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Trauma and Trauma Systems > Burns > Flashcards

Burns Flashcards

1
Q

introduction to burn injuries

A
  • 1.25-2 million Americans treated for burns annually
  • 45,000 require hospitalizations
  • 90% of burns can be prevented
  • 3-5% considered life threatening
  • 2nd leading cause of death for children <12
  • half of all tap water burns occur to children <5
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2
Q

greatest risk for burn injuries

A
  • very young -> greater BSA/weight ratio and thinner skin
  • very old -> thinner and doesn’t heal as well
  • infirm
  • firefighters
  • metal smelters
  • chemical workers
  • drugs and alcohol play major role
  • uncle rob
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3
Q

reduction in burn injuries

A
  • improved building codes
  • safer construction techniques
  • sprinkler systems
  • use of smoke detectors
  • educational campaigns aimed primarily at school children
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4
Q

layers of skin

A
  • epidermis - dead
  • dermis - nerves, hair
  • subcutaneous
  • underlying structures:
  • fascia
  • nerves
  • tendons
  • ligaments
  • muscles
  • organs
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5
Q

functions of the skin

A
  • protection from infection
  • sensory organ- temperature, touch, pain
  • controls loss and movement of fluids
  • temperature regulation
  • insulation from trauma
  • flexible to accommodate free body movement
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6
Q

emergent phase (stage 1)

A
  • pain response
  • catecholamine release:
  • tachycardia
  • tachypnea
  • mild hypertension
  • mild anxiety
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7
Q

fluid shift phase (stage 2)

A
  • length 18-24 hours
  • begins after emergent phase- reaches peak in 6-8 hours
  • damaged cells initiate inflammatory response:
  • vasodilation:
  • increased capillary permeability
  • intravascular hypovolemia
  • extravascular edema
  • burns over 30% BSA present with system immune response *****
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8
Q

hypermetabolic phase (stage 3)

A
  • lasts for days to weeks
  • large increase in the body’s need for nutrients as it repairs itself
  • fluid and electrolytes begin to move back into the vasculature
  • influx of fluid within vascular space causes the GFR to increase, leading to diuresis
  • fluid shifts may lead to hypernatremia and hypokalemia
  • cardiac workload and O2 consumption increase
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9
Q

resolution phase (stage 4)

A
  • scar formation

- general rehabilitation and progression to normal function

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10
Q

stages of pathophysiology of burns

A
  • emergent phase
  • fluid shift phase
  • hypermetabolic phase
  • resolution phase
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11
Q

types of burns

A
  • thermal
  • electrical
  • chemical
  • radiation
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12
Q

thermal burns

A
  • heat changes the molecular structure of tissue -> denatures proteins
  • extent of burn damage depends on:
  • temperature of agent
  • concentration of heat
  • duration of contact
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13
Q

jacksons theory of thermal wounds: zone of coagulation

A
  • area in a burn nearest the heat source that suffers the most damage as evidenced by clotted blood and thrombosed blood vessels
  • center of burn
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14
Q

jacksons theory of thermal wounds: zone of stasis

A
  • area surrounding zone of coagulation characterized by decreased blood flow
  • middle portion
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15
Q

jacksons theory of thermal wounds: zone of hyperemia

A
  • peripheral area around burn that has an increased blood flow
  • outermost area
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16
Q

burn infection

A

-people dont come in because they think the skin is intact but really a whole layer is burned off and an infection has already developed

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17
Q

electrical burns

A
  • greatest heat occurs at the points of resistance:
  • entrance and exit wounds
  • dry skin = greater resistance
  • wet skin = less resistance
  • longer the contact, the greater the potential of injury -> increased damage inside body
  • smaller the point of contact, the more concentrated the energy, the greater the injury
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18
Q

electrical current flow

A
  • tissue of less resistance - blood vessels and nerve
  • tissue of greater resistance - muscle and bone
  • results in:
  • serious vascular and nervous injury
  • immobilization of muscles
  • flash burns
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19
Q

chemical burns

A
  • destroy tissues
  • acid
  • alkalis
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20
Q

chemical burns: acids

A
  • form a thick, insoluble mass where they contact tissue

- coagulation necrosis - limits burn damage

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21
Q

chemical burns: alkalis

A
  • destroy cell membrane through liquefaction necrosis

- deeper tissue penetration and deeper burns

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22
Q

radiation

A
  • transmission of energy
  • nuclear energy
  • ultraviolet light
  • visible light
  • heat
  • sound
  • x-rays
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23
Q

radioactive substance

A
  • emits ionizing radiation

- radionuclide or radioisotope

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24
Q

alpha particles

A
  • slow moving
  • low energy
  • stopped by clothing and paper
  • penetrate a few cell layers on skin
  • minor external hazard
  • HARMFUL if ingested
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25
Q

