Burns (1305) Flashcards
What population are burns more likely to occur in?
Ages 20-40 yrs old
What is the epidermis?
Thinner outer layer providing protection from environment
What is the dermis?
Thicker inner layer providing sensory, sweat glands, oil, etc
What is the Zone of Coagulation?
Where irreversible cellular death occurs; necrosis of skin
What is the Zone of Stasis?
Surrounds zone of coagulation. Decreased blood due to inflammation and tissue injury; tissue WILL DIE if not treated
What is the Zone of Hyperemia?
Sustains the least damage. Inflammatory mediators increase blood to this area.
How many categories can burns be classified in?
3 (or 4-6, depends what you read)
What are First Degree (superficial) Burns?
Minor tissue damage to EPIDERMIS. Skin is red, painful, and DRY. Will heal without scarring.
i.e: sunburns
What are Second Degree (Partial Thickness) Burns?
Damage penetrates epidermis and in varying depths of dermis. Skin is red, painful, WET, and will BLISTER. Will heal without scarring
What are Second Degree (Full Thickness) Burns?
Damage is deeper into the dermis. Can be yellow/white and will be dry. Pain may not be appropriate given severity of burn.
What are Third Degree (Full Thickness) Burns?
Damage to ALL layers of skin and subcutaneous tissue; no skin cells left therefore no healing. Because nerve fibers are severed, no pain/loss of sensation. Will scar, contract, and limit mobility.
Denatured skin protein becomes hard, forms ESCHAR tissue
Patho of Burns?
Goal of burn resus? To RESTORE or PRESERVE tissue perfusion.
- Severe burns cause increase in capillary permeability
- This causes intravascular proteins (inside blood vessels) and fluid to move into interstitial space
- This causes edema
- Due to loss of intravascular fluid (massive loss within 8-12 hours), there is a DECREASE in Cardiac Output
- This ultimately causes hypotension and organ failure
4 types of Burn Injuries?
Thermal, Chemical, Electrical, Radiation
Examples of Thermal Burns?
Contact - prolonged contact or touching something extremely hot (i.e hot stove, industrial accidents)
Flame - results in partial or full thickness burns. Consider inhalation injury (i.e house fire)
Scalds - tends to be superficial/partial thickness. (i.e children and hot drinks/bath water)
Flash - explosions with no sustained fire. Single wave of heat; stronger in larger explosions
What are Chemical Burns?
- Alkali burns (worse than acids)
- Deep damage in tissue; won’t stop until removed completely
- Damage depends on chemical and duration
- Patient will require decontamination prior to transport
- Ask for MSDS
What are Electrical Burns?
- Damage caused by heat from electricity (entry wound and exit wound)
- Higher voltage = more damage (>500 volts)
- Cardiac arrhythmias are common. Monitor them carefully
What is a lichtenberg figure?
When electricity travels across superficial blood vessels; rare but telltale sign of lightning strike
How many volts are in a lightning strike?
> 10,000,000 volts in a millisecond of duration
What should you expect with someone who’s been hit by lightning?
- 1st or 2nd degree burns from vapourized water
- If patient is in arrest, it’s normally secondary to hypoxia (global depolarization)
- In an event of an MCI, these people get resus FIRST. No black/blue tag
What are Radiation Burns?
- Caused by x-ray, radiation therapy, nuclear energy
- Common cause is UV light from sunburns
- Severity depends on amount of radiation + length of exposure
Can NOT be differentiated from thermal burns
BLS Burns Standard?
Refer to BLS Standard
What’s in your Burn Kit?
Bandage, conforming gauze roll - 4
Burn sheet (150 x 225) - 1
Burn sheet (37 x 37) - 2
Burn sheet (75 x 75) - 2
Sterile gloves - 2 pairs
Irrigation fluid - Min 1000 mL
Rule of 9’s?
Refer to diagram
What is the Parkland Burn Formula?
Fluid replacement guide for burn patients over a 24 hr period based on percentage of body burned. ONLY FOR PARTIAL AND FULL THICKNESS BURNS
Formula:
Total fluid = 4ml/kg x % of burned area
S&S of Inhalation Injury?
- Burns to face or mouth
- Soot in mouth, nose, or sputum
- Inability to swallow
- Stridor
- Coughing
- Facia/oral edema
What is the #1 cause of fire related deaths?
Carbon Monoxide poisoning
- Byproduct of combustion (unintentional if suicide is related)
- Colourless, odourless, tasteless
- 257x more affinity to hemoglobin than O2
- PATIENTS REQUIRE HIGH FLOW O2
What should you cover 1st degree burns with?
Moist sterile dressing then cover with dry sheet or blanket
What should you cover 2nd degree burns with <15% BSA?
Moist sterile dressing then cover with dry sheet or blanket
What should you cover 2nd degree burns with >15% BSA?
Dry sterile dressing or sheet
If remoistening dressing, what should you do?
remove dry sheet or blanket, then remoisten previously applied sterile dressing
What should you cover 3rd degree burns with?
Dry, sterile dressing or sheet
