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
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
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
4
Q
layers of skin
A
- epidermis - dead
- dermis - nerves, hair
- subcutaneous
- underlying structures:
- fascia
- nerves
- tendons
- ligaments
- muscles
- organs
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
6
Q
emergent phase (stage 1)
A
- pain response
- catecholamine release:
- tachycardia
- tachypnea
- mild hypertension
- mild anxiety
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 *****
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
9
Q
resolution phase (stage 4)
A
- scar formation
- general rehabilitation and progression to normal function
10
Q
stages of pathophysiology of burns
A
- emergent phase
- fluid shift phase
- hypermetabolic phase
- resolution phase
11
Q
types of burns
A
- thermal
- electrical
- chemical
- radiation
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
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
14
Q
jacksons theory of thermal wounds: zone of stasis
A
- area surrounding zone of coagulation characterized by decreased blood flow
- middle portion
15
Q
jacksons theory of thermal wounds: zone of hyperemia
A
- peripheral area around burn that has an increased blood flow
- outermost area
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
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
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
19
Q
chemical burns
A
- destroy tissues
- acid
- alkalis
20
Q
chemical burns: acids
A
- form a thick, insoluble mass where they contact tissue
- coagulation necrosis - limits burn damage
21
Q
chemical burns: alkalis
A
- destroy cell membrane through liquefaction necrosis
- deeper tissue penetration and deeper burns
22
Q
radiation
A
- transmission of energy
- nuclear energy
- ultraviolet light
- visible light
- heat
- sound
- x-rays
23
Q
radioactive substance
A
- emits ionizing radiation
- radionuclide or radioisotope
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
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
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
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
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
