Burns Flashcards
1st deg - Superficial burns
> Skin involvement
Color
Pain/No Pain
Scar/No Scar
Blister/No Blister
Duration of healing
> Epidermis
Red
Painful
No scar
No blister
Heals in 7-10 days by desquamation
2nd deg - Superficial Partial Thickness burns
> Skin involvement
Color
Pain/No Pain
Scar/No Scar
Blister/No Blister
Duration of healing
Surgery/No Surgery
> Full Epidermis and superficial dermis
Pink
Painful
Scars
Blisters
Heals in 10-14 days by re-epithelialization with minimal to no scarring.
Does NOT require surgery
2nd deg - Deep Partial Thickness burns
> Skin involvement
Color
Pain/No Pain
Scar/No Scar
Blister/No Blister
Duration of healing
Surgery/No Surgery
> Full Epidermis and Deep (reticular) Dermis
Mottled white to cherry red
No Pain
Scars
Blisters
Heals in 21-35 days (retarded re-epithelialization) with scarring and possible contractures
Requires surgery: Surgical excision and grafting
3rd deg - Full Thickness burns
> Skin involvement
Color
Pain/No Pain
Scar/No Scar
Duration of healing
Surgery/No Surgery
> Full Epidermis and Full Dermis Necrosis
White, Dry, sometimes Brown and Leathery
with Thrombosed blood vessels
No Pain
Scars
Healing by granulation and Secondary intention with substantial scar and contracture
Requires surgery: Surgical excision and grafting
High risk of infection
4th Degree burns
> Skin involvement
Management
Penetrates subdermal fat, even muscle and bones.
Require multiple surgeries for debridement and reconstruction
TBSA (Total Burn Surface Area) only takes into account which types of Burns
2nd degree (Partial thickness) and 3rd degree (Full thickness) burns
A Patient sustained deep partial thickness burns on the entire bilateral thighs, posterior lower torso, and right anterior arm. What is his %TBSA?
31.5%
R Entire thigh - 9
L Entire thigh - 9
Post lower back - 9
R anterior arm - 4.5
A Patient sustained multiple full thickness burns covering the back of his head, his groin, the entire L arm and his posterior lower L leg. What is his %TBSA?
19%
Post head - 4.5
Groin - 1
Entire L arm - 9
Posterior L Lower Leg - 4.5
A 3/F patient sustained multiple superficial partial thickness burns due to a scald burn covering her Face, anterior trunk, and entire R leg. What is her %TBSA
41%
Face - 9%
Ant trunk - 18%
Entire R Leg - 14%
A 2/M sustained full thickness burns from a flash injury covering his Ant lower trunk, Ant R arm, and Ant R leg. What is his %TBSA
20.5%
Ant lower trunk - 9
Ant R arm - 4.5
Ant R leg - 7
A-B-C-D-E-F of Primary Survey
Airway and C-spine protection
Breathing and ventilation
Circulation and Compartment syndrome
Disability/Deficits
Exposure & Environmental control
Fluid Resuscitation
Measures for airway control
Chin lift
Jaw thrust
Oropharyngeal airway in unconscious px
Endotracheal intubation must be considered in patients with Inhalational injury and what %TBSA
≥ 40 % TBSA
Inhalational injury should be suspected in patients with what signs
> Burn to face
Sooty phlegm
Singed nostril hairs
Hoarseness or stridor
found uncoscious at scene
Circumferential chest burn
Breathing should be established via administration of high-flow oxugen at ___L/min for patients suspectedof inhalational injury
15L/min (100%)
One of the most reliable gauge of adequate circulation
Urine output
Allowable heart rate elevation in burn patients.
