Burns Flashcards
Are acid or alkali chemical burns more serious?
ALKALI in general.
Body cannot buffer the alkali.
Why are electrical burns so dangerous?
Most of the destruction is internal.
Cardiac dysrythmias, myoglominuria, acidosis and renal failure are common.
Treatment for myoglobinuria
To avoid renal injury, think “HAM”.
Hydration
Alkalization with IV HC03
Mannitol diuresis
Epidermis only
First degree
Epidermis and varying levels of dermis
Second degree
Full thickness
All layers of the skin including the entire dermis
Third degree
Burn into bone or muscle
Fourth
Painful dry, red areas that do not form blitsters(sunburn)
First degree
Painful, hypersensitive, swollen, mottled areas with blisters and open weeping surfaces
Second degree
Painless, insensate, swollen, dry, mottled, white, charred areas; DRY LEATHER
Third degree
What is the major clinical difference between second and third degree burns?
Third degree burns are painless
Second are painful
Which measure is burn severity determined?
Depth and TBSA affected by second and thired degree burn
Treatment of second degree burns
Remove blisters, apply antibiotic
Silver ion dressings
Third degree burn treatment
Early excision of eschar( within first week of postburn) and STSG
what prophylaxis should the burn patient get in the ER?
Tetanus
What is used to evaluate the eyes after third degree burn?
Fluorescein
Diagnostic imaging used for smoke inhilation
bronchoscopy
Lab test for smoke inhilation
Carboxyhemoglobin
Loss of fluid from the intravascular space as a result of burn injury, which causes “leaking capillaries” that require crystalloid infusion
burn shock
What is the Parkland Formula
TBSA x wt in kg x 4
1/2 in first 8
1/2 in the next 16 hours
Adult urine output goal for burn.
30-50cc
Why is glucose-containing IVF contraindicated in burn patients in the first 24 hours?
Serum glucose will be elevated on its own because of the stress response
Minimal urine output for burn patients
Adults 30cc; children 1-2 cc/kg/hr
Best monitoring tool for volume status
Urin output
Why do most severely burned patients require nasogastric decompression?
Patients with >20% TBSA burns usually develop paralytic ileus –> vomiting –> aspiration risk –> pneumonia
What stress prophylaxis must be given to burn patients?
PPI to preven burn stress ulcer
What is the most common sign of burn wound infection?
discoloration of burn eschar
What are the common organisms found in burn wound infection?
Staph, Psudomonas, strep, candida
Why are systemic IV antibiotics contraindicated in fresh burns?
Bacteria live in the eschar, which is avascular (the systemic antibiotic will not be delivered to the eschar); thus, apply topical antimicrobial agents
Are prophylactic antibiotics administered for burns patients including inhalational injury?
NO
Circumferential, full-thickness burns to the extremities are at risk for what complication?
distal neurovascular impairment
What is the major infection complication in burn patients?
Pneumonia, central line infection
From which burn wound is water evaporation highest?
Third-degree
Can infection convert partial-thickness injury to a full thickness injury?
YES
How is carbon monoxide inhalation overdose treated?
100% O2
Which electrolyte must be closely followed acutely after a burn?
Na
What is the name of the gastric/duodenal ulcer associated with burn injury?
Curling’s ulcer
Think: CURLING iron
