Burns

Question 1

Name and describe the 3 zones of cellular damage in burns.

Answer 1

a. coagulation: usually where the heat source was strongest, tissue is dead and has undergone coagulation necrosis
b. Stasis: tissue that is damaged but not dead, proper treatment can allow full recovery
c. Hyperemia: vasodilation of medium and small arteries in the dermis turns the tissue red and inflammation can damage this tissue, however, proper care allows full recovery

Question 2

Describe the two ways to classify burns

Answer 2

Question 3

Describe the depth, pain and appearance of a 1rd degree burn.

Answer 3

Involves the epidermis only, painful and hypersensitive, usually reddened and dry

Question 4

Describe the depth, pain and appearance of a 2st degree burn.

Answer 4

Involves the epidermis and part of the dermis, causes extreme pain, it’s red to pale with blisters. Wet, weepy, skin sloughing

Question 5

Describe the depth, pain and appearance of a 3nd degree burn.

Answer 5

Destruction of the epidermis and dermis, no pain sensation, white, tan, black, charred appearance. Skin is dry and leathery

Question 6

What is a pathophysiologic consequence of severe burn injuries?

Answer 6

If more than 40% of the body is involved, a hypermetabolic and hypercatabolic state that lasts up to 2 years occurs. In children it can result in growth restriction.

Question 7

Describe the 2 phases of stress response to burns.

Answer 7

1. ebb phase: 2-3 days with decreased tissue perfusion and decreased metabolism
2. flow phase: 3-5 days with increased metabolic rate and hyperdynamic circulation

Question 8

Describe the effect of burns on Resting Metabolic Rate

Answer 8

Question 9

What effects does a severe burn have on the liver, heart, muscle, and glucose?

Answer 9

1. Liver: severe hepatomegaly
2. Heart: ebb phase-decreased CO, flow phase- increased CO
3. Muscle: loss of lean mass because the muscle is degraded faster than it is synthesisized with increased BMR
4. Hyperglycemia due to insulin insensitivity and increased glucose production by the liver

Question 10

What is done in the primary survey of a burn patient?

Answer 10

ABCs just like any other trauma patient

Question 11

Name the 3 types of inhalation injury and a general cause of each.

Answer 11

1. Carbon Monoxide Poisoning: inhaling CO
2. Injury above the glottis: heat damage or airway obstruction from edema
3. Injury below the glottis: chemical injury

Question 12

Treatment for CO poisoning

Answer 12

100% O2

Question 13

How is the extent of burns in adult burn victims determined for fluid resuscitation?

Answer 13

Rule of Nines (in children it’s a little different, the head accounts for 18% and the legs are 14% each)

Question 14

What is teh ABA recommendation for fluid management during the primary survey of a burn patient?

Answer 14

IV lactated ringers

1. Younger than 5: 125mL/hr
2. 6-13yrs: 250mL/hr
3. 14+: 500mL/hr

Question 15

How is fluid resuscitaton managed in patients during the secondary survey?

Answer 15

Body Surface Area burned (BSA%) x body weight (kgs) x type of injury (n)

Type of Injury:

1. Adult or Chemical burn: 2mL
2. Pediatric patient (less than 14): 3mL
3. High voltage burn: 4mL

The 1st half is given in the first 8hrs and the second half is given in the last 16hrs.

Question 16

What is the end point for fluid resuscitation?

Answer 16

Urine output. When an adult (greater than 30kg) reaches a 0.5cc/kg/hr urine output, they are done with fluids. When kids (less than 30kg) reach 1cc/kg/hr, they are done.

Question 17

Drug used to manage burn patient pain.

Answer 17

IV Morphine

Question 18

How is infection treated in burn victims?

Answer 18

Topical Antimicrobials (Silvadene ointment) used on wounds delay colonization. Prophylactic antibiotics have NO role.

Question 19

What is a very crucial component in chemical burn management?

Answer 19

Copious Flushing for 30minutes

Question 20

What are 3 multi-system concerns when a patient presents with an electrical burn?

Answer 20

1. Cardiac Arrhythmias (V-fib)
2. Comparment syndrome (muscular)
3. Myoglobinuria (renal failure from muscle degradation)

Question 21

What is the indication for an Escharotomy?

Answer 21

Deep circumferential trunk or limb burns. The leathery skin can cause ischemia to a limb or restrict the thorax making breathing dificult. Incisions are made in the burned skin to release pressure.

Question 22

When are fasciotomies performed?

Answer 22

To relieve compartment syndrome and only done in the OR.

Question 23

When is surgery indicated for burn patients?

Answer 23

Deep 2nd degree or 3rd degree burns.

Question 24

What TBSA% requires referral to a burn center?

Answer 24

10% or greater or any “full thickness” burns

Question 25

Which 6 body regions requires referral to a burn center?

Answer 25

1. Face
2. Hands
3. Feet
4. Genitalia
5. Perineum
6. Major Joints

Question 26

Which types of burns require referral to a burn center?

Answer 26

Chemical, Electrical, Inhalation Injury, burned children in hospitals unable to care for them, burn patients with pre-existing medical conditions or that require special social, emotional or long-term rehab intervention