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XIO > burns > Flashcards

burns Flashcards

1
Q

BURNS: DEFINITION

A

TISSURE INJURY CAUSED by THERMAL, CHEMICAL, ELECTICAL, or INHALATION BURNS

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2
Q

INITIAL ASSESSMENT AND TREATMENT - and what organ is important?

A

Assessment and initial treatment of burns is performed simultaneously with trauma resuscitation.
The initial management focuses on
Stabilizing the airway, breathing and circulation.
The primary evaluation includes:
Assessing for evidence of respiratory distress and smoke inhalation
Evaluating cardiovascular status
Determining the depth and extent of burns

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3
Q

INHALATION INJURY - is it a common cause of death?

A

Inhalation injury remains a leading cause of death in adult burn victims.

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4
Q

INHALATION INJURY - what type of breathing? and mental status?

A

COMMON SIGNS OF SIGNIFICANT SMOKE INHALATION INJURY:
Persistent cough, stridor or wheezing.
Hoarseness
Deep facial or circumferential neck burn
Nares with inflammation or singed hair
Carbonaceous (black) sputum
Depressed mental status

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5
Q

3 types of smoke & inhalation injuries (gloat about the types of inhalation)

A

Carbon Monoxide Poisoning
Inhalation injuries above the glottis
Inhalation injuries below the glottis

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6
Q

CARBON MONOXIDE (CO)

A

Colorless, tasteless, odorless, poisonous gas that is produced by incomplete combustion of burning materials.

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7
Q

CARBON MONOXIDE

A

When inhaled displaces O2 on the Hgb molecule causing hypoxia.
Has 250X’s the affinity to the Hgb molecule than O2
Accounts for the majority of deaths at the fire scene

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8
Q

INHALATION INJURY - what do pts usually need w/ severe inhalation burns?

A

CLINICAL HIGHLIGHTS:
SUPPLEMENTAL OXYGEN AND AIRWAY PROTECTION ARE THE CORNER STONES OF TREATMENT OF INHALATION INJURY. PTS WITH SEVERE BURNS OFTEN REQUIRE TRACHEAL INTUBATION.

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9
Q

FLUID RESUSCITATION - when does shock occur?

A

24-48 HRS after a MAJOR BURN, burn shock may develop

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10
Q

FLUID RESUSCITATION

A

Delay in fluid resuscitation is associated with increased mortality.
Pts. with moderate to severe burns , establish 2 large IV bore placed through unburned skin. May place through burned tissue to avoid delays
The most common formula is the Parkland formula

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11
Q

FLUID RESUSCITATION: THE PARKLAND FORMULA

A

Parkland Formula: (Commonly used)
4ml LR /Kg of body wt X Percent of TBSA burned
Give ½ of total in first 8 hours
½ in next 16 hours

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12
Q

Most reliable indicator of adequate fluid resuscitation in Burn patient is (how much)

A

urinary output. 30-50ml/hr ( 0.5 ML/KG )

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13
Q

RHABDOMYOSIS (Myoglobin)
Acute Renal Necrosis

A

Muscle damage leads to Myoglobin release from damaged muscle tissue

The Myoglobin (protein) can clog the renal tubules.
Clogged renal tubules lead to Acute Renal Necrosis.

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14
Q

Monitoring for Acute Renal Necrosis (necrosis is brown) AND

A

Myoglobinuria
Red to reddish-brown urine.
If urine dipstick is positive for blood, but neg for RBC’s on micro – consider Myoglobinuria

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15
Q

TREATMENT OF MYOGLOBINURIA (sodium and urine kills protein)

A

Increase urine output to 75 –100cc/hr
Increase urine alkalinity as this makes myoglobin more soluble.
Add NaHCO3 (sodium bicarbonate) to IV fluid.
The goal is to prevent myoglobin from clogging the renal tubules.

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16
Q

CONTRACTURES AND HYPERTROPHIC SCARS and KELOIDS - splinting for how long?

A

ROM, P.T.
Splinting and pressure garments for > 1 year
Multiple cosmetic or reconstructive surgeries

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17
Q

COMPLICATIONS: COMPARTMENT SYNDROME (compartmentalize the eschar)

A

With increased edema , there is elevation of the compartment pressure.
This may compromise distal circulation and requires escharotomy
Decompressive escharotomy of an extremity may be required for circumferential full thickness burn.
Escharotomy of the neck and chest may be required if mechanical constriction from eschar prevents respiration

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18
Q

GI COMPLICATIONS - SHOCK FROM THERMAL BURNS RESULTS IN (what about stomach?)

A

MESNTERIC VASOCONSTRCITION PREDISPOSING TO GASTRIC DISTENSION , ULCERATION AND ASPIRATION.

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19
Q

NUTRITION in MAJOR BURNS: - when can you start?

A

Hypermetabolic: 50 – 100% above normal.

