Burns

Question 1

Cellular Changes with Burns

Answer 1

Intracellular influx of Na/H2O

Extracellular migration of K+

Disruption of cell membrane function

Failure of sodium pummp

Question 2

Burn Shock

Answer 2

Myocardial depression

Metabolic acidosis

Question 3

Hematologic Changes with Burns

Answer 3

Increase in hematocrit

Increase in blood viscosity

Anemia due to rbc destruction

Question 4

Local Progressive Injury with Burns

Answer 4

Liberation of vasoactive substances

Disruption of cellular function

Edema formation

Question 5

Burn Zones Pathophysiology

Answer 5

Zone of coagulation: irreversibly destroyed

Zone of stasis: stagnation of microcirculation; can/will extend if not treated appropriately

Zone of hyperemia: increase blood flow

Question 6

First Degree Burn

Answer 6

Erythema of skin

Possibly minimal surrounding edema

Minimal pain

Question 7

Second Degree

Answer 7

Deeper - involves partial thickness

Much more painful than 3rd degree

Red/mottled skin with blisters, swelling, wet/weeping and sensitive to air

Deep sunburn; hot liquids; flash burns from gas

Question 8

Third Degree

Answer 8

Damage to all skin layers; subQ to nerve endings

Pale white/charred leathery skin with fat exposed, dry surface, painless with edema

Question 9

Burn Inhalation Specific Issues

Answer 9

Carbon around nose or burns of the mouth

Causes significant respiratory problems

Fires in enclosed areas; CO exposure

Cyanide

Intubate early is a must

Question 10

Chemical Burns

Answer 10

Aklali or acid

Do not try to neutralize

Solution is dilution - irrigate

Alkali burns are more serious - penetrate deeper

Question 11

Electrical Burns

Answer 11

Always more serious than they appear

Skin has more resistance of all body substances - more damage to deeper structures

Occult muscle damage causing rhabdomyolysis -> myoglobin release -> acute renal failure

Question 12

Electrical Damage - Renal Failure

Answer 12

Dark urine = assume myoglobin and aim for urine output >1000 ml/hr

Mannitol for complete diuresis if urine doesn’t clear

Control metabolic acidosis w/ perfusion and add sodium bicarbonate as needed

-alkalinize urine to solubilize myoglobin

Question 13

Secondary Survey for Burns

Answer 13

Look closely at eyes for evidence of corneal burns

Inspect the throat for soot

Estimate depth and extent of burn and record

Every significant burn patient gets a foley - critical for monitoring resuscitation and ensuring adequate renal perfusion

Question 14

Burn Management

Answer 14

>20% BSA partial-thickness burn needs NG tube placed - ileus is likely

Get CBC, CMP, BUN, Creatinine, Glucose

ABGs, carboxyhemoglobin, CXR, EKG with suspected inhalation

Urine for myoglobin and CPK

Check Tetanus status

Question 15

Burn Dressings - Minimal Burns

Answer 15

Minimal burns treated outpatient

• silvadene and re-evaluate every 24 hours
• Change dressings BID until burn stops weeping

Question 16

Burn Transfer Guidelines

Answer 16

>10% BSA partial thickness

Burn over face, hands, feet, genitalia, perineum, major joints

Third degree burn in any group

Electrical burns - especially lightening

Burns with preexisting complicating disorders

Children with significant burns not in children’s hospital

Question 17

Esophageal Burns

Answer 17

Airway

Alkali worse than acid

Stop at burn with scope - have to Dx degree and length