Fiser Chapter 17 BURNS Flashcards Preview

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1

1st degree burn

Epidermis (sunburn)

2

2nd degree burn

Superficial dermis (papillary): Painful to touch, blebs/blisters, hair follicles intact, blanches, do NOT need skin graft

Deep dermis (reticular): decreased sensation, LOSS OF HAIR FOLLICLES, need skin graft

3

3rd degree burn

Leathery (charred parchment); down to subcutaneous fat

4

4th degree burn

Down to bone; into adjacent adipose or muscle tissue

5

Which burns heal?

1st and superficial 2nd degree burns: epithelialization from hair follicles

6

Complications of burns

Compartment syndrome
Rhabdomyolysis with myoglobinuria

Tx: hydration, alkalinize urine

7

Who gets admitted to a burn center?

No 1st degree burns

2nd and 3rd degree:
>20% (>10% if <10 or >50)
Or if significant hand/face/feet/genital/perineal/joint skin burns

3rd degree: >5% any age group

Electrical and chemical burns

Concomitant inhalational injury

Mechanical trauma, preexisting medical conditions, patients with special needs, child abuse/neglect

8

TBSA assessment

Rule of 9s

Head 9
Arms 9 each
Chest 18
Back 18
Legs 18 each
Perineum 1

Or palm = 1%

9

Parkland formula

Use for burns >/= 20%

Volume LR = 4 cc/kg x kg x % TBSA
Give 1/2 in first 8 hours, second half in second 16 hours

UOP best measure: goal 0.5-1.0 cc/kg/h in adults, 2-4 cc/kg/h in <6mo

10

When can Parkland formula grossly underestimate volume requirement?

inhalational injury
EtOH
electrical injury
post-escharatomy

11

What do you use in burn resuscitation?

LR in first 24 hr
Albumin in first day can cause increased pulmonary complications. Can use after 24hr

12

Escharotomy indications

-Circumferential deep burns
-Low temp
-Weak pulse
-Decreased capillary refill
-Decreased pain sensation
-Decreased neurological function in extremitiy
-Problems ventilating patient with chest torso burns

Perform within 4-6 hours

13

Fasciotomy indication in burn patient

If compartment syndrome suspected after escharotomy

14

Risk factors for burn injuries

EtOH
Drugs
Age (very young or very old)
Smoking
Low socioeconomic status
Violence
Epilepsy

15

H&P signs that suggest abuse

-Delayed presentation for care
-Conflicting histories
-Previous injuries
-Sharply demarcated margins
-Uniform depth
-Absence of splash marks
-Stocking or glove patterns
-Flexor sparing
-Dorsal location on hands
-Very deep localized contact injury

Child abuse accounts for 15% of burn injuries in children

16

Lung injury MoA

Carbonaceous materials and smoke (not heat)

17

Risk factors for airway injury in burn

-EtOH
-Trauma
-Closed space
-Rapid combustion
-Extremes of age
-Delayed extrication

18

Signs and symptoms of possible airway injury

-Facial burns
-Wheezing
-Carbonaceous sputum

19

Indications for intubation

-Upper airway stridor or obstruction
-Worsening hypoxemia
-Massive volume resuscitation can worsen symptoms

20

Most common infection in patients with >30% BSA burns

Pneumonia
Also MCC death after >30% BSA burns

21

MCC death after 30% BSA burns

Pneumonia

22

Acid and alkali burns tx

Copious water irrigation

Alkalis produce deeper burns due to liquefaction necrosis

Acid burns produced coagulation necrosis

23

Hydrofluoric acid burns tx

Calcium

24

Powder burns tx

Wipe away before irrigation

25

Tar burns tx

Cool, then wipe away with lipophilic solvent (adhesive remover)

26

Electrical burns tx and complications

Cardiac monitoring
Monitor for rhabdo and compartment syndrome

Watch for polyneuritis, quadriplegia, transverse myelitis, cataracts, liver necrosis, intestinal perforation, gallbladder perforation, pancreatic necrosis

27

Lightning burn complication

Cardiopulmonary arrest 2/2 electrical paralysis of brainstem

28

Caloric need in burns

25 kcal/kg/day + (30 kcal x % burn)

29

Protein need in burns

1 g/kg/day + (3 g x % burn)

30

Glucose need in burns

Best source of nonprotein calories in patients with burns
Burn wounds use glucose in an obligatory fashion