Burns Flashcards
Causes of burns
- Thermal
- Radiation
- Chemical
- Electrical
Cell damage occurs at temps >______F
113F (45C)
How do you get radiation burns?
UV light or non-solar
- Sunlight
- tanning beds
- XRs
- radiation trmnts
what can cause chemical burns?
- strong acids
- Strong bases (Alkalines like cement, lye, paint thinner, gas)
- can cause deep tissue necrosis that progresses several hrs after exposure
SS of impending airway obstruction
Stridor
Hoarseness
Respiratory distress, tachypnea, hyperpnea
Cough
SS of internal injury
- Tachycardia
- Oropharyngeal burns– These are important when identified; however, significant esophageal involvement may occur in the absence of oropharyngeal lesions
- Drooling
- Subcutaneous air
- Acute peritonitis– Abdominal guarding, rebound tenderness, and diminished bowel sounds
- Hematemesis
Consult ____ for chemical burns
MSDS and poison control
Complications of chemical burns
- Airway obstruction due to tissue edema
- Bowel perforation
- Fluid loss from vomiting, third spacing, GI bleeding
- Metabolic acidosis is acid is ingested
- Hypocalcemia if hydrogen fluoride (gasoline)
- Later: Strictures, fistulas, motility issues(hypo), GI CA
third spacing = pulling fluid from vasculature and putting it towards tissues needing help
Trmnt of chemical burns
Symptomatic Patients:
ABC
Emergent GI consult for EGD
Minimally symptomatic:
Can be D/C after 2-4 hrs observation, tolerating oral fluids, has normal labs, speech and mentation
What are electrical burns?
Burns at the cellular level due to electroporation of the cell membranes from a massive current of electrons.
High voltage, >1000V, will cause damage to deep tissue, especially conductive tissues such as muscles, nerves, and blood vessels.
Look for source and ground points, may have both
Severity of electrical burns depends on
Type of current (direct [DC] or alternating [AC])
Voltage
Duration of exposure
Body resistance
Pathway of current (which determines the specific tissue damaged)
AC vs DC
AC travels in various directions (Alternating current)
DC travels in 1 direction (Direct current)
Is found in defibrillators/batteries
Often throws person off source, stronger, but shorter exposure
where is AC found?
Is found in plug ins
Lower voltage and causes muscle contraction, so it is difficult to pull away, lower voltage, longer exposure
AC traveling through the heart for even 1 sec can cause VF
Arm to arm or to foot cross the heart
The following symp are most likely to occur from which type of burn?
* Muscular contractions
* Seizures
* Ventricular fibrillation
* Respiratory arrestdue to central nervous system (CNS) damage or muscle paralysis may occur.
* Cardiac arrest
Electrical burns
Burn WU
- ECG and cardiac enzymes if any potential for contact with heart
- UA for myoglobin
- CT/MRI for unconscious patients, due to possible other injuries
Pathophys of burns
Heat denatures proteins -> coagulative necrosis, around this tissue platelets aggregate -> vessels constrict, this reduces blood supply to the edges of the damaged area, which can further the damage
Damage to skin results in:
Possible bacterial invasion
Fluid loss
Impaired thermoregulation
Burn classification
1st degree
2nd degree
3rd degree (healing is only poss from outside->IN. usu only feel pain on superficial edges bc you fried the deep nerves)
Rule of 9s
Which degree burn?
These burns are red, blanch markedly and widely with light pressure, and are painful and tender. Vesicles or bullae do not develop.
1st degree
_______ thickness burn
These burns blanch with pressure and are painful and tender. Vesicles or bullae develop within 24 hours. The bases of vesicles and bullae are pink and subsequently develop a fibrinous exudate.
Superficial partial-thickness
______ thickness burns
These burns may be white and pliable, black and charred, brown and leathery, or bright red, pale burns may simulate normal skin except the skin does not blanch to pressure. usually not painful.
Hairs can be pulled
easily from their follicles.
No vesicles.
Full-thickness
why does a pt with a large burn suddenly get sever hypovolemia at about 6-8hrs after injury?
Intravascular fluid loss and large fluid shifts takes time
IV fluids are required for burns >____% TBSA
TBSA = total body surface area
10
Trauma protocol for burns?
- ABC – Airway, Breathing, Circulation
- Smoke inhalation get 100% oxygen
- Remove all clothing
- All chemical are flushed with water except powders, (dust off powder before flushing)
- Acid burns are flushed for 20 minutes
- calculate TBSA quickly (if >10% -> give IV fluids)
- Adjust IVF rate based on urinary outpt (goal is 30-50ml/hr for adults)
- +/- give albumin
- clean the burn
- transger to burn center
- Discharge with wound care
If no shock is observed, use the _______ formula to determine how much fluid needs to be given within first 24hrs
Parkland formula
(4 mL/kg) × % TBSA burned
to estimate fluid volume needs in the first 24 hours after the burn. Half the calculated amount is given over the first 8 hours; the remainder is given over the next 16 hours. Fluid is lactated Ringer’s solution because large amounts of normal saline could result in hyperchloremic acidosis.
what type of fluids need to be given?
lactated ringers bc its gonna be a large volume
more isotonic than saline
IVF rate is adjusted based on _____
urinary output
Goal is to maintain 30-50ml/hr in adults
.5-1ml/kg/hr in children
When to give albumin
Some clinicians give albumin, after 12 hours to patients who have larger burns, are very young or very old, or have heart disease and require large fluid volumes.
how to clean wounds
use analgesia, topical, oral, IV, depending on severity of burn
remove all loose debri
use room temp water to flush
Debride all ruptured blisters, leave others intact
consult burn center for what type of burns?
- Full-thickness burns>1% TBSA
- Partial-thickness burns>5% TBSA
- Burns of the hands, face, feet, or perineum (partial-thickness or deeper)
- old >60 and young <2
Should you treat burns if you plan on sending them to burn center?
only if you ask them what they want! dont ruin their plans
Silver Sulfadiazine, Silvadene treats ____ thickness burns and requires to be damp to be wet
partial-thickness
change dressings daily
update tetnus
FU outpt in 24-48hrs
We usu let burns that will heal within a few weeks do their own thing w/o Sx
Sx indications
- Expected for most deep partial and full thickness burns. Those expected to not heal within 2-3 weeks.
- Eschar is removed within 3 days, excision of damaged material occurs, then grafting
- Fasciotomy is done when edema within a muscle compartment elevates compartment pressure>30 mm Hg. Compartment syndrome is rare in burns other than high voltageelectrical burns
Sx indications
- Expected for most deep partial and full thickness burns. Those expected to not heal within 2-3 weeks.
- Eschar is removed within 3 days, excision of damaged material occurs, then grafting
- Fasciotomy is done when edema within a muscle compartment elevates compartment pressure>30 mm Hg. Compartment syndrome is rare in burns other than high voltageelectrical burns
