Burns Flashcards
Burn Pathophysiology:
-describe the cellular changes seen
Cellular Changes:
- intracellular influx of Na/H2O (edema)
- extracellular migration of K
- Disruption of cell membrane function
- failure of Na pump
Burn shock with depression of myocardium and metabolic acidosis
Burn Pathophysiology:
- hematologic changes
- cell damage occurs at what temperatures?
Heme:
- increase in HCT
- increase blood viscosity
- anemia d/t RBC destruction
Cell damage at temperatures greater than 113F
Burn Size:
-how is this quantified? also, describe two methods.
Quantified as a % of body surface area (BSA) burned.
Rapid method: based on the area of the back of the pts hand is approximately 1% of BSA
Rule of 9’s breaks portion of body into multiples of 9 with the perineum being 1% (Lund and Browder burn diagram)
First degree burn:
- signs/sx
- ex
2nd degree burn:
- sx/signs
- ex
3rd degree:
- signs/sx
- ex
Signs/Sx:
- erythema
- possibly edema
- minimal pain
(e. g. sunburn)
2nd degree:
Signs/sx:
- partial thickness
- much more painful than 3rd degree burn
- skin appears:
- -red/mottled
- -blisters with broken epidermis
- -considerable swelling
- wet/weeping surfaces
- -sensitive to air
e.g. deep sunburn, contact with hot liquids, flash burns from gasoline flames
3rd degree:
Signs/sx:
- damage to all skin layers, subQ tissues, and nerve damage
- pale white or charred
- leathery
- broken skin with fat exposed
- dry surface
- painless to pin prick
- edema
Inhalation Burns:
- signs
- causes
- management
signs:
- carbon around nose
- burns involving the mouth
- peri oral edema
- talking in raspy voice
- significant resp problems
Cause:
- fire in enclosed area
- remember CO exposure
- Toxic gases from combustion*
Management: intubate early
Chemical Burns:
- types
- -which type is worse?
- tx
Types:
- alkali
- acids
Alkali burns are more serious than acid burns b/c the alkalis penetrate deeper
Tx:
-the solution to pollution is dilution (IRRIGATE!!!)
Electrical Burns:
-more damage is done to the skin or deeper structures such as bone, muscle, blood vessels, and nerves?
- what are the consequences of muscle destruction?
- How would we tell muscle destruction has occurred and how do we manage that?
- how do we control metabolic acidosis?
More damage is done to the deeper structures.
Consequences:
-occult destruction of muscle can cause rhabdomyolysis which causes the release of myoglobin and can lead to acute renal failure
Rhabdo
- if urine is dark, assume myoglobin and increase fluids to achieve a urine output of 100 ml/hr
- if urine doesn’t clear, use mannitol to ensure continued diuresis
Metabolic acidosis controlled by perfusion and sodium bicarbonate to alkalinize urine to soluble myoglobin.
Burn Management
- check for evidence of airway involvement and if present consider endotracheal intubation early!
- start 2 large bore IVs ASAP
- inspect for corneal burns
- estimate depth and extent of burn and record.
- greater than 20% BSA partial thickness burn needs NG tube placed as ileus is likely
- CBC, CMP
- ABGs, carboxyhemaglobin level
- CXR and EKG
Urine for myoglobin and CPK
Tetanus Status
Foley catheter placement (every pt with significant burns gets one)**
Pain control
Burn Management:
-adult/child fluid resuscitation, what type of fluids are used?
Adult fluid resuscitation: NS or RL
Children: NS or RL 3ml/kg X %BSA
Minimal burns/outpatient burns Tx
Which burns require admission to burn center?
Minimal:
- silver sulfadiazine/silvadene
- re-evaluate every 24hrs
- change dressings BID until burn stops weeping
Admission to burn center:
- partial thickness burns of greater than 10% BSA
- burns involving face, hands, feet, genitalia, perineum, or major joints
- 3rd degree burns in any age group
- electrical burns
- burns with preexisting complications (medical disorders)
- children with significant burns taht are not in a childrens hospital
