Burns Flashcards
Why does partial/full thickness burns result in disruption of the barrier function and contribute to free water deficits?
because the skin provides the semipermeable barrier to prevent evaporate water loss
Fluid and electrolyte abnormalities seen in burn shock are result of alterations of _________________
cell membrane potentials.
-intracellular influx water and sodium
-extracellular migration of potassium
Burns >60% body surface area (BSA) is associated with decreased _____________ > lack of response to aggressive fluid resuscitation
cardiac output
The rule of 9’s (look at pic on slide 8)
quantified as the percentage of BSA. All of the numbers add to nine or are all divisble by 9
________ degree burn involves the epidermal layer ONLY. The skin is red, painful, tender, NO _______ formation. E.g. sunburn. It heals within ______ days with no scarring, requires only symptomatic tx
First
blister
7
________ degree burns extend into the dermis. What are the two types?
second
1. superficial partial thickness
2. deep partial thickness
In a superficial partial thickness burn, the __________ and ______________ are damaged. It heals in _____________ scarring minimal, full return of function.
epidermis
superficial dermis (papillary layer)
14-21 days
Blistering of skin, exposed dermis is red and moist at blister base. Very painful to the touch, good profusion best describes which type of burn?
superficial partial thickness burn
A deep partial thickness burn extends deep into the ____________. Damage is done to the ________, ____________ and ________ glands.
dermis(reticular layer)
hair follicles, sweat, sebaceous glands
Skin is blistered, exposed dermis is pale white to yellow color, burned area does not blanch, absent cap refill, absent pain sensation best describes which type of burn?
deep partial thickness burn
A deep partial thickness burn may be hard to distinguish from a _______ degree burn
3rd
A deep partial thickness burn heals in _________ and scarring is common. May need surgical debridement, skin graft to return to normal function.
3weeks to 2 months
What are the common causes of deep partial thickness burns?
hot liquid, steam, grease, flame
Third degree burns are also called _______________. All ___________ and _________ structures are destroyed.
full thickness burns.
epidermal, dermal
Skin is charred, pale, painless, and leathery best describes which type of burn?
3rd degree akak full thickness burn
What are the causes of a third degree burn?
flame, hot oil, contact with hot objects
What is the treatment for third degree burns?
they will NOT spontaneously heal. need surgical repair, grafting, significant scarring.
Fourth degree burns extend through the skin to the ___________, __________ and even __________. These are life threatening injuries and you need amputation, extensive reconstruction.
subq fat, muscle, bone
How do you care for minor burn: 1st degree and superficial 2nd degree burn
- analgesics
- clean with soap and water
- debride as needed
- topical antimicrobial (bacitracin ointment, triple antibiotic ointment)
- synthethetic occlusive dressing
- tetanus
__________ can be covered with moist saline soaked dressing while ___________ can use sterile drapes
small wounds
large wounds (application of saline soaked could cause hypothermia, avoid sterile dressing in ED > they have to undress to eval wound)
Airway
re-evaluation of airway
early intubation
-signs of airway burn (mouth, nose) swelling, inhalation injury
Breathing
continuous pulse ox monitor with supplemental O2
determine carboxyhemoglobin level
-carbon monoxide
bronchoscopy if inhalation injury is concern
Circulation
BP, HR, cap refill, UO, mental status
establish TWO large bore access lines in UNBURNED skin if possible
cardiac monitoring
IV administration of lactaid ringers (LRs) solution using parkland formula
Fluid resuscitation: Parkland Formula
Adults
LR4ml x weight (kg) x BSA burned over initial 24 hrs
Half= over first 8 hrs from time of burn
Example: 154 lb, 40% 2nd and 3rd degree burns
4mL x 70kg x 40 = 11,200 mL over 24 hours
5600mL in the first 8 hours