ADULT BURNS Flashcards
WHAT DO THE DEPTH OF INJURY MEAN? (1,2,3,4 DEGREE BURNS)
1-EPIDERMIS ONLY. REDNESS, PAIN, MINIMAL EDEMA, NO BLISTERS, IE SUNBURN.
2-AKA PARTIAL THICKNESS-SUPERFICIAL DERMIS AND DERMIS CAPILLARIES AND NERVE ENDINGS. BASEMENT MEMBRANE IS INTACT. PINK, WET, PAINFUL. FLASH FIRE.
3 AKA FULL THICKNESS- DEEP DERMIS REACHING LARGE VESSELS. LOOKS WHITE, DRY. PAINLESS. IMMERSION SCALD OR ELECTRICAL FLAME.
4-DEEP THERMAL INJURY INVOLVING BONY TENDON AND MUSCLE.
WHAT ARE THE 4 TYPES OF BURNS?
ELECTRICAL, CHEMICAL, THERMAL, RADIATION
WHAT IS THE RULE OF 9’S?
CLASSIFICATION OF BURN SIZE ON TOTAL BODY SURFACE AREA TBSA. ITS CUT UP INTO 9’S
HEAD 9, UPPER EXTREMITIES 9 EACH, ANTERIOR TRUNK 18, POSTERIOR TRUNK 18, LEGS 18 EACH.
WHAT BURNS QUALIFY FOR A HOSPITAL STAY?
PARTIAL THICKNESS GREATER OR= TO 25% TBSA
FULL THICKNESS GREATER OR= TO 10% TBSA
FULL THICKNESS OF FACE HANDS OR FEET
ELECTRICAL BURNS (POSS. INNER ORGAN PROB.)
SMOKE INHALATION INJURY (RESP. PROB)
WHAT ARE THE 4 CV EFFECTS THAT OCCUR WITHIN THE FIRST 24-48 HRS?
VASCULAR PERMEABILITY INCREASES
PLASMA VOL REDUCED
CARDIAC OUTPUT DECREASES
FLUID RESUSITATION
WHAT ARE THE CV EFFECTS AFTER 24-36 HRS?
HYPERDYNAMIC STATE
DECREASED RBC SURVIVAL TIME TO 40 DAYS
POTENTIAL FOR CARDIAC ARREST
VASCULAR PERMEABILITY INCREASES CAUSING A REGIONAL LOSS OF MICROVASCULAR INTEGRITY. A BURN OF WHAT % TBSA IS GENERALIZED LOSS EXPERIENCED?
30%
WHAT IS USED FOR FLUID RESCUSITATION IN THE FIRST 24-48HRS?
CRYSTALLOIDS. LR/NS. COLLOIDS WOULD JUST LEAK OUT AND BRING FLUID WITH IT…(IN THE RESUSUTATION PHASE)
WHAT IS THE KEY FACTOR IN DECREASING BURN DEATH AND WHO SHOULD IT BE GIVEN TO?
AGGRESSIVE FLUID RESUSCITATION. ADMINISTERED TO ALL BURN PT WITH GREATER THAN 15-20% TBSA BURN
HOW DO YOU CALCULATE FLUID VOLUME REPLACEMENT?
PARKLAND METHOD.
FOR FIRST 24HRS: 4ML/%BURN/KG. HALF IN THE FIRST 8HRS. THEN THE OTHER HALF IN THE NEXT 16 HRS. NO COLLOID.
2ND 24HRS: D5W MAINTENANCE. COLLOID: .5ML/%BURN/KG
WHEN DOES THE HYPERDYNAMIC STATE OCCUR? AND WHAT WILL YOU SEE?
AFTER 24-36 HRS. SEE FIGHT OR FLIGHT RXN. CARDIAC OUTPUT INCREASES, CATECHOLAMINE RELEASE. THIS CAN BE SUSTAINED FOR HOURS OR DAYS.
HOW IS CARBON MONOXIDE POISONING MEASURED IN PTS?
BY MEASURING CARBOXYHEMOGLOBIN LEVELS….NORMAL IS LESS THAN 1% NONSMOKER, LESS THAN EQUAL TO 10% IN SMOKER.
HOW DOES CARBON MONOXIDE CAUSE PROBLEMS?
IT HAS 200X THE AFFINITY FOR HGB OVER O2 SO OXYGEN ISNT DELIVERED TO TISSUES. SHIFT TO LEFT ON O2/HGB CURVE.
WHICH ORGANS ARE MOST SENSITIVE TO HYPOXIA?
HEART AND BRAIN
WHAT IS TREATMENT FOR CARBON MONOXIDE POISONING?
100% O2
WHAT ARE THE SYMPTOMS OF CO TOXICITY AS A FUNCTION OF BLOOD COHB LEVEL?
LESS THAN 15-20: HA, DIZZINESS, CONFUSION
20-40: N/V, DISORIENTATION, VISUAL DIST.
40-60: AGITATION COMBATIVENESS, HALLUCINATIONS, COMA, SHOCK
GREATER 60: DEATH
WHAT IS THE MOST SENSITIVE INDICATOR OF VOLUME STATUS AND PERIPHERAL PERFUSION?
URINE OUTPUT
.5ML/KG/HR IS MINIMUM
WHAT ARE YOU LIKELY TO SEE IN BURN PT AFTER GIVING THEM PROTEIN BOUND DRUGS LIKE BENZO’S OR DILANTIN?
A GREATER EFFECT BECAUSE MORE IS IN CIRCULATION AND NOT BOUND TO PROTEIN. LIVER TOOK A HIT AND IS PRODUCING LESS ALBUMIN.
WHAT MUSCLE BLOCKER IS CONTRAINDICATED IN BURN PTS?
AVOID SUX 24 HRS TO 2 YEARS AFTER BURN INJURY. ITS OKAY IN THE FIRST 24HRS.
HOW WILL BURN PT REACT TO NDMR?
THEY WILL CHEW THROUGH IT QUICKLY! BECAUSE THEY HAVE INCREASED RECEPTOR SITES, INCREASED BMR, INCREASE IN AAG, ALTERED RECEPTOR AFFINITY FOR MUSCLE RELAXORS.
WHATS THE EBL FOR AN EXCISION AND GRAFTING?
EBL=200ML/1%BSA
PAST 24 HRS YOU CAN USE COLLOIDS AGAIN.
