Burns

Question 1

What are the functions of the Skin?

4 functions

Answer 1

Protects underlying tissues from injury

Temperature regulation

Acts as water tight seal, keeping body fluids in

Sensory organ

Question 2

What do injuries to skin or loss of skin have problems with what?
3 things

Answer 2

Infection

Inability to maintain normal water balance

Inability to maintain body temperature

Question 3

what are 3 factors that affect survival in burn patients?

Answer 3

Age

Percent of Body Area (greater the BSA the greater the mortality)

If there is Respiratory Involvement

Question 4

What happens in first degree burns?

Answer 4

reddening
Tenderness and Pain
Increased warmth
Edema may occur, but no blistering
Burn blanches under pressure

Example - sunburn
Usually heal in ~ 7 days

Question 5

What happens in 2nd degree burns?

Answer 5

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

Question 6

What happens in 3rd degree burns?

Answer 6

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

Question 7

How do you fix 3rd degree burns?

Answer 7

The patient cant heal, skin needs to be grafted

Question 8

What is the rule of 9 for adult patients?

Answer 8

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%

Question 9

What is the rule of 9 for Peds and babies?

Answer 9

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

Question 10

What happens in the emergent phase in burns?

Answer 10

Body responds to pain and releases catacholamines

Question 11

What happens in the fluid shift phase of burns?

Answer 11

massive capillary leak in the intravascular and leaks extravascular

Question 12

What happens in hypermetabloic phase?

Answer 12

there is an increase in the demand for nutrients in order to repair damaged tissue

Question 13

What happens in the resolution phase?

Answer 13

scar tissue and remodeling of tissue

Question 14

What is done to correct fluid shift phase?

Answer 14

Give lots of fluid - Lactated Ringers

Fluid status can affect mortality and must be assessed hourly

Question 15

How do you know how much fluid to give burn patients?

Answer 15

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

Question 16

What is Eschar tissue?

Answer 16

Full-thickness circumferential and near-circumferential skin burns result in the formation of a tough, inelastic mass of burnt tissue

Question 17

Where and why is Eschar troublesome?

Answer 17

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

Question 18

What emergent procedure is done to correct circumferential Burns? how is it performed?

Answer 18

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

Question 19

What are things we should be looking out for in burns that have respiratory involvement?

Answer 19

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

Question 20

What are our respiratory interventions for ventilation and oxygenation in burn patients?

Answer 20

100% oxygen via NRB

Intubation

Question 21

When is 100% fi02 NRB needed?

Answer 21

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.

Question 22

How long is it necessary to keep Fi02 at 100%?

Answer 22

until HbCO is less than 10%

Question 23

What can toxic combustion products do to breathing?

Answer 23

It can depress it. making respiratory rates unreliable.

Question 24

What is an inhalation injury?

Answer 24

Defined as the inhalation of superheated gases, steam, or products of incomplete combustion

Question 25

What are the 2 types of inhalation injuries?

Answer 25

Supraglottic and Subglottic

Question 26

What are danger signs in a Subglottic Burn?

Answer 26

Loss of consciousness
Burned in a closed space
Tachypnea (+/-)
Cough
Rales, wheezes, rhonchi
Carbonaceous sputum

Question 27

What is a subglottic burn? what does the degree of injury depend on?

Answer 27

It primarily affects the lower airways

Depends on:
size of particle (how far down it gets)
solubility of chemicals carried on smoke

Question 28

What occurs in a subglottic burn? (pathology)

Answer 28

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

Question 29

What is the treatment for subglottic burns?

Answer 29

Beta agonists for bronchospasm

Aggressive pulmonary toilet

Question 30

What is not a recommended treatment for burns?

Answer 30

Steroids

Question 31

What occurs in a large amount of burn patients with inhalation injuries? how is it handled?

Answer 31

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

Question 32

What are the symptoms of CO poisoning?

Answer 32

Headache, nausea, vomiting,
“roaring” in ears,
unconsciousness

Question 33

What poison is also associated with CO poisoning?

Answer 33

Hydrogen Cyanide

Question 34

What is a high level of HbCO that requires intubation?

Answer 34

30% or more

Question 35

What is the half lift of CO?

Answer 35

Half life of CO = 5 hrs on RA, 74 minutes with 100% and 1ATM, and less than 30minutes at 3ATM

Question 36

Pulseox during inhalation injuries?

Answer 36

meaningless, don’t rely on values from it

Question 37

What should you look for in Supraglottic Burns?

Answer 37

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

Question 38

What should you use to assess damage of smoke inhalation injuries?

Answer 38

Bronchoscopy

Question 39

Tell my about electrical burns?

Answer 39

There will be two wounds, an entrance and an exit

Small wound can do a lot of damage inside

Question 40

What kind of damage do electrical burns do?

Answer 40

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