Burns Flashcards
Why do you need to reassess wound dressings and IVs in burn patients?
Edema can develop later and cause dressings to dislodge or become too tight if they are circumferential
Why should you exercise care when pulling off burned clothing or other burned material from a burn wound?
The material may be stuck to damaged skin and extracting it can pull up damaged tissue.
Explain the “burns are clean” mantra.
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.
Circumferential burns of the _________ indicate intubatiuon.
neck
Delayed edema of the neck tissue can cause airway compromise.
In the initial evaluation of burn patients, consider obtaining what burn-specific blood lab?
Carboxyhemoglobin
Burn patients are at risk of CO poisoning and may need treatment with 100% O2.
Review the Parkland formula for adults and kids.
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.
Review the rule of 9’s for adults.
- Legs 36%
- Chest and abdomen: 18%
- Back: 18%
- Arms: 18%
- Head: 9% each
- Groin: 1%
Review the body surface area for kids.
- Legs: 28%
- Head: 18%
- Back: 18%
- Arms: 18%
- Chest and abdomen: 13%
- Butt: 5%
In calculating the Parkland formula, only use ___________ burns.
full-thickness or partial-thickness (not superficial)
Review the four types of burns by appearance:
- Superficial
- Superficial partial-thickness
- Deep partial-thickness
- Full-thickness
- 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
What initial physical exam items do you need to assess in a burn patient?
- 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
True or false: you should deroof blisters in the evaluation of burn patients.
False
Blisters are protective and should be left on.
Why should you cover burn patients with a clean sheet?
Even light air currents over the wound can cause pain in severe burns, so an occlusive sheet can help with pain.
Don’t forget to assess ____________ status in burn patients.
tetanus
TDaP is indicated in burns that are more than minor.
True or false: severe burn patients should receive preemptive antibiotics.
False
Antibiotics should be reserved for infectious wounds only.
Why do patients who’ve had electrical injuries need to be on continuous cardiac telemetry?
Electrical injuries can lead to arrhythmias that present later
How should hot tar or asphalt injuries be treated?
Cool the tar so that continued burn doesn’t occur then carefully remove the substance
Review the criteria for transferring burn patients to specialized burn centers.
- 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
In small children, how can you estimate BSA?
The palm is taken to be 1% of BSA
What are indications for hyperbaric treatment of CO poisoning?
- Carboxyhgb > 25% or 15% if pregnant
- FND, AMS, confused
- Syncope
- Shock
Review the criteria for treating CO poisoning with hyperbaric oxygen.
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
Why is ROM important in burn assessment?
If it’s bad in the ED it may get worse. Refer to burn surgery.
Why should you debride large burn blisters?
1) To see the underlying wound
2) To improve mobility
Review the treatments for CO and cyanide in the setting of a burn.
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.
True or false: the 1% rule is just palm, no fingers.
False
Palm and fingers
