Dermatology

Created by adoherty 

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which pathogens most commonly infect open wounds from burns

STAPH, STREP, followed by pseudomonas. As antibiotic usage increases, a major complication is 2° infection w/Candida, aspergillus and mucormycoses.

Be able to recite the most common infectious complication among hospitalized burn patients, as well as less common complications.

Most common infectious complication: Pneumonia
Others: septic pulmonary emboli; suppurative thrombophlebitis of catheter sites, endocarditis, UTI's and acute renal failure

"Rule of 9's".

Estimate extent of injury, count only 2nd and 3rd degree burns. Anterior trunk = 18%, Posterior trunk= 18%, each leg 18%
Head/neck=9%, each arm = 9%

Be familiar with guidelines for burn management, fluid resuscitation, and the Parkland formula.

Immediate: apply cool water, NO ice, cover w/dry, sterile dressings
Parkland formula: Ringer's Lactate, 4 mL/kg/% burned in first 24 hours after burn
i. ½ given over first 8 hours
ii. ¼ given over second 8 hrs
iii. ¼ given over third 8 hrs
25% albumin begun 24hrs after burn

Most commonly used wound cream for burns

silvadene

Risk factors for devo of P ulcers

Prolonged time in one position, Head of bed raised more than 30°, Friction, moisture, illness/debility/altered sensation to pain

each stage of development of pressure ulcers

a. Stage I  Non-blanchable erythema of intact skin
b. Stage II  partial-thickness skin loss involving the epidermis or dermis or both. The ulcer is superficial and manifests clinically as an abrasion, blister or shallow crater.
c. Stage III  Full-thickness skin loss and damage or necrosis of subQ tissue that may extend to, but not through, underlying fascia. Deep crater.
d. Stage IV  Full-thickness skin loss associated with extensive destruction, tissue necrosis, or damage to muscle, bone, or supporting structures such as tendons or joint capsules.

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