Burns

Question 1

How to prevent burns?

Answer 1

• Working smoke detectors and carbon monoxide detectors monoxide detectors
• Create emergency plan escape plan
• never leave cooking food or open flames unattended.
• Install childproof devices.
• Never leave young children unattended.
• Check electrical cords for damage.
• Keep fire extinguishers and practice stop, drop and roll.
  -Set home water heater to 120 degrees.
• Wear protective clothing, use sunscreen, avoid tanning beds,
• Do not smoke or have flame in room with oxygen in use.

Question 2

How to determine the depth of thermal burns?

Answer 2

-The temperature the skin is heated to.
- The duration of contact with the heat source.

Question 3

What are thermal burns?

Answer 3

Fire, Steam, scald, hot objects or liquids.

Question 4

What are electrical burns?

Answer 4

Contact with lighting or electrical energy sources.

Question 5

What can electrical burn cause?

Answer 5

neurological problems
Cardiac arrest

Common causes: work related: powerlines and children from electrical cords or sockets.

Question 6

What is chemical burn?

Answer 6

contact with industrial/household chemicals (acids, alkalis, organic compounds)
- gasoline
-hydrofluoric,
- drain cleaner
-oven cleaner -
-bleach

Question 7

How to treat chemical burn?

Answer 7

Continuous irrigation with water.

Question 8

Type of burns

Answer 8

Thermal
Electrical
Chemical
Radiation

Question 9

What are radiation burns?

Answer 9

-Sun
-Tanning
- X-rays
-radiotherapy
-Nuclear accidents

Question 10

What does a radiation burn look like?

Answer 10

Can look similar to thermal burns.
-erythema
-edema
-blisters
-pain

-Cause: NVD, HA, Fever and fatigue

Question 11

describe Superficial

Answer 11

-epiderma layer
-heal within 3-7 days
-pink/red, pain
-Most commonly known as sunburns

Question 12

describe superficial partial- thickness

Answer 12

-Epiderma layer

-Blister, pink/red, blanches.

• heals within 1-2 weeks.

Question 13

describe deep partial thickness

Answer 13

• Demis layer:

blister, waxy, pink/cherry red, edema.
-no blanching, pain around edges, decrease sensation
- heal withing 3-6 weeks.
-may require surgical debridement or skin grafting.

Question 14

describe full thickness.

Answer 14

Subcutaneous layer:

leathery, dry white/brown/tan/black eschar, no blanching, no pain.
- require surgical excision and grafting

Question 15

Burn wound healing: inflammation phase

Answer 15

Begins immediately after injury, vasodilation, increase in capillary permeability

Question 16

Care of minor burns

Answer 16

• Cool compression or cool water
• provide analgesic
• use lotion in intact skin
• cleanse with mild soap and tepid water
• apply anti microbial agent to non-intact skin
• Apply a dressing if clothing is irritating
• drink plenty of fluid
• reach to observer for infection

Question 17

Burn wound healing: proliferation phase

Answer 17

2-3 days after burn, granulation tissue forms, epithelial cells cover wound

Question 18

Burn wound healing: remodeling phase

Answer 18

May last for years, collagen fibers reorganize, scars contract, fade

Question 19

Total body surface area: ( TBSA): underestimating?

Answer 19

Underestimate: means we don not give enough and the patient can go into shock and organ failure.

Question 20

Total body surface area: TBSA overestimating

Answer 20

We give too much they cannot tolerate and May develop pulmonary edema

Question 21

How to determine the survival?

Answer 21

Age and medical history are most important in determining survival because small burns can fatal to older adults

Question 22

Age and medical history are most important in determining?

Answer 22

Survival, small burns can be fatal to older adults.

Question 23

Severity of a burn is determined by:

Answer 23

• presence of inhalation
• patient age
• past medical history
• presence of concomitant injury
• anatomical location of burn injury

Question 24

Infants and children lifespan considerations.

Answer 24

Different developmental stages = different burn types

• be alert to signs of child abuse when history does not match injury**

Question 25

Adolescent: lifespan Considerations

Answer 25

Forewarn about edema/ changes in child’s body from injury response

Question 26

Pregnant women: lifespan consideration

Answer 26

Complication treatment and threatens fetus * relationship between % of TBSA involved and fetal- maternal survival *

Question 27

Lifespan considerations: Older adults

Answer 27

- Most burns accidentally - greatest risk of death - May not tolerate fluid resuscitation and surgery - skin less elastic and harder to heal

Question 28

Zone of coagulation

Answer 28

area with most contact with heat source and most severe damage, eschar often present, and no pain because all nerves destroyed.

Question 29

Zone of stasis

Answer 29

- surrounds zone of coagulation. - damaged with impaired circulation. - most at risk area to become deeper and convert to zone of coagulation if fluid resuscitation is not adequate.

Question 30

Zone of hyperemia

Answer 30

outermost area with increase blood flow and usually more minimal and recovers in 1-2 weeks.

Question 31

Full extent and depth of a burn

Answer 31

is not known for 24-72 hours.

Question 32

functional changes

Answer 32

- Long term morbidity - impaired function: burns to hands, feet, genitalia, perineum and major joints. - Altered appearance burns to face - May require multiple lifelong plastic and reconstructive surgeries to maintain function.

Question 33

Inhalation injury

Answer 33

Exposure to heat asphyxiants Smoke - May not occur for 24-48 hours after injury - Most common in patients that was injured/trapped in an enclosed space (car, house) or if they have face, neck or chest burns.

Question 34

Upper airway injury

Answer 34

-above the glottis -Most Common -involves nose, throat mouth.

Question 35

Lower airway injury

Answer 35

below the glottis Most often chemical

Question 36

carbon monoxide poisoning

Answer 36

Carboxyhemoglobin level >10% with S&S

Question 37

Airway management

Answer 37

100& humidified O2 -cough/deep breathing - Elevated HOB - Endotracheal intubation

Question 38

S/S of inhalation injury

Answer 38

- Facial burns - Signed nasal and facial hairs - Carbonaceous sputum (SOOT), hypersecretions - Naso- or Oropharynx erythema - Excessive agitation/anxiety (hypoxia) - Tachycardia - intercostal retractions -flaring nostrils -Inability to swallow - Hoarseness, grunting, brassy voice -Rales, Rhonchi, Diminished breath sounds

Question 39

S/S Carbon monoxide poisoning

Answer 39

-Mild headache and confusion - Severe headache, flushing vision changes - disorientation, nausea - Irritability, dizziness, vomiting _Tachypnea, tachycardia - Coma, Seizure, death

Question 40

Two most concerning electrolytes during burn shock

Answer 40

Potassium and Sodium

Question 41

Burn shock is a combination of

Answer 41

distributive and hypovolemic shock

Question 42

Burn shock occurs from?

Answer 42

Massive fluid shift due to increased capillary permeability ( 8-36 hours)

Question 43

Explain pathophysiology of burn shock

Answer 43

Electrolytes, water, plasma, protein leak out into interstitial space called third spacing.

Question 44

Burn shock: W/o fluid resuscitation develop

Answer 44

hypotension tachycardia Decrease urine output. AMS Multi-organ failure