Burn Injuries

Question 1

___% of injuries during military operations involve significant burns

Answer 1

5-10%

Question 2

The most challenging time in the resuscitation of a burn patient is typically the first ___ hours

Answer 2

48 hours

Question 3

The skin serves several complex functions, including:

Answer 3

Protection

Regulation of fluids

Thermoregulation

Sensation

Question 4

Epidermis is __ mm thick

Answer 4

0.05-1mm

Question 5

Dermis is ___ mm thick

Answer 5

10mm

Question 6

Made up of adipose and connective tissue – keeps outer layers attached to underlying structures.

Contains some of the larger blood vessels and nerves

Answer 6

Subcutaneous layer

Question 7

A full thickness burn has what 3 zones of tissue injury

Answer 7

Zone of coagulation (central zone) - Necrosis

Zone of stasis - adjacent to necrosis

Zone of hyperemia - Outmost zone - minimal cell injury

Question 8

Withhold final judgement of the burn until __ hours after injury

Answer 8

48 hours

Question 9

Involve ONLY EPIDERMIS.

Red and painful.

Heal well within a week without scar

Answer 9

Superficial (1st degree)

Question 10

Involve epidermis and varying portions of the dermis

Can be classified as superficial or deep

Blisters with a glistening or wet base

Zone of necrosis involves entire epidermis and varying depths of superficial dermis, can progress to full thickness if not properly treated

Answer 10

Partial thickness burns (2nd degree)

Question 11

Most often appear thick, dry, white, and leathery regardless of skin color

Thick leathery damaged skin referred to as eschar

These burns can be disabling and life threatening.

Answer 11

Full thickness burns

Question 12

Point of injury care for burns

Answer 12

Stop the burning process
Provide resuscitative care. Hemorrhage control. Airway maintenance
Remove all constricting articles
Cover the patient.
Protect against hypothermia.
IV access
Fluid resuscitation with LR

Question 13

Inhalation burn patients will need:

Answer 13

Intubation or cricothyroidotomy

Question 14

Full thickness burns of the chest that prevent effective chest motion with need what lifesaving procedure to permit adequate chest excursion

Answer 14

Escharotomy

Question 15

Burns

Initial hourly fluid rate

Answer 15

%TBSA burn x 10ml/hr

40% = 400 ml/hr

Question 16

Rule of nines

Patients hand = __% of TBSA

Answer 16

1%

Question 17

Burns

Rate of infusion is based on:

Answer 17

Physiologic response

Question 18

Burns

If patient is unresponsive to fluids what should you do?

Answer 18

Adjust by 25%

Question 19

Burn center referral criteria

Answer 19

• Partial-thickness burns greater than 10% of TBSA
• Burns that involve the face, hands, feet, genitalia, perineum, or major joints
• Third-degree burns in any age group
• Electrical burns, including lightning injury
• Chemical burns
• Inhalation injury
• Burn injury in patients with preexisting medical disorders
• Burned children in hospitals without qualified personnel
• Burn injury in patients who will require special social, emotional, or rehabilitative intervention

Question 20

Ideal for monitoring of burn patients

Answer 20

TWO IV’s, Foley, ECG monitoring, pulse Ox, a core temp, and NG tube

Question 21

Burns

Single most reliable indicator of adequate resuscitation

Answer 21

Foley catheter with hourly monitoring

Question 22

Target urine output in a burn patient

Answer 22

0.5 ml/kg/hr

Question 23

Burns

If urine output is less than target, increase fluid rate by:

Answer 23

25%

Question 24

Urine output in a burn patient

If response is greater than target decrease rate by:

Answer 24

25%

Question 25

Wound and extremity care for burn patients

Answer 25

Topical antibiotics after cleaning

Silver nitrate dressings

Topical antimicrobial solutions or creams

Question 26

Exercised burned extremities _____

Evaluate pulses and neuro status ____

Adequate perfusion must be assessed _____

Answer 26

Hourly

Question 27

Greater than __% TBSA require formal fluid resuscitation

Answer 27

20%