Frostbite and Burn Severity Overview

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Questions and Answers

What characterizes a 3rd degree frostbite?

Hyperemia and vesicle formation

Partial thickness necrosis

Gangrene of the affected part (correct)

Necrosis of the entire skin thickness (correct)

Which burn grade results in complete destruction of the epidermis and dermis?

1st degree burn

2nd degree burn

3rd degree burn (correct)

Partial thickness burn

What type of burn is characterized by the presence of blebs and vesicles?

3rd degree burn

Full thickness burn

2nd degree burn (correct)

1st degree burn

Which condition is primarily caused by significant fluid loss from burns?

Burn shock Signup and view all the answers

What is a key feature of a full thickness burn?

Loss of skin sensation Signup and view all the answers

Which electrolyte imbalance commonly occurs in burn patients?

Increased potassium levels Signup and view all the answers

How is the extent of burn wounds typically estimated?

The 'rule of nines' Signup and view all the answers

What does a rapid fall and subsequent rise in eosinophil count indicate in burn patients?

Prognosis for recovery Signup and view all the answers

What condition is associated with the formation of Councilman bodies in the liver due to burn injuries?

Focal necrosis Signup and view all the answers

What percentage of hospitalized burn cases typically experience Curling ulcers?

25% Signup and view all the answers

What is the primary goal of fluid resuscitation in burn patients?

To maintain vital organ function Signup and view all the answers

In cases of severe burns that lead to edema beneath the fascia, which surgical procedure is most necessary?

Fasciotomy Signup and view all the answers

Which formula outlines fluid resuscitation using Ringer's Lactate during the first 24 hours?

Using 1000-4000 mL of Ringer's Lactate and 1000 mL of Normal Saline Signup and view all the answers

What is the most common site of infection in patients with burn injuries?

Lungs Signup and view all the answers

What is essential in the management of an escharotomy wound post-procedure?

Constant coverage with a topical antimicrobial agent Signup and view all the answers

What are Curling ulcers a result of in burn patients?

Acute stress response Signup and view all the answers

Which topical agent penetrates the eschar and suppresses bacterial proliferation effectively?

Mafenide Acetate Signup and view all the answers

What is the best condition for a burn wound to be ready for a split-thickness skin graft?

The surface bacterial count must be less than 105/sq.cm Signup and view all the answers

What is the hallmark characteristic of a 2nd degree burn?

Formation of blebs and vesicles between separating epidermis and dermis Signup and view all the answers

Which of the following describes the role of temporary wound coverings in burn management?

They cover the wound until autograft can be applied. Signup and view all the answers

What is a significant disadvantage of using thinner skin grafts?

They provide inferior cosmetic results. Signup and view all the answers

Which complication is primarily associated with severe burns?

Oligaemic shock Signup and view all the answers

What condition is associated with thermal burns that is primarily gastrointestinal in nature?

Curling ulcer Signup and view all the answers

In which degree of frostbite does necrosis of the entire skin thickness occur?

3rd degree Signup and view all the answers

What is the ideal condition for a burn wound to be ready for split-thickness skin grafting?

Red, finely granular granulation tissue with bacterial count less than 105/sq.cm Signup and view all the answers

Which skin graft technique is preferable when donor sites are limited?

Mesh or expanded grafts Signup and view all the answers

What happens to eosinophil count within the first 12 hours of burns?

Falls abruptly Signup and view all the answers

What type of dressings are used for temporary coverage of open granulation tissue during the healing process?

Physiologic or biologic dressings like homografts or heterografts Signup and view all the answers

Which anatomical area corresponds to 18% of body surface area?

Right lower extremity Signup and view all the answers

How does graft thickness impact the success rate and cosmetic result in skin grafting?

Thicker grafts yield better cosmetic results but may affect the take negatively Signup and view all the answers

What is the expected outcome for a partial thickness burn?

Spontaneous regeneration of epithelium Signup and view all the answers

What percentage of blood sodium chloride content typically decreases following severe burns?

