Burns

Question 1

Scald and Fire injuries, Hot water/grease, smoke inhalation - all examples of what kind of burn

Answer 1

Thermal burns

Question 2

Sunburns are what kind of burn

Answer 2

Radiation

Question 3

Four steps to initial evaluation of burns

Answer 3

1. Airway management
2. Evaluation of other injuries
3. Estimation of burn size (depth and % BSA)
4. Diagnosis of CO and cyanide poisoning

Question 4

Perioral burns and singed nasal hairs are a sign of

Answer 4

direct thermal injury to upper airway (smoke inhalation)

can lead to severe airway edema

low threshold for intubation

Question 5

Hoarse voice, wheezing / stridor indicate

Answer 5

Direct thermal injury to upper airway (smoke inhalation)

can lead to severe airway edema

low threshold for intubation

Question 6

Consider Intubation if:

Answer 6

Suspect airway injury, full thickness burns to face/mouth, circumferential chest burns

Question 7

Continued management of burn patients (after initial evaluation)

Answer 7

1. large bore IVs + fluids ASAP
2. Hypothermia common
3. Tetanus booster
4. TREAT PAIN / ANXIETY

Question 8

Only epidermal layer. Dry, red, painful, blanching. Typically heal in 3-6 days. NO blisters

Answer 8

Superficial / 1st degree

Question 9

Have dermal involvement. Takes 3-8 weeks to heal. Painful! Blisters.

Answer 9

partial-thickness 2nd degree (superficial or deep)

Question 10

Painless, no blanching, do NOT spontaneously heal; Skin grafts

Answer 10

Full-thickness (3rd degree)

Question 11

Life Threatening: may extend into tissue, fascia, muscle bone, organs; multiple surgeries usually required

Answer 11

4th degree

Question 12

Burns typically evolve over _____ hrs after injury

Answer 12

48-72 hrs

Question 13

Superficial vs deep partial thickness burns

Answer 13

Superficial&raquo_space; epidermis and superficial dermis. 2-3 weeks to heal. No scar.

Deep&raquo_space; epidermis and deep dermis, sweat glands, hair follicles. Permanent Scar. 3-8 weeks to heal.

Question 14

Decreased sensation, dry leathery eschar, hypoesthesia, and ability to easily pull hairs - suggests what level burn

Answer 14

Full thickness / 3rd degree

Question 15

Burn size estimation “rule of nines”

Answer 15

In adults
anterior and posterior trunk account for 18%

each lower extremity 18%,

each upper extremity 9%,

head 9%.

Hands 1%

**In peds < 3yrs, head = 18% **

Question 16

Superficial or first degree burns - included in rule of nines?

Answer 16

NO

Question 17

Parkland formula for fluid resuscitation in burn tx

Answer 17

LR 4ml x wt (kg) x %BSA = amount given in 24 hours

Half over first 8 hours, half over subsequent 16 hours

Question 18

100 kg male with 20% TSA Burn: how much fluid to give?

Answer 18

4ml * 100 * 20 = 8,000 mL

4 L over first 8 hours, 4 L over 16 hrs

Question 19

how often should burn dressings be changed

Answer 19

twice daily

Question 20

Two important care steps for chemical burns

Answer 20

CAREFULLY remove the substance:

Remove clothes and brush away chemical
Copious irrigation with water

Question 21

Which is worse - alkalis or acids?

Answer 21

Alkalis produce far more tissue damage than acids b/c they penetrate the skin deeper and longer than acids and present a greater danger of toxicity from systemic absorption.

Question 22

partial thickness burns of more than ____% BSA should be referred to burn center

Answer 22

> 10%