Burns

Question 1

Burns

Hypovelmic Shock

Answer 1

Mostly w/ thermal burns
fluid leaves vascular space -> risk for compartment syndrome
Burns more serious for children b/c surface area
* + eldery b/c less elastic skin

Mulit organ failure = big prob w/ electrical burns
Pulmonary inhalation senn w/ chemical burns

Question 2

Thermal Burns

Answer 2

Flame- ignitions of combustilble material, flash (vapors, gasoline)- explosions especially with combustible, Scalds- hot liquid, steam, **Direct contact with hot objects **

Question 3

Electrical Burns

Answer 3

high voltage or low
greatest heat is at point of entry
injury greater than it appears- deep tissue necrosis

Question 4

Chemical Burns

Answer 4

tissue damage contin until agent completely removed or neutralized
pulmonary inhalation

strong acid- ammonia, bleach, cleaners for drain, battery acid

Question 5

Inhalation Burns

Answer 5

breathe hot air or noxious chemical
need a carboxyhemo level
1) metabolic asphyxiation
2) injury above the glottis
3) injury below the glottis (more serious)

dx with bronchoscopy

Question 6

Patho of Burn Shock

Answer 6

increase cap permeability ( leak)
Loss of plasma and protein and electrolytes
Increase intersitial fluid
decrease intravascular volume
edema
decrease BP

Question 7

Upper airway injuries

Answer 7

Supraglottis - from heat or chemicals
Look for facial hair burns, singed nasal hair, erytherma, swelling
brassy cough
facial redness
* 100% humidified O2 w/ mask

peaks at 24-48 hrs post injury

Question 8

Lower Airway injuries

Answer 8

increased secretions
* intubate ! before airway closes

meticulous pulmonary toilet -> ARDS ( SUCTIONING FREQ)

Question 9

Carbon Monoxide Poisoning

Answer 9

CO inhaled as by product of the combustion
more likely to bind to hemoglobin than O2- hypoxemia is a result
Always suspect enclosed area
**Pulse OX is unreliable **
check carboxyhemoglobin level
**Hyperbaric oxygen **to treat

Question 10

Classes of Burns

First Degree

Answer 10

superficial thickeness (epidermis)
Redness, mild edema
heals, no scarring
no fluid resusciation necessary

Question 11

Second Degree

Answer 11

1. Partial thickeness (epi, dermis): blister - prevent popping
2. Deep partial thickeness( subcutaneous tissue): whote insensate, waxy ( big infections risk -> 3rd degree)

pain management for partial

Question 12

Third Degree

Answer 12

Full thickness ( all dermis, and subq tissue), affecting subQ tissue
* insensate ( no pain) no nerve ending
* skin graft needed

Also classify wound by size/severity
Lurd + Browder chart, rule of 9’s
(also give guideline for fluid resuscitation)

Question 13

Fourth Degree

Answer 13

deep full thickeness
all the way to the bone

Question 14

Parkland Formula

Answer 14

2-4 mL of LR x # kg x % BSA burns

VTBI= 1/2 total in 1st 8hrs, 1/4 total in 2nd 8hrs, 1/4 total in 3r 8 hrs
Calculate from time of injury, not time of admin

Question 15

CARE

Answer 15

ATC pain meds
* + Breakthrough pain coverage (PT, dressing change)

Nurition support
* (increase protein, increase carb)

Question 16

Fasciotomies/Eschraotomies

Answer 16

Montior NV check
if blood flow is lost may need to do emergent bedside fascio

Question 17

Hypothermia/Frostbite

Answer 17

Effects are reversible
remove wet clothes, warm resuscitative IVF, warm blankets
Hypothermia induces diuresis so UO is a good indicators