Burns Flashcards
What are the functions of the Skin?
4 functions
Protects underlying tissues from injury
Temperature regulation
Acts as water tight seal, keeping body fluids in
Sensory organ
What do injuries to skin or loss of skin have problems with what?
3 things
Infection
Inability to maintain normal water balance
Inability to maintain body temperature
what are 3 factors that affect survival in burn patients?
Age
Percent of Body Area (greater the BSA the greater the mortality)
If there is Respiratory Involvement
What happens in first degree burns?
reddening Tenderness and Pain Increased warmth Edema may occur, but no blistering Burn blanches under pressure
Example - sunburn
Usually heal in ~ 7 days
What happens in 2nd degree burns?
Damage extends through the epidermis and involves the dermis.
Not enough to interfere with regeneration of the epithelium
Moist, shiny appearance
Salmon pink to red color
Painful
Does not have to blister to be 2nd degree
Usually heal in ~7-21 days
What happens in 3rd degree burns?
Both epidermis and dermis are destroyed with burning into Subcutaneous fat
Thick, dry appearance
Pearly gray or charred black color
Painless - nerve endings are destroyed
But patient may still be in pain!!! Pain is due to intermixing of 2nd degree
May be minor bleeding
How do you fix 3rd degree burns?
The patient cant heal, skin needs to be grafted
What is the rule of 9 for adult patients?
this estimates the BSA of patients
Anterior, Posterior abdomen, and each leg are 18% each
The head and each arms are 9% each
Palms are 1%
What is the rule of 9 for Peds and babies?
HEAD, anterior and posterior are is 18%
each Leg is 14%
each Arm are 9%
penis and palm are 1%
For each year over the age of 1, subtract 1% from head and add equally to legs
What happens in the emergent phase in burns?
Body responds to pain and releases catacholamines
What happens in the fluid shift phase of burns?
massive capillary leak in the intravascular and leaks extravascular
What happens in hypermetabloic phase?
there is an increase in the demand for nutrients in order to repair damaged tissue
What happens in the resolution phase?
scar tissue and remodeling of tissue
What is done to correct fluid shift phase?
Give lots of fluid - Lactated Ringers
Fluid status can affect mortality and must be assessed hourly
How do you know how much fluid to give burn patients?
Parkland burn formula
4 ml/kg of body weight/ % of body burned (rule of 9)
the value you get from that:
1/2 of that is given during first 8 hours
last half given during the last 16 hours
There is a decline in fluid need ~18-24 hrs, less vascular shift
What is Eschar tissue?
Full-thickness circumferential and near-circumferential skin burns result in the formation of a tough, inelastic mass of burnt tissue
Where and why is Eschar troublesome?
Skin constricts over wound
increased pressure underneath
restricts blood flow
Respiratory and Circulatory
secondary to circumferential eschar around the thorax prevent chest expansion. (HIGH PEEPS)
Circulatory compromise
secondary to circumferential eschar around extremity
What emergent procedure is done to correct circumferential Burns? how is it performed?
Escharotomy
make lateral incisions in the anterior axillary line to 9th or 10th rib and transverse incisions across top and bottom of the chest to relieve compressive effect
What are things we should be looking out for in burns that have respiratory involvement?
Soot or singing involving mouth, nose, hair, face, facial hair
coughing, black sputum
Patient coming from an enclosed fire environment
Ask patient a question and assess for stridor or hoarseness
What are our respiratory interventions for ventilation and oxygenation in burn patients?
100% oxygen via NRB
Intubation
When is 100% fi02 NRB needed?
Moderate or critical burn
Patient unconscious
Signs of possible airway burn/inhalation injury
History of exposure to carbon monoxide or smoke
But if airway involvement and closure is suspected, Intubate early.
How long is it necessary to keep Fi02 at 100%?
until HbCO is less than 10%
What can toxic combustion products do to breathing?
It can depress it. making respiratory rates unreliable.
What is an inhalation injury?
Defined as the inhalation of superheated gases, steam, or products of incomplete combustion
What are the 2 types of inhalation injuries?
Supraglottic and Subglottic
What are danger signs in a Subglottic Burn?
Loss of consciousness Burned in a closed space Tachypnea (+/-) Cough Rales, wheezes, rhonchi Carbonaceous sputum
What is a subglottic burn? what does the degree of injury depend on?
It primarily affects the lower airways
Depends on:
size of particle (how far down it gets)
solubility of chemicals carried on smoke
What occurs in a subglottic burn? (pathology)
Airways narrowed by edema Alveoli become permeable to Edema Denuding of airway mucosaI layer, mucoucillary escalator impaired Air trapping V/Q mismatch, hypoxemia Bronchial irritation - bronchospasm
What is the treatment for subglottic burns?
Beta agonists for bronchospasm
Aggressive pulmonary toilet
What is not a recommended treatment for burns?
Steroids
What occurs in a large amount of burn patients with inhalation injuries? how is it handled?
Pneumonia or Tracheobronchitis
No Prophylactic Antibiotics are given though
When you notice Sputum is changing, you then run a C and S and get the sensi results to know how to treat it.
Daily CXR is controversial
What are the symptoms of CO poisoning?
Headache, nausea, vomiting,
“roaring” in ears,
unconsciousness
What poison is also associated with CO poisoning?
Hydrogen Cyanide
What is a high level of HbCO that requires intubation?
30% or more
What is the half lift of CO?
Half life of CO = 5 hrs on RA, 74 minutes with 100% and 1ATM, and less than 30minutes at 3ATM
Pulseox during inhalation injuries?
meaningless, don’t rely on values from it
What should you look for in Supraglottic Burns?
Closed space burns, inhalation of steam Neck, face burns Singing of nasal hairs, eyebrows Tachypnea, hoarseness, drooling Red, dry oral/nasal mucosa Carbonaceous debris in mouth or sputum
What should you use to assess damage of smoke inhalation injuries?
Bronchoscopy
Tell my about electrical burns?
There will be two wounds, an entrance and an exit
Small wound can do a lot of damage inside
What kind of damage do electrical burns do?
Depolarization can cause: asystole or other arrythmia and central apnea.
Heart usually starts again, but apnea may be prolonged.
Also other neuro symptoms are common.
Heat generated causes direct tissue injury and coagulation in vessels
