Burns Flashcards
What is the 3rd leading cause of accidental death in the US?
You guessed it… burns
What is the most common type of burn?
Thermal burns
Soft tissue is typically burned when it is exposed to temperatures above ??
115F or 46C
What are the 4 types of burns?
Thermal, chemical, electrical, radiation
What does thermal energy do to proteins?
Denatures and coagulates
Is tissue in the zone of coagulation salvageable? What about the area SURROUNDING it?
Zone of coagulation - irreversible destruction; Area SURROUNDING zone of coagulation is salvageable
Is perfusion increased or decreased at the outer margins of the burn?
Increased
Is perfusion increased or decreased surrounding the zone of coagulation?
Decreased
How large does a burn have to be for a patient to develop systemic responses to vasoactive mediators?
Greater than 15-20%
Myocardial depression from a burn occurs when a patient’s TBSA is greater than or equal to ___% burned
40
Burn shock and burn edema occur when the TBSA is greater than or equal to ____% burned
40
How long does systemic capillary leak persist for?
18-24 hours
What causes the reduction in oxygen carrying capacity that could exacerbate burn shock?
Local blood cell destruction and reduction of RBC mass
Largest body organ?
Skin
This is the outermost layer of skin composed of cornified epithelial cells. Outer surface cells die and are sloughed off as newer cells divide at the stratum germinativum/basale.
Epidermis
This is the middle layer of skin composed of primarily connective tissue. It contains capillaries that nourish the skin, nerve endings, and hair follicles.
Dermis
Layer of adipose and connective tissue between the skin and underlying tissues
Hypodermis
Who has “thin skin”
Less than 5 or older than 55
Involves only the epidermis; skin is red, dry, and PAINFUL; no blisters, blanches with pressure
Superficial
How long does it take a superficial burn to heal?
4-7 days
Involves epidermis and extends into dermis; Skin is red, moist, painful to TEMP AND AIR, and blisters may be present; Blanching is still present
Superficial partial thickness burn
How long does it take for a superficial partial thickness burn to heal?
14-21 days
Involves epidermis and deeper into dermis; Skin is whitish or yellowish, perception of pressure can be felt but there is usually no overt pain; Blanching is absent, 2-point discrimination is diminished. This burn WILL SCAR.
Deep partial thickness burn
How long does it take for a deep partial thickness burn to heal?
21 days to 3 months
Burns through all layers to subcutaneous tissue; Charred and black to pale and waxy white, leathery, painless (except in surrounding area of more superficial burns); Only deep pressure can be felt
Full thickness burn
Will a full thickness burn heal on its own?
NO! Skin grafting required
Extends into deeper tissue (fat, bone, muscle) and may require amputation
4th degree burn
What are the two types of burns that are likely to cause a full-thickness burn
Chemical and electrical
When do you use TBSA?
Only for burns more severe than superficial
A persons hand including fingers represents ___% of total BSA
1%
What is the rule of 9’s?
Entire head and neck 9% One entire arm 9% One entire leg 18% Entire back and buttock 18% Entire chest and abdomen 18%
Diagram that improves estimations for children as their head size relative to the rest of the body is of a higher percentage than in adults.
Lund and Bowder diagram
Partial thickness burn greater than 10% BSA; burns that involve face, hands, genitalia, feet, perineum; electrical/chemical burns; burns w/ smoke inhalation injury; other things that I am too lazy to type
Refer to burn center
Where do you treat a minor burn?
Outpatient
Where do you treat a moderate burn?
Admit to hospital
Where do you treat a major burn?
Refer to burn center
Cool burns down in cool/room temp water; pain management; clean burns with soap and water; MAYBE pop blisters (hopefully I love popping blisters); Silver sulfadiazine
What type of burn is this the treatment regimen for?
Minor!
How do you treat a burn infection?
Admission and IV abx
Stabilize ABCs; Assess for smoke inhalation injury; remove hot and burned clothing; transfer to burn center; look for single or multi system trauma
What type of burn is this the treatment regimen for?
Moderate to severe
_____ _____ can rapidly lead to airway edema
smoke inhalation
Most common cause of death in burn victims/
Inhalation injury
Do you always assume inhalation injury in any person confined in a fire environment?
YES
How do you treat for smoke inhalation injury?
Intubate PRN or use high-flow O2
Best way to improve circulation in a burn patient?
IO
Best fluid for burn patients?
Lactated ringers
What formula will determine how much fluid a burn patient needs?
Parkland formula
Parkland formula for children?
Galveston formula
What must you monitor for if more than 10% of a patient’s BSA is burned?
Hypothermia
When do you order a full diagnostic workup for a burn?
Moderate and severe burns
What causes more than 75% of fire-related deaths?
Pulmonary dysfunction
What do you do when interstitial pressure rises to the point of compromising vascular flow? What causes this?
Eschar formation - need escharotomy to return blood flow
HHOTIE signs of sepsis
Hyperventilation, hyperglycemia, obtundation, thrombocytopenia, intolerance of enteral feeding (diarrhea, ileus)
