38 - burns

Question 1

3 rules to determine size of a burn

Answer 1

1. rule of nines
   - half leg, one arm, head, half one side of torso
2. hand
   - patient’s hand is 1%
3. lund and browder diagram
   - more precise

Question 2

5 levels of burns

Answer 2

1. superficial (1st) - epi only
   - painful and no blister
   - 1 week
2. superficial partiel (2nd)
   - epi and superfical dermis
   - painful and blister
   - 2-3 weeks
3. deep partial (2nd)
   - involves hair and sebacious glands
   - sense absent and blistered
   - 2 months and scarring common
4. full thickness (3rd)
   - epi and all dermal layers
   - skin pale, insenate and charred
   - scarring in all cases
5. 4th degreee
   - fat muscle and bone
   - amputation may be required

Question 3

risk in inhalation injury

Answer 3

1. airway obst.
2. ARDS
   - beware of toxins

Question 4

what to do for inhalations

Answer 4

1. O2
2. ABG for CO
3. hyperbaric chamber if needed

Question 5

steps in burn mgmt

Answer 5

1. ABCs
2. cooling
   - immersion or compresses
   - no ice
3. fluid resus
   - for >20%
   - 4ccs/kgxBSA for first 24 hours
   - half in first 8 hours and half in next 16
4. analgesia
5. wound care
   - gauze and polysporin
6. no role for prophylactic Abx
   see guidlines for going to burn center

Question 6

2 divisions of electrical injuries

Answer 6

1. high voltage - >1000 and low

Question 7

4 things to look out for in high voltage

Answer 7

1. dysrhythmias
2. deep muscle injury and nercrosis
3. rhabdo
   - fluid resus
4. compartment syndrome

Question 8

2 main types of chem. burns

Answer 8

1. acid
   - coag necrosis and eschar
2. alkali
   - liquifaction and deep