Flashcards in Burns and Thermal Injuries Deck (28)
only the epidermis. Erythema and minor microscopic changes.
Second degree/partial thickness
all of the epidermis and some of the corium or dermis.
Third degree/full thickness burns
white, dry, waxy appearance. May look unburned to untrained eye. Prolonged exposure to heat may be brown, red, or black. No sensation or cap refill, and has a leathery texture
Topical antibacterial agents (good for what, which ones)
lowers incidence of sepsis. Treatment of choice = silver containing product because silver has superior antimicrobial properties. Ex: Silver sulfadiazine, silver release dressings
Exposure therapy (what, why, why not)
no dressings. Usually over face or head. Disadvantages= increased pain, heat loss, and cross-contamination
Closed method (what, why not)
occlusive dressing. Preferred method. Usually changed twice a day. Disadvantages= increased bacterial growth if not changed frequently enough.
alternative to topical agents for partial thickness or clean excised wounds. Reepithelialization is accelerated and pain is better controlled
human skin. Better on large excised wounds but is difficult to obtain.
use of this treatment has decline. Studies show an infection rate increase with immersion in a tub because of generalized inoculation of a previously local infection.
hydrotherapy on a slant board
useful once the wounds are in the process of being debrided and closed.
Showering as hydrotherapy
great at wound cleansing for stable patients
Operative debridement and grafting
Within the first several days post burn. Varies from an extensive burn excision and grafting within several days of injury to limiting debridements to less than 15% of the burned area. Excision can be carried down to fascia or to viable remaining dermis or fat. Excision to fascia is more commonly used when the burn extends well into the fat. A meshed skin graft can be covered with a biologic dressing to avoid desiccation of the uncovered wound.
Sepsis syndrome (from current surgery)
occurs in all major burns. Fever, hypermetabolism, catabolism, and leukocytosis are typical characteristics, the result of local burn and total body inflammation. (Infection is often not present according to Current Surg, various websites state the syndrome is due to infection)
Continued deterioration of a wound is likely due to _______. A more common cause of infection today is a ________. __________ is the third most common cause of infection.
Continued deterioration of a wound is likely due to invasive infection. A more common cause of infection today is a pulmonary complication (pneumonia). Catheter sepsis is the third most common cause of infection.
Circumferential burns of an extremity or trunk
Swelling beneath the unyielding eschar may act as a tourniquet to blood and lymph flow, and the distal extremity may become swollen and tense. Swelling may compromise the arterial supply. Tx: escharotomy must be performed before arterial ischemia develops.
Constriction involving the chest or abdomen may severely restrict ventilation.
Prevention of Acute gastroduodenal (Curling) ulcers (once a common complication of severe burns)
early antacid and nutritional therapy and the decrease in the rate of sepsis.
Complication of burns unique to kiddos
seizures. Causes: electrolyte imbalance, hypoxemia, infection, or drugs. Hyponatremia= most frequent cause. 1/3 of time cause is unknown!
major cause of death after burns
respiratory failure or complications. inhalation injury, aspiration, bacterial pneumonia, pulmonary edema, and post traumatic pulmonary insufficiency. Smoke inhalation markedly increases mortality from burn injury.
If you think someone has an inhalation injury consider...
Carbon monoxide poisoning. Get arterial blood gases. Carboxyhemoglobin >5% in nonsmokers and >10% in smokers= CO poisoning
Mild carbon monoxide poisoning symptoms
headache, slight dyspnea, mild confusion, and diminished visual acuity
Moderate Carbon monoxide poisoning
irritability, impairment of judgment, dim vision, nausea, and fatigability.
Severe carbon monoxide poisoning
hallucinations, confusion, ataxia, collapse, and coma. Levels in excess of 60% carboxyhemoglobin are usually fatal.
Silver sulfadiazine (Silvadene)
For the prevention and treatment of infection in second and third degree burns.
Contraindications: premature infants or neonates <2 months of age (sulfonamides may displace bilirubin and cause kernicterus); pregnancy (approaching or at term)
MOA: Acts upon the bacterial cell wall and cell membrane. Bactericidal for many gram-negative and gram-positive bacteria
For treatment of second and third degree burns to prevent septicemia
MOA: interferes with bacterial folic acid synthesis through competitive inhibition of para-aminobenzoic acid. Spectrum of activity encompasses both gram positive and negative organisms, including Pseudomonas and some anaerobes.
For cauterization of wounds. Astringent
MOA: Free silver ions precipitate bacterial proteins by combining with chloride in tissue forming silver chloride; coagulates cellular protein to form an eschar; silver ions or salts or colloidal silver preparations can inhibit the growth of both gram-positive and gram-negative bacteria
antiseptic for topical application in the treatment and prevention of infection in wounds
Contraindications: hyperthyroidism, after treatment with radio iodine, and in patients with dermatitis herpetiformis (Duhring's disease)
Used to treat superficial infections of the skin.
Contraindications: allergy to aminoglycosides
MOA: Interferes with bacterial protein synthesis by binding to 30S and 50S ribosomal subunits resulting in a defective bacterial cell membrane