Burns Flashcards
What age range is at the highest risk of burns?
18-35 y/o
Are males or females more likely to have a burn? At what ratio?
Males, 2:1
What age range is at the highest risk of scalds from hot liquids?
1-5 y/o
Burn injury historically carries a (good/poor) prognosis
Poor
Advances in ____ ____ and early excision of wounds has greatly increased survival. Early ____ ____ is very important and referral to _____ is key!
fluid resuscitation; fluid resuscitation; specialized burn center
What are the two specialized burn centers in NC?
NC Burn Centers: Wake Forest and UNC Chapel Hill
What are the four types of burns? How are they acquired?
Thermal: Scald and Fire injuries, Hot water/grease, smoke inhalation
Electrical: Lightning, household electricity
Chemical: Acids and Alkalis
Radiation: Sunburns
What are four crucial assessments that must be made on every burn victim?
Airway management
Evaluation of other injuries
Estimation of burn size (Burn Depth and %BSA)
Dx of CO and cyanide poisoning (Look for soot in the airway, etc)
You should have a low threshold for intubation when it comes to burn victims. Some indications that you should intubate a burn victim include ____, ____, and ____.
Suspect airway injury, full thickness burns to face/mouth, circumferential chest burns
Direct thermal injury to the upper airway (smoke inhalation) can cause rapid and severe _____ _____ (as a reaction to foreign particles). ____ ____ and ________ are signs of this. Also, be sure to note any presence of a ____ voice, _____/_____, or _____.
airway edema; Perioral burns and singed nasal hairs are signs of this
Note hoarse voice, wheezing/stridor, dyspnea
Should you consider burn patients as trauma patients?
Yes!
In a burn victim, you should place ______ and begin _____ as soon as possible.
2 large bore IVs
Fluids
If a pt has burns all over their arms, you may need to place a _______
central line to establish IV access
(Hypothermia/Hyperthermia) is common in pre-hospital pts
Hypothermia
T/F You should transfer a burn victim in clean, damp, blankets to best protect their skin
False, they should be clean and DRY
In a stable burn victim, what are we most concerned about treating?
their pain and anxiety
Is there a need for prophylactic abx tx in burn victims?
No
In burn victims, it is important to administer a ______
tetanus booster
If a topical abx were needed for better burn protection, what would be a good option?
Cephalexin
Why do burn victims suffer increased fluid losses?
Burns cause increased fluid losses due to heat and loss of a protective skin barrier
The burn or inhalation drives an inflammatory response that leads to capillary leakiness and thus intravascular fluid loss
Define a thermal burn
Type ofburnresulting from making contact w/ heated objects
Ex: boiling water, steam, hot cooking oil, fire, and hot objects
Related to structural fires and associated inhalation/CO poisoning
What is the most common type of burn in pediatric pts?
Scalding, which could be a signifier of abuse (also hot bathtub water)
What is the most common cause for hospital burn admissions?
Flames
Match the following descriptions of burns with their names (Superficial/1st degree, Partial-thickness/2nd degree, Full thickness/3rd degree, 4th degree)
A. Life-threatening: may extend into tissue, fascia, muscle bone, organs; multiple surgeries usually required.
B. Painless, non-blanching, does NOT spontaneously heal; Skin grafts.
C. Only epidermal layer. Dry, red, painful, blanching. Typically heals in 3-6 days. NO blisters.
D. Takes ~3-8 weeks to heal. Blisters.
4th degree = Life-threatening: may extend into tissue, fascia, muscle bone, organs; multiple surgeries usually required.
3rd degree = Painless, non-blanching, does NOT spontaneously heal; Skin grafts.
1st degree = Only epidermal layer. Dry, red, painful, blanching. Typically heals in 3-6 days. NO blisters.
2nd degree = Takes ~3-8 weeks to heal. Blisters.
Burns typically evolve over ___-___ hours after injury which complicates ability to predict healing
48-72 hours
How long does it typically take for a 1st degree burn to heal? Superficial 2nd degree? Deep 2nd degree? 3rd? 4th?
Scar or no scar?
1st degree: 7 days, no scar
2nd degree (superficial): 14-21 days, no scar
2nd degree (deep): 3-8 weeks, scar
3rd degree: months, severe scar
4th degree: months, multiple surgeries required
What is the first triage tx that should be performed in pts?
