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A1 > ATLS thermal injuries > Flashcards

ATLS thermal injuries Flashcards

1
Q

Burns inside or around the mouth mean you should take what action

A

Intubation

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2
Q

What are the clinical indications of inhalation injury? (5)

A
  • Burns or soot around mouth and face
  • Inflammation of the nose/pharynx
  • Hoarseness
  • H/o confinement in a burning building
  • Carboxyhemoglobin level over 10%
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3
Q

True or false: if the patient has an inhalational injury, they should be intubated and shipped to the nearest burn center

A

True

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4
Q

When in the course of the disease does stridor occur with inhalational injuries?

A

Late–intubate NOW

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5
Q

Circumferential burns to the neck indicate the need for what?

A

Intubation now

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6
Q

Should you remove clothing from a burn victim?

A

Yes, but do not peel off adherent clothing

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7
Q

What temperature water should be used to clean burn patients?

A

Warm

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8
Q

Any patient with burns over more than (__) of the

body surface requires fluid resuscitation.

A

Any patient with burns over more than 20% of the

body surface requires fluid resuscitation.

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9
Q

If the extent of the burn precludes placement of the catheter through unburned skin, what should be done?

A

Place IV through the burned skin into an accessible vein

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10
Q

Why are upper extremity veins better for establishing IVs than lower ones?

A

Lower risk of phelbitis

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11
Q

The palmar surface (including the fingers) of the patient’s hand represents approximately (__) of the patient’s body surface

A

1%

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12
Q

What defines second degree burns?

A

Erythema, Blisters and edema, painful, wet

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13
Q

What defines third degree burns?

A

Dead, insensate tissue, that does not blanch with pressure

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14
Q

What percent of the body surface area does the head represent in an adult?

A

9%

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15
Q

What percent of the body surface area do the arms represent in an adult?

A

9% apiece

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16
Q

What percent of the body surface area does the anterior torso and back (respectively) represent in an adult?

A

18% apiece

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17
Q

What percent of the body surface area do the legs represent in an adult?

A

9% apiece

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18
Q

What percent of the body surface area does the genital area represent in an adult?

A

1%

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19
Q

What percent of the body surface area does the head represent in an infant?

A

18%

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20
Q

What percent of the body surface area do the arms represent in an infant?

A

9% apiece

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21
Q

What percent of the body surface area do the legs represent in an infant?

A

14% apiece

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22
Q

What percent of the body surface area does the anterior torso represent in an infant?

A

18%

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23
Q

What percent of the body surface area does the back (excluding the buttocks) represent in an infant?

A

13%

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24
Q

What percent of the body surface area do the buttocks represent in an infant?

A

2.5% apiece for a total of 5% for the entire butt

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25
Q

The clinical manifestations of inhalation injury may be subtle and frequently do not appear in the first (__) hours

A

The clinical manifestations of inhalation injury may be subtle and frequently do not appear in the first 24 hours

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26
Q

What are the three major breathing concerns (not airway) with inhalational injuries?

A

Hypoxia
CO poisoning
Smoke inhalation

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27
Q

Circumferential chest burns may induce (__) indicating the need for (__)

A

hypoxia from constriction, indicating the need for intubation

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28
Q

CO levels under what % usually cause no s/sx?

A

20%

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29
Q

What should all patients suspected of CO poisoning get?

A

CO levels

Non-rebreather mask with high flow O2

30
Q

Why do you need a bigger sized ET tube when intubating a burn patient?

A

Will need for bronchoscopy later

31
Q

Why is there an increased risk of pneumonia in inhalational injuries?

A

Edema and sloughing of cells in the airways leads to plugging

32
Q

What are the two factors needed to diagnose inhalational injury?

A

Exposure to a combustible agent

Signs of exposure to smoke in the lower airways

33
Q

What is the treatment for smoke inhalation injury?

A

good supportive care

34
Q

Why, if appropriate, should an inhalational injury victim be sit up at 30 degrees in bed? What needs to be excluded before doing this?

A

Reduced neck and chest wall edema–but make sure no spinal injury or hemodynamic compromise

35
Q

What is the goal urine output in an adult burn victim? Children?

