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Clin Med Peds > burns > Flashcards

burns Flashcards

1
Q

what does burn severity and survival depend on?

A

patient age, comorbidites, inhalation injuries, burn size

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2
Q

what are the 4 zones of full thickness burns?

A

coagulation, stasis, hyperemia

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3
Q

what is the coagulation zone of full thickness burns?

A

dead or dying tissue d/t coagulation necrosis and absent blood flow

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4
Q

what is the stasis zone of full thickness burns?

A

red and may blanch with pressure, becomes avascular and necrotic by day 3

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5
Q

what is hyperemia zone of full thickness burns?

A

blanches with pressure and heals by day 7

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6
Q

when does systemic inflammatory response syndrome occur with burns?

A

burns affecting >30% of TBSA

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7
Q

what’s a superficial aka first degree burn? example?

A

minor epithelial damage to epidermis

redness, tenderness to pain, no blistering

healing occurs over several days w/out scarring

no infection

Ex: sunburn or flashburn

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8
Q

what is the appearance, sensation, and healing time of superficial partial-thickness burns?

A

appearance: blisters, moist, red, weeping, blanches with pressure
sensation: painful to temperature and air

healing time: 7-21 days

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9
Q

what is the appearance, sensation, healing time of deep partial-thickness burns?

A

appearance: blisters (easily unroofed), wet or waxy dry, variable color, doesn’t blanch with pressure
sensation: perceptive of pressure only

healing time: >21 days - usually needs surgery

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10
Q

what is the appearance, sensation, healing time of full-thickness/3rd degree burns?

A

appearance: waxy white to leathery gray to charred and black, dry and inelastic, no blanching with pressure
sensation: deep pressure only

healing time: rare, unless surgically treated

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11
Q

what is the appearance, sensation, healing time of fourth degree burns?

A

appearance: extends into fascia and/or muscle
sensation: deep pressure

healing time: never, unless surgically treated

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12
Q

what is the mantra for treating thermal burns?

A

ABCs and stabilization of the pt

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13
Q

what are 2 complications of thermal burns?

A

infection (major cause of death)

burn shock

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14
Q

what is the major cause of death in thermal burns?

A

infection

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15
Q

what are low voltage electrical burns?

A

<1000 V

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16
Q

what are high voltage electrical burns?

A

> 1000 V

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17
Q

how are low voltage electrical burns usually caused?

A

hand/mouth d/t contact with exposed wire

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18
Q

what’s the initial tx of low voltage electrical burns?

A

clean and dress with topical abx

splint, elevate and reassess in 2-3 days

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19
Q

what’s the surgical tx of low voltage burns? (skin loss only vs deeper injury)

A

skin loss only -> skin graft

deeper injury -> amp or flap coverage

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20
Q

an oral electrical injury is initially…

A

painless

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21
Q

what’s the tx for oral electrical injury?

A

clean and apply petroleum based abx ointment QID

treat with immediate dental prosthetic splinting to reduce need for oral reconstruction surgery in future

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22
Q

what is the most commonly devastating thermal burns?

A

high voltage electrical burns

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23
Q

LOC is more common in what electrical burns, low voltage or high voltage?

A

low voltage

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24
Q

baseline EKG for what burns?

A

electrical burns

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25
Q

when do you admit patient with electrical burn?

A

abnormal EKG, CP, transthoracic conduction, or h/o cardiac disease -> admit for 1-2 days for monitoring

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26
Q

what bx for electrical burn?

A

muscle bx

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27
Q

what fluid for electrical burn tx?

A

IVF resuscitation and foley cath

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28
Q

referral to who for high-voltage electrical injuries?

A

to burn specialist

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29
Q

who with electrical burn can be sent home?

A

anyone with mild sx’s and normal CPK/EKG can be sent home after obs in ER

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30
Q

when do you transfer patient to burn center?

A

high-voltage burn, significant burn, oral burns

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31
Q

what are s/s of frostbite?

A

coldness, stinging, burning, throbbing

numbness and complete loss of sensation

loss of muscle dexterity (clumsy fingers)

loss of large muscle dexterity (trouble walking)

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32
Q

if have soft palpable skin, what type of frostbite?

A

superficial frostbite

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33
Q

if have pitting edema or hard to touch, what type of frostbite?

A

deeper frostbite

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34
Q

what is first degree frostbite?

A
  • epidermal involvement
  • central white plaque with ring of hyperemia
  • poor sensation, mild edema
  • dequamation over several weeks
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35
Q

what is second degree frostbite?

