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X Emergency Med Exam 3 > Burns > Flashcards

Burns Flashcards

1
Q

Types of burns

A

Scalds, contact, thermal, radiation, chemical, electrical, friction

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2
Q

Risk factors for burns

A 
Inadequate or faulty electrical wiring
Lack of smoke detectors
Arson
Water heater temps set to high
Careless with cigs
Young kids and older adults
Workplace exposure
Substances altering mental status
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3
Q

Superficial burns (first degree)

A 
Epidermal layer
Red, painful, dry
Blanches with pressure
No blisters!
Heals within 7 days
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4
Q

Examples of superficial burns

A

Sunburn
Mild scalds
Mild electrical burn

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5
Q

Wound care for superficial burns

A 
Remove clothing and debris
Cool with water (room temp or slightly cooler-not longer than 5 mins)
Gentle cleansing
Topical calamine or aloe vera based gel
Topical polysporin
No dressing usually
OTC acetaminophen or NSAIDs if needed
Tetanus booster maybe
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6
Q

Partial thickness burns (2nd degree)

A

Partially extends into dermis

Minimal to severe scarring

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7
Q

Categories of partial thickness burns

A

Superficial (pink/moist/blisters, pain, heal in 7-21 days)

Deep (pale pink to white, decreased cap refill, pain with pressure or none, heal in 3-12 wks)

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8
Q

Management for all partial thickness burns

A

Keep moist and debride wound (re-epithelitalization-see red little new cells)
Dressing changes 1-2x daily (opioids maybe)
Wash wound with each dressing change with mild soap and water
Tetanus booster

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9
Q

Management of superficial partial thickness burn

A

Petroleum based moisturizer or bacitracin

Occlusive dressing like Xeroform

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10
Q

Management of deep partial thickness burn

A

Same as superficial unless eschar present

If eschar, silver sulfadiazine cream on 4x4 covered with roll gauze

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11
Q

Full thickness burn (3rd degree)

A

Epidermis and full thickness dermis (skin charring)
Hard, leathery and painless
(flame burn)
Will not heal well spontaneously (surgical repair and skin grafting)

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12
Q

Management of full thickness burn

A 
Wash with mild soap and water
Debride wound
Silver sulfadiazine cream
Change dressing twice daily
Opioids
Tetanus booster
f/u
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13
Q

Beyond full thickness burn (4th degree)

A

Involvement of muscle, tendon, bone, blood vessel or nerve

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14
Q

When to refer with a burn

A

Partial thickness >10% TBSA
3rd degree burn any age
Burns involving face, hands, feet, genitalia, perineum or major joints
Electrical burns (lightning)
Chemical burns
Inhalation injury
Burn in pt with preexisting medical disorders that might complicate management etc
Burn and concomitant trauma
Kids in hospital without qualification for care
Burn in pt needing social/emotional/rehab

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15
Q

When should you intubate in a burn injury?

A

History suggests airway compromise (closed space smoke exposure, carbonaceous sputum, facial burns, COHb>5, hoarse voice, singed facial hair)
Pt unable to protect airway (trauma, opioids)

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16
Q

Number one cause of death related to fires

A

Smoke inhalation

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17
Q

Why to intubate early with burns?

A

Airway and facial edema happen quickly

So don’t have to wait for difficult airway

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18
Q

1 cause of most prehospital deaths

A

Carbon monoxide (takes half life to 15-30 min in hyperbaric chamber)

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19
Q

What to check with CO poisoning

A

Pulse ox not reliable
Carboxyhemoglobin levels
Delayed neurologic sequelae (symptomatic initial clinical picture, elderly pts, prolonged exposure)

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20
Q

Sxs of cyanide poisoning

A

HA to AMS
Hypotension, arrhythmia, CV collapse
Shock

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21
Q

Preferred tx for CN toxicity

A

Hydroxocobalamin

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22
Q

What is hydroxocobalamin?

