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MS3 Exam 2 > Burns > Flashcards

Burns Flashcards

1
Q

3 layers of skin

A
  • epidermis (outermost)
  • dermis
  • SQ tissues/fat pads
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2
Q

epidermis

A
  • thin

- body vs. environment

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3
Q

dermis

A
  • hair follicles
  • sweat/oil glands
  • sensory nerves
  • capillaries
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4
Q

functions of your skin

A
  • immunologic defense
  • barrier
  • thermoregulation
  • neurosensory
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5
Q

Causes of Burns

A
  • inhalation
  • thermal
  • electrical
  • chemical
  • radiation
  • cold thermal
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6
Q

Prevalence of burns

A

birth to 2: scald, contact burns

5 to 20: thermal burns

20 percent pediatric burns r/t abuse or neglect

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7
Q

inhalation

A
  • results from hot air, noxious chemicals
  • major predictor of mortality
  • requires quick treatment
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8
Q

inhalation injury types

A
  • carbon monoxide poisoning
  • inhalation injury above the glottis
  • inhalation injury above the glottis
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9
Q

Carbon monoxide Poisoning

A
  • incomplete combustion of burning materials
  • CO displaces O2
  • skin has “cherry red” appearance
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10
Q

Tx of CO Poisoning

A
  • 100% humidified O@

- hyperbaric oxygen therapy

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11
Q

CO displaces O2 causes…

A
  • hypoxia
  • carboxyhemoglobinemia
  • death
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12
Q

Inhalation injury above the glottis

A
  • steam inhalation
  • aspiration of scalding liquid
  • hot smoke/air
  • mucosal burns on oropharynx and larynx
  • causes mechanical obstruction
  • medical emergency
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13
Q

Tx for injury above the glottis

A
  • ABGs
  • O2
  • Intubation (Stridor)
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14
Q

Inhalation clues

A
  • facial/neck burns
  • singed nasal hair, beard, eyelashes, eye brows
  • hoarseness, painful swallowing
  • darkened oral/nasal membranes
  • hyper-secretions
  • respirations distress
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15
Q

Injury below the glottis

A
  • usually chemical injury

- pulmonary edema may be instant or 12-24 hours later

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16
Q

Tx for injury below the glottis

A

-intubation

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17
Q

Pulmonary edema causes

A
  • impaired cililary action
  • hypersecreation
  • edema
  • ulceration of mucous membranes
  • spasm of bronchi and bronchioles
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18
Q

Thermal burns

A
  • most common type of burn

- caused by flame, scald, sun/radiation, hot objects

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19
Q

150 degree water…

A

1/2 second to get 3rd degree burn

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20
Q

Hot water accounts for..

A

24 percent of all scalds in children

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21
Q

US water burns..

A

65 percent of all children under 4 is from hot tap water

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22
Q

1 million/year…

A

in US suffer from thermal burns

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23
Q

45,000 are…

A

admitted to the hospital

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24
Q

must eval for…

A

s/s of abuse

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25
Q

Initial tx for small burns

A

-cover with clean cloth, cool, tap water

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26
Q

initial tx for large burns

A
  • ABCs
  • do NOT immerse in cold water or ice pack
  • wrap in clean, dry sheet or blanket
  • remove burned clothing unless adhered to site
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27
Q

Electrical burns

A
  • result of coagulation necrosis
  • direct damage
  • severity varies
  • entry/exit points
  • passes thru vital organs
  • sparks
  • inability to assess damage
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28
Q

electrical burns are high risk for…

A
  • dysrhythmias
  • metabolic acidosis
  • myoglobinuria
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29
Q

Initial tx for electrical burns

A
  • assure source is shut off
  • remove the patient from source
  • rescuer must be protected
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30
Q

Chemical burns

A
  • destruction: acids, alkalis, organic compounds
  • severity: agent, concentration, volume, duration of contact
  • destroys tissue proteins and leads to necrosis
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31
Q

Chemical burns result in…

A
  • skin
  • eyes
  • resp system
  • liver and kidney damage
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32
Q

With chemical burns, alkali’s..

