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Complex Care > Burn > Flashcards

Burn Flashcards

1
Q

What if the inflammatory process? (6)

A
  1. Pain
  2. Increased blood flow
  3. Release of vasoactive substances
  4. Increased capillary permeability
  5. Fluids shifts form the vascular to interstitium
  6. Edema
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2
Q

What is the complications of fluids loss that burn patients are at risk for? (4)

A
  1. Edema
  2. Hypovolemic shock
  3. Hypovolemia
  4. Continued pain

These can result in organ and tissue damage

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3
Q

How are burns classified? (3)

A
  1. Etiology
  2. Depth of tissue damage
  3. Total body surface area (TBSA) involved, severity
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4
Q

What is the etiology of burns? (5)

A
  1. Thermal: exposure to heat like flame, steam, scald, and inhalation of heated gases
  2. Chemical such as alkaline, acidic and organic agents
  3. Electrical: r/t voltage, lightning
  4. Radiation: radiation therapy or industrial exposure like nuclear platens
  5. Condition that cause loss of skin/epidermal cells
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5
Q

What is a verified burn center?

A

Prevent, education, teach, research, care for burn pt and rehab

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6
Q

What is the role of the skin? (6)

A 
Protective barrier
Sensation
Water balance 
Temperature regulation 
Vitamin production 
Cosmetic
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7
Q

What is a superficial burn?

A

1st degree

Only to the thin epidermis layer

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8
Q

What is a partial thickness burn?

A

1st degree

Burn into minimal layers of the dermis

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9
Q

What is a deep partial thickness burn?

A

2nd degree

All the way through the dermis

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10
Q

What is a full thickness burn?

A

3rd and 4th degree burn
Dermis and epidermis are gone
All the way down to the subcutaneous layer
Can involve fat, muscles and bone

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11
Q

What do hair tell you about a burn?

A

If you tug on the hair and it comes right out them you know that the burn if as deep as the hair follicle

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12
Q

What if the sweat glands are destroyed by the burn?

A

Then the body will not be able to thermoregulate

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13
Q

How long does it take to determine how deep a burn is?

A

24 hours

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14
Q

What is the most common cause of a superficial burn?

A

Sunburn

Minor scald

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15
Q

What are the s/s of a superficial burn?

A
  1. Mild erythema
  2. Hypersensitivity to things like water and air
  3. Blanches
  4. Painful
  5. Irritability and discomfort
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16
Q

How do you manage a superficial burn and how long does it take to heal?

A
  1. OTC relief gel or cream
  2. Oral hydration
  3. NSAIDs
  4. Diphenhydramine
  5. Moisturizer without alcohol or perfume

Heals in 3-5 days without any scarring

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17
Q

What are the s/s of a superficial-partial thickness burn?

A
  1. Blisters
  2. Erythema
  3. Shiny
  4. Wet
  5. Inflammed
  6. Mild ot moderate edema
  7. Pain d/t exposed nerve endings sensitive to touch and air
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18
Q

How long does it take a superficial partial thickness burn to heal? What if it is a large area of the body? Will to scar?

A

1-3 weeks

Large areas of the body (70%) might need a biological dressing because hard for body to tolerate it

Minimal to no scarring

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19
Q

What is a secondary injury that can occur with a superficial-partial thickness burn?

A

Without adequate perfusion, burn damage can extend further into the dermis and convert into a deep partial thickness burn

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20
Q

What is the goal of treatment for superficial-partial thickness burn?

A

Promote self healing

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21
Q

What is the management of a superficial-partial thickness burn?

A
  1. May need a graft or biological dressing
  2. Blisters more than 2 cm should be deroof
  3. Wound care thoroughly clean the wound then put on topical antimicrobial and non adherent dressing
  4. Hydration: IV if more than 20%
  5. Systemic antibiotics only if s/s of infection
  6. Teach s/s of infection
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22
Q

What are the s/s of a wound infection?

