99: Burns Flashcards
What are the four general phases in managing large burns?
- Initial evaluation and resuscitation 2. Wound debridement and biologic closure 3. Rehabilitation and reconstruction 4. Long term outcome quality assessment.
What safety implementations have contributed to a 60% decrease in burn injuries since the early 1990s?
- Reduction in tobacco use and alcohol abuse 2. Prevention education programs 3. Change in home cooking practices 4. Decreased industrial employment.
What is the most common mechanism of burn injury in the outpatient setting?
Scald burns.
What percentage of burn patients admitted to burn centers are due to electrical burns?
4%.
What is the relationship between the duration of contact with an electrical source and tissue destruction?
The duration of contact with the electrical source is proportional to tissue destruction; longer contact times increase tissue damage.
What are the characteristics of flame burns?
- Caused by fire or flames
- Most common burn etiology over the past decade
- Associated with the highest risk of death and complications
- 64% occur at home; 12% at work; 6% recreational
- 17% involve smoke inhalation injury, especially if indoors or in an enclosed space
- 24% mortality if with inhalation injury; 4% if without.
What factors determine the severity of electrical burns?
The severity of electrical burns is determined by: 1. The current (amperage) of electricity 2. The direction of travel of the current 3. Duration of contact with the electrical source.
What is the ‘no let-go’ phenomenon in electrical burns?
The ‘no let-go’ phenomenon refers to the increased contact time during electric shock, which leads to greater tissue destruction due to the strength of flexors being greater than extensors.
What is the likelihood risk of fire-related death in the United States?
1.5: 1000.
What is the mortality rate for burn patients with inhalation injury compared to those without?
24% mortality if with inhalation injury; 4% if without.
What is the primary cause of contact burns in children?
Touching a hot object.
What is the significance of TBSA in assessing burn severity?
TBSA is an unreliable surrogate for burn severity as it does not reflect the degree of internal tissue and organ damage caused by electrical current penetration.
What are the common causes of chemical burns and their associated injuries?
Common causes of chemical burns include:
- Acids bind hydrogen ions to proteins, inducing coagulation.
- Alkali causes deeper and more serious injuries with liquefactive necrosis.
Chemical | Associated Injury |
|———-|——————|
| Carbon monoxide | High frequency of associated injury |
| Ammonia | High frequency of associated injury |
| Chlorine | High frequency of associated injury |
| Hydrochloric acid | High frequency of associated injury |
| Sulfuric acid | High frequency of associated injury |
What are the treatment steps for chemical burns?
The treatment steps for chemical burns include:
- Remove clothing and accessories.
- Brush or dust solids or powders off the skin.
- Irrigate the wound with copious amounts of water.
- Hydrate the area with saline.
- Avoid attempts at neutralizing the chemical, as this may worsen the reaction.
- Administer antidotes as necessary.
What are the clinical features used to characterize different regions of burns?
The clinical features used to characterize different regions of burns include:
- Zone of coagulation: Cell death occurs in this area.
- Zone of stasis: Cell injury that can either recover or transform into the zone of coagulation.
- Zone of hyperemia: Cells in this area will recover from injury.
What are the complications associated with smoke inhalation injury?
Complications associated with smoke inhalation injury include:
- Burns sustained in structural fires.
- Exposure to carbon monoxide and cyanide toxicity.
- Symptoms typically present as perioral burns and the presence of ashes and soot around the mouth and oropharynx.
- Direct thermal injury to the pulmonary epithelium, leading to edema and airway obstruction.
- Smoke inhalation injury can double the mortality rate.
What factors contribute to the higher prevalence of permanent disability from burns in low to middle income countries?
The higher prevalence of permanent disability from burns in low to middle income countries is attributed to:
- Inadequate safety measures.
- Lack of specialized burn centers.
- Limited prevention outreach.
- Deficiencies in training and resources necessary to provide impactful burn care.
A patient with a chemical burn caused by hydrofluoric acid presents to the emergency department. What is the specific antidote and its administration?
The antidote is topical calcium gluconate gel, intra-arterial calcium infusion, or subeschar injection of dilute 10% calcium gluconate solution.
A patient with a burn injury has a zone of stasis. What does this zone represent, and what is its clinical significance?
The zone of stasis represents cell injury that can either recover or progress to cell death. It is critical to optimize perfusion to prevent further damage.
A patient with a burn injury is found to have tympanic membrane rupture. What is the likely cause?
The rupture is likely due to secondary electrical injury from explosive shock waves generated by electric arcs.
A patient with a burn injury is found to have a zone of coagulation. What does this zone represent?
The zone of coagulation represents cell death and is the area of greatest tissue damage.
A patient with a burn injury is found to have a toxic level of cyanide. What is the likely source and management?
The likely source is smoke inhalation from structural fires. Management includes administering hydroxocobalamin or sodium thiosulfate.
A patient with a burn injury is found to have a zone of hyperemia. What does this zone represent?
The zone of hyperemia represents cells that will recover from injury.
What is the leading cause of injury-related deaths?
Burns are the 4th leading cause of injury-related deaths.
What are the common chemicals associated with chemical burns?
Carbon monoxide, ammonia, chlorine, hydrochloric acid, and sulfuric acid.
What is the recommended treatment for chemical burns?
Remove clothing, irrigate with water, hydrate with saline, and give antidote if necessary.
