Surgery: Burn Care

Front 1

What are the steps of neutralizing a burn?

Back 1

1. Stop the burning process
2. Remove clothing
3. Remove chemical
4. Irrigate for up to 60 min with warm tap water.
5. Avoid hypothermia

Front 2

What is the leading cause of death associated with fires?

Back 2

CO

Front 3

What does carbon monoxide poisoning cause?

Back 3

oxyhemoglobin curve to shift left

Front 4

How do you treat carbon monoxide poisoning?

Back 4

100% oxygen until COHb less than 7%

Front 5

Does hyperbaric oxygen yild more rapid displacement of carbon monoxide?

Back 5

Yes

Front 6

What is the gaseous form of cyanide?

Back 6

hydrocyanide

Front 7

Where does cyanide come from?

Back 7

burning synthetics

Front 8

How does cyanide poisoning work?

Back 8

binds to cytochrome, inhibiting cell metabolism and ATP production.

Front 9

How do you treat cyanide poisoning?

Back 9

hydration
10-20cc of 3% sodium nitrite over 10 minutes
50cc of 25% sodium thiosulfate

Front 10

How does hydration and sodium nitrite treat cyanide poisoning?

Back 10

converts cyanide to sodium thiosulfate --> excreted into urine

Front 11

What improves the outcome of inhalation injury?

Back 11

early intubation and positive pressure ventilation

Front 12

True or False: You can tell an inhalation injury as soon as you see the patient.

Back 12

False: inflammatory reaction evolves over period of hours to days

Front 13

Are prophylactic antibiotics indicated for suspected inhalation injury?

Back 13

No

Front 14

When would you suspect an inhalation injury?

Back 14

Injured in a closed space
Extensive burns or with burns on face
Unconscious at time of injury
Singed nasal hairs, hoarseness, or wheezing
Coughing up carbonaceous sputum

Front 15

When does edema-induced distortion peak?

Back 15

18-24 hours

Front 16

When do inhalation injury heals?

Back 16

a matter of a few days to weeks

Front 17

What pulmonary support is required for inhalation injuries?

Back 17

Humidified oxygen
Elevation head and chest 20-30 degrees
Bronchodilators - manage bronchospasm

Front 18

Why do you elevate a patients head in inhalation injuries?

Back 18

increases tidal volume and allows for increase perfusion/diffusion

Front 19

True or False: IV steroids are found to decrease the degree of inhalation injury.

Back 19

False: not found to decrease injury

Front 20

What role do steroids have in inhalation injuries?

Back 20

Aerosolized steroid can decrease airway hyperreactivity

Front 21

What are the rules of nines?

Back 21

Each arm: 9%
Each leg: 18%
Anterior trunk: 18%
Posterior trunk: 18%
Head: 9%
Genitalia: 1%

Front 22

How do you resuscitate a burn patient?

Back 22

Isotonic fluids
Excess of 20% TBS (intestinal ileus)
No glucose

Front 23

Do you give glucose in resuscitation of a burn victim? Why/why not?

Back 23

No; intolerance due to catecholamines

Front 24

What is the Parkland formula?

Back 24

Lactated Ringers:
4mL/kg/%TBS plus maintenance

Front 25

When resuscitating a burn victim, what do you want to keep their urine output at?

Back 25

0.5cc/kg/hr

Front 26

Can you use hypertonic solutions in resuscitation of burn victims?

Back 26

Yes: they have some good reports

Front 27

What constitutes a first degree burn?

Back 27

outer epidermis
erythema and mild discomfort
no residual scarring

Front 28

In a first degree burn, when does pain resolve? When does the damaged tissue peel away?

Back 28

48-72 hours; 5-10 days

Front 29

What is injured in a superficial second-degree burn?

Back 29

variable portions of dermis destroyed
-microvessels injured and permeability increased

Front 30

Blisters first appear in what degree burn?

Back 30

superficial second-degree

Front 31

How long does it take superficial second degree burns to heal?

Back 31

7-14 days from repopulation epithelial cells from hair follicles, sweat glands

Front 32

Do you give tetanus prophylaxis for second degree burns?

Back 32

Yes

Front 33

Do you give tetanus prophylaxis for first degree burns?

Back 33

No

Front 34

What are the characteristics of a deep second-degree burn?

Back 34

well into dermal layer
epithelialization slow (months)
no blister formation
dense scarring results
pain

Front 35

What are the characteristics of third degree burns?

Back 35

entire dermis destroyed
waxy white color
absence of pain

Front 36

True or False: Topical antibiotics in burn victims decrease rate of wound healing.

Back 36

True

Front 37

What is the role of topical antibiotics in burn victims?

Back 37

Deep burns are protected from early bacterial invasion which converts wound to deeper injury.

Front 38

What does Silvadene cover?

Back 38

gram-negative organisms with some antifungal effects

Front 39

What is the primary complication of Silvadene?

Back 39

Transient Leucopoenia

Front 40

What do high-voltage injuries resemble?

Back 40

crush injuries

Front 41

With a high-voltage injury, why do you correct the acidosis?

Back 41

to prevent myoglobin in renal tubules

Front 42

How do you treat myoglobinurea?

Back 42

Mannitol 25g bolus, then 12.5g every 2-4 hours
Sodium bicarbonate to keep urine pH >7
Low-dose dopamine
Loop diuretic if pigment load persists >8 hours

Front 43

What complications can occur from a high-voltage injury?

Back 43

Cardiac - ventricular fibrillation
Lung - respiratory distress
CNS - seizures, coma, mental changes
Eye - retinal detachment, cataract (delayed)
Muscle necrosis, renal failure

Front 44

What are complications for low-voltage injury?

Back 44

Cardiac - ventricular fibrillation
Tetany and muscle spasm leads to fractures and suffocation
CNS - result of hypoxia

Front 45

What causes the CNS symptoms in a low-voltage injury?

Back 45

hypoxia

Front 46

Who will be transferred to a burn unit?

Back 46

2nd degree > 30% TBS
3rd degree > 10% TBS
Complicated by respiratory tract injury, fractures, or critical areas (face, hands, feet, perineum)
High-voltage electrical burns
Significant preexisting disease
Children