beta particles

A
  • smaller than alpha
  • higher energy than alpha
  • stopped by aluminum or similar materials
  • less local damage than alpha
  • HARMFUL if inhaled or ingested
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26
Q

gamma rays

A
  • highly energized
  • penetrate deeper than alpha or beta
  • EXTREMELY DANGEROUS
  • penetrate thick shielding
  • pass entirely through clothing and body- extensive cell damage
  • indirect damage- cause internal tissue to emit alpha and beta particles
  • LEAD SHIELDING
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27
Q

neutrons

A
  • more penetration than other radiation
  • 3-10 times greater penetration than gamma
  • less internal hazard when ingested than alpha or beta
  • direct tissue damage
  • only present in nuclear reactor core
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28
Q

clean accident

A
  • exposed to radiation
  • not contaminated by products
  • properly decontaminated - little danger to personnel
29
Q

dirty accident

A
  • associated with fire at scene of radiation accident

- trained decontamination personnel

30
Q

radiation injury management

A
  • park upwind
  • notify radiation response or hazmat response team
  • look for radioactive placards
  • measure radioactivity
  • decontamination patients before care
  • routine medical care (ABCs, etc.)
31
Q

inhalation injury: toxic inhalation

A
  • synthetic resin combustion
  • cyanide and hydrogen sulfide
  • systemic poisoning
  • more frequent than thermal inhalation burn
32
Q

carbon monoxide poisoning

A
  • colorless, odorless, tasteless gas
  • byproduct of incomplete combustion of carbon products
  • suspect with faulty heating unit
33
Q

pulse oximetry

A
  • clinical assessment of hypoxia is very difficult in the prehospital setting
  • cyanosis typically occurs with O2 saturation <70%
  • may be falsely positive in the patient with significant blood loss or CO poisoning
  • CO -> 200x greater affinity for hemoglobin than oxygen
  • hypoxemia and hypercarbia -> force the oxygen on rather than CO
  • measures hemoglobin saturation, NOT oxygenation
34
Q

airway thermal burn

A
  • supraglottic structures absorb heat and prevent lower airways burns
  • moist mucosa lining the upper airway
  • injury is common from superheated steam
  • symptoms:
  • stridor or “crowing” inspiratory sounds
  • singed facial and nasal hair
  • black sputum or facial burns
  • progressive respiratory obstruction and arrest due to swelling
35
Q

burn depth

A
  • superficial burn- epidermis
  • partial thickness burn- epidermis and dermis
  • full thickness burn- epidermis, dermis, fat, and muscle
36
Q

superficial burn

A
  • 1st degree
  • red
  • painful
  • dry (no blisters)
  • epidermis
37
Q

partial thickness burn

A
  • 2nd degree burn
  • red or white
  • painful
  • blisters (wet)
  • ultraviolet keratitis should be suspected in welders
  • epidermis and dermis
38
Q

full thickness burn

A
  • 3rd degree
  • leathery skin
  • white, dark brown
  • charred
  • minimally painful
  • dry
  • hard
  • epidermis, dermis, fat, muscle
39
Q

rule of nines

A
  • best used for large surface areas
  • expedient tool to measure extent of burn
  • head and neck- 9%
  • upper posterior trunk- 9%
  • lower posterior trunk- 9%
  • upper anterior trunk- 9%
  • lower anterior trunk- 9%
  • each upper extremity- 9%
  • external genitalia- 1%
  • posterior lower extremity- 9%
  • anterior lower extremity- 9%
  • if you had anterior part of arm and chest -> 22.5% burnt
40
Q

rule of palms

A
  • irregular or splash burns
  • best used for burns <10% BSA
  • a burn equivalent to the size of the patients hand is equal to 1% body surface area (BSA)
41
Q

hypothermia

A
  • disruption of skin and its ability to thermoregulate

- ironic but true

42
Q

hypovolemia

A
  • shift in proteins, fluids, and electrolytes to the burned tissue
  • general electrolyte imbalance
43
Q

eschar

A
  • hard, leathery product of a deep full thickness burn
  • dead and denatured skin
  • escharotomy- slicing the skin to allow it to expand
44
Q

infection

A

-greatest risk of burn is infection

45
Q

organ failure

A
  • release of myoglobin

- blocks the kidneys -> stops function

46
Q

special factors

A

-age and health

47
Q

physical abuse

A

-elderly, infirm, or young

48
Q

scene size up

A
  • fire department

- SCBA and protective clothing

49
Q

primary assessment

A
  • ABCs MUST be intact
  • consider ET or RSI early with airway burns
  • rapid evacuation of patient if scene is unstable
50
Q

