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Med Surg 3 > BURNS > Flashcards

BURNS Flashcards

1
Q

YOUR SKIN

A
  • largest organ
  • three layers
  1. epidermis
    - thin
    - body vs environment
  2. dermis
    - hair follicles
    - sweat/oil glands
    - sensory nerves
    - capillaries
  3. SQ tissue/ fat pads
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2
Q

FUNCTIONS OF YOUR SKIN

A
  • immunologic defense
    protection from infection and injury
  • barrier
    prevention of body fluid loss
  • thermoregulation
    regulation of body temperature
  • neurosensory
    provides sensory contact with the environment
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3
Q

CAUSES OF BURNS

A
  • inhalation
  • thermal
  • electrical
  • chemical
  • radiation
  • cold thermal
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4
Q

PREVALANCE

A

BIRTH - 2 YEARS

  • scald
  • contact burns

5- 20 YEARS
-thermal burns (suns)

-20% pediatric burn r/t abuse or neglect

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5
Q

INHALATION

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

INJURY TYPES

  • carbon monoxide poisoning
  • inhalation injury above the glottis
  • inhalation injury below the glottis
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6
Q

CARBON MONOXIDE POISONING

A
  • incomplete combustion of burning materials
  • CO displaces O2
  • hypoxia
  • death
  • carboxyhemoglobinemia
  • skin has “cherry red” appearance
  • treatment:
    100% humidified O2
    hyperbaric oxygen therapy
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7
Q

INJURY ABOVE THE GLOTTIS

A

-steam inhalation
-aspiration of scalding liquid
- hot smoke/air
- mucosal burns
oropharynx
larynx

  • causes mechanical obstruction
  • medical emergency
  • TREATMENT:
  • ABG’s, O2, intubation (stridor)
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8
Q

SIGNS OF INHALATION BURN

A
  • facial / neck burns
  • singed nasal hair /beard, eyelashes, eye brows
  • hoarsness, painful swallowing
  • darkened oral/nasal membranes
  • hyper secretions
  • respiratory distress (stridor, wheezes)
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9
Q

INJURY BELOW THE GLOTTIS

A

-usually chemical injury
smoke, toxic fumes

  • pulmonary edema may be instant or 12-24 hours later
    1. impaired cillary action
    2. hypersecretion
    3. edema
    4. ulceration of mucous membranes
    5. spasm of bronchi and bronchioles

TREATMENT: intubation

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10
Q

THERMAL BURNS

A
  • most common type of burn
  • caused by :
  • flame(dry heat)
  • scald (moist heat)
  • sun/radiation
  • hot objects
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11
Q

THERMAL BURNS

A
  • only 1/2 sec for 3rd degree burn in 150 degrees of water
  • hot water accounts for 24% of all scalds in children
  • US -65% of all children <4 is from hot tap water
  • 1million/ year in US suffer from thermal burns
  • 45,000 are admitted to the hosipital
  • must evaluate for S/S abuse
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12
Q

INITIAL TREATMENT THERMAL BURNS

A

SMALL BURNS
-cover with clean cloth , cool tap water

LARGE BURNS

  • ABC’s
  • do not immerse in cold water or ice
  • wrap in clean , dry sheet or blanket
  • remove burned clothing unless adhered to site
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13
Q

ELECTRICAL BURNS

A
  • results of coagulation necrosis
  • direct damage

severity depends on :

  • amount of voltage
  • type of voltage
  • tissue resistance
  • current pathway
  • surface area
  • duration of flow
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14
Q

ELECTRICAL CONT

A

-entry and exit points
- passes through vital organs
- sparks
thermal , electrical

  • inability to assess damage
  • HIGH RISK
  • dysrhythmias
  • metabolic acidosis
  • myoglobinuria
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15
Q

INTIAL TREATMENT ELECTRICAL BURNS

A
  • assure source is shut off
  • remove the patient from the source (VS, neuro check , etc)
  • rescuer must be protected
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16
Q

CHEMICAL BURNS

A 
DESTRUCTION 
- acids 
- alkalis
-organic compounds (the worst)
topically inflammatory 
systemically toxic

SEVERITY

  • agent
  • concentration
  • volume
  • duration of contact
17
Q

CHEMICAL

A

DESTROYS TISSUE PROTEINS
-leads to necrosis

ALKALI’S MORE DIFFICULTS TO NEUTRALIZE

  • cause deeper penetration
  • cause protein hydrolysis and liquefication
  • damage continues

RESULTS IN INJURY TO :

  • skin
  • eyes
  • respiratory system
  • liver and kidney damage
18
Q

CHEMICAL

A
  • remove quickly from the skin
  • remove saturated clothing
  • brushing from skin if a powder
  • irritating with copious water
  • burning process and tissue injury can last 72 hours
19
Q

COLD THERMAL

A

Varied degrees

  • frostbite
  • systemic hypothermia
20
Q

FROSTBITE

A

1 degree- white/ yellow firm plague
-accompanying pain

2 degree- superficial blistering

  • very painful
  • clear or milk fluid

3 degree- deep blistering
-red or purple fluid

21
Q

CIRCUMFERENTIAL BURNS

A
  • chest or extremity
  • completely surround the extremity or torso
  • cause respiratory / circulatory compromise
  • as fluid enters the circumferential burn pressure increases
22
Q

COMPARTMENT SYNDROME

A
  • eschar is stiff and non-flexible
  • high enough pressure impedes blood flow or respiratory effort
  • creates ischemia
  • can progress to necrosis
  • requires “escharotomy”
  • cut down to fat pads
23
Q

Jackson’s burn model

A

ZONE OF COAGULATION

  • severest damage
  • will not recover
  • slough out over time
  • will leave scar

ZONE OF STASIS

  • less damaged tissue
  • inflammation occurs
  • vascularity damaged
  • potential for full recovery ( unless further stress is put on burn)

ZONE OF HYPERAEMIA

  • intense vasodilation and increased blood flow
  • invades the other zones under appropriate conditions to help heal
24
Q

SEVERITY OF BURNS

A 
1st= superficial 
2nd= superficial or deep partial thickness 
3rd= full thickness
25
Q

1ST DEGREE- SUPERFICIAL

A
  • superficial burn
  • epidermis only
  • redness
  • hypersensitivity
  • painful to touch
  • peeling skin
  • heals <7 days

Example: sunburn, short steam exsposure

26
Q

2ND DEGREE - SUPERFICAIL, PARTIAL THICKNESS

A
  • epidermis and part of the dermis
  • red/weepy
  • blistering
  • edematous
  • very painful
  • blanch to touch
  • heals 2-3wks
  • can cause scarring

Examples: scalds, flash flame, grease splatter

27
Q

3 DEGREE - FULL THICKNESS

A
  • destruction of entire dermis
  • white or charred
  • all sensation lost
  • eschar formation
  • no blanch / blisters
  • examples: flame, chemicals, electrical, explosions
  • heals 4-8 wks (small)
  • usually requires surgery /grafting
  • always scarring
  • highest risk of infection (triples)

Med Surg 3 (5 decks)

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