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CLINICAL SKILLS II > Burns > Flashcards

Burns Flashcards

1
Q

What are the different types of burns?

A
  • Chemical
  • Electrical
  • Contact
  • Scald
  • Fire/Flame
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2
Q

Where do Burns occur?

A
  • Recreational
  • Streets/Highway
  • Occupational
  • Home
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3
Q

What are the different layers of skin?

A
  • Epidermis
  • Dermis
  • Hypodermis
  • Muscle layer
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4
Q

What are the classifications of Burns?

A
  • First degree burn (Epidermis)
  • Second degree burn (Dermis)
  • Third degree burn (Hypodermis)
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5
Q

Describe the initial evaluation and management of Burns

A

1) Assess airway/breathing
2) Ensure source of heat removed
3) Estimate extent of burn
4) Obtain/ensure adequate IV access
5) Initiate/continue resuscitation
6) Closely monitor urine output
7) Keep patient warm

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6
Q

Describe the Smoke Inhalation Assessment

A
  • Flame burns
  • Enclosed space
  • Burns to face/mucosal membranes
  • Singed eyelashes/nasal hairs
  • Carbonaceous sputum
  • Hoarseness
  • Difficulty swallowing
  • Wheezing
  • Restlessness/confusion
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7
Q

How do you estimate the TBSA %?

A
  • Patient’s palmar surface = 1% TBSA
  • Rule of nines
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8
Q

What is the rule of nines?

A
  • Head (front & back) = 9%
  • Back = 18%
  • Chest = 18%
  • L/R arm = 9%
  • L/R leg = 18%
  • Perineum = 1%
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9
Q

What are the factors that affect Burn depth?

A
  • Temperature
  • Duration of contact
  • Dermal thickness
  • Blood supply
  • Very young/Very old have thinner skin
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10
Q

Describe Superficial/1st degree burn

A
  • Epidermis only
  • Pain & redness
  • Heals in a few days
  • Outer injured epithelial cells peel
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11
Q

Describe Partial Thickness/2nd degree burn

A
  • Entire epidermis & portion of dermis
  • Pain, blisters, moist, capillary refill
  • Uninjured dermis & epidermal appendages at risk
  • Heals spontaneously in 2-3 weeks
  • Skin graft may improve functional & cosmetic outcome
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12
Q

Describe Full Thickness/3rd degree burn

A
  • All skin layers affected
  • White, hemorrhagic, brown, black or charred
  • Inelastic and leathery
  • Painless or numb
  • Requires skin grafting
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13
Q

What are the properties of IV access?

A
  • Large burn = 2 large bore IV’s
  • Smaller burn (<15%) = 1 IV
  • Suture IVs started through burns
  • IV through non-burn area if possible
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14
Q

EMT/Paramedics start IV fluid:

A
  • Adults @ 500 mL/hour
  • Children <40kg @ 250 mL/hour
  • Children <10kg @ 125 mL/hour
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15
Q

What is the Calculated Resuscitation in first 24 hours?

A

Parkland Formula (LR)

2 mL X weight in kg X % TBSA burned

[give 1/2 volume in first 8 hours and the other 1/2 over the next 16 hours]

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16
Q

For patients <10kg, what is the calculated resuscitation in the first 24 hours?

A

4-2-1 Rule

For 0-10kg: 4 mL/kg/hr
For 10-20kg: + 2 mL/kg/hr
For >20kg: +1 mL/kg/hr

17
Q

What are the properties of Urine output?

A
  • Place Foley if >20% TBSA
  • Do not use diuretics to maintain urine output
  • Urine output goal is 100 ml/hr if concern for MYOGLOBINURIA
18
Q

What is the adequate urine output?

A
  • 1mL/kh/hr in children
  • 0.5ml/kg/hr in adults
19
Q

What is the severity of a chemical burn dependent on?

A
  • Type of chemical
  • Concentration of chemical
  • Duration of exposure
20
Q

What is the management for chemical burns?

A
  • Remove any chemicals before flushing with water
  • Remove patient’s clothing
  • Continue flood for 20 mins after burning has stopped
21
Q

What is the physiology behind an electric burn?

A

For electricity to flow, there must be a complete circuit between the source and the ground -> Any substance that PREVENTS is called an INSULATOR -> Any substance that ALLOWS is called a CONDUCTOR -> Human body is a good conductor

22
Q

What is the severity of an Electric burn dependent on?

A
  • Type of electric current
  • Magnitude of current
  • Voltage
23
Q

What is the management for Electric Burns?

A
  • If indicated, begin CPR and apply an AED (Be prepared to defibrillate)
  • Give supplemental oxygen and monitor
  • Treat soft-tissue injuries with dry, sterile dressings
  • Provide prompt transport
24
Q

What are the different types of Thermal burns?

A
  • Flame burn
  • Scald burn (Hot liquids)
  • Contact burn
  • Steam burn -> Topical burn
  • Flash burn (Explosion/lightening)
25
Q

In Inhalation burns, what is upper and lower airway damage caused by?

A
  • UPPER AIRWAY DAMAGE = inhalation of superheated gases
  • LOWER AIRWAY DAMAGE = inhalation of chemicals and particulate matter
26
Q

___________ intoxication should be considered whenever a group of people in the same place all report a headache or nausea

A

Carbon monoxide

27
Q

What is the management for Inhalation burns?

A
  • Hydrogen Cyanide poisoning -> Decontamination & Supportive care
  • Care for any toxic gas exposure includes: recognition, identification and supportive treatment
28
Q

What are the three types of Ionising radiation?

A
  • Alpha = little penetrating, stopped by skin
  • Beta = Greater penetrating, stopped by protective clothing
  • Gamma = very penetrating, passes through body and solid materials
29
Q

What is the management for radiation burns?

A
  • Patients with a radioactive source on their body must be initially cared for by a HazMat responder
  • Irrigate open wounds
  • Notify the emergency department
30
Q

What are the patient assessment steps?

A

1) Scene size-up
2) Primary assessment
3) History taking
4) Secondary assessment
5) Reassessment

31
Q

What are the typical signs of a burn?

A
  • Pain
  • Redness
  • Swelling
  • Blisters
  • Charring
32
Q

What is the difference between the Primary Assessment & Secondary Assessment?

A

PRIMARY ASSESSMENT
- Rapid scan
- Form a general impression
- Airway and breathing
- Circulation (Pulse rate & assess for shock)
- Transport

SECONDARY ASSESSMENT
- Physical examinations (rule of nines, classification of burn)
- Assessment of patient’s respiratory, neurologic and musculoskeletal system

33
Q

What are the functions of dressings and bandages?

A
  • To control bleeding
  • To protect the wound from further damage
  • To prevent further contamination and infection
34
Q

Why shouldn’t you use elastic bandages to secure dressings?

A

The bandage may become a tourniquet and cause further damage

35
Q

Why shouldn’t you use ice packs?

A
  • Delays oedema
  • Reduces pain
  • Can worsen tissue distraction
36
Q

Which pain medications are used?

A

IV
- Dilaudid
- Fentanyl
- Morphine

ORAL
- Oxycodone

37
Q

What factors should lead to a Burn Center referral?

A
  • All burned children
  • Any burn >10% TBSA
  • Any full-thickness burn
  • Burns to hands, face, feet or perineum
  • Any electrical or chemical burns
  • Inhalation injury
  • Burns and pre-existing medical problems

CLINICAL SKILLS II (3 decks)

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