Burn Care Flashcards
how does the dermis protect the skin in additional ways from the epidermis?
trauma - provides elasticity and durability
fluid balance and thermal balance via regulation of blood flow
provides growth factors and epidermal regeneration
What is a 1st degree burn?
It is a superficial burn that is in the epidermis only
equivalent to a sunburn
pink/red tissue with no blisters
What is a second degree burn?
a burn that goes in to the dermis layer
it should blanch when you put your finger on it and it should hurt to touch - if not probably deeper
what is a third degree burn?
a burn that is all the way through the dermis
it will often be white with eschar and insensate to touch
it should not blanch when touched and it is often cold
what is a fourth degree burn?
burn all the way down to tendon, muscle and bone
frequently requires amputation
when do we do massive fluid resuscitation in burn patients?
TBSA > 20% 2nd degree or greater burns
how can you estimate burns other than the rule of 9s?
1% TBSA = the patient’s palm and fingers
what are the burn center referral criteria?
>10% TBSA for partial thickness (2nd degree only)
burns of face, hands, feet, genitalia, perineum, over major joints
3rd degree burns in any age group
electrical, chemical inhalation, children, traumas where burn is greatest risk to mortality
what should you do prior to transfer of a burn patient?
stabilize airway
establish IV access
estimate TBSA
Parlkand initiated (if appropriate)
pain control
dry sterile dressings for transfer
what is the Parkland formula?
>20% TBSA
4cc x TBSA burn x wt (Kg) = total fluid amount
replace 1/2 in the first 8 hours
replace next 1/2 in the next 16 hours
LR is the fluid of choice
what are the fluid resuscitation goals for a burn patients?
urine output of 0.5 cc/kg/hour
(1.0-1.5 in kids and electrical)
what can you do if urine output is not where you want it to be?
increase LR rate
add 5% albumin
when do you intubate an inhalation injury?
decreased LOC
stridor, retraction, respiratory distress
progressive hoarseness
carbonaceous/pink, frothy sputum (look at deep sputum)
High CO
Clue: enclosed space injury
(can do bronch if you have the time)
ALWAYS GIVE 100% O2 to patients with potential airway burns
At what CO level do you see alterations in LOC?
15-20% - headache, confusion
20-40% - disorientation, fatigue, nausea, visual changes
40-60% - hallucinations, combatitiveness, coma, obtundation
>60% mortality >50%
what should you do for supraglottic injury?
intubate early (swelling may start after you start fluids)
Sux is safe for RSI
