Burns Flashcards
Define Burn
Burn is defined as interaction between energy (thermal, chemical, electrial or radiation) and biological matter
What are the 3 zones of a burn injury
- Zone of hyperaemia
- Zone of stasis
- Zone of coagulation
What is the goal of burn care when it comes to the 3 zones of a burn?
The goal of burn care is to prevent the zone of stasis from becoming necrotic. If this fails the zone of coagulation and the zone of statis are lost
Define Granulation tissue
New tissue which grows just above capillary bed when a wound if healing. Can become a keloid scar if overgrown
Define Keloid Scarring
Web-like scar compromised of ganulation tissue. Very disfiguring and can itnerfere with function of a body region
What age range is rule of 9s most accurate for?
Pts older than 10 years of age
What are 2 factors that influence tissue destruction in a burn?
- temperature
- duration of exposure
What are some factors that influence the ability of a pt to resist burns?
- water content of skin tissue
- thickness and pigmentation of skin
- insulation sunstances
- peripheral circulation of skin
Why do pts that have burns go into hypovolemic shock
hypovolemic shock reults from a systemic fluid shift from intravascular space into interstitial space, resulting in oligemia (decreased blood flow to an area)
Why are the 2 causes of hypovolemic shock in burn pts
- increased vascular permeability from damaged blood vessels and histamine release
- proteins able to escape, resulting in an increased osmotic pressure
- Na-K pump damaged - Accelerated evapoartive water loss through burned tissue
What is the aim of fluid therapy in a burn pt and what fluid do you use
- supporting pts through hypovolemic shock and preventing renal failure
- crystalloid solutions are the fluid of choice for intial resuscitation
What is the parkland formula?
- used to estimate the amount of replacement fluid required for the first 24 hours in a burn pt to ensure hemodynamic stability
- 4ml/kgxTBSA(%) 50% is given in the first 8 hours, 50% given in next 16 hours
What are some complications that arise from burns?
- Infection
- renal failure=rhabdomyolysis, hemolysis
- lung damage= results from inhalation injury
- sluggish blood flow - increased blood clots
- poorly perfused tissure - metabolic acidosis
- electrolyte imbalances = hyper k
What is a special consideration when treating facial burns?
- associated with airway compromise
- elevate head of stretcher to greater than 30 degrees
What are some special considerations when treating extremity burns
- remove jewellery to prevent vascular compromise from edema
- assess distal CSM frequently
What are some special considerations when treating circumferential burns?
- threat to pts life or limb
- tourniquet-like effect on extremity or chest
How do strong acids burn the body?
They cause coagulation necrosis in which it disolves the proteins and the proteins act like a buffer against other tissues
How alkalis cause burns?
liquefication necrosis with loosening of tissue, allows substances to difuse more deeply into tissues (keeps burning)
What are some examples of alkalis?
- Oven cleaners
- drain cleaners
- fertilizers
- heavy industrial cleaner
How do toxic organic compounds cause burns?
Ex - phenol
- ph 6 (classified as neutral)
- denatures proteins, can lad to respiratory failure and CNS depression
When assesing a pt who has been burned by chemical agent, what are some things you shoudl determine
- chemical agent
- concentration of chemical
- volume of chemical
- MOI
- time of contamination
- first aid before EMS arrival
- appearance
- pain
When managing chemical burns remember the phrase “ The solution is….
diltution
When talking about electrcity, what does voltage describe?
the force of the electrical current
think water pressure in a hose. The higher the pressure the faster the water moves
When talking about electricity what does amperage describe?
Amperage is the amount of electricty flowing.
Think amount of water in the hose
What are some factors that affect the severity of electrical burns
- time exposed
- type of current
- area through which current passes in body
- moisture on pt
- insulation
What type of effects can electrical burns have on the muscoskeletal system
- similar to crush injuries (myoglobin released from muscle damage)
- fractures and dislocations
What type of effect can electrical burns have on the cardiovascular system?
Signifigant dysrhytmias like VF
WIth electrical burns is there the risk of internal burns between the entrance and exit wounds?
Yes
What type of effect can electrical burns have on the cardiovascular system
- tetany of respiratory muscles
- ventilation impaired
What type of effect can electrical burns have on the neurological system
- nerve tissue is a great conductor of electricity
- brain tissue injury
True or False: Amnitoic fluid does not conduct electricity
False
Areas to look out for when assessing a lighting injury
- cardio-respiratory arrest
- superficial burns
- paraesthesia
- blast injury
- dysrhytmias