A
  • full thickness freezing
  • clear blister with surrounding erythema
  • hard outer skin, resilient tissue underneath
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36
Q

what is third degree frostbite?

A
  • subdermal plexus freezing
  • blue grey skin discoloration with hemorrhagic blister formation
  • thick gangrenous eschar w/in 2 weeks
  • deep burning pain on rewarnming (Can last 5 weeks)
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37
Q

what is 4th degree frostbite?

A
  • involvement of muscle, bone, and tendons
  • frozen, hard, avascular skin and tissue
  • relatively little pain or edema on rewarming
  • demarcation b/w viable and nonviable tissue takes 1 month
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38
Q

what are 3 subtypes of frostbite?

A

frostnip, trench foot, pernio

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39
Q

what is frostnip?

A

transient numbness and paresthesias that resolve with rewarming

no ice crystal formation in tissues or tissue loss

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40
Q

what is trench foot?

A

peripheral neuromuscular damage w/o crystal formation (reversible if treated early)

-pain, paresthesias, pallor, pulselessness, paralysis

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41
Q

what is permio?

A

painful, inflammation lesions from chronic exposure to damp, non-freezing cold (12 hrs post injury)

damage to capillary beds

resolves in 7-14 days

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42
Q

what must you do as quickly as possible in treatment of frostbite?

A

rewarm as quickly as possible

-40-42 C water for 15-30 mins or until signs of flush, soft, pliable tissue

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43
Q

avoid what after rewarming in frostbite?

A

refreezing

44
Q

how long can healing of frostbite take?

A

6-12 months

45
Q

favorable prognosis of frostbite is?

A

clear blister over hemorrhagic blister

46
Q

poor prognosis of frostbite is?

A

absence of edema, hemorrhagic blebs that don’t extend to phalanges

47
Q

what is hypothermia?

A

mechanism of temperature regulation is overwhelmed by cold stressor

48
Q

causes of hypothermia?

A
  • decreased heat produced
  • increased heat loss
  • impaired thermoregulation
  • infection, cardiac arrest, drugs
49
Q

what is mild hypothermia degrees?

A

32-35 C (89-95 F)

50
Q

what is moderate hypothermia degrees?

A

28-32 C (68-89 F)

51
Q

what is severe hypothermia?

A

<28 C (<68 F)

52
Q

what is seen on EKG for hypothermia at 30 C (86F)?

A

J or Osborne waves

atrial and ventricular arrhythmias

53
Q

brain death on EEG at what temp?

A

19-20C

54
Q

what are s/s of hypothermia?

A

mood changes, confusion, irritability

slurred speech, ataxia

rhythmic movements

shivering stops at <31 C (87.8F)

55
Q

what’s the ABG like for hypothermia?

A

falsely high O2/CO2

56
Q

what’s the CBC like for hypothermia?

A

high HCT

57
Q

what’s the K like for hypothermia?

A

K>10 = cell necrosis

58
Q

need what temp of pt to determine degree of hypothermia?

A

core temp

59
Q

how do you slowly rewarm hypothermic pt?

A

warmed IV fluids, heated humidified O2 by mask, warmed blankets

60
Q

how do you moderately rewarm hypothermic pt?

A

warmed IVF, warmed gastric lavage, peritoneal lavage w/45 C fluid

61
Q

how do you rapidly rewarm hypothermic pt?

A

thoracic lavage, cardiopulmonary bypass, ECMO, AV dialysis, warm water immersion

62
Q

what are complications of hypothermia?

A

rewarming shock, cardiac arrhythmias at <32 C

63
Q

pt is not pronounced dead until what?

A

until rewarmed to 32 C/89.6 F or above

64
Q

what is hyperthermia elevated core temp? catastrophic?

A

elevated core temp >38.5C (101.3F)

catastrophic: >41.1C (106F)

65
Q

what are the 2 types of hyperthermia?

A

heat exhaustion and heat stroke

66
Q

what is heat exhaustion?

A

normal-slightly increased core temp

67
Q

s/s of heat exhaustion?

A

intact MS, fatigue, dehydration

68
Q

what is heat stroke?

A

temp >40.5C (104.9)

69
Q

2 subtypes of heat stroke?

A

exertion heat stroke, nonexertional heat stroke

70
Q

s/s of heat stroke?

A

AMS, anhidrosis

71
Q

GI findings for hyperthermia?

A

GIB and hepatic injury

72
Q

vitals for hyperthermia?

A

temp >40.5, HR >130, hypotension

73
Q

CNS findings for hyperthermia?

A

AMS, seizures, posturing

74
Q

eye findings for hyperthermia?

