Burns

Question 1

automatic burn center admissions

Answer 1

-burns involving face, eyes, ears, hands, feet, perineum
-inhalation injury
-electrical burns, including lightening injury
-burn patients with associated trauma
-10% or greater TBSA

Question 2

goals related to burns

Answer 2

-prevention of an incident
-medical management of the severely burned person
-prevention of disability and disfigurement through early specialized and individualized care
-rehabilitation through reconstructive surgery and rehabilitation programs

Question 3

Thermal burns

Answer 3

-most common type of burn
-caused by steam, seals, contact with heat & fire
-seen most common in children ages 2-4

Question 4

Electrical burns

Answer 4

-electrical and lightening injuries
-~1000 deaths per year
-visual examination is not predictive of burn size and severity
-low or high voltage current
-entry and exit points (close of distant in proximity)
-every entrance has a an exit

Question 5

Chemical Burns

Answer 5

-flush until you get neutralizing agent
-bases are the worst burn, will tear through layers until neutralized

Question 6

Inhalation burns

Answer 6

-intubate this person
-may have cough & hoarseness & singed nasal hairs

Question 7

severity of burns

Answer 7

-age (surface area, thinner skin)
-severity of burn (depth & amount of surface area burned)
-presence of inhalation injury
-presence of other injuries
-Location of injuries: face, perineum, hands, or feet)
-presence of comorbidities (DM)

Question 8

considerations based on young age

Answer 8

-scalding or flames
-hot tap water burns
-thinner skin
-accidents & abuse

Question 9

considerations based on older age

Answer 9

-higher burn mortality rate
-fire/flame is most common cause
-complications: pneumonia, sepsis, dysrhythmias)
-thinner skin
-fluid resuscitations vs. fluid overload
-malnutrition
-pre-existing impaired pulmonary function

Question 10

First degree burns

Answer 10

-superficial
-causes: sunburn, low-intensity flash
-skin involvement: epidermis
-clinical manifestations: tingling, pain soothed by cooling, peeling, itching
-wound appearance: reddened minimal to no edema, possible blister
-treatment: recovery within a few days, oral pain med, cool compressions, skin lubricants (Aloe), acetaminophen

Question 11

Second degree burns

Answer 11

PARTIAL THICKNESS
-causes: scalds, flash flame, contact
-skin involvement: epidermis, portion of dermis
-clinical manifestations: pain, hypersensitivity, sensitive to air currents
-wound appearance: blistered, mottled base, weeping surface, edema
-treatment: recovery in 2-3 weeks, some scarring & depigmentation, may need grafting

Question 12

Third degree

Answer 12

-full thickness (epidemic & dermis)
-cause: flame, prolonged exposure to hot liquids, electric current, chemical contact
-skin involvement: epidemic, dermis, subQ tissue, may involve deeper tissue
-clinical manifestations: shock, possible contact points (electrical), myoglobinuria (red pigment in urine)
-wound appearance: dry, pale white, thin, red, leathery, vessels may be visible, edema
-treatment: eschar may slough, grafting necessary, scaring & loss of contour & function

Question 13

Fourth degree burns

Answer 13

-Full thickness that included fat, fascia, muscle, and/or bone
-causes: prolonged exposure, high voltage electrical injury
skin involvement: deep tissue, muscle, bone
-clinical manifestations: shock, myoglobinuria, hemolysis
-wound appearance: charred
-treatment: typically amputations

Question 14

TBSA methods

Answer 14

-rule of nines
-Lund & Browder Method
-Palmar method

Question 15

Rule of nines

Answer 15

-most common tool used to assess
-the body is broken down in areas and nines are assigned to each area based on anatomic regions
-a calculation used to calculate total body surface area (TBSA) burned for burns partial thickness or greater
-the percentage will determine treatment including fluid replacement and if the patient meets the criteria for a burn unit

Question 16

Patients with severe burns go into hypovolemic shock BURN SHOCK

Answer 16

-the peripheral edema is a collection of fluid from the intravascular fluid
-when the blood vessels don’t have enough fluid –> the body releases catecholamine –> which causes vasoconstriction and increased perfusion
-leading to further decreases tissue perfusion including organ perfusion

Question 17

Fluid & Electrolyte Alterations

Answer 17

-If burns are greater than 30% TBSA, inflammatory mediators stimulate local and systemic reactions resulting in extensive shifting of fluids & electrolytes

-Hyperkalemia (first hyperkalemia from the injured cells nursing) then hypokalemia when fluid is resuscitated
-Hyponatremia (3rd spacing)

-generally don’t give K+

Question 18

Escharotomy

Answer 18

-incision through the eschar relieves pressure from the constricting force of fluid buildup under circumferential burns on the extremity or chest that improves circulation

Question 19

Fasciotomy

Answer 19

-Inscision through eschar and fascia relieves tissue pressure when escharotomy alone does not

Question 20

can burn patients get compartment syndrome?

Answer 20

yes

Question 21

Pulmonary alterations from burns

Answer 21

-6%-30% of burn center patients have inhalation injury
-bronchoscopy is standard diagnostic tool
-upper airway: obstructive from direct thermal injury or secondary edema from head/neck burn
-lower airway: expectoration of carbon particles in sputum is cardinal sign

Question 22

when carboxyghemoglobin levels are greater than 10%? what does that mean?

Answer 22

strong indication of smoke inhalation injury, very dangerous

do neurochecks in these patients

Question 23

Kidney alterations

Answer 23

-altered as a results of the decreased blood volume post-burn injury
-pink-red urine
-destruction of RBC at injury site

Question 24

Thermoregulatory alterations

Answer 24

-critical skin functions are thermal regulation and infection prevention
-immunologic defenses are greatly altered
-burn centers implement strict infection prevention policies and procedures

Question 25

GI alterations

Answer 25

-increased risk of altered GI motility