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Trauma/Critical Care > Burns > Flashcards

Burns Flashcards

1
Q

First 3 priorities in acute management of burns?

A

1) Stop the burning process
2) Establish airway access
3) IV access

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2
Q

4 things that increase risk of upper airway obstruction?

A

1) increasing burn size and depth
2) inhalation injury
3) burns inside the mouth
4) burns to the head and face

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3
Q

When in doubt?

A

intubate, if you wait for stridor, its too late

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4
Q

How do you stop the burning process?

A

Remove all clothing and jewelery, take care removing synthetics

Never take off without putting back on, apply dry linens afterwards to prevent hypothermia

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5
Q

Who gets fluid resuscitation?

A

Any patient with > 20%TBSA

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6
Q

Details of IV access?

A
  • at least 2, 16 gauge

- if needed, place them through burned skin, upper extremity better than lower

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7
Q

How to estimate burn size? (babies too)

A

-Rule of nines

  • head is 9
  • entire arm is 9
  • front torso 18
  • back torso 18
  • entire leg is 18

-babies (head 9, entire arm 9, front 18, buttcheek 2.5, entire leg 14)

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8
Q

Definition of first degree burns (superficial)?

A
  • Erythema, pain, absence of blisters

- Ex sunburn, do not require IVF, do not factor into TBSA calculation for IVF

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9
Q

Definition of partial-thickness burns?

A
  • Red or mottled appearance with swelling and blister formation
  • painfully hypersensitive, even to wind
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10
Q

Definition of full-thickness burns?

A
  • usually appear dark and mottled, or traslucent or waxy white
  • painless
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11
Q

What are the three main breathing issues and how to reverse them?

A

-Reverse all three with O2 mainly

  • hypoxia
  • CO poisoning, frequently missed
  • inhalation injury, due to smoke or gasses
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12
Q

Details of CO poisoning?

A
  • half life 4hrs with room air, 40min when breating 100% O2

- requires > 20% carboxyhemoglobin to have symptoms

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13
Q

Adjuncts to your assessment in Breathing or Respirations, in the A/B/C, MARCH pathway?

A
  • CXR

- VBG/ABG

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14
Q

What is the rate and type of fluid administered to patients with burns?

A

-Rule of 10s

  • Estimate burn size to the nearest 10%.
  • Multiply %TBSAx10 = Initial fluid rate in mL/hr (for adult patients weighing 40 kg to 80 kg).
  • For every 10 kg above 80 kg, increase the rate by 100 mL/hr

-Ringers lactate(or other crystalloid)

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15
Q

What it your IVF resuscitation goal?

A

-maintaining UOP of 0.5mL/kg/hr for adults and 1ml/kg/hr for children

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16
Q

When would you move on to the secondary survey?

A

AFTER MARCH, burning process stopped, airway maintined, IV access obtained and fluids started

17
Q

What are two large priorities on repeat exams after initial assessment and treatment?

A

1) follow up on UOP and adjust IVF accordingly
2) watch out for compartment syndrome, maintain peripheral circulation
* *remove ALL jewelery or bands on pt extremities**

18
Q

What to worry about in a circumferential burn?

A

-increased pressure to muscle, lungs, circulature

19
Q

When to do escharatomy?

A
  • when relief of circulatory compromise needed

* not usually needed within first 6 hours of burn

20
Q

What injuries are higher risk for needed fasciotomies?

A
  • skeletal injuries
  • crush injuries
  • lightening/electricity injuries
  • burns underneath fascia
21
Q

What tubes do you place in burn patients?

A

-like most trauma pts, nearly all holes get tubed

  • foley catheter
  • 2 PIVs
  • endotracheal tube
  • gastric tube if TBSA >20%, especially if nauseous or vomiting
22
Q

Aspects of topical care of the partial thickness burn?

A

Just cover it with clean sheets/non-adherent dressings

Dont

  • baste it in antiseptics
  • break blisters
  • apply cold compresses (can cause hypothermia)
  • apply cold water
23
Q

What about antibiotic use for prophylaxis in burns?

A

There is NO indication for prophylactic abx in early post-burn period

Should be reserved for treatment of infection

24
Q

What immunization should be administered if not up to date?

A

tetanus immunization! so know the status of all your deploying soldiers beforehand

25
Q

What to do about chemical burn?

A
  • irrigate with COPIOUS amounts of water

- do NOT apply neutralizing agent, causes more harm

26
Q

What to watch out for early in electrical burns/injuries?

A
  • cardiac arrythmias, ECG monitoring ideal

- fasciotomies often needed

Trauma/Critical Care (4 decks)

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