29.11 Traumatic Burns

Question 1

The most challenging time in the resuscitation of a burn patient is typically the first

Answer 1

48 hours

Question 2

A full thickness (or 3rd degree) burn has 3 zones of tissue injury

Answer 2

• Zone of coagulation – central zone
• Zone of stasis – adjacent to zone of necrosis, immediately after injury blood flow is stagnant
• Zone of hyperemia – outermost zone

Question 3

What is the Zone of coagulation – central zone

Answer 3

Region of greatest destruction resulting in Necrosis and not capable of repair.

Question 4

What is the Zone of stasis

Answer 4

1)Cells are injured but not irreversible.
2)Will become necrotic if deprived of blood flow.
3)Timely burn care and resuscitation will preserve blood flow and oxygen delivery.

Question 5

What is Zone of hyperemia

Answer 5

1)Minimal cellular injury and characterized by increased blood flow secondary to inflammatory reaction initiated by the burn injury

Question 6

BURNS EVOLE OVER TIME. Withhold final judgement until appx how long after injury.

Answer 6

48 hours

Question 7

What kind of burn:
(a)Historically referred to as first degree.
(b)Involve ONLY EPIDERMIS.
(c)Red and painful.
(d)Rarely clinically significant except in the situation of large sunburns which canincrease the risk of dehydration
(e)Heal well within a week without scar.
(f)Not included when calculating the percentage of total body surface area of burns.

Answer 7

Superficial Burns

Question 8

What kind of burn:
(a)Once referred to as second degree.
(b)Involve epidermis and varying portions of the DERMIS.
(c)Can be classified as superficial or deep.
(d)Will appear as BLISTERS or “denuded” burned areas with glistening or wetappearing base.
(e)Zone of necrosis involves entire epidermis and varying depths of superficial dermis, can progress to full thickness if not properly treated

Answer 8

Partial thickness burns

Question 9

What kind of burn:
(a)May have several appearances.
(b)Most often appear thick, dry, white, and leathery regardless of skin color.
(c)Thick leathery damaged skin referred to as eschar.
(d)Common, misconception that these burns are pain free because nerve endingsare destroyed. These patients have varying degrees of pain, surrounding areashave superficial and partial thickness burns. These nerves are intact. These burns can be disabling and life threatening.

Answer 9

Full thickness

Question 10

Point of injury care for burns

Answer 10

(1) Stop the burning process.
(2) Provide resuscitative care. Hemorrhage control. Airway maintenance.
(3) Remove all constricting articles.
(4) Cover the patient
(5) Protect against hypothermia
(6) Establish IV access.
(7) Begin resuscitation
(a)Use LR solution or similar.
(b)Continue during evac.
(c)Starting rate 500ml/hr for adults.

Question 11

What is a lifesaving procedure for full thickness burns of the chest

Answer 11

Perform immediate escharotomy as a lifesaving procedure to permit adequate chest excursion

Question 12

What is the primary index of adequate resuscitation for burn victims

Answer 12

UOP

Question 13

Hourly fluid rate for burns

Answer 13

1)Initial hourly rate = %TBSA Burn x 10 ml/hr
2)Example 40% TBSA = 400 ml/hr
3)Rate of infusion or LR adjusted based on physiological response. UOP. Avoid abrupt changes in rate.
4)Adjust rate by 25% as needed.
5)Remember to adjust based on UOP.

Question 14

What should be used for monitoring burn patients?

Answer 14

TWO IV’s, Foley, ECG monitoring, pulse Ox, a core temp, and NG tube are ideal for monitoring depending on capabilities

Question 15

Target UOP for burn victims

Answer 15

0.5 ml/kg/hr

Question 16

Wound care for burn victims

Answer 16

(a)Topical antibiotics agents after cleaning
(b)Silver nylon dressings which provide antimicrobial coverage
(c)Topical antimicrobial solution or creams