Decreases Signup and view all the answers

What graft types are recommended when grafting an extensive area with limited donor sites?

Mesh or expanded grafts Signup and view all the answers

Which complication is NOT commonly associated with thermal burns?

Electrical conduction arrythmia Signup and view all the answers

What is a critical feature of a full thickness burn?

Spontaneous regeneration is not possible Signup and view all the answers

During which week after a burn do bacteriaemia and bacteraemic shock usually result in death?

Usually occurs between the second and third week Signup and view all the answers

What is the preferred treatment for electrical burns and why?

Mafenide acetate for its deep tissue penetration and anticlostridial spectrum Signup and view all the answers

In the context of wound healing, what does 'reconstitution' specifically refer to?

The coordinated regeneration of multiple tissue types to reform an organ Signup and view all the answers

What is the critical factor to measure when diagnosing acute pancreatitis in burn patients?

Amylase excretion rate Signup and view all the answers

Study Notes

Frostbite Degrees

Second-degree frostbite involves hyperaemia, vesicle formation, and partial thickness necrosis of the skin.
Third-degree frostbite involves necrosis of the entire skin thickness and variable thickness of the underlying subcutaneous tissue.
Fourth-degree frostbite involves necrosis of the entire thickness of skin and all underlying structures, leading to gangrene of the affected part.

Burn Severity

First-degree burns are characterized by hyperaemia of the skin with slight oedema of the epidermis. Microscopic destruction of superficial epidermis layers occurs, and healing is rapid and without scarring.
Second-degree burns involve the entire thickness of epidermis destruction. Blebs and vesicles form between separating epidermis and dermis. These burns can be mild or severe, and in severe cases, skin grafting may be necessary due to insufficient epithelium for resurfacing.
Third-degree burns involve complete destruction of the epidermis and dermis. Irreversible damage to dermal appendages, epithelium, and sensory nerves occurs, making skin grafting obligatory.

Burn Classification

Partial-thickness burns involve the entire thickness of the epidermis and sometimes the superficial part of the dermis. Spontaneous regeneration of the epithelium is expected, and skin grafting is not necessary. Sensation and pin prick test are positive.
Full-thickness burns involve the whole thickness of the epidermis and dermis. Spontaneous regeneration is not possible, requiring skin grafting. Sensory nerves are destroyed, leading to loss of sensation and a negative pin prick test.

Burn Extent and Anatomical Area Percentage

The length and width of the burn wound is expressed as a percentage of the total surface area displaying 2nd or 3rd degree burns.
The "rule of nines" is most commonly used to estimate the extent of burns.
A table can be used to determine the percentage of body surface area for different anatomical regions, such as the head, face, neck, upper extremities, lower extremities, trunk, and external genitalia. This table is applicable to adults only.

Burn Complications and Associated Conditions

Important sequelae of severe burns include oligaemic shock, which is a common cause of death in burn patients.
Bacteraemia and bacteraemic shock are common causes of death in burns, usually occurring between the second and third week after the burn.
Significant fluid outflowing leads to a remarkable increase in red blood cell count and haemoglobin levels.
Electrolyte imbalances in burn patients include a fall in sodium chloride (NaCl) content and an increase in potassium levels due to massive cell destruction and release of intracellular fluid.
A characteristic of burns is an abrupt fall in eosinophil count in the first 12 hours. The count should rise in 24 hours, which can be an indication of the prognosis of the case.

Focal Necrosis (Councilman Bodies) in Burn Patients

The liver in burn patients may show numerous areas of focal necrosis.
Intracellular inclusions and Councilman bodies may contain those found in Yellow Fever.

Acute Ulceration in Burn Patients

Acute ulceration of the stomach and duodenum is a complication of major thermal injury.
These ulcers, first described by Curling in 1842, are known as Curling ulcers.
Curling ulcers occur in 25% of hospitalized burn cases.
Acute ulceration of the colon has also been recognized in severe burn patients.

