Burns Flashcards
What are the four types of burns?
Chemical, electrical, thermal, and inhalation.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 901.
How are burns classified?
Burns are classified as either first, second, third, or fourthdegree.
First-degree consists of erythema with only
microscopic damage to the superficial epidermis. Seconddegree
burns, also called partial thickness, extend through the
epidermis into the dermis. Spontaneous regeneration of the
skin is possible with second-degree burns. In third-degree
burns, total destruction of the skin, dermal appendages, and
epithelial elements occurs with no spontaneous regeneration of
the skin possible. Fourth-degree burns involve muscle, fascia,
and bone.
Yao FF. Anesthesiology: Problem-Oriented Patient
Management. 7th ed. Philadelphia: Lippincott, Williams, and
Wilkins; 2012: 1204.
How does the rule of nines allocate the surface area
percentages according to arms, legs, head, and
trunk in adults?
In adults, each arm represents 9%, each leg represents 18%,
the entire trunk is 36%, the head is 9%, and the perineum is 1%.
Yao FF. Anesthesiology: Problem-Oriented Patient
Management. 7th ed. Philadelphia: Lippincott, Williams, and
Wilkins; 2012: 1204.
What is the initial treatment for chemical burns and
why?
Chemical burns are caused by disruption of the cellular
components of the skin by the chemical irritant. The initial
treatment is irrigation with water or saline irrigation because the
chemical will continue to damage tissue until it is removed.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 901.
What are the characteristics of electrical burns?
Electrical burns vary in severity based on the voltage and
duration of contact with the source. Electrical burns will cause
damage at a point of entry and exit. These wounds may appear
superficial and conceal internal damage to nerves, vessels,
muscle and bone. Significant damage to muscle tissue can
cause the massive release of myoglobin which can place these
patients at risk for renal damage.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 901.
Why is fluid resuscitation such a critical part of the
care of a burn patient?
The area of edema from the burn acts as a ‘third-space’ into
which fluid becomes sequestered. Fluid administration must be
sufficient to maintain tissue perfusion and adequate urine
output. Varying formulas are used to calculate the appropriate
amount of fluid with which to resuscitate the patient. The most
commonly used formula for determining the amount of fluid to
administer in the first 24 hours is % body surface area X Kg X 2
to 4.
Yao FF. Anesthesiology: Problem-Oriented Patient
Management. 7th ed. Philadelphia: Lippincott, Williams, and
Wilkins; 2012: 1208.
What chemical mediators are released with burn
injury and what responses would you expect to see
as a result?
Burned tissues release histamine, prostaglandins, bradykinin,
nitric oxide, serotonin, and substance P. In small burns, the
mediators are responsible for local inflammation. Severe burns
can result in the widespread release of these mediators and a
systemic inflammatory response syndrome can result.
Yao FF. Anesthesiology: Problem-Oriented Patient
Management. 7th ed. Philadelphia: Lippincott, Williams, and
Wilkins; 2012: 1205-1206.
What are the adverse effects of carbon monoxide
that occur with smoke inhalation?
Carbon monoxide has an affinity for hemoglobin that is 200
times greater than that of oxygen, impairs mitchondrial function,
uncouples oxidative phosphorylation and reduces ATP
production resulting in metabolic acidosis, and shifts the
oxyhemoglobin dissociation curve to the left, impairing the
unloading of oxygen to the tissues. In addition, it acts as a
direct myocardial toxin and can prevent survival in resuscitation
efforts during cardiac arrest.
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 1515-1516.
Is the SpO2 a good indicator of oxygenation
following a severe burn?
No. The PaO2 and SaO2 may be normal despite high levels of
carboxyhemoglobin (carbon monoxide poisoning).
Lee CY. Manual of Anesthesiology. Singapore: McGraw-Hill;
2006: 326-327,333.
What is the difference between upper and lower
airway inhalation injury?
Upper airway inhalation injury is usually caused by superheated
air and steam. The larynx, epiglottis, tongue, and pharyngeal
tissue swell rapidly and can result in complete airway
obstruction. Lower airway inhalation injury is usually due to
exposure to soot and chemical toxins. The toxins produce
acidic and alkaline compounds that disrupt the capillary
permeability of the pulmonary epithelium and can result in
alveolar damage.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 901-902.
What is the minimum urinary output for a patient with
high-voltage electrical burns?
In patients with high-voltage electrical burns, the minimum
urinary output to maintain is 1-1.5 mL/kg/hour. In ordinary
burns in adults, the minimum urinary output is 0.5 mL/kg/hour.
In pediatric patients less than 30 Kg, the minimum is 1
mL/kg/hour.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 905.
A patient involved in an MVA has multiple fractures
and burns of the face and neck. The patient is
breathing spontaneously, but you suspect he may
have an inhalation injury. How should you approach
airway management?
Establishment of a surgical airway should be the last resort due
to the high risk for complications. Direct laryngoscopy or awake
fiberoptic intubation are preferred, if possible.
Is succinylcholine contraindicated for a patient with
an acute burn?
No. Although succinylcholine should be avoided 72 hours after
a burn injury is sustained because of the risk of hyperkalemia, it
is not contraindicated in the immediate resuscitation stage.
Lee CY. Manual of Anesthesiology. Singapore: McGraw-Hill;
2006: 326-327,333.
A patient has burns over his entire body. How do
you place ECG electrodes?
In patients undergoing surgical debridement for burns,
placement of the ECG leads can be challenging. In situations
where the adhesive pads cannot be placed due to the damage
they would cause to the burned tissue, the leads should be
stapled to the patients skin or needle electrodes should be used.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 909.
