3- Burns Flashcards
75% of burn related deaths result from what?
House fires
Pt presents with painful burn that appears red, dry, blanches with presssure, and does NOT have blisters. What type of burn is this and what skin layer is affected?
Superficial, epidermal layer
Sunburns, mild scalds, and mild electrical burns are what type of burn?
Superficial
What is included in the wound care for a superficial burn?
Remove clothing/ debris
Topical calamine/ aloe vera
Topical polysporine (infection)
Dressing not usually needed
Pt presents with painful burn that appears pink, moist, blanches with presssure, and has blisters. What type of burn is this and what skin layer is affected?
Partial thickness, superficial
Partially extends into dermis
Pt presents with burn that is mottled in color from patchy white to red, is non-blanching, has blisters, and is painful with pressure. What type of burn is this and what skin layer is affected?
Partial thickness, deep
Partially extends into dermis
What is the difference in healing between a superficial and deep partial thickness burn?
Superficial: 1-3 weeks, scars not typical
Deep: 2-9 weeks, hypertrophic scarring common
What is included in the wound care for a partial thickness burn?
Keep wound moist + debridement (re-epithelialization)
Do not pop blisters
Petrolium moisturizer/ Bacitracin
Occlusive dressing
If deep w/ eschar: silver sulfadiazine cream + PT
Pt presents with painless burn that appears dry, non-blanching, hard, and has a leathery texture. What type of burn is this and what skin layer is affected?
Full thickness, epidermis + full thickness dermis
What is included in the wound care for a full thickness burn?
Surgical repair + skin grafting
Silver sulfadiazine cream
Opioids
What tissues are involved in a fourth degree/ beyond full thickness burn?
Muscle, tendon, bone, blood vessel, nerve
(life threatening)
What is the management for chemical burns?
Copious irrigation with water, monitor progress with litmus paper
What is the greatest concern with electrical burns?
Damage may be hidden under good skin (current follows path of least resistance)
What is an associated risk of electrical burns?
Rhabdomyolysis
What is the management for electrical burns?
Fluid resuscitate (1-2 cc urine/kg/hr)
Pt presents with feathering skin and Lichtenberg figures. What type of burn are you concerned for?
Lightning burn
(often have permanent injury)
What are the 6 P’s of compartment syndrome and what type of burn are they a/w?
Pain, paresthesia, pallor, paralysis, poikilothermia, pulselessness
A/w circumferential burns
What surgical procedures are used in the management of circumferential burns to relieve pressure?
Escharotomy, fasciotomy
How is breathing managed in a burn pt? (ABCs)
100% oxygen non-rebreather
How is circulation managed in a burn pt? (ABCs)
2 large bore IVs, unburned skin
Calculate TBSA involved (Parkland resuscitaion if ≥ 20%)
What is the #1 cause of death related to fires?
Smoke inhalation
What measurement is NOT reliable for pts with carbon monoxide poisoning?
Pulse ox
Elderly pt with prolonged exposure to carbon monoxide may present with a symptomatic initial clinical picture and are at risk for what complication?
Delayed neurologic sequelae
Pt presents with inhalation injury and skin has “cherry red” appearance. You suspect cyanide (CN)/ hydrogen cyanide poising. What is the tx?
Cyanokit
Hoarseness, stridor, and substernal retractions are sxs of upper or lower airway inhalation injuries?
Upper
Tachypnea, decreased breath sounds, wheezing/ rales/ rhonchi, and accessory muscle use are sxs of upper or lower airway inhalation injuries?
Lower
What is included in the tx for inhalation injuries?
Mechanical ventilation
Aggressive pulmonary toilet
Pneumonia prevention/ tx
Supplemental nutrition
Pt should be intubated if hx suggests airway compromise or they are unable to protect their airway (trauma, opioids). What hx is suggestive of compromise? (6)
- Closed space smoke exposure
- Carbonaceous sputum
- Facial burns
- COHb > 5
- Hoarse voice
- Singed facial hair
What are the goals of circulation resuscitation in burn pts?
Maintain perfusion to end organs
Monitor I+O
Diuretics not indicated in acute setting
What is the Parkland formula for TBSA for burn pts?
(used if ≥ 20%)
4mL LR x kg x TBSA = 24 hr post burn total
Half of volume given in first 8 hrs post burn
Rest given in remaining 16 hrs
Burn pts who have a delay in receiving care can experience under-resuscitation and are at risk for what?
Intravascular volume depletion
Suboptimal tissue perfusion
Burn pts who are over resuscitated are at risk for what?
Abdominal compartment syndrome
Compartment syndrome
Pulmonary edema
When/ why is nutritional support recommended for burn pts?
25% TBSA
Losses exceeding 10% body weight a/w poorer outcome
What nutritional support is recommended for burn pts?
High carb, low fat diet
Protein needs ~1.5-2 g/kg
Vitamins A, E, D, C, + selenium/ zinc
TPN NOT recommended (increases mortality)
According to ABA referral criteria, who is transferred to a burn center for care?
- Partial thickness > 10% TBSA
- 3rd degree burns, any age group
- Face, hands, feet, genitalia, perineum, major joints
- Electrical/ chemical/ inhalation
- Concomitant trauma
Infection is the leading cause of morbidity/ mortality a/w burns. Wounds that become colonized in 3-5 days typically involve what type of organisms?
G (+), S. aureus
What type of grafts are used as a temporary skin covering in a staging graft procedure?
Allograft, xenograft
What is the only definitive grafting for large or deep burn wounds?
Autograft (pts own skin)
Requires donor site (painful and takes time to heal)
Pt presents with decreased urine output, elevated bladder pressure > 25 mmHg, increased peak expiratory pressure, and poor ventilation. What burn complication are you concerned about and what is the treatment?
Abdominal compartment syndrome
Tx: decompressive laparotomy (if unable to reverse)
Pt presents with trismus (lockjaw) and subsequent descending muscle rigidity within 24-48 hours. What burn complication are you concerned for?
Tetanus
In what circumstances is a wound prone to tetanus?
- Present > 6 hours
- > 1 cm deep
- Exposed to saliva/ feces
What complications are a/w tetanus?
Abscess, gangrene
What is the major concern with chronic ulcerations (complication of burn)?
Marjolin ulcer
What type of burn scar is an overgrowth of scar tissue that extends beyong the area of injury?
Keloid
What type of burn scar is thick, raised, red, and does not extend beyond original injury?
Hypertrophic
What type of burn scar is connective tissue replaced with fibrotic tissue and is a/w decreased ROM that leads to shortening of the muscle?
Scar contractures
