Burns

Question 1

Reduce chemical burns 2

Answer 1

Approved labeled containers
Educate workers-protection

Question 2

Reduce Electrical burns 4

Answer 2

Avoid frayed wiring
Avoid outdoor activities in storms
make sure power is off before doing work
wear eyewear and gloves when making repairs.

Question 3

Reduce inhalation burn 1

Answer 3

instal smoke and carbon detectors

Question 4

reduce scald burn 4

Answer 4

Use anti scald devices
Lower hot water temp to 120
check bath with back of hand or thermometer
supervise bath

Question 5

Where do alkalis burns come from? 5

Answer 5

Cement, Oven and drain cleaners, heavy cleaners-phenols, disinfectants, petroleum, (creosote and gasoline)

Question 6

What causes Metabolic asphyxiation
And what percent of what

Answer 6

Inhaling carbon monoxide and or hydrogen cyanide- mostly from inhalation at fire.
Carboxihemaglobin greater than 20%

Question 7

What is compromised in an upper airway 3
lower? 3

Answer 7

mouth oropharyns layrnx
trachea, bronchiole, and alveoli

Question 8

Eschar

Answer 8

tightens and constricts

Question 9

Assessment for inhalation burns 7
and what can it progress to?

Answer 9

Singed nasal hair, hoarsness, painful swallowing, dark mucosa, carbonaceous sputum, hx of being burned in enclosed space, burns around neck and chest
ARDS

Question 10

When does pulmonary edema develop?

Answer 10

12 to 48 hours

Question 11

Patho of electrical burns

Answer 11

Intense heat from electric current that damages nerves and vessels causing tissue anoxia and death.

Question 12

Electrical burn and bones vs vessels vs organs

Answer 12

Bones and fat have more resistances that vessels and nerves
worst organs are brain, kidneys, and heart.

Question 13

What else may electrical burns cause?

Answer 13

Flash burn someone may ignite

Question 14

How to tx electrical burn 4

Answer 14

It is most likely under the skin so hard to tell. Find points of contact. can cause mm contractions that break long bones and vertebrae so C spine mobilization.

Question 15

What do electrical burns put a patient at risk for? 5

Answer 15

DysR and cardiac arrest ( up to 24 hours later), broken bones, metabolic acidosis, myoglobinurea-rabdo so AKI or ATN

Question 16

upper airway manifestations of injury 4

Answer 16

copious secretions, stridor, substernal and intercostal retractions, airway obstructions.

Question 17

Lower airway manifestations 6

Answer 17

ALC, Carb sputum, dyspnea, facial burns, hoarsness, wheezing

Question 18

How do we decide severity of burn?

Answer 18

Depth, extent of burn calculated as TBSA, location, and age, med history, circumstances, complicating factors.

Question 19

Superficial burn is?
4 s/s

Answer 19

Partial thickness Superficial epidermal damage first degree burn
Erythema, Blanching on pressure, pain, mild swelling, after 24 hours skin my blister and heal

Question 20

Deep burn is?
3 s/s

Answer 20

Partial thickness epidermis and dermis involved with varying depths. skin elements form and skin can regenerate.
fluid filled vesicles that are red, shinny, wet
severe pain from nerve injury
mild to mod swelling

Question 21

3rd and 4th degree burns 4 about
4 s/s

Answer 21

Full thickness, skin elements and nerves are destroyed, coagulation necrosis is present, need surgical interventions.

Dry waxy white leathery hard skin, visable thrombosed vessles, no pain, might involve mm tendons or bones

Question 22

how do we measure depth?
Extent of burn?

Answer 22

Full or partial thickness
lund brower or rule of nines (LB is more accurate nines is fast).

Question 23

Describe patho of a burn

Answer 23

Increased vascular permeability, edema, decreased blood volume, decreased vascular volume, increased hematocrit, increased viscosity, increased peripheral resistance =Burn shock

Question 24

What are we concerned about with burns?

Answer 24

Hypovolemic shock in first 8 hrs.
Infection

Question 25

How do we measure splash burns/irregular Burns.

Answer 25

Assume palm is 1 percent use to approximate irregular size

Question 25

How do we measure splash burns/irregular Burns.

Answer 25

Assume palm is 1 percent use to approximate irregular size

Question 26

Rule of nines

Answer 26

Head- 4.5% x 2
Trunk 18% X2
legs 9%x2
Arms 1.5% X2
Genitals -1%

Question 27

One thing to remember when calculating BSA of burns

Answer 27

Superficial burs do not count

Question 28

What is important about location of burn?

