Burns (1305)

Question 1

What population are burns more likely to occur in?

Answer 1

Ages 20-40 yrs old

Question 2

What is the epidermis?

Answer 2

Thinner outer layer providing protection from environment

Question 3

What is the dermis?

Answer 3

Thicker inner layer providing sensory, sweat glands, oil, etc

Question 4

What is the Zone of Coagulation?

Answer 4

Where irreversible cellular death occurs; necrosis of skin

Question 5

What is the Zone of Stasis?

Answer 5

Surrounds zone of coagulation. Decreased blood due to inflammation and tissue injury; tissue WILL DIE if not treated

Question 6

What is the Zone of Hyperemia?

Answer 6

Sustains the least damage. Inflammatory mediators increase blood to this area.

Question 7

How many categories can burns be classified in?

Answer 7

3 (or 4-6, depends what you read)

Question 8

What are First Degree (superficial) Burns?

Answer 8

Minor tissue damage to EPIDERMIS. Skin is red, painful, and DRY. Will heal without scarring.

i.e: sunburns

Question 9

What are Second Degree (Partial Thickness) Burns?

Answer 9

Damage penetrates epidermis and in varying depths of dermis. Skin is red, painful, WET, and will BLISTER. Will heal without scarring

Question 10

What are Second Degree (Full Thickness) Burns?

Answer 10

Damage is deeper into the dermis. Can be yellow/white and will be dry. Pain may not be appropriate given severity of burn.

Question 11

What are Third Degree (Full Thickness) Burns?

Answer 11

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

Question 12

Patho of Burns?

Answer 12

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

Question 13

4 types of Burn Injuries?

Answer 13

Thermal, Chemical, Electrical, Radiation

Question 14

Examples of Thermal Burns?

Answer 14

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

Question 15

What are Chemical Burns?

Answer 15

• 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

Question 16

What are Electrical Burns?

Answer 16

• Damage caused by heat from electricity (entry wound and exit wound)
• Higher voltage = more damage (>500 volts)
• Cardiac arrhythmias are common. Monitor them carefully

Question 17

What is a lichtenberg figure?

Answer 17

When electricity travels across superficial blood vessels; rare but telltale sign of lightning strike

Question 18

How many volts are in a lightning strike?

Answer 18

> 10,000,000 volts in a millisecond of duration

Question 19

What should you expect with someone who’s been hit by lightning?

Answer 19

• 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

Question 20

What are Radiation Burns?

Answer 20

• 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

Question 21

BLS Burns Standard?

Answer 21

Refer to BLS Standard

Question 22

What’s in your Burn Kit?

Answer 22

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

Question 23

Rule of 9’s?

Answer 23

Refer to diagram

Question 24

What is the Parkland Burn Formula?

Answer 24

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

Question 25

S&S of Inhalation Injury?

Answer 25

• Burns to face or mouth
• Soot in mouth, nose, or sputum
• Inability to swallow
• Stridor
• Coughing
• Facia/oral edema

Question 26

What is the #1 cause of fire related deaths?

Answer 26

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

Question 27

What should you cover 1st degree burns with?

Answer 27

Moist sterile dressing then cover with dry sheet or blanket

Question 28

What should you cover 2nd degree burns with <15% BSA?

Answer 28

Moist sterile dressing then cover with dry sheet or blanket

Question 29

What should you cover 2nd degree burns with >15% BSA?

Answer 29

Dry sterile dressing or sheet

Question 30

If remoistening dressing, what should you do?

Answer 30

remove dry sheet or blanket, then remoisten previously applied sterile dressing

Question 31

What should you cover 3rd degree burns with?

Answer 31

Dry, sterile dressing or sheet