Escharotomy

Circumferential third-degree or full-thickness burns of the extremities or thoracic wall may form an unyielding crust called eschar.
Eschar exerts pressure on blood vessels and restricts motions of the chest wall.
Escharotomy is a surgical procedure to relieve pressure and requires no local anesthesia. Constant coverage of the escharotomy wound with a topical antimicrobial agent is essential.

Fasciotomy

Fasciotomy is necessary when edema beneath the investing fascia hinders blood flow improvement.
Fasciotomy must be performed under general anesthesia.

Fluid Resuscitation

Fluid resuscitation should begin promptly in all adults with burns exceeding 10% of their body surface area, and in children with burns of 15% or more.
Blood transfusions are required for burns involving more than 20% of full thickness or 40% of partial thickness of total body surface.
The goal of fluid resuscitation is to maintain vital organ function as quickly as possible.
Many formulas are available for calculating fluid resuscitation needs, including Moore's, Evans, and Brooke's.

Assessment of Resuscitation

The rate and amount of transfusion, and efficacy of intravenous resuscitation, are assessed by repeated red cell volume and hematocrit estimations.
Hourly monitoring of vital signs, general condition, and urinary output is crucial.
Urinary output reflects adequacy of resuscitation.

Methods of Burn Treatment

Two methods for burn treatment: exposure and closed
Exposure method involves leaving the burned area uncovered, applying topical agents every 12 hours, and allowing a crust to form and separate later.
Closed method involves covering the wound with dressings in 3 layers. The inner layer is non-adherent and antiseptic, the second layer is ordinary sterile cotton gauze, and the third layer is a cotton bandage.

Topical Burn Agents

Silver Nitrate is an effective antimicrobial agent but can cause electrolyte disturbances.
Cerium Nitrate is an effective topical antimicrobial agent currently being evaluated clinically.
Mafenide Acetate penetrates the eschar to suppress bacterial proliferation, effective against Clostridium and Pseudomonas. The main disadvantage is hyperchloremia.

Common Burn Wound Infection

The most common site of infection in burn patients is the lungs. The causative organism is Pseudomonas.

Burns of Face and Scalp

The exposure method is used with 1% povidone iodine lotion applied daily.

Wound Healing

Regeneration is the replacement of lost tissue with tissue similar in type.
Reconstitution is the coordinated regeneration of several types of lost tissue, resulting in the reformation of a whole organ or limb. This is not possible in humans. The closest example in humans is the reformation of the pancreas following partial pancreatectomy.

Burn Wound Readiness for Grafting

When the burn wound is covered with red, finely granular granulation tissue, with a surface bacterial count of less than 105/sq.cm and no residual non-viable tissue, it is ready for split-thickness skin grafting (autograft). Pinch grafts are often used in such cases.

Temporary Wound Coverage

Between eschar separation and the point where the wound is ready for autograft, the open wound of granulation tissue can be temporarily covered with a homograft or heterograft. This temporary coverage is known as physiologic or biologic dressing.

Graft Thickness and Take

The thicker the grafted skin, the better the cosmetic result. However, the thinner the grafted skin, the better the take or success rate.

Mesh or Expanded Grafts

If the area to be grafted is extensive, and the donor sites are limited, mesh or expanded grafts are used.

Excision and Skin Grafting

Excision of the burn wound is a viable alternative to conventional treatments. Excision with immediate skin grafting may shorten the hospital stay.

Complications of Thermal Burns

Curling ulcer (stomach & duodenum)
Acute pancreatitis (amylase excretion rate is a sensitive diagnostic test)
Acute cholecystitis
Superior mesenteric artery syndrome
Non-occlusive ischemic enterocolitis
Myocardial infarction

Mafenide Acetate Preferred for Electrical Burns

Mafenide acetate is preferred in electrical burn cases due to its superior ability to penetrate injured tissues deeply and its unique anticlostridial spectrum.

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Description

This quiz examines the various degrees of frostbite and burns, detailing the characteristics and damage involved at each level. Understand the physiological effects and treatment implications for second to fourth-degree frostbite and first to third-degree burns.