Burns Flashcards
Highest Risk of Burns
Age: 18-35
Male > Female
Role of Skin
Semi-permeable barrier
Responsible for control of body temp
Cellular Changes Seen in Burns
Intracellular influx of Na/H20
Extracellular migration K
Disruption of cell membrane function
Failure of Na/K pump
Hematologic Changes in Burns
Increase in hematocrit
Increase in blood viscosity
Anemia due to RBC destruction
When does cell damage occur in burns?
113+ F
Denatures protein
3 Zones of Burns
Zone of coagulation
Zone of stasis
Zone of hyperemia
Zone of Coagulation
Irreversibly destroyed
Zone of Stasis
Stagnation of microcirculation
Will extend if not treated appropriately
Zone of Hyperemia
Increase blood flow
Burn Size
Rule of 9’s
Lund and Browder diagram
Clinical Features of First Degree Burns
Erythema of skin
Minimal surrounding edema
Minimal pain
Clinical Features of Second Degree Burns
Partial thickness
Very deep sunburn
MUCH MORE painful than 3rd degree
Appearance of Skin in Second Degree Burns
Red/mottled Blisters with broken epidermis Considerable swelling Wet/weeping surfaces Painful Sensitive to air
Clinical Features of Third Degree Burns
Damage to all skin layers
Subcutaneous tissues
Nerve endings
Appearance of Skin in Third Degree Burns
Pale white or charred Leathery Broken skin with fat exposed Dry surface Painless to pinprick Edema
Inhalation Burns
Carbon around nose Significant respiratory problems Carbon monoxide exposure CYANIDE Intubate early
Chemical Burns
Alkali worse than acids
IRRIGATE
Electrical Burns
More serious than they appear Deeper structures have more damage Can cause rhabdomyolysis Acute renal failure Urine Output: 100+ mL/h Mannitol
Management of Burns in the ED
ABCDE Intubate early if airway involvement 2 large bore IVs Secondary survey Look for corneal burns Estimate depth and extent of burn BSA 20+% needs NG tube Labs Tetanus status Remove jewelry Monitor distal pulses Foley Pain control
Labs for Burn Victims
CBC CMP ABGs Carboxyhemoglobin level CXR EKG Urine myoglobin and CPK
Dressing for Burns
1% silver sulfadiazine (silvadene)
Re-evaluate q24h
Dressing changes BID until it stops wheeping
Guidelines to Transfer
Partial thickness of 10+% Burns involving face, hands, feet, genitalia, perineum, or major joints 3rd degree burns Electrical burns Burn + complicating co-morbidities Children
Esophageal Burns
Intubate early
Alkali worse than acid
Scope: stop at burn
