Burn Management Flashcards
Burns can cause?
Coagulative Necrosis
If a burn is chemical or electrical in origin, what can it do to the body in addition to “heat transfer?”
Direct Injury to cell membranes
What can cause a burn?
- Flame
- Scald
- Contact
- Chemical
- Electricity
What factors are taken into account for the depth of a burn?
- Temperature
- Time exposed
- Specific Heat of the substance.
When you are burned, what is released?
Inflammatory Mediators
With a burn, there is an increased capillary permeability. What is the consequence of this?
- Lead proteins into interstitium
- Get edema into burned and non-burned skin
T/F: There are large fluid loss due to fluid shifts in the body and also losses from exposed burned skin.
True
Characteristics of Burn
- Low metabolism/Cardiac Output
- Decreased Temp
Then!!! - Hypermetabolism
- High Cardiac Output
- Hyperglycemia
- Increased Heat Production
This occurs when too much fluid moves from the intravascular space (blood vessels) into the interstitial.
Third Spacing
This is a type of burn that is localized to the epidermis (sunburn).
1st Degree Burn
This is a type of burn that is injury to both the dermis and epidermis
2nd Degree Burn
This type of burn is typically red, painful, blister, “wet” appearing. Regeneration usually occurs in 7-14 days from the hair follicles/sweat glands.
Superficial 2nd degree burn (Papillary Dermis)
This type of burn is typically more pale/mottled, dry and decreased sensation.
Deep 2nd degree burn (Reticular Dermis)
This is a type of burn that full covers the epidermis and dermis. It is commonly hard and leathery eschar. This is PAINLESS! (Goes into SQ fat)
Third Degree Burn
This type of burn involves muscle, bone, etc.
Fourth Degree Burn
When should you go to a burn center?
- Partial Thickness >10% if less than 10 yo, or greater than 50 yo
- Partial Thickness >20%
- Face, Hands, Feet, Genital/Perineum, Joints
- Full thickness >5%
- Electrical Injury
- Chemical Burn
- Inhalation Injury
- Comorbidities like CHF
- Concomitant Trauma
- Children
- Special, emotional, social, or rehab needs
What do you do when someone comes in with a burn? (ABCDE)
- Airway – give O2, put on pulse ox, pre-emptively intubate as needed
- Breathing - sounds and chest rise
- Circulation
- Disability - GCS < 8 = Intubate
- Exposure - remove clothing
Airway complications with housefires
- Direct injury from heated air/smoke –> Edema
- Edema from inflammatory response to burns
- Edema from the resuscitation fluids
What does progressive hoarseness indicate?
Impending Airway Obstruction
When do you pre-emptively intubate anyone?
- Respiratory Distress
- Inhalation Injury (Bronch helps dx this)
- Large burns (due to edema)
Things to do with circulation in a burn victim:
- 2 large bore IV
- Start burn resuscitation with Lactated Ringers
- PLace patient on continuous EKG/monitor
- Palpate or doppler extremity signals with circumferential Burns
Initial Assessment of Burn victims after the ABCDE! (AMPLE)
A-Allergies
M-Medications (also ask about last tetanus)
P-PMH (CHF = careful with fluids)
L-Last meal
E-Events regarding the injury (how did it start, how long where you exposed, what type?)
When figuring out the burn size, what is a good rule of thumb?
The size of the palm of the hand is roughly 1% or the Rule of 9s (will see the Rule of 9s later)
What is the Parkland Formula?
4 x weight(kg) x %TBSA = ml to give in 1 day
– Titrate to UOP of 0.5 mL/kg/hr in adults and 1 mL/kg/hr in children
DO NOT GIVE COLLOID IN FIRST 24 HOURS
