BURNS

Question 1

What are the 4 types of burns?

Answer 1

Thermal
Chemical
Electrical
Radiation

Question 2

What is occurring pathophysiologically with a thermal burn?

Answer 2

Thermal energy denatures & coagulates proteins. The surrounding zone (zone of stasis) has increased perfusion and is salvageable (if not in hypotension too long)

Question 3

What can occur physiologically with the patient?

Answer 3

Myocardial depression can occur → leading to hypotension (burn shock) & edematous (burn edema)

Question 4

In general, when we have a burn patient, what 4 things must we consider?

Answer 4

Severity (based on depth, extent, location)

Associated injuries & trauma (smoke inhalation, CO poisoning)

Other comorbidities/psychological impact

Always consider abuse

Question 5

Name the 3 layers of the skin from outermost to innermost?

Answer 5

Outer = epidermis

Middle = Dermis

Innermost = Hypodermis (adipose/connective tissue)

Question 6

What are the 5 levels for depth of burn injury?

Answer 6

Superficial; 
Superficial partial thickness; 
Deep partial thickness; 
Full thickness; 
4th degree burn

Question 7

If a patient has a dry, red, painful burn without any blisters & it blanches without pressure – what level, what layer of skin, and how is the Tx prognosis?

Answer 7

Level = Superficial              
Layer = Epidermis              
Tx = Heals 4-7 days without scarring

Question 8

If a patient has a red, moist, and painful burn, you do notice blistering & it blanches – what level, what layer of skin, and how is the Tx prognosis?

Answer 8

Level = Superficial partial thickness              
Layer = Epidermis and extends into the dermis              
Tx = Heals 14-21 days without scarring

Question 9

If a patient has a whitish burn that is not overly painful that lacks blanching but pressure is felt – what level, what layer of skin, and how is the Tx prognosis?

Answer 9

Level = Deep partial thickness           
Layer = Epidermis and DEEPER into the dermis           
Tx = Healing may take 21 days – 3 months; scarring is common

Question 10

If a patient presents with waxy white/leathery looking burn, that is absolutely painless (except the surrounding areas) – what level, what layer of skin, and how is the Tx prognosis?

Answer 10

Level = Full thickness      
Layer = Extends through the dermis into subQ tissues            
Tx = Will NOT heal with skin grafting

Question 11

If a patient has burn that extends into the fat & muscle – what level and how is the Tx prognosis?

Answer 11

Level = 4th degree burn

Tx = May require amputation

Question 12

We will always want to re-evaluate the burn depth after 24-72 hours; but what special circumstances will it be essential to re-evaluate in?

Answer 12

“Thin skin”; Age less than 5 or over 55; volar surface of arms, medial thigs, perineum, and ears

Question 13

If the entire front of a person’s hand is involved in a burn – what %? What if it is front & back of the hand?

Answer 13

Front is 1%

Front & Back of hand is 2%

Question 14

What else in the body accounts for 1% of total surface area?

Answer 14

Front of neck

Back of neck

Front of forearm

Back of forearm

Top of foot

Bottom of foot

Genitals

Question 15

If a patients entire from of chest is involved in a burn - what %? What if it is the entire front & abdomen?

Answer 15

Chest = 13%

Chest & Abd = 18%

Question 16

If an entire leg is involved in a burn – what %?

Answer 16

18% (9% for back & front)

Question 17

If an entire arm is involved in a burn – what %?

Answer 17

9% (~4% front & back)

Question 18

What are the 3 special considerations for burns that MUST be transferred to a burn center?

Answer 18

Circumferential burns (even is .1%)

Burns crossing joints

Burns involving face, hands, feet, genitalia, and perineum

Question 19

Besides the 3 special considerations for burns that must be transferred to a burn center, when else would we refer to a burn center (the MAJOR criteria)?

Answer 19

Partial thickness burns >10% of BSA (>5% in kids)

ANY electrical or chemical burns

Burns associated with smoke inhalation

Burns in patients with pre-existing medical conditions that could complicate management

Burns + trauma (fracture)

Patients who require special social, emotional, or long-term rehab intervention

Children (unless your hospital is qualified)

Question 20

If a patient has a full thickness burn covering less than 2% of BSA and they’re between the ages of 10-50, what category of burn are they?

Answer 20

Considered a minor burn & can be treated on an outpatient basis

Question 21

What’s the best approach for treating a burn?

Answer 21

Cool immediately with room temp water

Pain management

Clean burns with mild soap/water

MIGHT drain a large blister if >2cm & is likely to rupture

Topical Abx (silver sulfadiazine if not under the age of 2)

Tetanus immunization of Ig

Question 22

In the final stages of healing, what can a patient put on their burn?

Answer 22

Non-perfumed moisturizing cream (Vaseline, eucerin) – must avoid Lanolin

Question 23

What is the basic dressing of a burn involve?

Answer 23

1st Abx ointment
2nd Non-adherent dressing
3rd Fluffed gauze
4th Elastic gauze – don’t forget to wrap fingers/toes individually!

Question 24

When do you F/U with a burn pt?

Answer 24

24 hours

Question 25

What is the initial approach to moderate of severe burns?

Answer 25

ABCDE

Airway – Breathing – Circulation – Disability (other injuries) – Expose (remove burned clothing/debris)

Question 26

After we have completed ABCDE, we note a full thickness burn (or large BSA partial thickness) what do we do next?

Answer 26

Complete laboratory & diagnostic workup

Question 27

What causes 75% of fire-related deaths?

Answer 27

Pulmonary dysfunction

Question 28

If we suspect inhalation injury – what can we do?

Answer 28

Fiberoptic bronchoscopy; check carbon monoxide poisoning; and treat with hyperbaric O2 if necessary

Question 29

If a patient has a high-voltage burn, what should we check?

Answer 29

EKG (if abnormal, they’re at an increased risk of arrhythmias)

Question 30

If the eschar is behaving like a tournequette and a patient can’t breath well what do we do?

Answer 30

Escharotomy

Question 31

What are the signs of SEPSIS?

Answer 31

HHOTIE (Hyperventilation, hyperglycemia, obtundation, thrombocytopenia, intolerance or enteral feeding

Question 32

How do we prevent burns/fires?

Answer 32

Smoke detectors, hot water temp control, light fuse & get away