Burns

Question 1

what is the third leading cause of accidental death in the US?

Answer 1

burns

Question 2

at what temp do we get thermal burns?

Answer 2

115 F (46 C)

Question 3

what is the zone called where we see irreversible tissue destruction?

Answer 3

zone of coagulation

Question 4

what causes the extravasation of fluid into the interstitial space around the burn, leading to hypotensive burn shock?

Answer 4

vasoactive mediators (cytokines, prostaglandins) that increase capillary permeability

Question 5

patients with 40 percent or more TBSA involved in their burn are at risk for what?

Answer 5

myocardial depression and hypotensive burn shock

Question 6

answer the following for superficial (1st degree) burns:

1) is it painful?
2) does it blister?
3) does it blanch?
4) how long until it heals?
5) will it leave scar?
6) common cause?

Answer 6

1) YES painful
2) no blisters
3) will blanch without pressure
4) heals in 4-7 days
5) no scars
6) really bad sunburn

Question 7

answer the following for superficial partial thickness (2nd degree) burns:

1) is it painful?
2) does it blister?
3) does it blanch?
4) how long until it heals?
5) will it leave scar?

Answer 7

1) yes painful
2) yes blisters
3) blanching is still present
4) heals in 14-21 days
5) no scarring

Question 8

answer the following for deep partial burns:

1) is it painful?
2) what color is the skin?
3) does it blanch?
4) how long until it heals?
5) will it leave scar?

Answer 8

1) NOT painful; nerve supply interrupted – can only feel pressure
2) whitish or yellow
3) blanching is ABSENT
4) heals in 21 days-3 months
5) scarring is common

Question 9

answer the following for full thickness:

1) is it painful?
2) what color is the skin?
3) does it blanch?
4) how long until it heals?

Answer 9

1) not painful
2) charred and black to pale and waxy white
3) no blanching
4) will NOT heal spontaneously; requires skin grafting

Question 10

what type of burn extends into the deeper tissue (fat, bone, muscle) and may require amputation?

Answer 10

4th degree burn

Question 11

which type of burn extends deeper than the dermis?

Answer 11

full thickness – it extends into the subcutaneous tissue

Question 12

a person’s hand (including fingers) can be used to estimate what percent of TBSA?

Answer 12

1 percent

Question 13

a person’s entire leg (front and back) is how much TBSA? how about a person’s entire arm?

Answer 13

entire leg = 18

entire arm = 9

Question 14

a person’s entire chest and abdomen (front only) is how much TBSA? how much for the back?

Answer 14

entire chest and abdomen = 18

entire back and buttocks = 18

Question 15

a person’s entire head and neck (front and back) is what percent TBSA?

Answer 15

9

Question 16

which part of the body accounts for 1 percent TBSA?

Answer 16

genitals

Question 17

why must we ALWAYS refer circumferential burns to burn center, no matter what the depth is?

Answer 17

they can constrict blood supply

Question 18

why do we ALWAYS refer burns covering joints to burn center, no matter what the depth?

Answer 18

they can lead to contractures

Question 19

how should electrical, chemical, or smoke inhalation injuries be handled?

Answer 19

refer to burn center

Question 20

your patient with a 4 percent TBSA superficial partial thickness burn comes in. they have diabetes. what should you do?

Answer 20

refer to burn center – anyone with pre-existing medical conditions that could complicate management

Question 21

burns involving these 5 areas should always be referred to the burn center?

Answer 21

face (eyes), hands, feet, genitalia, perineum

Question 22

less than 10 percent TBSA burn in adults, less than 5 percent TBSA in young or elderly, and less than 2 percent full-thickness burn are considered what?

Answer 22

minor burns

TX as outpatient

Question 23

loaded question, but how do we treat minor burns? (6 steps)

Answer 23

1) cool burns immediately
2) pain management
3) clean burns with mild soap and water
4) topical ABX ointment should be applied and wrapped (silver sulfadiazine or bacitracin)
5) tetanus immunization or tetanus Ig
6) heavy moisturizers in final phase

Question 24

which types of blisters may require drainage and debridement? which should we leave intact?

Answer 24

drain large blisters over 2 cm or blisters with likelihood of rupturing (over a joint)

leave small blisters – you could introduce infection

Question 25

when dressing the hands and feet, what should you make sure to do?

Answer 25

wrap them individually to prevent adherence/maceration

Question 26

what does initial management of moderate or severe burns primarily focus on?

Answer 26

ABCDE!

1) ensure patent airway
2) intubate if needed, otherwise, high-flow O2
3) 2 large bore IV lines
4) remove burned clothes

Question 27

what is the most common cause of death in burn victims?

Answer 27

inhalation injury! 75 percent die from pulmonary dysfunction. monitor dat airway

Question 28

what are common signs of smoke inhalation injury?

Answer 28

carbonaceous (black) sputum, singed facial or nasal hairs, voice changes

assume injury in any person confined in fire environment!

Question 29

what is the name of the formula we use for fluid resuscitation in the acute phase? what type of fluid do we use, how much, and when do we deliver it?

Answer 29

parkland/consensus formula

use lactated ringers

4mL x percent BSA x W (kg) = volume in 24 hours

give first half in 8 hours and remaining over following 16 hours

Question 30

if the burned area is over 10 percent BSA, what must we monitor for?

Answer 30

hypothermia! we may need to administer warmed IVF

Question 31

if transfer is imminent, how should we care for our severe burn patient?

Answer 31

just wrap their wounds in clean sheet and send them along their way

if not imminent: draw pretty much every single lab and EKG and CXR and the whole shebang and follow wound care guidelines

Question 32

in what type of burns is myoglobinuria and elevated CK levels noted?

Answer 32

electrical injuries – damage the myocardium and skeletal muscle

Question 33

what can we do if the diagnosis of potential inhalation injury is in doubt?

Answer 33

fiberoptic bronchoscopy

Question 34

if we note carbon monoxide poisoning in our patient, how do we treat them?

Answer 34

hyperbaric O2

Question 35

why must we make sure to incise eschar?

Answer 35

it acts like a tourniquet, restricts blood flow, and causes necrosis

Question 36

in what directions do we incise when performing an escharotomy?

Answer 36

along the lateral aspect of the extremity with a linear and lengthwise incision

and pretty much cut the chest off if ventilatory motion interrupted

Question 37

what should we do following escharotomy?

Answer 37

place ABX covered dressing on the wound to maintain homeostasis

Question 38

what is the abbreviation we can use for signs of sepsis? what does it mean?

Answer 38

HHOTIE
Hyperventilation
Hyperglycemia
Obtundation
Thrombocytopenia
Intolerance of Enteral Feeding (diarrhea, ileus)

Question 39

patients with severe burns have metabolic rates how much higher than the regular person?

Answer 39

100-150 percent

Question 40

another loaded card…what types of drugs do we give to lower the metabolic rate and increase protein synthesis in a patient with a severe burn?

Answer 40

1) propranolol to slow down heart, inhibit peripheral lipolysis
2) IGF-1: induces protein anabolism by modulation GH
3) GH: increases collagen content and tensile strength of skin through protein anabolism
4) insulin: decreased protein breakdown and more glycogen deposition
5) oxandrolone/testosterone/ketoconazole: anabolic steroids that increase protein synthesis