A 
Adult = 0.5 mL/kg/hr
Children = 1 mL/kg/hr if under 30 kg
36
Q

Why is ECG monitoring necessary for fluid resuscitation of burn victims?

A

Electrolyte abnormalities can occur

37
Q

What is the parkland formula (mathematically)?

A

V = 4m(A*100) | m = kg, A = surface area and V is mL

38
Q

What is the parkland formula used for? How is it applied?

A

To calculate fluids needs in first 24 hours

First half of fluids given over 8 hours, rest given over 16

39
Q

What are the orders to be placed for burn/smoke inhalation victims? (5)

A 
CBC
BMP
ABG
Type and cross
Pregnancy test
40
Q

How is compartment syndrome 2/2 circumferential burns treated?

A

Escharotomy

41
Q

Circumferential abdominal burns + aggressive IVFs = ?

A

Abdominal compartment syndrome

42
Q

Why should all jewelry be removed from burn patients?

A

Resulting edema can cause compartment syndrome

43
Q

When is an NG tube indicated for burn pts?

A

n/v or more than 20% burned surface area

44
Q

Severely burned patients may be restless and anxious from hypoxemia or hypovolemia rather than pain. What is the significance of this?

A

Hypoxemia and inadequate fluid resuscitation should be managed before administration of narcotic analgesics or sedatives, which can mask the signs of hypoxemia and hypovolemia

45
Q

Why should you not apply cold compresses to burns over 10% BSA?

A

Hypothermia

46
Q

What is the role of Abx prophylactically in burn pts

A

Not given–only for infx

47
Q

Which are more serious and why: alkali or acid burns?

A

Alkali because it penetrates deeper

48
Q

Why is water preferred over neutralizing acid/bases in chemical burns?

A

Neutralizing agents will produce heat and further damage tissue

49
Q

Alkali burns to the eye require continuous irrigation during the first (__) hours after the burn.

A

8 hours

50
Q

Why are electrical burns more serious than they appear?

A

can burn inside due to rapid cooling of outer skin, but no so deeper

51
Q

True or false: electrical burn patients frequently need fasicotomies

A

True

52
Q

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.

A

True

53
Q

Why is rhabdo a major concern with electrical injuries?

A

Compartment syndrome and severe muscle contraction from electrocution

54
Q

What is the rate of IVF administration for rhabdo in children and adults respectively?

A

100 mL/hr in adults or 2 mL/kg in children

55
Q

Partial-thickness and full-thickness burns on greater than (__) of the BSA in any patient require transfer to a burn center

A

10%

56
Q

Partial-thickness and full-thickness burns involving what areas of the body require transfer to a burn center? (4)

A

head
hands
feet
genitals/perineum

57
Q

True or false: full thickness burns in anyone require burn center eval

A

True

58
Q

True or false: any significant chemical or electrical burns needs to be transferred to a burn center

A

True

59
Q

True or false; inhalational injuries always transfer to a burn center

A

True

60
Q

What is the treatment for frostnip?

A

Supportive

61
Q

What is frostnip?

A

White or red skin that is reversible with warming

62
Q

What is first degree frostbite?

A

Hyperemia and edema without skin necrosis

63
Q

What is second degree frostbite?

A

Large, clear vesciles formation + hyperemia and partial skin necrosis

64
Q

What is third degree frostbite?

A

Full thickness an SQ tissue necrosis, with vesicle formation

65
Q

What is fourth degree frostbite?

A

Full thickness skin necrosis, including muscles and bone with gangrene

66
Q

When is the only time rewarming is not indicated for the treatment of frostbite?

A

If there is a chance of refreezing

67
Q

What is the treatment for all forms of frostbite?

A

Rewarm and give analgesics

68
Q

True or false: cardiac monitoring is not needed when rewarming frostbite

A

False-is needed

69
Q

Does a pt need to stop smoking with frostbite

A

Yes–vasoconstriction

70
Q

When can the patient bear weight on a frost bitten extremity?

A

When edema is resolved

71
Q

What temp defines hypothermia and severe hypothermia?

A

36 C = hypothermia

32 C = severe hypothermia

72
Q

Why is hypothermia in the trauma patient particularly bad?

A

Worsens coagulopathy

A1 (32 decks)

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