Burns Flashcards
What are the 3 types of burns?
Thermal (contact with flame, heat, liquids)
Electrical (energy converted to heat)
Chemical (contact, inhalation, ingestion, injection)
*First degree burn symptoms
Involves only epidermis
Reddened skin
Pain at burn site
No blistering
Second degree burn symptoms
Epidermis and dermis
Red
Painful
Blistered
Pale areas
Mottled areas
Third degree burn symptoms
Involves epidermis, dermis, subcutaneous tissue
Dry, leathery skin (white, dark brown, or charred)
Loss of sensation (little pain)
All dermal layers/tissue may be involved
Forth degree burn symptoms
Includes involvement of muscle and bone
Loss of function
Painlessness
Black, charred appearance
May require amputation, escharotomy, fasciotomy
How long does it take first degree burns to heal?
2-5 days
How long does it take for second degree burns to heal?
10 days to 6 weeks
Which layers of skin do blisters occur between?
Why shouldn’t burn blisters be popped?
Occurs at dermal-epidermal junction
Fluid filled with inflammatory mediators
Properties of burn eschar
Occurs with full thickness burn
Dead and has no normal function
Must be removed through debridement
Why are circumferential burns a surgical emergency?
They are limb threatening or threat to internal organs if burns to trunk
Veins collapse due to edema
Need to do fasciotomy
Reasons to suspect inhalation injury
Closed space incident
Presence of heavy smoke
History of unconsciousness
Symptoms of inhalation injury
Facial burns
Profuse secretions
Carbonaceous sputum
Lacrimination
Singed nasal hair
Hoarseness
Wheezing
Stridor
Edema
Hypoxemia
Tachycardia
What lab is drawn immediately if carbon monoxide inhalation is suspected?
COHb
Treatment for carbon monoxide inhalation
100% oxygen via non-rebreather mask
S/s of CO poisoning
*Majority of pts are asymptomatic
50% have cherry red color
Possible HA
Possible confusion
Possible coma
No tachypnea or cyanosis - CO2 not affected
PaO2 normal
SaO2 normal
Symptoms of inhalation injury above glottis
Hoarseness
Dry cough
Labored breathing
Stridor
Difficulty swallowing
Treatment for inhalation injury above glottis
Intubate b/c edema = airway obstruction
Symptoms of inhalation injury below glottis
*Carbonaceous sputum
Bronchospasm
Wheezing
Consequences of electrical injuries:
*Cardiac arrhythmias (b/c of shock)
Cardiac and pulmonary arrest
Intracranial bleeding
Decreased LOC (d/t ammonia build up from protein breakdown)
Paralysis of extremity
Loss of peripheral pulses and limbs
*Myoglobinuria
Serum CK > 1000 IU (troponin = muscle breakdown)
Why might higher fluid volumes need to be given electrical injuries?
Goal for UOP
What else should we be looking for?
*to adequately resuscitate the d/t muscle damage and myoglobinuria
*Urine output should be 75-100 mL/hr
Assess carefully for compartment syndrome
What occurs during stage 1 of burns: emergent phase
And what symptoms will the patient experience
First 12-24 hours
Pain response
Catecholamine release (pt feeling anxious)
Tachycardia, tachypnea, mild HTN, mild anxiety
What occurs during stage 2 of burn: diuresis phase how long does this phase last?
Lasts 18-24 hours (reaches peak in 8 hours)
Damaged cells initiate *inflammatory response
- increased blood flow to cells
- shift of fluid from intravascular to extravascular (3rd spacing)
- MASSIVE EDEMA d/t “leaky capillaries”
Treatment for stage 2 of burn (diuresis phase)
Pt has no BP b/c fluid in wrong place (distributive shock) so need to constrict vessels
*Give dopamine/dobutamine
What occurs with stage 3 of burns: hypermetabolic phase how long does it last?
Lasts for days to weeks
Large increase in body’s need for nutrients as it repairs itself
Need protein
