Burns Flashcards
larger mortality risk in
- large burn size
- older age/comorbid
- female
physiologic effect of thermal injury
- disruption of sodium/potassium pump
- depression of myocardial contractility
- increased SVR
- metabolic acidosis
ALSO increased H/H, secondary anemia, local tissue injury, release of substances
disruption of Na/K pump
direct damage to protein content of cell causes this to break down
intracellular influx of sodium and water
extracellular efflux of potassium
substances released
histamine kinin serotonin arachadonic acid free oxygen radicals
zones of burns
- coagulation
- stasis
- hyperemia
zone of coagulation
irreversible cellular death
vessels essentially destroyed
zone of stasis
tenuous state
stagnation of microcirculation
blockage of blood flow
zone of hyperemia
increased blood flow
generally spontaneous recovery = congestion
how to quantify size of burn
percentage of BSA using Rule of Nines
rule of nines
use palm of patient hand (1%)
head, arms (ea.) 4.5
torso, pelvis, legs (ea.) 9
genital is 1%
how do we classify burn depth?
according to surgical need
- superficial thickness
- partial thickness (superficial or deep)
- full thickness
superficial thickness burn
skin is red, painful, tender NO BLISTER
epidermis
tx: symptomatic, heal 7 days
leading cause of injury in fire patients
inhalation injury
partial thickness burn
epidermis + dermis
can be superficial or deep
superficial partial thickness burn
blistering of skin + sunburn
often 2/2 hot water
tx: surgical evaluation, debridement
heal 14-21 days, no scar
deep partial thickness burn
Caused by:
hot liquids, steam, grease and flames
deep partial thickness burn Treatment:
Surgical evaluation MUST be provided, debridement and grafting are likely
heal with scar
Full Thickness burn
Entire thickness of the skin- All epidermal and dermal layers, and their structure are GONE
Description: Charred, pale, insensate (painless) and leathery
Full Thickness burn Caused by:
flames, hot oil, steam
Full Thickness burn Treatment:
Surgery, grafting guaranteed!
Specialized burn unit
significant scarring, prolonged healing time
Fourth Degree: Full thickness+
deeper than full thickness burns…extending into and through the subcutaneous fat, muscle and bone
life threatening and require reconsturciotn and amputation
Burn Unit Referral Criteria (9)
- Third Degree Burns (any age)
- Electrical Burns
- Chemical Burns
- Inhalation Injury
- Preexisting medical disorders
- Burn injury + trauma
- Children in hospitals w/o qualified personnel or equipment to care for children
- Patients who will require special social, emotional, or long-term rehabilitative intervention
- Burn injury in children < 10 y/o and adults > 50 y/o
tx of moderate burn
hospitalization
tx of minor burn
out patient
causes of inhalation injury
closed space fire
incapacitation
exposure to smoke (particulates, heat, toxic gasses, unknown)
smoke and inhalation injury
particulate matter
formed from incomplete combustion of organic substance
ignite inflammatory response and edema
toxic inhalation list
- toxic asphyxiants
- pulmonary irritants
- systemic
types of toxic asphyxiants (2)
- carbon monoxide
2. hydrogen cyanide
CO
causing CNS hypoxia and coma
reduces airway protective measures = aspiration
give oxygen to tx
HCN
wool, silk, polyurethane and vinyl
binds and disrupts mitochondrial ox phos
tx: hydroxycobalamin, amyl nitrate, sodium thiosulfate
inhalation injury patho
- damage to endothelial cells = mucosal edema and decreased alveolar surfactant
- bronchospasm and airway obstruction
- epithelial sloughing and edema
labs for inhaled pt
ABG/VBG and Carboxygemaglobin levels
who do you intubate? (inhalation injury)
full thickness burns to face/perioral region
circumferential neck burn
ARDS
progressive horness/signs fo distress
respiratory depression or AMS
supreaglottic edema and inflammation
pre-hopsital management
done by EMS
est. airway
transport pt promptly
remove burning clothes/jewelry
100% humidified oxygen
ED management
must review
AMPLE
allergies medications pertinent hx last oral intake events leading to injury
during which survey do you classify burn
during secondary survey
may need NG tube, urinary Cath
diagnostics always done
XRAY (chest)
ABG/VBG
COHgB
UA
tx for inhalation injury
100% humidified Oxygen
intubation/ventilation
bronchodilators and pulmonary toiling
burn shock rescuitation formulate
what resuscitation formula do we use??
parkland – universal standard
Parkland formula
24 hr fluid requirement = %TBSA burned x Weight in Kg x 4 mL
ABX and burn
NO systemic ANTIBIOTIC Prophylaxis
for a minor burn, we can do topical
pain management in burn
tx symptoms directly with drugs
burns are painful – makes surrounding tissue more painful too (Hyperalgesia)
preferred route of pain management
IV/IO 2/2 onset of medication action AND poor GI absorption in PO
medications used in pain management
fentanyl/morphine/benadryl IV
Ativan, versed
NSAIDS
prepping pt for transport
do NOT delay transfer
don’t need to deride, dissect wound
do not need to place stuff in wound since it will be reassessed