Lukewarm sterile water irrigation, administer pain medications as necerssary (i.e. Tramadol)
If a pediatric burn victim has ____% BSA affected, they should be referred
> 10%
How do you estimate burn size? (hint: it is a ‘rule’)
The Rule of Nines
In adults, anterior and posterior trunk account for ___% BSA, each lower extremity ___%, each upper extremity ___%, and head ___%.
In peds ____ y/o the head accounts for larger surface area.
In adults anterior and posterior trunk account for 18%, each lower extremity 18%, each upper extremity 9%, and head 9%.
In peds < 3 y/o the head accounts for larger surface area.
______ burns are NOT included in the rule of nines, so make sure to thoroughly clean the skin to avoid confusion.
Superficial/1st degree
Data suggests inexperienced providers (underestimate/overestimate) size of small burns and (underestimate/overestimate) large burns
Data suggests inexperienced providers overestimate size of small burns and underestimate large burns
IV fluids typically given for burns ____% BSA
> 10% BSA
The tough leathery tissue remaining after a full-thickness burn is called _____
Eschar
Describe an escharotomy. What can it be used for?
An escharotomy is performed by making an incision through the eschar to expose the fatty tissue below. It can be performed as a prophylactic measure as well as to release pressure, facilitate circulation, and combat burn-inducedcompartment syndrome.
What is the Parkland formula (used in fluid replacement for thermal burn victims)?
LR 4cc x wt (kg) x %BSA = amount given in 24 hours
Half over first 8 hours, half over subsequent 16 hours
LR maintains a more stable ______ than NS in long term resuscitation
Blood pH
LR contains less ____ and ____ than NS because large amounts of NS could cause _________.
Na+ and Cl-; hyperchlorermic acidosis
One liter of Ringer's Lactate solution contains: \_\_\_ mEq of sodium ion = 130 mmol/L \_\_\_ mEq of chloride ion = 109 mmol/L \_\_\_ mEq of lactate = 28 mmol/L \_\_\_ mEq of potassium ion = 4 mmol/L \_\_\_ mEq of calcium ion = 1.5 mmol/L
130 mEq of sodium ion = 130 mmol/L 109 mEq of chloride ion = 109 mmol/L 28 mEq of lactate = 28 mmol/L 4 mEq of potassium ion = 4 mmol/L 3 mEq of calcium ion = 1.5 mmol/L
In the treatment of thermal burns, are prophylactic abx recommended?
No. Prophylactic antibiotics are not given
How often should dressings be changed on thermal burns?
Dressings should be changed twice daily
In a pt with a thermal burn, you should treat their pain and administer what vaccination if not UTD (up to date)?
Tetanus
T/F Silver sulfadiazine (Silvadene) is the most widely used tx for thermal burns
True
Silvadene is primarily used as (prophylaxis/tx) for active infection
Prophylaxis
Silvadene is not significantly absorbed, but you should still use caution in pts with what type of allergy?
Sulfa Allergic Patients
Can Silvadene be used in pts with skin grafts?
No! It DESTROYS skin grafts!
In pts with smaller thermal burns, you may use Bacitracin and Neosporin topically, but you should not use Bacitracin or Neosporin in large burns due to what concern?
Nephrotoxicity
Is wound debridement always recommended?
No, it is controversial
The antibiotic ______ is considered 1st line for tx of cellulitis
Cephalexin
Surgery indicated typically for burns not expected to heal within how many weeks?
2 weeks
Full-thickness burns with a rigid eschar can cause a ______ effect as edema progresses, which may lead to _________, which is most common in burns on the ______, _____, and _____.
Tourniquet; Compartment syndrome; extremities; abd; thorax
What is the recommended tx for an eschar?
Escharotomy, which is performed at bedside
The best graft sites include…. What are the best sites for the elderly? For infants/children?
Thigh
Thicker skin of back (older pts)
Buttocks (infants/children)
Scalp
_________ grafts are the most common type of skin graft
Split thickness (autografts)
Permanent synthetic skin substitutes are (uncommon/common) and may be used in combination with autografts
Uncommon
Most chemical burns are caused by _____ and _____
Acids and alkalis
T/F Never neutralize acid w/base or vice versa
True
How common are chemical burns in comparison to other types of burns? Are they usually mild/moderate/severe?
Less common, but severe
____% of all burn center admissions are result of chemical burns
10%
In order to properly tx a pt with a chemical burn, what should you do?
CAREFULLY remove the substance:
Remove clothes and brush away chemical
Copious irrigation with water
Wound care and Tetanus
Where are a lot of chemical burns seen? How should you assess this type of chemical burn?