100-120bpm
An additional ECG is done for patients with what type of burn
Electrical burn
Management of compartment syndrome
Escharotomy and Fasciotomy
6Ps of Compartment syndrome
Pain
Pallor
Pulselessness
Paralysis
Paresthesia
Poikilothermia
AVPU method of assessing patient’s level of consciousness
A - Alert
V - Responds to Verbal stimuli
P - Responds to Painful stimuli
U - Unresponsive
Prolonged application of cold compresses poses a risk of:
Wound and body hypothermia
Fluid resuscitation should be started in adult patients with burns > ___%TBSA and children (<16yo) with burns > ___%TBSA
Adults: >20% TBSA
Children: >10% TBSA
Solution used for Burn Resuscitation
Plain Lactated Ringer’s solution (PLR)
Modified Brooke Formula for fluid resuscitation for the first 24 hours
2mL/kg/TBSA burned
Parkland Formula for fluid resuscitation for the first 24 hours
4mL/kg/TBSA burned
Half of the computed Fluid requirements should be given in the first __ hours AFTER injury, and the remaining half over the next __ hours
8 hours; 16 hours
International Society of Burn Injuries (IBSI) recommended fluid resuscitation for adults
PLR at 2-4ml x Wt (kg) x TBSA
International Society of Burn Injuries (IBSI) recommended fluid resuscitation for children
PLR at 3-4mL x Wt (kg) x TBSA
International Society of Burn Injuries (IBSI) recommended fluid resuscitation for infants and children < 30kg
D5LR or Glucose containing fluid added as a side drip calculated using Holiday-Segar formula
Holiday-Segar formula for infants and children <30kg
0-10kg: 100mL/kg
11-20kg: 1000mL + 50mL/kg for each kg in excess of 10kg
> 20kg: 1500mL + 20mL/kg for each kg in excess of 20kg
Reason behind administering the 1st half of fluids in the 1st 8 hours after injury
First 8 hours after injury: time of greatest capillary permeability and intravascular volume loss
Complications of over resuscitation
Pulmonary congestion and compartment syndrome
Reason behind addition of Glucose containing maintenance fluid to the resuscitation of children < 30kg
Lower hepatic glycogen stores, depleted in the first 12-14 h of fasting
Fluid of choice in the first 24 hours of fluid resuscitation
Crystalloid fluid (e.g., LR)
Approximates intravascular solute content
Fluid to be administered in the second 24 hours Post burn
Shift to 5% Dextrose in Water (D5LR) at the rate of 1cc/kg/%burn
Adequate urine output for Adults undergoing Fluid Resuscitation
0.5mL/kg/hour
Adequate urine output for Children < 30kg undergoing Fluid Resuscitation
1mL/kg/hour
Adequate urine output for Children > 30kg up to age 17 undergoing Fluid Resuscitation
0.5mL/kg/hour
Adequate urine output for Adults patients with high voltage electrical burns/myoglobinuria undergoing Fluid Resuscitation
1-1.5mL/kg/hour
AMPLET History in the Secondary Survey
A - Allergies
M - Medications
P - Past medical history or Pregnancy
L - Last meal/drink
E - Events/ Environment related to injury
T - Tetanus and childhood immunization
Tetanus administration for all burn patients
0.5mL Tetanus Toxoid
+ 250u Tetanus immunoglobulin/3000U anti-tetanus serum (ATS)
if absent/unknown prior immunization or if booster > 10 y ago)
Initial laboratory studies for Burn injury patients
> CBC w/ PT
Electrolytes
BUN, Crea, eGFR
Urinalysis
CXR
Toxic effect of 1% Silver Sulfadiazine
Transient Leukopenia
Wound dressing the provides a moist environment by trapping water in the matrix, thereby promoting wound healing. Works better than 1% SSD in pain reduction and number of dressing changes.
Hydrocolloid Dressings
Dressing that contains the highest amount of silver. Releases silver ions over a long period.
Silver Nanocrystalline dressings
Tangential excision of Eschar is usually done ____ days after burn injury
5-7 days
Burn Center Referral Criteria
- > 10% TBSA
- Burns involving the face, hands, feet, genitalia, perineum, or major joints
- 3rd degree (full thickness) burns in all ages
- Electric burns
- Chemical burns
- Inhalational injury
- Burn in patients with pre-existing medical conditions that can complicate management/prolong recovery/affect mortality
- Burns with concomitant trauma (fractures) in which burn poses the greatest risk
- Burned children in hospitals without qualified personnel or equipment
- Burn in patients who will require special social, emotional, or rehabilitative intervention
Jackson Zones of Burn Injury
- Coagulation
- Stasis
- Hyperemia
Jackson Zone of burn injury where there is ongoing inflammation and vasodilation
Zone of Hyperemia
Jackson Zone of burn injury with no capillary blood flow
Zone of Coagulation
Jackson Zone of burn injury that is salvageable with appropriate resuscitation
Zone of Stasis
Most common cause of death in burns
Burn wound sepsis
Adverse effect of Silver Nitrate
Hyponatremia
Methemoglibinemia
