Burns Flashcards
Order of frequency?
Scolds/flame
contact
chemical
electrical
high risk - infant and elderly
3 zones of injury at a burn
Zone of Coagulation
Zone of stasis (ischemia)
Zone of hyperemia
What is the zone of coagulation?
- Innermost zone
- Direct contact with source
- No blood flow
- Tissue is necrotic, needs to be removed. Leads to sepsis
What is zone of stasis?
- Ischemia
- Blood supply is weak, if perfusion not restored than will lead to necrosis
- Middle zone
- Goal of fluid resuscitation is to preserve this zone
What is zone of stasis?
- Ischemia
- Blood supply is weak, if perfusion not restored than will lead to necrosis
- Middle zone
- Goal of fluid resuscitation is to preserve this zone
What is zone of hyperemia?
- “Excess of blood”
- Most perfused
- Blanches when touched, redness, swelling
Degree classifications of burn depth
- 1st degree = superficial
- Epidermis damaged
- Sunburn, painful
- 2nd degree = partial thickness
- Down to dermis - hair follicles, nerves, sweat glands
- MOST painful
- Blisters
- 3rd degree = full thickness
- burned to subcutaneous, maybe muscle
- Skin falling off
- Nerve endings burned, tiny pain
- Grey, leathery
- 4th degree
- Burned to bone, i.e. electrical.
What is eschar?
Dry, dark scab or falling away of dead skin from burn or bite
What is an “area of function”?
face, genitals, perineum, eyes, hands, feet
Describe a minor burn.
- Partial thickness <15% in adults
- Partial <10% in peds and elderly
- Full thickness < 2% NOT involving an area of high function
Describe a moderate burn.
- 15 - 25% Partial adults
- 10 - 20% Partial peds or geris
- 2 - 10% Full
- Does not include high voltage (1000+ volts)
- No inhalation
- Not in high risk individuals (babies and 60+)
Describe a severe burn
- Partial
- > 25% adults
- > 10% is chidren less than 10
- >10 % in elderly 50+
- > 25% adults
- Full thickness
- > 10%
- Any area of high function
- Caustic chemicals
- High voltage electrical
- Inhalation injury
- Complicated by trauma
Most common cause of death with burns?
- MODS - Multiple Organ Dysfunction Syndrome
Problems secondary to burns (5 listed)
Sepsis, pneumonia, infection, MODS, burn shock (distributive)
Inhalation injuries increase burn mortality by how much?
30%
4 Categories of Burn Causes
Thermal, chemical, electrical, radiation
Rule of 9’s adult
Vesicants
Chemicals that destroy tissue through blistering.
I.e. mustard gas
Organics
Carbon atoms mostly, i.e. paint strippers, pain, wax
Acid burn characteristics
Weak acids tan the skin, strong acids cause necrosis.
COAGULATE
Burns from bases characteristics
- Lipophilic - cross the cell membrane.
- Liquifies the tissue, causing cell death and necrosis.
- WORSE THAN ACID
Treatment for acid/base burn
- Dry chemical -
- Brush them off, then spray down with water
- Liquid
- irrigation
High voltage injuries
- Cardiac injury - most common cause of death is v fib post electrocution
- Skeletal muscle - myoglobin in the urine, causing renal failure, cause nephron damage in kidneys
- Hyperkalemia from release of K+
- Long bones may fracture
- Neuralgia from nerve damage
Treatment for electrocution
ABC’s
Spinal immobilize
IV fluids
Ferning or Lichtenberg patterns
unique pattern on skin post lightning strike
Physiology of Burn Shock
- DISTRIBUTIVE shock
- Plasma lost due to capillary leakage and vessels swelling. (third spacing)
- Massive cytokine release, causing capillaries to open and leak plasma, causing edema.
- Thermal injury also causes destruction of RBC’s, leading to anemia
- Heart loses contractility
- ejection fraction drops
- CO drops
- Hyperdynamic heart
- Increase HR, low EF
Burn shock treatment
PARKLAND FORMULA
4mL x kg x TBSA%
½ of total over first 8 hours
½ of total over last 16 hours
Goal BP is 90 sys, 60 MAP
Tailor to VS and urinary output
- 5 - 1.0 mL/kg/hr ADULTS
- 0 - 1.5 mL/kg/hr PEDS
Parkland Formula
4ml x kg x TBSA burned
½ of total over first 8 hours
½ of total over last 16 hours
Types of Radiation and what can stop them
Alpha - paper (least penetrating)
Beta - skin and flesh
Gamma - lead
