Week 4: Burns, Vasculitis and Vasculopathy, Irregular Wounds

Types of burns?

Thermal, chemical, electrical, radiation

Thermal burns are usually - burns, if non-painful it is - -

Combination, full thickness

For chemical burns, you need to - with -

Neutralize, water

Depth of Burn Categories

• Pain (3)

• No pain (2)

• 1st degree/superficial, 2nd degree/superficial partial thickness, 2nd degree/deep partial thickness

• 3rd degree/full thickness, 4th degree/subdermal

Describe each “degree”

• 1/s: epidermis, pink/red, no blisters, heal in a few days

• 2/spt: epidermis + papillary dermis, red, blisters, blanching

• 2/dpt: epidermis + dermis, pale, no blanching

• 3/ft: through epidermis + dermis and into subcutaneous tissue, dry, yellow/red/black

• 4/sub: to fascial layer/muscle, charred, underlying structures exposed

What is rule of nines?

• How much for each side of arms vs legs?

• What is the remaining 1%?

Helps us quantify burns by total body surface area

• 4.5 arms, 9% legs

• Genatalia

In emergent phase of burn, we want to manage - and push -

In acute phase, we want to manage -, prevent -, perform -, and ensure -

Airways, fluids

Pain, infection, debridement, nutrition

What is vasculitis?

Inflammation (+narrowing) of the vessels resulting in reduced BF to organs/skin

What causes vasculitis?

RA/lupus, infectious, medications, cancer, idiopathic

What is vasculopathy?

Occlusion of vessels (thrombi) resulting in reduced BF to organs/skin

Vasculitis/Vasculopathy looks similar to -, but is very painful

• Describe

• Hallmark of VT

• Hallmark of VP

Venous

• Palpable pulse, in lower legs/feet, necrotic or granular, irregular edges, spotty red coloration, atrophy blanche

• PALPABLE PURPURA

• LIVEDO RETICULARIS

What should compression look like for these pts?

Low resting pressure

Abnormal Wounds. What is….

• Pyoderma Gangrenosum

• Calciphylaxis

• Necrotizing Fascitis

• Overactivation of Neutrophils → Well demarcated wound with red borders, undermining of edges; Rapidly enlarging ulcer; Exquisitely painful

• Calcium deposits in micro-circulation causing ischemia + necrosis → Red/mottled + indurated skin, irregular borders with black eschar covering wound, painful, stomach or proximal LE

• Rapidly spreading flesh eating disease → Red, swollen limb, fever+nv, pain out of proportion with clinic findings

Abnormal Wounds. What is….

• Ulcerative Gout

• Sickle Cell

• Malignancy

• Uric acid crystals deposit into joints, can deposit elsewhere if chronic → Red, swollen painful joint; white crystals coming through wound bed

• Medial/lateral ankle+foot+toes, very painful, dusky around edges due to ischemia

• Raised edges, friable tissue, irregular edges, malodorous, fungating tumor

Treatment for…

• Pyoderma Gangrenosum

• Calciphylaxis

• Necrotizing Fascitis

• Ulcerative Gout

• Sickle Cell

• Malignancy

• Steroids, immunosuppressants, antimicrobials, autolytic debridement support

• Sodium thiosulfate, surgical debridement, NPWT

• Surgical debridement, antibiotics, NPWT

• Meds for UA level, standard wound care, immobilization

• Pain management, debridement, modalities

• You already know this