Burns Flashcards
Reduce chemical burns 2
Approved labeled containers
Educate workers-protection
Reduce Electrical burns 4
Avoid frayed wiring
Avoid outdoor activities in storms
make sure power is off before doing work
wear eyewear and gloves when making repairs.
Reduce inhalation burn 1
instal smoke and carbon detectors
reduce scald burn 4
Use anti scald devices
Lower hot water temp to 120
check bath with back of hand or thermometer
supervise bath
Where do alkalis burns come from? 5
Cement, Oven and drain cleaners, heavy cleaners-phenols, disinfectants, petroleum, (creosote and gasoline)
What causes Metabolic asphyxiation
And what percent of what
Inhaling carbon monoxide and or hydrogen cyanide- mostly from inhalation at fire.
Carboxihemaglobin greater than 20%
What is compromised in an upper airway 3
lower? 3
mouth oropharyns layrnx
trachea, bronchiole, and alveoli
Eschar
tightens and constricts
Assessment for inhalation burns 7
and what can it progress to?
Singed nasal hair, hoarsness, painful swallowing, dark mucosa, carbonaceous sputum, hx of being burned in enclosed space, burns around neck and chest
ARDS
When does pulmonary edema develop?
12 to 48 hours
Patho of electrical burns
Intense heat from electric current that damages nerves and vessels causing tissue anoxia and death.
Electrical burn and bones vs vessels vs organs
Bones and fat have more resistances that vessels and nerves
worst organs are brain, kidneys, and heart.
What else may electrical burns cause?
Flash burn someone may ignite
How to tx electrical burn 4
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.
What do electrical burns put a patient at risk for? 5
DysR and cardiac arrest ( up to 24 hours later), broken bones, metabolic acidosis, myoglobinurea-rabdo so AKI or ATN
upper airway manifestations of injury 4
copious secretions, stridor, substernal and intercostal retractions, airway obstructions.
Lower airway manifestations 6
ALC, Carb sputum, dyspnea, facial burns, hoarsness, wheezing
How do we decide severity of burn?
Depth, extent of burn calculated as TBSA, location, and age, med history, circumstances, complicating factors.
Superficial burn is?
4 s/s
Partial thickness Superficial epidermal damage first degree burn
Erythema, Blanching on pressure, pain, mild swelling, after 24 hours skin my blister and heal
Deep burn is?
3 s/s
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
3rd and 4th degree burns 4 about
4 s/s
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
how do we measure depth?
Extent of burn?
Full or partial thickness
lund brower or rule of nines (LB is more accurate nines is fast).
Describe patho of a burn
Increased vascular permeability, edema, decreased blood volume, decreased vascular volume, increased hematocrit, increased viscosity, increased peripheral resistance =Burn shock
What are we concerned about with burns?
Hypovolemic shock in first 8 hrs.
Infection
How do we measure splash burns/irregular Burns.
Assume palm is 1 percent use to approximate irregular size
How do we measure splash burns/irregular Burns.
Assume palm is 1 percent use to approximate irregular size
Rule of nines
Head- 4.5% x 2
Trunk 18% X2
legs 9%x2
Arms 1.5% X2
Genitals -1%
One thing to remember when calculating BSA of burns
Superficial burs do not count
What is important about location of burn?
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
High Risk populations concerns for burns 4 ish
Preexisting heart, lung, or kidney disease. PVD, diabetes, gen physical weakness or malnut from alcohol or drug use,
fractures, head injuries or other trauma.
Prehospital burn care
2 things
Small burns?
large?
Clothes?
2 more things
best time to start cooling?
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
Cooling a burn
No ice-vasoconsrict
cool no longer than 10 mins
no immersion
How to tx CO poisoning
100%. humidified 02
three things about fluid resuscitation
2 lg bore IV
TBSA> 15%
Lactated ringers
What are the phases of burn management
Emergent (resuscitative), acute (wound healing) and rehab (Restorative)
One thing about emergent care for burns Emergent care
Cath if burn is > than 15%
different emergency care for electrical burns 2
Blood gasses
find sites
How do you flush eyes?
inside corner out with LR if available
What defines the emergent phase
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+
Why is a burn patient at risk for infection
Skin barriers are compromised and WBC are impaired
2 common things that happen with burn patients
Peri illius
shivering
how do you diagnose inhalation injury?
fiberoptic bronchoscopy and carboxyhemoglobin
when does a patient with face burns need to be intubated?
1-2 hours
Fluid replacement for burns called?
adults
peds
electrical and rabdo?
after 24hr
one thing about all
the parkland
2ml/kg/TBSA
3ml/kg/TBSA
4ml/kg/TBSA
33%
1/2 in first 8hrs then other 1/2 in 16 hrs
Fluid replacement for burns called?
adults
peds
electrical and rabdo?
after 24hr
one thing about all
the parkland
2ml/kg/TBSA
3ml/kg/TBSA
4ml/kg/TBSA
33%
1/2 in first 8hrs then other 1/2 in 16 hrs
what do we want urine output to be?
electrical?
.5-1ml/kg/hr or
75-100ml/hr
Nutrition for burns?
High cal high prot early
enteral
Wound care for burns
Debridement
Open method
Closed method
debridement in emergent phase removes necrotic tissue, extensive is done in OR
topical antimacrobial no dressing-face
antimacrobila ointment sterile gauze
When do you use cadaver graft?
burn is 50% or over
three thing about meds and burn patients
two types of meds
IM doesn’t work
Give tetnes but later
topical not systemic
anticoags
GI support
What is the Acute phase?
Start?
End?
Time?
3 things to look at
5problems
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
degrees
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
nutrition for burns
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