A
  • cause deeper penetration
  • cause protein hydrolysis and liquefication
  • damage continues
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33
Q

Destruction of tissue proteins leads to…

A

necrosis

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34
Q

Tx for chemical burns

A
  • remove quickly from the skin
  • remove saturated clothing
  • brushing from skin in a powder
  • irrigating with copious water
  • burning process and tissue injury can last 72 hours
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35
Q

Cold Thermal

A

-varies from frostbite to systemic hypothermia

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36
Q

1ST degree frostbite

A

white/yellow firm plaque

-accompanying pain

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37
Q

2nd degree frostbite

A
  • superficial blistering
  • very painful
  • clear or milky fluid
38
Q

3rd degree frostbite

A
  • deep blistering

- red or purple fluid

39
Q

Circumferential Burns

A
  • chest or extremity
  • completely surround the extremity or torso
  • cause resp/circulatory compromise
  • as fluid enters the circumferential burn pressure increases
40
Q

Compartment Syndrome

A
  • eschar is stiff and non-flexible
  • high enough pressure impedes blood flow or resp effort
  • creates ischemia
  • can progress to necrosis
  • requires “escharotomy”
  • cut down to fat pads
41
Q

Jackson’s Burn Model

A
  • middle: zone of coagulation
  • next layer in to out: zone of stasis
  • outermost layer: zone of hyperaemia
42
Q

zone of coagulation

A
  • severest damage
  • will not recover
  • slough out over time
43
Q

zone of stasis

A
  • less damaged tissue
  • inflammation occurs
  • vascularity damaged
  • potential for full recovery
44
Q

zone of hyperaemia

A
  • intense vasodilation and increased blood flow

- invades the other zones under appropriate conditions

45
Q

1st degree burn

A

superficial

  • epidermis only
  • redness
  • hypersensitivty
  • painful to touch
  • peeling skin
  • sunburn
  • short steam exposure

heals less than 7 days

46
Q

2nd degree burn

A

superficial or deep partial thickness

  • epidermis and part of the dermis
  • red/weepy
  • blistering
  • edematous
  • very painful
  • blanch to touch
  • scalds
  • flash flame
  • grease splatter

heals 2-3 weeks
can cause scarring

47
Q

3rd degree burn

A

full thickness

  • destruction of entire dermis
  • white or charred
  • all sensation lost
  • eschar formation
  • no blanch/blisters
  • flame
  • chemicals
  • electrical
  • explosions

-heals 4-8 wks for small
usually requires -sx/grafting
-always scarring
-highest risk of infection

48
Q

Cardiovascular effects of a severe burn

A
  • decreased BP (fluid movement from intravascular ro interstitial)
  • Na+ and protein
  • increased HR
  • decreased CO
  • decreased tissue perfusion
  • F&E shifts
49
Q

Insensible loss for severe burns

A

Norm: 30-50 ml/hr

Severe burn: 200-400 ml/hr

50
Q

Respiratory effects of a severe burn

A
  • edema formation
  • airway obstruction
  • direct alveolar damage
  • pneumonia, ARDS
51
Q

GU effects of a severe burn

A
  • decreased BF to kidneys
  • renal ischemia
  • acute tubular necrosis
52
Q

GI effects of a severe burn

A

decreased peristalsis and ischemia

53
Q

Phases of burn tx

A
  • pre hospital
  • emergent (resuscitative)
  • acute (wound healing)
  • rehab (restorative)
54
Q

Pre-hospital initial management of burns

A
  • drop and roll
  • remove from source
  • stop the burning
  • primary survey A-F
  • secondary survey, obtain info
55
Q

Extent of burns: The rule of the 9’s

A

???

56
Q

Extent of burns: Lund-Browder chart

A
  • more accurate
  • recognizes percentage of BSA for various anatomic parts
  • table for various ages
  • head and trunk present larger proportions of BSA in children
57
Q

Emergent Phase - Resuscitative

A
  • time frame to resolve immediate problems resulting from the injury
  • last 24-48 hours
  • phase of fluid loss and edema formation
  • lasts until fluid immobilization and diuresis starts
  • F&E shifts: hypovolemic shock and hyperkalemia
58
Q

Emergent Phase: Fluid resuscitation

A
  • Ringer’s Lactate used
  • 2 large bore IVs
  • half estimated volume given first 8 hours
  • remainder of over next 16 hours
  • rate increases or decreases by one-third if UO increases or decreases over 2-3 hours
59
Q

Fluid formula for children

A

3-4 ml RL x kg x precentage BSA burns

60
Q

Fluid formula for adult

A

2-4 ml RL x kg x percentage BSA burns

61
Q

Management Principles

A
  • universal precautions
  • circulation management
  • NG insertion
  • Foley placement
  • pain relief
  • pulse assessment
  • ventilatory evaluation
  • emotional support
62
Q