Chemical burns are commonly seen in the eye; you should stain it and look for damage
Electrical burns make up ___% of admissions
4%
Electrical burns are typically seen at what areas?
Areas of electrical contact
T/F Electrical burns need admission and care by burn specialist
True
What are potential complications of electrical burns?
Cardiac arrhythmias, compartment syndrome, and rhabdomyolysis
If a pt presents with entry and exit wounds, you would expect that this injury was obtained via (AC/DC) current. If a pt presents with contact wounds c/o sustained muscle spasms, you would expect for this injury to have been obtained via (AC/DC) current.
DC; AC
Electrical burns often cause extensive deep tissue damage to what type of tissues? Examples?
electrically conductive; such as muscles, nerves, and blood vessels
Do patients with electrical burns typically have copious or minimal cutaneous injury?
minimal
______ injury increases mortality in burn patients
Inhalation
In a pt with an inhalation injury, how would we expect the pt obtained an upper airway injury? Lower airway injury?
Direct heat (upper airway) Inhalation of combustible products (lower airway)
What are some examples of signs and sx of smoke inhalation?
Cough, wheezing, nares with singed hair, soot in mouth/nose, hoarseness, HA
What is the recommended tx for pts with inhalation injury?
Fluids and supportive care (oxygen, possible intubation, bronchodilators, etc)
T/F Inhalation injury is commonly obtained via a fire in an open space
False; Fire in an enclosed space
Direct inhalation injury causes swelling that is generally worse in the first ___-___ hrs
24-48 hours
Combustibles can cause what types of injuries/complications if inhaled?
mucosal injury, bronchoconstriction, obstruction
What is a potential consequence of smoke inhalation injury?
CO poisoning
T/F CO poisoning contributes to early mortality from smoke inhalation
True
CO has an affinity for hemoglobin that is ___-___ times (lower/higher) than that of oxygen, which can lead to _____.
200-250 times higher; anoxia/death
What are potential signs and sx of CO poisoning?
Headache, lightheadedness, dizziness, confusion, tachypnea, hypoxia
If you suspect a pt has CO poisoning, what PE should be performed? Labs/imaging?
Neuro exam very important
Consider CXR and CO levels
How do you tx a pt with CO poisoning?
High flow O2 administration of 100% O2
How do you tx a pt with CO poisoning?
High flow O2 administration of 100% O2
_________ toxicity is also a risk of smoke inhalation, and has been described as being mostly odorless, but with a slight _____ odor.
Hydrogen cyanide; burnt almond
Hydrogen cyanide poisoning should be considered with a pt has sx of CO poisoning but has a normal _______ level
carboxyhemoglobin
High flow O2 reduces the half life of CO from _____ mins to ___-___ mins
250 minutes; 40-60 minutes
Children ____ y/o and adults ____ y/o are considered high risk burn patients and should be referred to and admitted to a burn center right away
Children <10 y/o and Adults >50 y/o are considered high risk patients
There are many guidelines for when to refer a pt to a burn center. Some of them include the following:
Partial-thickness burns ____% TBSA
Burns involving the ____, ____, ____, ____, ____ or major ____
____-degree burns in any age group
Partial-thickness burns >10% TBSA
Burns involving the face, hands, feet, genitalia, perineum or major joints
Third-degree burns in any age group
There are many guidelines for when to refer a pt to a burn center. Some of them include the following:
______ burns (including _____ injury), _____ burns, _____ injury
Burns in pts with complicated _______
Circumferential burns of _____ or _____
______ pt in hospital without qualified ______ specialists
Burn pts requiring special ____/_____ rehab
Electrical burns (including lightning injury), Chemical burns, Inhalation injury
Burns in pts with complicated comorbidities
Circumferential burns of chest or extremity
Peds pt in hospital without qualified peds specialists
Burn pts requiring special social/emotional rehab
What are the most important indicators for mortality in burn pts?
Age, burn size and inhalation injury
Recent study of >68,000 burn patients found the highest predictors of mortality to be ____, ____, ____, ____, and ____.
Age % TBSA Inhalation injury Co-existent trauma PNA
____ and/or ____ are recommended to burn patients to prevent functional loss
PT; OT
_______ of the hand are a huge complication and liability in burn patients
Contractures
What type of scarring is common in burn patients?
Hypertrophic
What type of rehab is extremely important in burn pts? Why?
Psychological; Depression, PTSD, body image concerns, return to work…
