Burns Flashcards
3 layers of skin
Epidermis, dermis and subcutaneous tissue
what part of the epidermis is metabolically active
inner
A barrier that prevents loss of fluid by evaporation and loss of body heat
Dermis
layer of skin w/ blood vessels, nerves, sweat glands, appendages (allow you to regrow skin)
dermis
layer of skin that is mostly fat but also has skin appendages, blood vessels, and nerves
Subcutaneous layer
what happens w/ a first degree burn
Involves only the epidermis
Epidermal barrier remains intact
No blistering
2 types of second degree burns
superficial
deep
upper 1/3 of dermis is invovled
superficial 2nd degree burn
lower 2/3 of dermis is involved
deep 2nd degree burn
if there fluid loss w/ a superficial 2nd degree burn?
not, most barrier intake
how long does it take for a superficial partial-thickness burn to heal
10-14 days
dry and thickened burn that is red or white
can have high fluid loss and can get infected
deep second degree burn
healing time w/ 2nd degree burn (deep)
heal in 4-8 weeks on their own
better outcome w/ skin grafting
May look unburned skin
Can be white and waxy to completely black
Can be dark red, but dry and non-blanching
Leathery texture
non-painful
3rd degree (full-thickness) burn
tx for 3rd degree burn
full thickness skin grafts
a 3rd degree burn where Dermal proteins coagulate and contract is called what
causes skin to be tight
eschar
what is an Escharotomy
making an incision for skin to expand so
a person can breathe or save a limb
what are respiratory injuries
inhalation aspiration from unconscious patients bacterial pneumonia pulmonary edema post-traumatic pulmonary insufficiency ARDS
are inhalation injuries more common outside or in an enclosed area?
enclosed area
what scenarios should you suspect an inhalation injury
History of closed space exposure Perioral burns Intraoral burns Carbonaceous material in the oropharynx Progressive hoarseness Singed facial and nose hairs
when should you suspect CO posioning
Suspect in same patients that you suspect of inhalation injury + HA and mental status change
can pulse ox and PaO2 be normal in CO poisoning
yes
symptoms w/ CO poisoning
Asymptomatic – HA – dizziness – syncope – coma - death
treatment w/ CO poisoning
100% oxygen
may need intubation or hyperbaric chamber
what do you need to determine if CO poisoning
send off blood for CO levels
In trauma what do you want for fluid resuscitation?
2 large bore IV’s
14 or 16 gages
when do you need to do a urinary cath for burns?
> 20% TBS
what burns are used to determine total body surface area?
only 2nd (deep) and 3rd degree burns
what are considered major burns
partial thickeness >25% body adults >20% peds full thickness burns >10% TBSA 2nd or 3rd involving- hands, feet, fact, perineum, genitalia, major joints associated w/ inhalation injury burns + fractures electrical/ lightning/ chemical circumferential burns really young or old
what is the consensus formula
2-4 mLs X %TBSA (2nd and 3rd degree) x wt in kgs
give 1/2 of volume in first 8 hours
giver other 1/2 in remainder 16 hours
when does “time” for treatment start for burns?
at time of burn
need to make up those fluids once they get to you
what directs you fluid rate (consensus formula only duies)
BP
pulse rate
what should you add to the %TBSA for an inhalation injury
20-30%
what can make ARDS worse?
over-resuscitation (too much fluid)
how do you tx a superficial partial thickness burn
occlusive dressing to minimize air exposure
no need for topical abx
how to you tx a facial superficial partial thickness burn
topical abx
what abx do you not want to use on the face?
Silver sulfadiazine, if used more than a few days, can cause blue/gray discoloration
how should nutrients be administered to a burn victim
enterally- reduces risk of infection
best topical abx for burns
silver sulfadiazine
ADR w/ silver sulfadiazine
transient luekopenia
ABX that Penetrates eschar better than silver sulfadiazine
Can induce metabolic acidosis
mafenide
why do you mesh the skin for a graft?
to cause epithelialization
can cover a large wound
(partial thickness skin graft)
when wouldn’t you use a mesher for a burn?
on face, joints, etc
ulcers that people get in their stomach due to severe burns
curling ulcers
how do you prevent curling ulcers
put them on PPI for prophylaxis
what can you put on a burn for a fungal infection
nystatin
do burns from alkalis or acid penetrate deeply?
alkalis
what type burn forms an eschar but doesn’t penetrate as deeply
acid
what do burns by organic compounds (petroleum products, phenols) do?
dissolve cell membranes
tx for chemical burns
brush off dry powders
copiously irrigate w/ water
what are low resistance tissues w/ electrical injuries?
nerves
blood vessels
muscles
what rhythms can someone w/ an electrical burn go into?
v fib and asystole
what is the minimum a person needs to be on telemetry for w/ an electrical burn?
24 hours
patients w/ electrical burns are at risk for what
rhabdomyolysis (breakdown of muscle)
compartment syndrome
how do you treat rhabdomyolysis
lots of fluids
how to determine compartment syndrome?
pain w/ passive movement
lack on sensation between first and second toe
how do you diagnose compartment syndrome
put a needle in a muscle compartment to determine pressure
tx for frostbite
rewarm in water bath at 40-42.2 degrees for 20-30 minutes
what will dead tissue from frost bite do?
become demarcated and usually sough on own
