Burns Flashcards
Carbon Monoxide poisoning
Most frequent cause of death at burn scene
- Has greater affinity for hemoglobin than oxygen
- Binds as carboxyhemoglobin
- Prevents RBCs from transporting oxygen to tissues
- PaO2 and SaO2 levels are normal
- Must measure COHgb levels ( > 60 % - death )
Rule of nines
- Head ( ant + post ) - 9 %
- Ant torso - 18 %
- Post torso - 18 %
- Leg ( ant + post ) - 18 %
- Arm ( ant + post ) - 9 %
- Genitalia - 1%
Involves epidermis, pink and red in color, blanches with pressure, mild edema, painful, heals - 3-5 days
E: sunburn
Superficial burn
Involves epidermis + possibly part of the dermis, pink or red, blisters , mild to moderate edema, heals - 2 weeks
E: scald burn with brief contact
Superficial Partial Thickness burn
Red or white, moderate edema, painful, soft dry eschar ; heals - 2-6 weeks - graft can be used .
E: scald, grease burn with prolonged contact
Deep Partial Thickness burn
Black, brown, - leathery appearance; severe edema, may or may not be painful, eschar is hard and inelastic; heals - weeks to months - possible loss of function and digits - graft required
E: prolonged exposure to source
Full Thickness burn
Parkland formula
4 ml x weight (kg) x TBSA (%)
1/2 of the volume over first 8 hours ( begins at the time of the burn )
1/2 over remaining 16 hrs
Bactericidal agent; little eschar penetration; transient leukopenia within 2-3 days
Silver Sulfadiazine (Silvadene)
Bacteriostatic, fungicidal; zero penetration of eschar ; turns everything black; hypotonic - Na and K depletion
Silver Nitrate
Hydrophilic based cream ; effective aginst gram +/- organisms; rapid diffusion eschar; causing burning pain for 20 min after application - Medicate !! can cause electrolyte imbalances - metabolic acidosis, respiratory alkalosis (monitor ABGs)
Mafenide Acetare ( Sulfamylon)
Homograft/Allograft
from another human (cadaver)
Heterograft/Xenograft
from an species - pigskin
Autograft
from another part of your own body
Cardiac dysrhythmias are often evident in … burns
electrical
Electrocuted patient - red/burgundy color urine - why ?
release of myoglobin from damaged muscles
Risk for cardiac arrhythmias or arrest ;
Causes coagulation necrosis - burn type ?
Electric
Hot cooking oil; can be caused by explosive flare - burn type ?
Thermal
Tissue adherence with protein hydrolysis - burn type ?
Chemical
May cause carbon monoxide poisoning; Indicated by facial burns and hoarseness - burn type
Smoke and inhalation
Complications of eschar formation
- Infection
2. Compartment syndrome
Factors that may impair the circulatory system during hypovolemic or distributive shock
Increased blood viscosity
Circulating catecholamines
During the rehab phase of wound healing, the contour of scarring can be controlled with …
pressure garments - must be worn 23 hours/day for 12-24 mo
acute gastroduodenal ulcer that occurs with the stress or injury; Burn ( ulcer develops within 24 hrs) - reduced GI blood flow and mucosal damage. Normally mucus lining the stomach - barrier to the hydrogen ions. TX- H2 histamine blockers + early enteral feeding
Curlling’s ulcer
Resuscitation/Emergent Phase
onset through first 48 hrs
Acute Phase
diuresis to wound closure
Rehabilitation Phase
wound closure - patient has reached their highest level of functioning that is possible
Burns - blisters
leave the blisters intact because they protect wound from infection
What is the maximum temperature that the skin can tolerate without injury
104 F - 40 C
