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SU-18 ER > Burns > Flashcards

Burns Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

larger mortality risk in

A
  1. large burn size
  2. older age/comorbid
  3. female
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2
Q

physiologic effect of thermal injury

A
  1. disruption of sodium/potassium pump
  2. depression of myocardial contractility
  3. increased SVR
  4. metabolic acidosis

ALSO increased H/H, secondary anemia, local tissue injury, release of substances

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3
Q

disruption of Na/K pump

A

direct damage to protein content of cell causes this to break down

intracellular influx of sodium and water

extracellular efflux of potassium

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4
Q

substances released

A 
histamine
kinin
serotonin
arachadonic acid 
free oxygen radicals
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5
Q

zones of burns

A
  1. coagulation
  2. stasis
  3. hyperemia
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6
Q

zone of coagulation

A

irreversible cellular death

vessels essentially destroyed

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7
Q

zone of stasis

A

tenuous state

stagnation of microcirculation

blockage of blood flow

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8
Q

zone of hyperemia

A

increased blood flow

generally spontaneous recovery = congestion

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9
Q

how to quantify size of burn

A

percentage of BSA using Rule of Nines

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10
Q

rule of nines

A

use palm of patient hand (1%)

head, arms (ea.) 4.5
torso, pelvis, legs (ea.) 9

genital is 1%

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11
Q

how do we classify burn depth?

A

according to surgical need

  1. superficial thickness
  2. partial thickness (superficial or deep)
  3. full thickness
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12
Q

superficial thickness burn

A

skin is red, painful, tender NO BLISTER

epidermis

tx: symptomatic, heal 7 days

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13
Q

leading cause of injury in fire patients

A

inhalation injury

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14
Q

partial thickness burn

A

epidermis + dermis

can be superficial or deep

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15
Q

superficial partial thickness burn

A

blistering of skin + sunburn

often 2/2 hot water

tx: surgical evaluation, debridement

heal 14-21 days, no scar

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16
Q

deep partial thickness burn

Caused by:

A

hot liquids, steam, grease and flames

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17
Q

deep partial thickness burn Treatment:

A

Surgical evaluation MUST be provided, debridement and grafting are likely

heal with scar

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18
Q

Full Thickness burn

A

Entire thickness of the skin- All epidermal and dermal layers, and their structure are GONE

Description: Charred, pale, insensate (painless) and leathery

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19
Q

Full Thickness burn Caused by:

A

flames, hot oil, steam

20
Q

Full Thickness burn Treatment:

A

Surgery, grafting guaranteed!

Specialized burn unit

significant scarring, prolonged healing time

21
Q

Fourth Degree: Full thickness+

A

deeper than full thickness burns…extending into and through the subcutaneous fat, muscle and bone

life threatening and require reconsturciotn and amputation

22
Q

Burn Unit Referral Criteria (9)

A
  1. Third Degree Burns (any age)
  2. Electrical Burns
  3. Chemical Burns

  4. Inhalation Injury

  5. Preexisting medical disorders
  6. Burn injury + trauma
  7. Children in hospitals w/o qualified personnel or equipment to care for children

  8. Patients who will require special social, emotional, or long-term rehabilitative intervention
  9. Burn injury in children < 10 y/o and adults > 50 y/o
23
Q

tx of moderate burn

A

hospitalization

24
Q

tx of minor burn

A

out patient

25
Q

causes of inhalation injury

A

closed space fire
incapacitation
exposure to smoke (particulates, heat, toxic gasses, unknown)

26
Q

smoke and inhalation injury

A

particulate matter

formed from incomplete combustion of organic substance

ignite inflammatory response and edema

27
Q

toxic inhalation list

A
  1. toxic asphyxiants
  2. pulmonary irritants
  3. systemic
28
Q

types of toxic asphyxiants (2)

A
  1. carbon monoxide

2. hydrogen cyanide

29
Q

CO

A

causing CNS hypoxia and coma

reduces airway protective measures = aspiration

give oxygen to tx

30
Q

HCN

A

wool, silk, polyurethane and vinyl

binds and disrupts mitochondrial ox phos

tx: hydroxycobalamin, amyl nitrate, sodium thiosulfate

31
Q

inhalation injury patho

A
  1. damage to endothelial cells = mucosal edema and decreased alveolar surfactant
  2. bronchospasm and airway obstruction
  3. epithelial sloughing and edema
32
Q

labs for inhaled pt

A

ABG/VBG and Carboxygemaglobin levels

33
Q

who do you intubate? (inhalation injury)

A

full thickness burns to face/perioral region

circumferential neck burn

ARDS

progressive horness/signs fo distress

respiratory depression or AMS

supreaglottic edema and inflammation

34
Q

pre-hopsital management

A

done by EMS

est. airway
transport pt promptly

remove burning clothes/jewelry

100% humidified oxygen

35
Q

ED management

must review

A

AMPLE

allergies
medications
pertinent hx
last oral intake 
events leading to injury
36
Q

during which survey do you classify burn

A

during secondary survey

may need NG tube, urinary Cath

37
Q

diagnostics always done

A

XRAY (chest)
ABG/VBG
COHgB
UA

38
Q

tx for inhalation injury

A

100% humidified Oxygen

intubation/ventilation

bronchodilators and pulmonary toiling

burn shock rescuitation formulate

39
Q

what resuscitation formula do we use??

A

parkland – universal standard

40
Q

Parkland formula

A

24 hr fluid requirement = %TBSA burned x Weight in Kg x 4 mL

41
Q

ABX and burn

A

NO systemic ANTIBIOTIC Prophylaxis

for a minor burn, we can do topical

42
Q

pain management in burn

A

tx symptoms directly with drugs

burns are painful – makes surrounding tissue more painful too (Hyperalgesia)

43
Q

preferred route of pain management

A

IV/IO 2/2 onset of medication action AND poor GI absorption in PO

44
Q

medications used in pain management

A

fentanyl/morphine/benadryl IV

Ativan, versed

NSAIDS

45
Q

prepping pt for transport

A

do NOT delay transfer

don’t need to deride, dissect wound

do not need to place stuff in wound since it will be reassessed

SU-18 ER (11 decks)

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