burns Flashcards
epi of burns
- high morbidity
- survival now at 94%
- M and M highest at extremes of age
2 most common causes
flame - superheated air
scalp - superheated liquids
classification of burns
1st - local to epidermis 2nd - thru epi into dermis - superficial - epi and dermis - deep - into deep dermis 3rd - into subcutaneous fat 4th - into muscle and bone
what are 3 zones and where effects can be made
coagulation - burn
stasis - can help
hyperemia - can help
which are painful
1, 2 and 3rd to pin prick
what is rule of 9s
abdo - 9% chest and stomach legs - 18% each arms 9% each head - 9% perineum - 1%
how to class severity of burns in terms of BSA
mild - 20
also severe if 5% full thickness burns, or to eyes, ears, genitals
who to send to burn center
- all severe
- electrical and chemical
- inhalation
- complicationg factors
3 reasons inhalation burns are an issue
- edema of upper airway - can occur rapidly
- edema of lower airway - pulmonary infiltrates
- CO toxicity a concern
4 phases of treatment
- initial eval and rescus
- initial would mgmt
- def. wound closure
- rehab
what is mgmt
ABCDE
- may need def. airway do to edema
- after AB are met, volume resus is important
when to suspect airway burns
- facial burns
- carbon sputum
- nasal hairs
- tachypneic
when to intubate
early
- 40% BSA
- resp. distress
- usual other crit.
what may interfere with B (5)
- airway obst.
- thoracic trauma
- eschars
- CO poisoning
- abdo ACS
what is special about C in burns
- will tend to be hypotensive
- volume loss
- can also get myocardial dep for first few days
- can get ACS with lots of fluid
what is parkland formula for fluid resus
4ml/kg/% BSA
- 1/2 in first 8hrs
- 1/2 in next 16hrs
use ringers lactate
3 aspects of DandE in burns
- all the usual
- can also have CO poinsoning
- loss of skin> loss of heat> hypothermia
3 processes of inhalation injury
- upper airway injury
- subglottic
- chemical asphyxia
what is issue with CO
Hb has stronger affinity for it
- not picked up on pulse oxymeter
- no effect of pO2
how to treat CO
100% O2
- possible hyperbaric O2
how is CO diagnosed
clinically
- Hx of exposure
- Sx of
- increase COHb in blood
Sx of CO
HA, confusion, nausea, vomiting, LOC, diszzyness
what are abnormal CO Hb levels
> 3% in normals
>10% in smokers
what is best predictor of outcomes
NOT COHb levels
- neurologic outcome