What is the significance of the zone of coagulation in burn injuries?
It represents the area of cell death due to the most severe damage from the burn.
What are the long-term disability statistics for children who survive burn injuries?
15% experience long-term temporary disability and 8% have permanent disability.
What complications can arise from smoke inhalation injuries?
Direct thermal injury to the pulmonary epithelium, leading to edema and airway obstruction, which can double mortality rate.
What should not be done when neutralizing chemical burns?
Attempts at neutralizing should not be undertaken as heat from exothermic reactions may worsen the severity of the reaction.
What are the three zones of burn injury characterization?
Zone of coagulation, zone of stasis, and zone of hyperemia.
What is the risk for patients who survive a lightning strike?
They are at high risk for arrhythmias and compartment syndrome between the entry and exit points.
What is compartment syndrome and what are its causes?
Compartment syndrome occurs due to circumferential burns of the extremities, leading to increased swelling and edema, which causes:
1. Nerve impingement
2. Vascular compromise.
What defines abdominal compartment syndrome and how is it treated?
Abdominal compartment syndrome is defined as bladder pressure over 30 mmHg, usually presenting with oliguria and abdominal distension. Treatment includes:
1. Lay the patient flat; restrict movement.
2. Escharotomy of the abdominal full thickness burns.
3. Decrease fluids.
4. Start diuresis or continuous renal replacement therapy to avoid decompressive laparotomy.
What is a Curling ulcer and what causes it?
A Curling ulcer, also known as acute stress gastritis, is caused by intravascular volume depletion and may lead to bleeding in the gastric or duodenal mucosa.
What are the consequences of acute renal failure in burn patients?
Acute renal failure in burn patients is often due to massive myoglobinuria, which is common in electrical burns.
What is ectopic bone formation in burn patients and its common site?
Ectopic bone formation occurs due to heterotopic ossification in patients with large total body surface area (TBSA) burns, presenting with severe pain, contractures, and restricting range of motion. The most common site is the elbow (upper extremity).
What is the hypermetabolic state in burn patients?
The hypermetabolic state in burn patients is often proportional to the size of the injury and involves muscle catabolism, hyperglycemia, and increased lipid liberalization with steatosis.
What are the two paradigms of etiology and pathogenesis in burn injuries?
The two paradigms of etiology and pathogenesis in burn injuries are:
1. Loss of skin organ function
2. Production of inflammatory response.
How does loss of skin organ function affect burn patients?
Loss of skin organ function leads to:
- Impaired barrier against microbes and absorption
- Unregulated insensible water losses causing IV volume depletion
- Increased susceptibility to infections like cellulitis and sepsis
- Loss of thermoregulation and sensory perception
- Development of Marjolin ulcers due to UV radiation exposure.
What is the inflammatory response in burn injuries?
The inflammatory response in burn injuries is profound and biphasic, characterized by:
1. Vasodilation and increased capillary permeability
2. Promotion of transudate production
3. Promotion of insensible fluid losses
- In cases of >20% BSA, systemic inflammatory response occurs, leading to fever, hyperdynamic circulation, and increased basal metabolic rate for 1-2 years.
What is the primary goal when assessing a burn patient?
The primary goal is to stabilize the patient and ensure proper assessment of the burn.
What percentage of burn patients experience inhalation injuries, and what is the significance of this statistic?
Inhalation injuries occur in approximately 10% of all burn patients but are present in 70% of those who eventually die, indicating a high risk of mortality associated with inhalation injuries.
What is the Parkland formula used for in burn management?
The Parkland formula (4ml x TBSA) is used for calculating fluid resuscitation in burn patients.
What percentage of burn patients experience inhalation injuries?
Approximately 10%, but they present in 70% of those who eventually die.
What is the Parkland formula used for in burn management?
The Parkland formula (4ml x TBSA x weight in kg) is used to calculate fluid requirements for burn patients within the first 24 hours after injury.
What is the recommended fluid administration schedule according to the Parkland formula?
Half of the calculated fluid volume is administered in the first 8 hours, and the second half is administered over the next 16 hours.
What is the gold standard for monitoring fluid status in burn patients?
The gold standard for monitoring fluid status is urine output.
What are the recommended fluids for burn resuscitation to avoid complications?
Lactated Ringer solution is recommended to avoid complications associated with metabolic acidosis and abnormal fluid shifts with colloid fluids.
What are the potential complications of aggressive hydration in burn patients?
Aggressive hydration can lead to potential rhabdomyolysis, which may result in acute kidney injury.
What should be closely monitored in burn patients to determine organ perfusion trends?
Close monitoring of the patient’s laboratories, including lactate, base deficit, central venous O2, and pH, is necessary to determine the trend in organ perfusion.
What is the initial fluid resuscitation plan using the Parkland formula for a 35-year-old male with 30% TBSA burn?
For a 35-year-old male weighing 70 kg with 30% TBSA burn: 4 × 30 × 70 = 8400 mL in 24 hours. Administer half (4200 mL) in the first 8 hours and the remaining half over the next 16 hours.
What are the key considerations for fluid resuscitation in a pediatric patient with 15% TBSA scald burn?
For children, the goal is 1 mL/kg/h urine output. Use the Parkland formula to calculate fluid needs and monitor closely for signs of overhydration or underhydration.