A

Delayed healing, increased pain, increased exudate, purulent exudate, redness, and swelling

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23
Q

Why do you want to use non-adherent dressings?

A

Don’t want to pull on the skin or pull any new skin cells off that are to grow

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24
Q

Which patients should be referred to the burn center?

A
  1. Patient with burn to peri area
  2. Patient with hand/finger burns and feet
  3. Any patient with a any kind of chemical burn
  4. Inhalation injury
  5. Burn to face or joints
  6. Circumferential burn
  7. Electrical burn
  8. Partial thickness burn > 20% TBSA
  9. Frostbite
  10. SJS
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25
Q

What are the s/s of a deep partial thickness burn?

A
  1. Hair follicle and sweat glands destroyed
  2. Less moist
  3. Decreased sensation and pain
  4. Light pink to cherry red
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26
Q

How do you manage a deep partial thickness burn?

A
  1. Systemic IV fluid support
  2. Pain management
  3. Increased nutritional needs
  4. May require skin graft or excision
  5. PT/OT right away especially if burn is on any joints
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27
Q

What are patients at risk for with a deep partial thickness burn? What helps prevent this?

A

At risk for conversion to a full thickness burn

To prevent this use systemic fluid support

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28
Q

What are the s/s of a full thickness burn?

A
  1. Non blanching (d/t no circulation left)
  2. Non tender b/c nerve damage
  3. Dry
  4. White, brown, or black
  5. Tough and leathery
  6. Waxy
  7. No blisters
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29
Q

How do you manage a full thickness burn?

A
  1. Do not heal on their own
  2. Systemic fluid support (IV x2)
  3. Nutritional support
  4. Requires excision and skin graft (b/c skin has nothing to grow back on)
  5. Functional support/positioning
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30
Q

What is an issue with a chest burn? What can you do to help?

A

No elasticity so chest wall can’t expand with inspiration

Need skin loosened up

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31
Q

What are you concerned about with a full thickness burn?

A

Assessment of life, limb and perfusion

32
Q

What is the reasoning for dark red urine with a full thickness burn? What can you do?

A

Rhabdo
Muscle breakdown –> myoglobin

Need fluid to keep renal tubule open

33
Q

What is burn conversion? What can you do to combat it?

A

Area of the burn the tis most at risk for conversion if patient does not get adequate resuscitation because it will decrease blood flow causing the zone of static to covert into the zone of coagulation

Give adequate resuscitation

34
Q

When is inhalation trauma considered? (9)

A
  1. Facial burns
  2. Enclosed space
  3. Wheezing
  4. Carbonanceous sputum or soot
  5. Dyspnea, tachypnea
  6. Hoarseness
  7. Cough
  8. Singed facial or nasal hair
  9. Painful swallowing
35
Q

What are some complications associated with inhalation trauma?

A
  1. Increases risk of death
  2. Complications associated with carbon monoxide poisoning
  3. Injury above and below glottis
  4. Respiratory complications like atelectasis, ARDS, pneumonia
36
Q

What is carbon monoxide poisoning? When does it occur? What is a s/s? How is it treated?

A

Occurs with inhalation of gas/smoke while in an enclosed space
Carbon monoxide binds selectively to HbG and Hbg can’t bind to oxygen anymore –> hypoxia

Cherry red face

Treat with 100% FiO2 to overwhelm the Hbg with O2

37
Q

Above glottis injury

A
  1. More common
  2. Protective reflex to cough all the irritants out
  3. Oral mucosa burns but lung parenchyma is not injured
  4. Facial/airway edema is primary concern
38
Q

Below glottis injury

A
  1. Patient possibly unconscious at the scene
  2. Injury to airway and injury to lung parenchyma
  3. Usually requires intubation
  4. Occurs when you have to take a deep breath and smoke gets past the epiglottis
39
Q

What are the complications associated with glottis injuries

A

Atelectasis
Pneumonia
ARDS
Death

40
Q

What occurs in the body d/t inhalation injuries

A
  1. Loss of cilia
  2. Respiratory epithelial cells
  3. Neutrophil infiltration d/t inflammatory process
  4. Atelectasis: d/t debris
  5. Pseudomembranous casts (thick goopy slough)
  6. Bacterial colonization –> pneumonia (commonly at 72 hours and d/t tissue damage)
  7. ARDS
  8. Asphyxiation
41
Q

What is the biggest concern r/t an inhalation injury? How do you care for it?

