Burns

Question 1

Why do you need to reassess wound dressings and IVs in burn patients?

Answer 1

Edema can develop later and cause dressings to dislodge or become too tight if they are circumferential

Question 2

Why should you exercise care when pulling off burned clothing or other burned material from a burn wound?

Answer 2

The material may be stuck to damaged skin and extracting it can pull up damaged tissue.

Question 3

Explain the “burns are clean” mantra.

Answer 3

If the injury was hot enough to kill skin, it would have killed most bacteria on the area. Thus, burns are cleaner than most other open wounds.

They may have been contaminated in the extinguishing process, however.

Question 4

Circumferential burns of the _________ indicate intubatiuon.

Answer 4

neck

Delayed edema of the neck tissue can cause airway compromise.

Question 5

In the initial evaluation of burn patients, consider obtaining what burn-specific blood lab?

Answer 5

Carboxyhemoglobin

Burn patients are at risk of CO poisoning and may need treatment with 100% O2.

Question 6

Review the Parkland formula for adults and kids.

Answer 6

Adults:
- 2 (wt in kg) (% body burned)
- Give half over 8 hours then the rest over the next 16 hours.

Peds:
- 3 (wt in kg) (% body burned)
- Give half over 8 hours then the rest over the next 16 hours.

Question 7

Review the rule of 9’s for adults.

Answer 7

• Legs 36%
• Chest and abdomen: 18%
• Back: 18%
• Arms: 18%
• Head: 9% each
• Groin: 1%

Question 8

Review the body surface area for kids.

Answer 8

• Legs: 28%
• Head: 18%
• Back: 18%
• Arms: 18%
• Chest and abdomen: 13%
• Butt: 5%

Question 9

In calculating the Parkland formula, only use ___________ burns.

Answer 9

full-thickness or partial-thickness (not superficial)

Question 10

Review the four types of burns by appearance:
- Superficial
- Superficial partial-thickness
- Deep partial-thickness
- Full-thickness

Answer 10

• Superficial: erythema w/o blisters
• Superficial partial-thickness: moist, painful, possibly blistering, and blanches to touch
• Deep partial-thickness: dry, painless, possibly blistering, and does not blanch with touch
• Full-thickness: dry, painless, and with a leathery or waxy appearance

Question 11

What initial physical exam items do you need to assess in a burn patient?

Answer 11

• Primary and secondary surveys (with special focus on potential inhalational injuries)
• Neurovascular assessment of areas distal to burns
• Removal of jewelry that may lead to compartment syndrome if edema develops

Question 12

True or false: you should deroof blisters in the evaluation of burn patients.

Answer 12

False

Blisters are protective and should be left on.

Question 13

Why should you cover burn patients with a clean sheet?

Answer 13

Even light air currents over the wound can cause pain in severe burns, so an occlusive sheet can help with pain.

Question 14

Don’t forget to assess ____________ status in burn patients.

Answer 14

tetanus

TDaP is indicated in burns that are more than minor.

Question 15

True or false: severe burn patients should receive preemptive antibiotics.

Answer 15

False

Antibiotics should be reserved for infectious wounds only.

Question 16

Why do patients who’ve had electrical injuries need to be on continuous cardiac telemetry?

Answer 16

Electrical injuries can lead to arrhythmias that present later

Question 17

How should hot tar or asphalt injuries be treated?

Answer 17

Cool the tar so that continued burn doesn’t occur then carefully remove the substance

Question 18

Review the criteria for transferring burn patients to specialized burn centers.

Answer 18

• Pediatric burns
• Inhalational injuries
• Chemical burns
• Electrical burns
• Burns w/ trauma
• Partial or full thickness that exceeds 10% of BSA
• Burns to sensitive areas (face, groin, hands, feet, and joints)
• Burns in people who are medically complex

Question 19

In small children, how can you estimate BSA?

Answer 19

The palm is taken to be 1% of BSA

Question 20

What are indications for hyperbaric treatment of CO poisoning?

Answer 20

• Carboxyhgb > 25% or 15% if pregnant
• FND, AMS, confused
• Syncope
• Shock

Question 21

Review the criteria for treating CO poisoning with hyperbaric oxygen.

Answer 21

Carboxyhemoglobin > 15% in pregnant women or > 25% in non-pregnant people (because fetal hemoglobin has a higher affinity for CO)

AMS with no other apparent cause

End-organ damage not attributable to other causes

Question 22

Why is ROM important in burn assessment?

Answer 22

If it’s bad in the ED it may get worse. Refer to burn surgery.

Question 23

Why should you debride large burn blisters?

Answer 23

1) To see the underlying wound
2) To improve mobility

Question 24

Review the treatments for CO and cyanide in the setting of a burn.

Answer 24

Hydroxocobalamin is the preferred agent to treat cyanide poisoning when there is co-exposure to CO. Cyanokit (amyl nitrate, sodium nitrate, and sodium thiosulfate) can be given but have a risk of methemoglobiinemia so are second-line agents.

Question 25

True or false: the 1% rule is just palm, no fingers.

Answer 25

False

Palm and fingers