Burns Flashcards
Burn injuries per year receiving medical treatment
450,000
Burn Hospitalizations
45,000
Fire and burn deaths per year
3,500
Survival rate upon admission to burn center
94.8%
Types of Burns
Fire/flame, scald, steam, gas, electrical, flash, and chemical
Fire/Flame Burns
Direct tissue injury
Burns occurring in enclosed spaces carry high risk of CO/CN poisoning and inhalational injury
Scald Burns
Resulting from contact with hot liquids
The more viscous and the longer the contact the more significant the damage
Steam Burns
Produce extensive injury from the high heat-carrying capacity of steam
The dispersion of pressurized steam and liquid can cause thermal injury to the distal airways of the lung
Gas Burns
Upper airway is at risk for thermal injury and subsequent occlusion due to edema
Distal airway injury is more likely to be due to the direct effects of the products of combustion on the mucosa and alveoli
Electrical Burns
Electrical burns produce heat injury by passing through tissue
Most problems from these burns present in patients exposed to more than 1000V
Children can have significant injury after exposure to 200-1000V
Most of the injury is deep in the skin
Cardiac injury is common
Flash Burns
Flash burns are a subset of flame burns and are a result of rapid ignition of a flammable gas or liquid
Chemical Burns
Alkaline substances and acidic substances can burn the skin and can be associated with systemic toxicity
First Degree Burns
Involves only the epidermis, erythema
Second Degree Burns
Partial thickness
Either superficial or deep
Deep burns do not heal spontaneously
Third Degree Burns
Full thickness
Loss of all epidermal and dermal elements extending to subcutaneous tissue (muscle, tendon, and bone)
Rule of Nines
Head and each arm = 9%
Chest, back, and each leg = 18%
Palm Rule
Palm = 1%
Lund Browder
Used to determine burned body surface area in infants and children
Smoke inhalational injury
Thermal lesions and exposure to toxic and asphyxiating fumes
Signs and symptoms of inhalational injury
Strider, hoarseness, use of accessory muscles (inc. WOB), facial burns, singing of eyebrows, soot or readiness of mucosa in mouth/pharynx, carbonaceous sputum, accident occurred in confined space
Integumentary System
Skin and structures derived from it
Functions of the Integumentary System
Protects the body, helps regulate temperature, eliminates some wastes, helps make vitamin D, and detects sensations such as touch, pain, warmth, and cold
Capillary fluid transport is governed by what equation?
Starling
Systemic spillover causes what phenomenon in the unburned tissue of a burn patient?
Fluid accumulation
The alveolar microenvironment of burn victims changes how?
Surfactant denaturation causes damage to the lungs
Loss of endothelial and epithelial barrier functions
Influx of inflammatory cells
Edema may develop within what time period for burn victims?
Minutes to 24 hours
T/F Burn victims experience a decrease in macrophage, phagocytic and bactericidal functions and increased neutrophils
True
In burn victims, sloughing of mucosal surface and decreased ciliary function result in…
Decreased airflow and gas exchange
Carbon monoxide poisoning leads to what condition?
Hypoxia
Symptoms of Mild (0.08%) Carbon Monoxide Poisoning
Headache, asphyxia, dizziness, dry cough, chest pain, nausea, vomiting, visual and auditory hallucinations, and high blood pressure
Symptoms of Moderate (0.32%) Carbon Monoxide Poisoning
Motor paralysis and loosing consciousness
Symptoms of Severe (1.2%) Carbon Monoxide Poisoning
Loosing consciousness after 2 or 3 breaths, convulsions, and respiratory arrest leading to death in less than 3 minutes
What effect does cyanide have on the body?
It inhibits normal cellular metabolism
What value must be obtained in a patient with carbon monoxide poisoning?
HbCO
Baux score is a function of what?
BSA plus age
A Baux score of what is associated with death in 50% of patients?
110
Inhalational injuries add how much to the Baux score?
17
What are the mortality risk factors in burn patients?
Age, BSA, inhalational injury, preexisting comorbidities, and concurrent trauma
Treatment for Burn Victims
Agressive fluid resuscitation (monitor urine output), Oxygen therapy (possible intubation), Escharotomy (incisions made in the skin; prevents restriction of breathing and/or compartment syndrome), antibiotics, debridement (prevent sepsis)
Preop Preparation for Burn Victims
Obtain clear information on procedure, patient preexisting issues, labs, respiratory status or vent requirements, drips and other drugs, current hemodynamics
Preparing the OR for Burn Victims
Blood must be available
OR must be very warm
What common induction drum should be avoided in burn victims? Why?
Succinylcholine
Increased acetylcholine receptor density
T/F Burn victims have increased sensitivity to nondepolarizers
False
T/F Burn victims have increased narcotic requirements
True
Percent of blood volume lost per percent of BSA excised
2% blood volume / 1% BSA
Burn victim cardiovascular concerns
Hypermetabolic state increases cardiac demand
Levels of circulating catecholamines are greatly increased
Burn victim hematologic concerns
Coagulopathy or hyper coagulable state
Altered drug metabolism
Burn victim renal concerns
Toxicity, inadequate fluid ressucitation causing prerenal azotemia, tubular necrosis due to myoglobinurea
Burn victim GI concerns
Curling’s Ulcers