A

Swelling of the tracheal –> closing the airway
Occurs between 2-96 hours

  1. Preparation for early intubation
  2. 6-12 hours bronchoscopy if not intubated to recheck airway
  3. High fowlers (over 45 degrees) without a pillow
  4. Suctioning for carbon sputum
  5. Maintain moist airway (humidified)
  6. Monitor what secretions pt is coughing up
42
Q

What is an electrical injury? Where does the current travel? What is least/what is most?

A

Electrical energy that converts to heat in the body

Current travels the path of least resistance through the body

Least: nerves, blood, fluid

Most: bones

43
Q

What does an electrical injury do to the body?

A
  1. Destroys tissue inside so injuries are hidden
  2. Heat damages adjacent to muscles and tissues
  3. Deep muscle and nerve injury can occur when muscle appears normal
44
Q

What is difficult about electrical injuries? What do deep injuries present as?

A

Difficult to assess because the injuries are hidden since they are internal

Deep muscle: won’t be able to move something
Deep nerve: won’t be able to feel something

45
Q

What are the risks/consequences associated with electrical injuries?

A
  1. Loss of consciousness
  2. Cardiac arrhythmia (v.fib)
  3. Muscles contractions and muscle damage
  4. Mummified extremities like fingers, toes, tips of ears and nose
46
Q

What occurs when the is muscle contraction d/t an electrical injury?

A

Clenched fists, feet flexed

Muscle damage and breakdown –> myoglobinuria which appears as a dark red urine

47
Q

How do you care for a patient with a electrical burn?

A
  1. Fluid resuscitation
  2. Identify points of contact
  3. ECG monitoring for 24 hours
  4. Assess for compartment syndrome with neuromuscular checks every hour for first 24
  5. Neuro exam every hour for first 24
  6. Assess for rhabdomyolysis and myloglobinuria
48
Q

What can excess myoglobin cause?

A
  1. Renal tubular obstruction
  2. Direct nephrotoxicity
  3. Intarenal vasoconstriction
  4. AKI
49
Q

If a patient has the dark red urine d/t muscle breakdown, what do you do?

A

Send labs - creatinine and BUN
Push fluids until tubules are rinsed
UOP goal is over 100-150 ml/hour until urine runs pink

50
Q

What electrolyte imbalance should you watch for with an electrical injury?

A

Hyperkalemia
Immediate threat for 24 hours
Cells are destroyed –> potassium into the blood

51
Q

What is compartment syndrome? What does it do to the body?

A

It is an increased pressure in the body compartments that compresses the nerves and the arteries
Causes inadequate perfusion when it compresses the arteries and inadequate nerve conduction and decreased sensation when it compressed the nerves

52
Q

What does compartment syndrome result in? What does it cause a direct threat to?

A

Results in tissue and nerve necrosis beyond the site of increase pressure

Threatening the limbs and life

53
Q

Which patients are at risk for compartment syndrome?

A
  1. Circumferential injuries like all the way around an arm, leg or chest
  2. Electrical injuries because edema comes form inside and pushes against skin
54
Q

What are the s/s of compartment syndrome?

A
  1. Pain
  2. Pulse
  3. Pallor
  4. Paraesthesia
  5. Paralysis
55
Q

What does a chemical burn do to the skin? What kinds of chemical cause a chemical burn?

A

destroyed the skin

  1. Acids (car battery, bleach, polishes, vinegar)
  2. Alkali (lime-calcium(cement), ammonia(cleaners), magnesium chloride(fireworks, flares))
56
Q

How do you treat a chemical burn

A
  1. Protect yourself
  2. Brush off any powder
  3. Remove clothing
  4. Irrigate copious amount of water (irrigate for 20 minutes or more)
  5. Identify the cause

REFER to burn unit!!

