces w/ forceps

Front 22

percentages of the "rule of nines"

Back 22

head and neck: 9%
anterior trunk: 18%
posterior trunk: 18%
upper extremities: 9% each
lower extremities: 18% each
genital area: 1%

Front 23

resuscitation fluid of choice for adult burns

Back 23

lactated ringers

Front 24

criteria for fluid resuscitation

Back 24

2nd or 3rd degree burns > 10% body surface area

Front 25

requirement for resuscitation fluid for children

Back 25

need glucose containing fluids

Front 26

Parkland formula for fluid resuscitation

Back 26

2-4 ml * weight (kg) * % TBSA = ml/24 hr

give half in the first 8 hours, the rest over the following 16 hours

Front 27

urine output goal for adults and children in monitoring response to fluid resuscitation

Back 27

30 ml/hour in adults

1 ml/kg/hour in children under 30 kg

Front 28

zones of injury in a burn

Back 28

zone of coagulation: irrevocably damaged
zone of stasis: possibly still viable
zone of hyperemia

Front 29

treatment for epidermal burns

treatment for superficial and mid-dermal burns

treatment for deep dermal and full thickness burns

Back 29

aloe vera or moisturizing lotion

bacitracin or silvadene

silvadene or sulfamylon

Front 30

mainstay of burn wound care

Back 30

silver based ointments and products

Front 31

graft using patient's own skin

graft using cadaver skin

graft using animal pig skin

Back 31

autograft

allograft

xenograft

Front 32

expensive treatment reserved for those w/ very extensive burns

Back 32

cultured epidermal autografts

Front 33

three types of common skin ulcers

Back 33

arterial
venous
neuropathic

Front 34

ankle brachial index result that indicates severe disease

do not use compression in treatment, arteries involved

Back 34

<0.5-0.6