focused and rapid trauma assessment

A
  • accurately approximate extent of burn injury:
  • rule of nines or rule of palms
  • depth of burn
  • area of body affected- any burn to the face, hands, feet, joints, or genitalia considered a serious burn
  • circumferential burns- wrap around a limb -> do not allow for expansion
  • age of patient affected
51
Q

general signs and symptoms of thermal burns

A
  • pain
  • changes in skin condition at affected site
  • adventitious lung sounds
  • blisters
  • sloughing of skin
  • hoarseness
  • dysphagia
  • dysphasia
  • burnt hair
  • edema
  • paresthesia
  • hemorrhage
  • other soft tissue injury
  • musculoskeletal injury
  • dyspnea
  • chest pain
52
Q

rule of nine: infant

A
  • posterior head/neck- 9%
  • anterior head/neck 9%
  • posterior trunk: upper and lower- each 9%
  • arms- 9% each
  • legs- 14% each
53
Q

minor/moderate burn severity

A
  • superficial are less than 50% BSA
  • partial thickness less than 15% BSA
  • full thickness less than 2% BSA
54
Q

critical burn severity

A
  • partial thickness less than 30% BSA

- full thickness less than 10% BSA

55
Q

ongoing assessment

A
  • non critical- reassess 15 mins
  • critical reassess 5 mins
  • burn center care
56
Q

management of local and minor burns

A
  • local cooling
  • partial thickness <1% of BSA
  • full thickness <2% BSA
  • remove clothing
  • cool or cold water immersion
  • consider analgesics:
  • morphine sulfate
  • fentanyl (sublimaze)
57
Q

management of moderate to severe burns

A
  • dry sterile dressings
  • partial thickness >10% BSA
  • full thickness
  • maintain warmth- prevent hypothermia
  • consider aggressive fluid therapy
  • burns over IV sites- place IV in partial thickness burn site
  • consider analgesics:
  • morphine sulfate
  • fentanyl (sublimaze)
58
Q

parkland formula

A
  • 4 mL x weight X% burn
  • 1/2 volume in first 8 hours
  • second 1/2 over last 16 hours
59
Q

management of moderate to severe burns

A
  • caution for fluid overload
  • frequent auscultation of breath sounds
  • consider analgesics for pain:
  • morphine
  • fentanyl
  • prevent infection
60
Q

management of inhalation injury

A
  • provide high flow O2 by NRB
  • consider intubation if swelling
  • carbon monoxide poisoning- consider hyperbaric oxygen therapy
  • cyanide exposure- hydroxocobalamin
61
Q

electrical injuries

A
  • safety
  • turn power off
  • energized lines act as whips
  • establish a safety zone
  • lightning strikes:
  • high voltage, high current, high energy
  • last fraction of a second
  • no danger of electrical shock to providers
62
Q

assessment and management of electrical, chemical, and radiation burns

A
  • entrance and exit wounds
  • remove clothing, jewelry, and leather items
  • treat and visible injuries- thermal burns
  • ECG monitoring- bradycardia, tachycardia, VF or asystole: ACLS protocols
  • treat cardiac and respiratory arrest
  • aggressive airway, ventilation, and circulatory management
  • consider fluid bolus for serious burns- 20 mL/kg
63
Q

chemical burns: scene size up

A
  • hazardous material team
  • establish hot, warm, and cold zones
  • prevent personnel exposure from chemical
64
Q

phenol: chemicals

A
  • industrial cleaner
  • alcohol dissolves phenol
  • irrigate with copious amounts of water
65
Q

dry lime: chemicals

A
  • strong corrosive that reacts with water
  • brush off dry substance
  • irrigate with copious amounts of cool water- prevents reaction with patient tissues
66
Q

sodium

A
  • unstable metal
  • reacts vigorously with water
  • releases- extreme heat, hydrogen gas, ignition
  • decontaminate- brush off dry chemical
  • cover the wound with oil substance
67
Q

riot control agents

A
  • CS, CN (mace), oleoresin, capsicum (OC, pepper spray)
  • irritation of the eyes, mucous membranes, and respiratory tract
  • no permanent damage
  • general signs and symptoms:
  • coughing, gagging, and vomiting
  • eye pain, tearing, temporary blindness
  • management- irrigate eyes with normal saline
68
Q

radiation burns

A

-Notify hazardous materials team.
-Establish safety zones- Hot, warm, and cold
– Personnel positioned upwind and uphill.
– Use older rescuers for recovery.
– Decontaminate ALL rescuers, equipment, and patients

69
Q

look at RAD chart *

A

Trauma and Trauma Systems (18 decks)

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