Burns

Question 1

burns overview

Answer 1

a common cause of injury and potential MM
burn prognosis: affected by the type of environment

The Heat from burns:
causes protein denaturation
coagulative necrosis
platelets aggregate, and vessels constrict
zone of stasis extends around an injury

zone stasis extends around injury
damage to normal epidermal barrier allows for bacterial invasion, external fluid loss, and impaired thermoregulation

Question 2

burn types 4

Answer 2

thermal : an external heat source, risk of toxic inhalation

Radiation burns:
Prolong exposure to solar or ultraviolet radiation

Chemical burns:
Strong acids, alkalies, phenols, cresols, mustard gas phosphorus and certain petroleum products

Electrical burns;
heat generation and electroporation of cell membranes
associated with massive currentl of electrons
high voltage, something > 1000 volts
causes extensive deep tissue damage to electricly conductive tissues

Question 3

burn depths

Answer 3

superficial 1ts degree
limited to epidermis
appears red and gray

Question 4

partial thickness

Answer 4

part of dermis , superficial or deep
heal in 1-2 week
blistered, wet
scaring is minimal

deep partial thickness
>2 weeks to heal; scaring is common in severe
appear white and wet , wounds may bleed
cutaneous sensation maintained

Question 5

Full thickness

Answer 5

extend to the entire dermis and underlying structures
the cutaneous sensation is lost
healing is only from skin graft and peripheral area

Question 6

Burn complications

Answer 6

contributing major risk factory for systemic complications
breakdown of skin integrity and fluid loss
greater % of total body surface area involved
- increases the risk of developing the systemic complication

Question 7

burns risk factor for severe systemic complication

Answer 7

partial and full thickness burns of > 40%
presence of simultaneous major trauma or smoke
inhalation

Question 8

most common systemic complication

Answer 8

hypovolemia
risk for hypoperfusion of burned area
due to direct damage to blood vessels or vasoconstriction
shock can result

Question 9

infection

Answer 9

impaired host defenses and devitalized tissue
enhance bacterial invasion and growth

Question 10

Most common pathogens

Answer 10

streptococci and staphylococci within the first few days then
gram-negative 5-7 days

Question 12

more burn complications

Answer 12

metabolic abm
hypoalbuminemia
hemodilution
protien loss into extravascular space

metabolic acidosis
electrolyte disturbances
- hypomagnesemia, hypophosphatemia, hypokalemia

rhabdomyolysis or hemolysis
deep thermal or electrical burns of muscle
the mechanism is due to constricting eschars

further complication as AKI

hypothermia
the large volume of cool IVF
extensive exposure to body surfaces
ileus after extensive burns

Question 13

Rule of Nines

Answer 13

calculate % of TBSA involved
applicable for partial thickness and total thickness burns
rule of 9 adults
lund browder chart kids

Question 14

Scattered smaller burns

Answer 14

estimates based on the size of the patient’s entire opened hand ( not the palm only)
hand size method :
calculating burn surface area of partially burned area

• ex subtract involved area from the 9% area of arm
  to more accurately calculate the burned surface area

Question 15

burn treatment plan

Answer 15

Initial treatment:
extinguish any ongoing burn
remove all clothing
check CBC BMP Myoglobin albumin CXR
airway and ventilation as needed
flush chemicals with water x powder
dust off powder
acids and organic compounds;
flush with h20 20 min after the original remains
manage complications
burn infections need bx

Question 16

Deep partial thickness and full thickness

Answer 16

require eary debridement
skin grafting to heal appriatley