BURNS Flashcards
what does the depth of a burn depend on?
temperature, duration of contact, and thickness of dermis
What are the issues of securing the intubation tube in a burn patient?
normally you tape it to the face but their face may be burned
What is the Tx of myoglobinuria?
Give bicarb to alkalinze the urine so that you can prevent further precipitation
How many large bore IV’s are required for large burns taking up over 30% of TBSA?
2
What is the nitrogen balance of a burn patient?
negative, they are breaking down protein much faster
During which phase is there low cardiac output?
ebb phase immediately post-burn
T/F: a childrens hospital is the best place for a burned child
FALSE the best place is a burn center
How do you evaluate the need to intubate the patient?
hoarseness/voice changes, stridor, accessory muscles, extenstive facial burns, mouth burns, burns covering > 40% TBSA, resp fatigue, poor oxygenation or ventilation
What is the equation for total 24 hour fluid replacement?
%BSA burned x wt (kg) x injury; one half in first 8 hours (from time of injury not arrival!!!) and one half in last 16
What liver changes may occur with burns?
severe hepatomegaly due to steatosis
Why do electrical burns cause myoglobinuria and hemoglobinuria?
The burn damages the muscle and releases myoglobin this precipitates in kidneys and results in renal failure
What is the Tx for CO poisoning?
100% O2 as it decreases the half life of CO
A partial thickness burn greater than ______ % TBSA should be referred
10%
What is used as the end-point of fluid resuscitation?
urine output (adults over 30 Kg should put out 0.5 cc/Kg/hr; kids under 30 kg should put out 1 cc/kg/hr)
What defines a high voltage injury?
greater than 1000 V
Which burn involves a loss of sensation?
third degree burn
Why is it important to treat zones on hyperemia and stasis?
So that they do not become a zone of coagulation
Describe the 3 zones of injury
There are zones of coagulation which are coagulative necrosis where the skin was exposed to the highest temp, stasis is not dead tissue and hyperemia is the least affected and should recover completely.
Why is an inhalation below the glottis a serious issue?
it is difficult to manage because it will damage the pneumocytes which means that no matter how much you oxygenate, the O2 will not get into the blood
What layer of skin contains hair follicles, sweat glands, and nerve endings?
the dermis
Explain the O2 saturation in CO poisoning
It is normal because they oxymeter detects color and Hb is bound to CO
Explain why a scald burn is “tricky”
they can initially look fairly innocuous and then progress from second to third degree over time
Which prophylactic systemic antibiotics should you use in acute burn injury?
there is no role for prophylactic systemic antibiotics
What is the primary concern with an inhalation injury that does damage above the glottis?
edema obstructing the airway
If a lineman burned himself on a telephone line and was found dead in the cherry picker, what was the likely cause of death?
VENTRICULAR FIBRILLATION MOST COMMON CAUSE OF DEATH AT THE SCENE FOR AN ELECTRICAL BURN
What antibiotic cream should be put on burns?
silvadine
What is the most common type of injury from an inhalation injury?
injury above the glottis
Which painkiller is indicated in burn patients? How should narcotics be administered and why?
MORPHINE. Intravenously, because the changes in fluid volume make absorption of drugs unpredictable
What are the 4 types of thermal burns?
flame, flash, scald, and contact
What kind of burn would likely result from burning your leg on a hot pipe?
Thermal contact burn
What kind of burn would likely result from throwing gasoline on a fire?
A thermal flash burn
How long are severe burns involving more than ________% of TBSA associated with hypermetabolic and hypercatabolic state for?
40%, up to 2 years
Why don’t systemic antibiotics work on burn eschars?
it is devitalized and avascular
Is it more important to prevent hyperthermia or hypothermia in a burn situation?
Hypothermia because they have low core temp
Which 3 types of burns should be referred to burn center?
inhalation injury, chemical burn, electrical burn
What percent of the body is burned if a childs head is burned? Legs?
18 %, 14% per leg
How much fluid (in lactated ringers) do you give a patient who is under 5? Between 6-13? Greater than 14?
125 ml LR/hr; 250 ml LR/hr; 500 ml LR/hr
Describe the management of wounds
clean the burn with soap and water and you must remove all ointments , provide adequate pain meds and debride blisters
When is surgical management indicated in burns?
For deep second degree burns and third degree burns
Why is a fasciotomy done in an OR whereas escharotomies can be done at bedside?
Fasciotomies are deeper and the likelihood of hitting a major vessel is greater
What depth of skin is involved in a third degree burn?
destroys the epidermis and the dermis
What is the initial assessment of the burn patient?
THE PRIMARY SURVEY OF ANY TRAUMA PATIENT
With a patient on morphine it is important to monitor for _____________
respiratory depression
What are the 2 phases to the stress response?
Ebb phase involves a decrease in flow and metabolism and the flow phase involves increased metabolism and hyperdynamic circulation
What are the possible side effects of silvadine?
leukopenia and thrombocytopenia
What 3 things should you not do for the patient prior to transfer?
don’t give antibiotics, don’t perform escharotomies, debridement and application of topical antibiotics is unnecessary
Which injury is most likely to present with ARDS, an inhalation above the glottis or below?
below because it damages the pneumocytes
Why would you need to do an escharotomy on a trunk burn?
The leathery skin may be restricting respiration
What depth of skin is involved on a first degree burn?
epidermis only
T/F: fluid resuscitation begins at the burn center
no it should begin BEFORE arrival? They will start to third space fluid immeidately and it is coming from the intravascular space therefore there is potential for shock
T/F: the presence of singed eyebrows and nasal hair is an indication for early intubation?
false
How much urine output should there be in an adult vs. child?
adult = 0.5 cc/Kg/hour; children = 1 cc/Kg/hr
What depth of skin is involved in a second degree burn?
epidermis and part of dermis
Why is it possible to develop DM II after a burn?
Due to severe hyperglycemia from gluconeogenesis being increased in the liver due to the catecholamines. This will impair glucose sensitivity
What is the role of silver sulfadiazene for burns?
It is a broad spec painless antibiotic cream to prevent colonization but it does not penetrate the eschar