57
Q

What don’t you do for a chemical burn?

A
  1. DO NOT look for a chemical antidote

2. DO NOT try to neutralize the chemical

58
Q

What is SJS? What does it affect?

A

Hypersensitivity reaction that causes the epidermal skin to die and slough off

Affects the skin, mucous membranes, eyes, mouth, GI, and GU

59
Q

What is the cause of SJS?

A

50% is caused from drug reactions

60
Q

What is the difference between SJS and TENS?

A

SJS: < 10% TBSA , no blood, less deadly
TENS: > 30% TBSA , bloody, more deadly (25-80%), sepsis is most common cause of death

61
Q

What are the common causes of SJS and TENS?

A
  1. Antiepileptics
  2. Antibiotics
  3. Sulfa drugs
  4. Antigout medications (allopurinol and probenecid)

**changes in drug formulation may cause SJS/TENS in patient taking same med for years

62
Q

What is frostbite? What does it do the the cells/body?

A

Ice crystals that form on the outside of the cell
Pulls water from the cells so the cells are destroyed from lack of oxygen and water
Blood vessels are also damaged and blood leaks while rewarming so want to treat them properly

63
Q

What is frostbite similar to?

A

Tissue destruction from cold is similar to burns

64
Q

When is frostbite assessed?

A

Once all extremities are warm and perfused

Within 24 hours

65
Q

What is the treatment for frostbite? (8)

A
  1. ED/EMS: warm the extremities slowly (DO NOT place in hot water)
  2. Warm the whole patient
  3. IV pain management
  4. Topical antimicrobials
  5. Allow tissue to desiccate and mummify to consider what is viable underneath
  6. Possible amputation but wait until patient is warm and has had a chance to perfuse
  7. Some can heal on own
  8. Refer to burn center with 24 hours for tPA
66
Q

Does blanching mean worse or better?

A

Worse

67
Q

What does TPA do to frostbite?

A

Mircothrombi develops in frostbite and blocks the arteries that feed the fingers/toes
TPA will clear these blockages

68
Q

Superficial burn injury

A

Pink dry, itchy, self healing

69
Q

Partial thickness burn injury

A

Pink, blisters, painful

70
Q

Full thickness burn

A

Leathery, dry, non painful

71
Q

Which type of burn can lead to burn fractures, myoglobinuria, dysrhythmias, and cardiac arrest? What type of monitoring do they need to be on?

A

Electrical

NEED to be on ECG for 24 hours

72
Q

What fluid imbalances occur during the emergent phase? (7)

A
  1. Decreased plasma
  2. Decreased UO
  3. Increased potassium (potassium is leaving the cell)
  4. Decreased sodium
  5. Decreased pH (low CO –> no nutrients –> lose aerobic metabolism –> anaerobic metabolism –> increase lactic acid)
  6. Increased hematocrit
  7. Decreased BP
73
Q

What would you do for a burn patient during emergency management?

A
  1. Establish and airway
  2. Establish large bore IV x2
  3. Assess for other injuries
  4. Apply cream to wounds
74
Q

What are 3 major injuries for a large burn?

A
  1. Airway
  2. Infection
  3. Hypovolemic shock**
75
Q

What type of patient is a risk for inhalation injury? What are the s/s? What is the timeline for airway safety? What is the best position? What should be added to the oxygen?

A
  1. Enclosed spaces
  2. Soot, facial hair is gone, coughing up carbon, voice changes (hoarse)
  3. 24-72 hours but usually can see it in the first 24
  4. Sitting up with no pillow
  5. Humidification so things are moist and don’t get stuck
76
Q

How do you find the MAP?

A

(Systolic + 2(diastolic)) / 3

77
Q

What is the most common drugs to cause SJS?

A

Antibiotics

Anti-epileptics

Complex Care (22 decks)

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