Acute Phase - Wound Healing

A
  • begins with -mobilization of extracellular fluid
  • hypernatremia
  • hypokalemia
  • necrotic tissue sloughs
  • re-epithelialization begins
  • partial thickness-heals from edges
  • full thickness-requires skin grafts
63
Q

Acute Phase: Wound cleansing and Wound debridement

A
  • hydrotherapy
  • 20-30 mins
  • surgical cleansing agent
  • eschar removal
  • may be done in OR

*all care done aseptic

64
Q

Burn Cream

A
  • broad antimicrobial
  • prevents wound sepsis
  • applied 1-2x day
  • applied immediately after hydrotherapy
  • thin layers
65
Q

Dressing Types

A
  • Mepitel

- Acticoat

66
Q

Mepitel

A

low adherent, silicone gel

67
Q

Acticoat: Partial Thickness

A
  • partial thickness
  • silver impregnated
  • antimicrobial
  • in place 3-7 days
  • moistened with sterile water to activate
68
Q

Acticoat: Full Thickness

A
  • highly absorbent
  • alginate
  • last up to 3 days
  • moist wound environment
  • rayon/polyester core manages moisture level
  • can be cut to desired shape and size
69
Q

Surgical Skin Allografting

A
  • done after debridement
  • natural skin grafting
  • thick or thin
70
Q

Donor site of allografting

A
  • dressed 1-2 wks
  • heals 10-14 days
  • lotion after
  • looks flaked/dry
71
Q

Graft site of allografting

A
  • dressed 2-5 days
  • protected from rubbing or pressure
  • assures adherence
72
Q

autograft

A

use of clients own skin

73
Q

allograft

A
  • use of skin from same species

- human or cadaver

74
Q

xenograft

A

use of porcine or bovine skin

75
Q

Skin burn Disease Therapy

A

-Phase 1: utilizing a mixed skin cell prep, including the patient’s skin stem cells, intra-op isolation and direct application

Phase 2: cell application with skin cell spray gun

Phase 3: cell and wound support with temp artifical would capillary system under the wound dressing

76
Q

Artifical Skin

A

-dermagraft-TC

  • made from human skin
  • less surgical procedures
  • less side effects
  • decreased rejection
  • $3600 sq ft
77
Q

complications of artificial skin: infection

A
  • partical thickness can become full thickness
  • progress to transient bacteremia,
  • sepsis
78
Q

complications of artifical skin: cardiopulmonary

A

may carry over from emergent phase

79
Q

complications of artifical skin: neurologic

A
  • disorientation
  • -ICU psychosis
  • use of analgesics/anti-anxiety drugs
80
Q

complications of artificial skin: musculoskeletal

A
  • decreased ROM

- contractures

81
Q

complications of artificial skin: GI

A
  • paralytic ileus

- curling’s ulcer

82
Q

complications of artifical skin: endocrine

A
  • elevated blood sugar

- increased insulin production

83
Q

Rehabilitative Phase (Restorative)

A
  • emollient water-based cream, keeps skin moist and supple
  • itching and flaking (benadryl)
  • OT/PT
  • psychological support
  • knowledge deficit (dressing changes)
  • potential reconstructive sx
84
Q

Wound Care

A

“6 C’s”

  1. clothing
  2. cooling
  3. cleaning
  4. chemoprophylaxis
  5. covering
  6. comforting
85
Q

clothing

A

-clear skin of burned, chemically contaminated clothing

86
Q

cooling

A
  • apply gauze soaked in cool water
  • 10 to 20 minutes
  • relieves burning, pain, chemicals
  • careful in small children or BSA greater than 10

-hypothermia risk

87
Q

cleaning

A
  • anesthetize (local, regional) first

- mild soap and water and avoid disinfectants

88
Q

chemoprophylaxis

A
  • common pathogens, staph aureus,pseudomonas
  • tetenus
  • topical antibiotics (silvadene, bacitracin)
  • biologic dressings
  • non-biologic dressings: change daily
89
Q

biologic dressings

A
  • xenograft
  • allograft (apply in 6 hrs) for endothelialization

-lower infection rate faster healing than antibiotics

90
Q

covering

A
  • first degree: no need for dressings, use topical skin lubricant
  • second, third degree: clean wound, apply topical antibiotic, cover with sterile dressing
91
Q

comforting

A
  • NSAIDs: decrease inflammation, edema

- Opioids : morphine

MS3 Exam 2 (3 decks)

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