A

nystagmus, oculogyric

75
Q

CV findings for hyperthermia?

A

hyperdynamic

76
Q

Pulm findings for hyperthermia?

A

Tachypnea and hypoxia

77
Q

renal findings for hyperthermia?

A

AKI (hypovolemia, low CO, rhabdomyolysis)

78
Q

ABG findings for hyperthermia?

A

respiratory alkalosis or metabolic acidosis

79
Q

lactate for hyperthermia?

A

> 4mmol/L (acidosis)

80
Q

CMP for hyperthermia?

A
  • hypernatremia
  • hypoglycemia
  • hypocalcemia
  • hypomagnesemia
  • hypokalemia (early phase -> hyperkalemia (late phase)
81
Q

elevated CK in hyperthermia means what?

A

rhabdomyolysis

82
Q

avoid what in tx of hyperthermia?

A

avoid overhydration

83
Q

what’s the tx for heat exhaustion?

A

non-invasive cooling techniques

electrolyte/hydration management

84
Q

what’s the tx for heat stroke?

A

decrease core temp to <40C (104F)

admin dantrolene if you suspect NMA and malignant hyperthermia

85
Q

what are non-invasive external cooling methods for hyperthermia?

A

ice packs (remove at 39 C)

spray bottle and fan - quickest

cooling blanket

bath at 0-14C: decrease temp <39 C in 20-40 min
-best for extertional, Benzes for shivering

cooled IVF

86
Q

what are invasive cooling methods for hyperthermia?

A

ice water gastric lavage

peritoneal lavage w/cooled NS

Dantrolene, Benzos for shivering, barbs for seizures, dobutamine for hypotension w/poor CO, IVF (but avoid overhydration d/t pulmonary edema)

87
Q

never use what meds to treat hyperthermia?

A

antipyretics, phenytoin, neuroleptics, alpha-adrenergic w/poor CO

88
Q

what’s the most common complication of burns?

A

neurologic complication

89
Q

what are neurologic complication of burns?

A

central, peripheral, spinal cord

can get LOC, confusion, stroke like symptoms, damage to peripheral nerves (sensory problems), degernative disease of spine cord

90
Q

what are cardiac complications of burns?

A

rhythm and conduction disturbances

fib with high voltage

ST-T changes are more common

91
Q

what pulmonary complications from burns?

A

pleural damage -> effusions, local lobular pneumonitis

92
Q

what abdominal organ is the most common to be injured electrically?

A

bowel

93
Q

when do you do cardiac monitoring after electrical injuries?

A

If ANY are true:

documented arrhythmia or evidence of ischemia, LOC, high voltage (>1000V)

94
Q

when do you not have to do cardiac monitoring after electrical injuries?

A

If ALL are true:

normal ECG, no LOC, low voltage (= 1000V)

95
Q

who do you admit for electrical burns?

A

anything beyond minor low-voltage injury

those with mild sx’s, mild burns, normal CPK and EKG can be d/c’d after several hour observation

96
Q

when do you transfer electrical burn to burn center?

A
  • high-voltage burn
  • significant burns
  • oral burns
97
Q

when are you at 2x the risk of frostbite/

A

pervious cold injury

98
Q

what are signs of post-rewarming injury?

A

edema w/in 3 hours and lasts 1 weeks

large clear blebs within 6-24hrs

small hemorrhagic blebs after 24hrs if deep

eschar in 9-15 days

99
Q

what are 2 big complications of frost-bite?

A

permanent sensory loss and wound infection

100
Q

what’s the best tx for frostbite?

A

circulating water 40-42Cfor 15-30

101
Q

aloe vera for what tx?

A

for minor frost-bite injury; used every 6 hours

102
Q

what burns must be sent to the burn center?

A

major burns

103
Q

what is classified as major burn?

A
  • partial thickness burns >25% in adults
  • partial thickness burns >20% in <10 y/o or >50 y/o
  • full thickness >10%
  • burns to face, eyes, ears, nose, hand, feet, perineum
  • caustic burns, high voltage burns, high-risk pts, inhalation injury
104
Q

what burns are hospitalized?

A

moderate burns

105
Q

what is classified as moderate burns?

A
  • partial thickness 15-25% in adults, 10-20% in child or older adult
  • full-thickness 2-10% that don’t fit major burn critiera
106
Q

what burns are treated at home?

A

minor burns

107
Q

what is classified as minor burns?

A
  • partial thickness <15% adults, <10% child or older adult

- full-thickness burns <2%

Clin Med Peds (10 decks)

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