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20
Q

Pain management - what drugs? (3 of them)

A

Procedures, Drsg changes, P.T. everything can hurt.
Pain management is critical, especially prior to procedures.
IV pain medication
MS, Dilaudid, Ativan

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21
Q

WOUND CARE - when are Allografts or homografts (cadaver grafts) used?

A

in emergent phase.

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22
Q

SKIN GRAFTING

A

Initially Synthetic or temporary grafts are used until permanent grafting is possible

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23
Q

PERMANENT GRAFTS: - when is autografting done?

A

AUTOGRAFTING is done when the patient can tolerate grafting/transplanting their own skin to the burn area.

24
Q

PERMANENT GRAFT: - CEA (The CEA is permanent)

A

CEA
(CULTURED EPITHELIAL AUTOGRAFTS)

Must have auto-grafts or CEA to heal full thickness burns

25
Q

REHAB PHASE (pink in rehab)
and when does the skin become raised? (raised the dead skin in 1 month)

A

New skin appears flat and pink.
After 4 to 6 weeks the skin will become raised and hyperemic (blood going to tissue)

26
Q

PRESSURE DRSGS - how long? and bathing?

A

Gentle continuous pressure applied 24 hours per day for 1 – 2 years
Removed for bathing.
Less scarring and keloids

27
Q

BURNS HIGHLIGHTS - how is Fluid resuscitation determined?

A

Pts with severe thermal burns are at significant risk of death and major morbidity.
Initial resuscitation : ABCs
Look for evidence of respiratory distress and inhalation injury.
Fluid resuscitation is determined by burn depth and size and is key to reconstitute intravascular volume
Parkland formula is the most commonly used formula.

28
Q

BURNS HIGHLIGHTS (hot or cold cleanse?)

A

Urine out put is a key determinant in the efficacy of fluid resuscitation.
Monitor for RHABDOMYOSIS
Early initiation of feeding .
Wound care: cool and cleanse wounds
Pain control
Burn : a colossal psychological toll: coordinate care
Lastly : be safe.

29
Q

new terms for 1st, 2nd, 3rd degree burns

A

superficial, superficial partial thickness, deep partial thickness, full thickness

30
Q

study slide 6

A
31
Q

dont need to know slide 7

A
32
Q

need to memorize slide 8!!! Rule of 9s (for 18, you need 9)

A

for 18, you need 9

33
Q

have an idea about slide 15

A
34
Q

Common cause of death within 48 hrs

A

inhalation injury

35
Q

inhalation injury - how prevalent

A

The risk of inhalation injury increases with the extent of the burn
It is present in 2/3 of patients with burns greater than 70% of TBSA

36
Q

MAJOR BURNS CAUSE A HYPERMETABOLIC STATE THAT IS ASSOCIATED WITH:

A

immunosuppression
Impaired wound healing
Muscle catabolism
Hepatic dysfunction.

37
Q

All full thickness burns must be

A

covered with autografts to heal.

38
Q

TEMPORARY GRAFTS

A

Xenografts or heterografts
Allografts or homografts
Synthetic materials

39
Q

Xenografts or heterografts

A

from animals (pigs)

40
Q

Allografts or homografts

A

from humans (donor, or cadaver)

41
Q

Synthetic materials - grafts (the opposite of integrity is lying)

A

Integra, Opsite, Lyofoam

42
Q

who should get fluids? (Mr. Burns is 15)

A

Ant patient with greater than 15% of TBSA of nonsuperfacial burns should receive fluid resuscitation.

43
Q

signs of shock

A

Myocardial depression
Increased capillary permeability

44
Q

what happens if pt develops shock?

A

Large fluid shifts
Depletion of intravascular volume

45
Q

shock - treatment

A

Rapid aggressive fluid resuscitation to expand intravascular volume is critical to maintain end-organ perfusion.

46
Q

carbon monoxide - levels? (CO10)

A

Carboxyhemoglobin levels > 10% abnormal
Standard pulse oxymetry is not reliable with CO poisoning.

47
Q

how to treat CO2

A

Tx with high flow O2 ( hyperbaric O2 if CO level are high)

48
Q

bowels after a burn?

A

Bowel can become ischemic and translocation of bacteria can lead to sepsis.

49
Q

when can you start eating? (starving for 2-3 days)

A

When bowel sounds return (2 – 3 days), start feeding (clear liq →reg diet)

50
Q

IF NPO - where does the feeding tube go?

A

Feeding tube (BELOW the Pyloris to prevent aspiration) (Test Question) or
TPN (total parental nutrition

51
Q

GI complications - same

A

Adynamic ileus (Paralytic ileus)
Translocation of bacteria
Sepsis

52
Q

superficial

A

blanches, dry red

53
Q

superficial partial thickness

A

blanches, weeping

54
Q

deep partial thickness

A

no blanching, cheesy white and red

55
Q

full thickness

A

no blanching, waxy gray black

XIO (372 decks)

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