Answer 28

it can influence severity
face, neck, circumferentail to chest or back
eyes, hands, feet, joints,
ears and nose perineum and butt= risk for infection
Circum to extremities can cause compartment syndrome

Question 29

High Risk populations concerns for burns 4 ish

Answer 29

Preexisting heart, lung, or kidney disease. PVD, diabetes, gen physical weakness or malnut from alcohol or drug use,
fractures, head injuries or other trauma.

Question 30

Prehospital burn care
2 things
Small burns?
large?
Clothes?
2 more things
best time to start cooling?

Answer 30

Secure the scene
Stop the burn
thermal 10% or less= cool tap water
if electrical or greater than 10% or unconscious CAB elevate burns
Remove clothes unless melted
flush if needed
prevent hypothermia
1min

Question 31

Cooling a burn

Answer 31

No ice-vasoconsrict
cool no longer than 10 mins
no immersion

Question 32

How to tx CO poisoning

Answer 32

100%. humidified 02

Question 33

three things about fluid resuscitation

Answer 33

2 lg bore IV
TBSA> 15%
Lactated ringers

Question 34

What are the phases of burn management

Answer 34

Emergent (resuscitative), acute (wound healing) and rehab (Restorative)

Question 35

One thing about emergent care for burns Emergent care

Answer 35

Cath if burn is > than 15%

Question 36

different emergency care for electrical burns 2

Answer 36

Blood gasses
find sites

Question 37

How do you flush eyes?

Answer 37

inside corner out with LR if available

Question 38

What defines the emergent phase

Answer 38

Solving life threatening problems, can last up to 72 hours, preventing hypovolemic shock and edema formation it ends with diuresis with low specific gravity and capillary permeability is restored
hypoNa+ hyperK+

Question 39

Why is a burn patient at risk for infection

Answer 39

Skin barriers are compromised and WBC are impaired

Question 40

2 common things that happen with burn patients

Answer 40

Peri illius
shivering

Question 41

how do you diagnose inhalation injury?

Answer 41

fiberoptic bronchoscopy and carboxyhemoglobin

Question 42

when does a patient with face burns need to be intubated?

Answer 42

1-2 hours

Question 43

Fluid replacement for burns called?
adults
peds
electrical and rabdo?
after 24hr
one thing about all

Answer 43

the parkland
2ml/kg/TBSA
3ml/kg/TBSA
4ml/kg/TBSA
33%
1/2 in first 8hrs then other 1/2 in 16 hrs

Question 43

Fluid replacement for burns called?
adults
peds
electrical and rabdo?
after 24hr
one thing about all

Answer 43

the parkland
2ml/kg/TBSA
3ml/kg/TBSA
4ml/kg/TBSA
33%
1/2 in first 8hrs then other 1/2 in 16 hrs

Question 44

what do we want urine output to be?
electrical?

Answer 44

.5-1ml/kg/hr or
75-100ml/hr

Question 45

Nutrition for burns?

Answer 45

High cal high prot early
enteral

Question 46

Wound care for burns
Debridement
Open method
Closed method

Answer 46

debridement in emergent phase removes necrotic tissue, extensive is done in OR

topical antimacrobial no dressing-face

antimacrobila ointment sterile gauze

Question 47

When do you use cadaver graft?

Answer 47

burn is 50% or over

Question 48

three thing about meds and burn patients
two types of meds

Answer 48

IM doesn’t work
Give tetnes but later
topical not systemic
anticoags
GI support

Question 49

What is the Acute phase?
Start?
End?
Time?
3 things to look at
5problems

Answer 49

When diuresis starts
ends when partial thickness wounds are healed and fullthickness are gafted
Can take weeks to months
WBC is better GI is better
Electrolytes are all over the place
Infection is a problem
still cardio and pulmonry problems
contractures
high glucose from stress

Question 50

degrees

Answer 50

First degree (superficial thickness): redness, some pain/tenderness, mild swelling, blanching
Second degree (partial thickness): blisters, mottled white, mod/severe pain, blanching, mod edema
Third degree (full thickness): dry, dull, tight, leather like, eschar present, waxy, white or brown charred look, burn odor, no sense of pain, no blanching-no cap refill
Fourth degree: deep structure involvement-bone

Question 51

nutrition for burns

Answer 51

Nutritional support very important to meet hypermetabolic state and to allow for wound healing. Patients require 2-3 X daily caloric intake for 6mths post burn. Intubated patients require enteral feedings (better than TPN) to preserve GI function and GI blood supply. Use of anabolic steroids for large burns, encourage fluids to prevent constipation