Burns 1

Question 1

Superficial partial thickness burn

Answer 1

Epidermis and upper part of dermis

Pink to red moist skin
Blisters

Needs analgesia

Heals over 2-4 weeks, minimal to no scars

Question 2

Deep partial thickness burn

Answer 2

Epidermis and most of dermis, down to hair follicles

Red/white and dry
No blisters
Moderate edema

May or may not have pain

Needs pain mgmt and skin graft

Heals over 2-6 weeks, scars present

Watch for infection, hypoxia and ischemia to surrounding tissue

Question 3

Full thickness burn

Answer 3

All of epidermis and dermis, affecting sweat glands, hair follicles

White or charred- leather like
No sensation

Pain mgmt, needs grafting and possibly amputation

Heals over weeks to months, significant scars

Watch for infection, hypoxia, ischemia of surrounding tissues

Question 4

Deep burn injury

Answer 4

All the way down past fat to muscle/bone

Question 5

Rule of 9s

Answer 5

Front and back of head: 9%
Each arm is 9%
Chest and stomach is 9%
Back is 9%
Each leg is 9%
Pubic area is 1%

Question 6

Burns on extremities are at risk for

Answer 6

Circulatory compromise distally and compartment syndrome

Question 7

Prehospital burn management

Answer 7

Small burn: Cool asap w/ clean water

Large burn: Cool asap, remove clothing, wrap in clean dry sheet

DONT immerse in water or use ice

Question 8

What constitutes a severe burn

Answer 8

15-20% TBSA affected

Question 9

Early/resusciative phase for burns

Answer 9

24-48hrs post injury

Onset of injury to restoration of capillary permeability

Question 10

Acute phase burn injury

Answer 10

36-48hrs post injury

Capillary stabilization to wound closure

Question 11

Rehabilitative phase post burn injury

Answer 11

From wound closure to highest level of functioning

Question 12

Early circulatory responses for burns

Answer 12

Capillaries leak to third spacing in first 12hrs up to 36hrs

Hyperkalemia
Hyponatremia

Very concentrated blood–> super viscous, can lead to shock (burn shock)

Diuretic stage 48-72hrs post injury

FLUID RESUSCITATION- use parkland formula

Question 13

Parkland formula for burn fluid replacement

Answer 13

4mL x weight (kg) x TBSA% burn= ___mL fluids to be given

4(weight in kg)(%burn)

First half of fluid given over first 8 hours from injury onset

Second half over remaining 16hrs

Question 14

Fluid resuscitation goals

Answer 14

30mL/hr urine output
Perfusion to major organs

RESPONSE TO THERAPY DICTATES FLUID REQUIREMENTS

Question 15

Metabolic response to burn

Answer 15

Metabolic demands INCREASED

Hormones secreted:

• Cortisol
• Catecholamines
• ADH
• Aldosterone

Core body temp increased

Question 16

Immune response to burn

Answer 16

Early phase: HIGH INFECTION RISK— open wounds and decreased immune function can lead to sepsis

Early to acute phase: May need escharotomy/fasciotomy to manage wounds/compartment syndrome

Question 17

Renal/urinary response to burns

Answer 17

Low renal flow–> low GFR, myoglobinuria–> AKI

Can lead to renal failure

Question 18

GI response to burns

Answer 18

Decreased perfusion–> low motility

Acute phase:

• Can have paralytic ileus
• Stress can lead to ulcers
• Watch for pain, N/V, blood in stool/vomit

Question 19

Respiratory response to burns

Answer 19

ASSESS ASSESS ASSESS AIRWAY

Burns can cause swelling–> cut off airway

Watch CO poisoning (measured by hbCO)

Normal hbCO range:
non-smokers under 3%
Smokers under 10%

OXYGEN THERAPY FOR HYPERCAPNIA

Question 20

Wound management in Acute burn phase

Answer 20

Debridement:
Mechanical (hydrotherapy)
-Enzymatic (collagenase)

Standard wound dressings

Grafts!!!!!

Minimize contractures