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235 Trauma > Burns > Flashcards

Burns Flashcards

1
Q

Order of frequency?

A

Scolds/flame
contact
chemical
electrical
high risk - infant and elderly

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2
Q

3 zones of injury at a burn

A

Zone of Coagulation
Zone of stasis (ischemia)
Zone of hyperemia

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3
Q

What is the zone of coagulation?

A
  • Innermost zone
  • Direct contact with source
  • No blood flow
    • Tissue is necrotic, needs to be removed. Leads to sepsis
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4
Q

What is zone of stasis?

A
  • 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
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5
Q

What is zone of stasis?

A
  • 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
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6
Q

What is zone of hyperemia?

A
  • “Excess of blood”
  • Most perfused
    • Blanches when touched, redness, swelling
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7
Q

Degree classifications of burn depth

A
  • 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.
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8
Q

What is eschar?

A

Dry, dark scab or falling away of dead skin from burn or bite

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9
Q

What is an “area of function”?

A

face, genitals, perineum, eyes, hands, feet

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10
Q

Describe a minor burn.

A
  • Partial thickness <15% in adults
  • Partial <10% in peds and elderly
  • Full thickness < 2% NOT involving an area of high function
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11
Q

Describe a moderate burn.

A
  • 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+)
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12
Q

Describe a severe burn

A
  • Partial
    • > 25% adults
      • > 10% is chidren less than 10
      • >10 % in elderly 50+
  • Full thickness
    • > 10%
  • Any area of high function
  • Caustic chemicals
  • High voltage electrical
  • Inhalation injury
  • Complicated by trauma
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13
Q

Most common cause of death with burns?

A
  • MODS - Multiple Organ Dysfunction Syndrome
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14
Q

Problems secondary to burns (5 listed)

A

Sepsis, pneumonia, infection, MODS, burn shock (distributive)

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15
Q

Inhalation injuries increase burn mortality by how much?

A

30%

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16
Q

4 Categories of Burn Causes

A

Thermal, chemical, electrical, radiation

17
Q

Rule of 9’s adult

A
18
Q

Vesicants

A

Chemicals that destroy tissue through blistering.

I.e. mustard gas

19
Q

Organics

A

Carbon atoms mostly, i.e. paint strippers, pain, wax

20
Q

Acid burn characteristics

A

Weak acids tan the skin, strong acids cause necrosis.

COAGULATE

21
Q

Burns from bases characteristics

A
  • Lipophilic - cross the cell membrane.
  • Liquifies the tissue, causing cell death and necrosis.
    • WORSE THAN ACID
22
Q

Treatment for acid/base burn

A
  • Dry chemical -
    • Brush them off, then spray down with water
  • Liquid
    • irrigation
23
Q

High voltage injuries

A
  • 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
24
Q

Treatment for electrocution

A

ABC’s

Spinal immobilize

IV fluids

25
Q

Ferning or Lichtenberg patterns

A

unique pattern on skin post lightning strike

26
Q

Physiology of Burn Shock

A
  • 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
27
Q

Burn shock treatment

A

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

  1. 5 - 1.0 mL/kg/hr ADULTS
  2. 0 - 1.5 mL/kg/hr PEDS
28
Q

Parkland Formula

A

4ml x kg x TBSA burned

½ of total over first 8 hours

½ of total over last 16 hours

29
Q

Types of Radiation and what can stop them

A

Alpha - paper (least penetrating)

Beta - skin and flesh

Gamma - lead

235 Trauma (6 decks)

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