ATLS thermal injuries Flashcards
Burns inside or around the mouth mean you should take what action
Intubation
What are the clinical indications of inhalation injury? (5)
- Burns or soot around mouth and face
- Inflammation of the nose/pharynx
- Hoarseness
- H/o confinement in a burning building
- Carboxyhemoglobin level over 10%
True or false: if the patient has an inhalational injury, they should be intubated and shipped to the nearest burn center
True
When in the course of the disease does stridor occur with inhalational injuries?
Late–intubate NOW
Circumferential burns to the neck indicate the need for what?
Intubation now
Should you remove clothing from a burn victim?
Yes, but do not peel off adherent clothing
What temperature water should be used to clean burn patients?
Warm
Any patient with burns over more than (__) of the
body surface requires fluid resuscitation.
Any patient with burns over more than 20% of the
body surface requires fluid resuscitation.
If the extent of the burn precludes placement of the catheter through unburned skin, what should be done?
Place IV through the burned skin into an accessible vein
Why are upper extremity veins better for establishing IVs than lower ones?
Lower risk of phelbitis
The palmar surface (including the fingers) of the patient’s hand represents approximately (__) of the patient’s body surface
1%
What defines second degree burns?
Erythema, Blisters and edema, painful, wet
What defines third degree burns?
Dead, insensate tissue, that does not blanch with pressure
What percent of the body surface area does the head represent in an adult?
9%
What percent of the body surface area do the arms represent in an adult?
9% apiece
What percent of the body surface area does the anterior torso and back (respectively) represent in an adult?
18% apiece
What percent of the body surface area do the legs represent in an adult?
9% apiece
What percent of the body surface area does the genital area represent in an adult?
1%
What percent of the body surface area does the head represent in an infant?
18%
What percent of the body surface area do the arms represent in an infant?
9% apiece
What percent of the body surface area do the legs represent in an infant?
14% apiece
What percent of the body surface area does the anterior torso represent in an infant?
18%
What percent of the body surface area does the back (excluding the buttocks) represent in an infant?
13%
What percent of the body surface area do the buttocks represent in an infant?
2.5% apiece for a total of 5% for the entire butt
The clinical manifestations of inhalation injury may be subtle and frequently do not appear in the first (__) hours
The clinical manifestations of inhalation injury may be subtle and frequently do not appear in the first 24 hours
What are the three major breathing concerns (not airway) with inhalational injuries?
Hypoxia
CO poisoning
Smoke inhalation
Circumferential chest burns may induce (__) indicating the need for (__)
hypoxia from constriction, indicating the need for intubation
CO levels under what % usually cause no s/sx?
20%
What should all patients suspected of CO poisoning get?
CO levels
Non-rebreather mask with high flow O2
Why do you need a bigger sized ET tube when intubating a burn patient?
Will need for bronchoscopy later
Why is there an increased risk of pneumonia in inhalational injuries?
Edema and sloughing of cells in the airways leads to plugging
What are the two factors needed to diagnose inhalational injury?
Exposure to a combustible agent
Signs of exposure to smoke in the lower airways
What is the treatment for smoke inhalation injury?
good supportive care
Why, if appropriate, should an inhalational injury victim be sit up at 30 degrees in bed? What needs to be excluded before doing this?
Reduced neck and chest wall edema–but make sure no spinal injury or hemodynamic compromise
What is the goal urine output in an adult burn victim? Children?
Adult = 0.5 mL/kg/hr Children = 1 mL/kg/hr if under 30 kg
Why is ECG monitoring necessary for fluid resuscitation of burn victims?
Electrolyte abnormalities can occur
What is the parkland formula (mathematically)?
V = 4m(A*100) | m = kg, A = surface area and V is mL
What is the parkland formula used for? How is it applied?
To calculate fluids needs in first 24 hours
First half of fluids given over 8 hours, rest given over 16
What are the orders to be placed for burn/smoke inhalation victims? (5)
CBC BMP ABG Type and cross Pregnancy test
How is compartment syndrome 2/2 circumferential burns treated?
Escharotomy
Circumferential abdominal burns + aggressive IVFs = ?
Abdominal compartment syndrome
Why should all jewelry be removed from burn patients?
Resulting edema can cause compartment syndrome
When is an NG tube indicated for burn pts?
n/v or more than 20% burned surface area
Severely burned patients may be restless and anxious from hypoxemia or hypovolemia rather than pain. What is the significance of this?
Hypoxemia and inadequate fluid resuscitation should be managed before administration of narcotic analgesics or sedatives, which can mask the signs of hypoxemia and hypovolemia
Why should you not apply cold compresses to burns over 10% BSA?
Hypothermia
What is the role of Abx prophylactically in burn pts
Not given–only for infx
Which are more serious and why: alkali or acid burns?
Alkali because it penetrates deeper
Why is water preferred over neutralizing acid/bases in chemical burns?
Neutralizing agents will produce heat and further damage tissue
Alkali burns to the eye require continuous irrigation during the first (__) hours after the burn.
8 hours
Why are electrical burns more serious than they appear?
can burn inside due to rapid cooling of outer skin, but no so deeper
True or false: electrical burn patients frequently need fasicotomies
True
True or false: If there are no arrhythmias in an electrical burn patient within the first few hours of injury, prolonged monitoring is not necessary.
True
Why is rhabdo a major concern with electrical injuries?
Compartment syndrome and severe muscle contraction from electrocution
What is the rate of IVF administration for rhabdo in children and adults respectively?
100 mL/hr in adults or 2 mL/kg in children
Partial-thickness and full-thickness burns on greater than (__) of the BSA in any patient require transfer to a burn center
10%
Partial-thickness and full-thickness burns involving what areas of the body require transfer to a burn center? (4)
head
hands
feet
genitals/perineum
True or false: full thickness burns in anyone require burn center eval
True
True or false: any significant chemical or electrical burns needs to be transferred to a burn center
True
True or false; inhalational injuries always transfer to a burn center
True
What is the treatment for frostnip?
Supportive
What is frostnip?
White or red skin that is reversible with warming
What is first degree frostbite?
Hyperemia and edema without skin necrosis
What is second degree frostbite?
Large, clear vesciles formation + hyperemia and partial skin necrosis
What is third degree frostbite?
Full thickness an SQ tissue necrosis, with vesicle formation
What is fourth degree frostbite?
Full thickness skin necrosis, including muscles and bone with gangrene
When is the only time rewarming is not indicated for the treatment of frostbite?
If there is a chance of refreezing
What is the treatment for all forms of frostbite?
Rewarm and give analgesics
True or false: cardiac monitoring is not needed when rewarming frostbite
False-is needed
Does a pt need to stop smoking with frostbite
Yes–vasoconstriction
When can the patient bear weight on a frost bitten extremity?
When edema is resolved
What temp defines hypothermia and severe hypothermia?
36 C = hypothermia
32 C = severe hypothermia
Why is hypothermia in the trauma patient particularly bad?
Worsens coagulopathy