A

Heme like molecule with complex cobalt so binds to CN to make cyanocobalamin and make renal excretion

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23
Q

Upper airway sxs of inhalation

A

Hoarseness
Stridor
Substernal rxns

24
Q

Lower airway sxs of inhalation

A

Tachypnea
Decreased breath sounds
Wheezing, rales, rhonchi
Accessory muscles

25
Treatments for inhalation
Mechanical ventilation (intubate) Aggressive pulmonary toilet (proper coughing) Supplemental nutrition Pneumonia prevention and tx
26
Management algorithm for burns
2 large bore IVs (unburned skin) Calculate total body surface area If >20% TBSA, Parkland Resuscitation
27
Rule of nines in adult for TBSA
``` Head is 9 Chest 18 Back 18 Each leg is 18 Each arm is 9 Groin is 1 ```
28
Rule of nines in kid for TBSA
``` Head is 18 Chest 18 Back 18 Each leg is 13.5 Each arm is 9 ```
29
Goals of circulation resuscitation
Maintain tissue perfusion to end organs Foley cath Urinary output (adults .5ml, kids 1 ml, electrical burns 1-2 ml) Diuretics not in acute setting!!
30
Parkland formula for resuscitation
Burns >20% TBSA: 4 ml lactated ringers x kg x TBSA=24 hr post burn total Half is given in first 8 hrs Rest given in next 16 hrs
31
What might affect the amount of fluids needed?
``` Burn depth Inhalation injury (increases need) Delay in resuscitation Compartment syndrome Electrical burns ```
32
What can happen with under resuscitation?
Intravascular vol depletion (hemoconcentration) | Suboptimal tissue perfusion (end organ failure, death)
33
What can happen with over resuscitation?
Resuscitation morbidity Abd compartment syndrome (renal failure from decreased BF, intestinal ischemia, obstruction) Compartment syndrome Pulmonary edema
34
Presentation of abd compartment syndrome
Decreased urine output Elevated bladder pressure (>25 mmHg) Increased peak expiratory pressure Poor ventilation
35
What to monitor with abd compartment syndrome
Hourly bladder pressures Decrease IV fluids Continuous renal replacement therapy if need Intraperitoneal cath to decompress
36
What to do if cannot reverse abd compartment syndrome
Decompressive laparotomy
37
Complications of burns
Tetanus
38
When is there a more severe clinical course with tetanus?
Symptomatic in first week
39
Sxs of tetanus
Maybe sore throat with dysphasia Localized: 1 limb or area of body near wound Generalized: trismus aka lockjaw Then muscle rigidity, descending pattern from jaw and facial muscles and within 48 hrs, goes to extensor muscles Temp, sweating, elevated BP, rapid heart rate, neck rigid, restless ness, reflex spasms
40
Vaccines for tetanus prophylaxis
``` Tetanous toxoid (Td, Tdap, DT, DTaP) Every 10 yrs ```
41
Wounds prone to tetanus
``` Present longer than 6 hrs >1 cm wound deep Grossly contminated Exposed to saliva or feces Avulsions, punctures, crush Burns ```
42
Tetanus immunization schedule
DTaP: 2 mo, 4 mo, 6 mo, 15-18 mo, 4-6 yrs Adults: sub Tdap once (Td booster every 10 yrs)
43
Pain control of burns
IV opioids and transition to oral ASAP (not IM!)
44
Tx for chemical burns
Copious irrigation with water (do not neutralize, litmus paper)
45
Management of electrical burns
Monitor for cardiac abnorms Injuries may be worse than appear Risk of rhabdo Fluid resuscitate small injuries
46
What burns are at high risk for compartment syndrome?
Circumferential (6 ps- pain, paresthesia, pallor, paralysis, poikilothermia, pulselessness)
47
Procedures for circumferential burns
Escharotomy (through burned skin to underlying subQ tissue) | Fasciotomy (incision through fascia overlying muscle compartment of extremity)
48
What is used for pts with circumferential torso burns?
Shield escharotomy to improve ventilation
49
Definitive coverage for burns
Autografts (pts own skin)-but needs donor site and very painful
50
When to use skin grafting?
Large or deep burn wounds
51
Tx for infection with burns
Wounds colonized in 3-5 days (gram +-s aureus) | Fever, edema, erythema, increased pain
52
Types of nutritional support
Enteral (reduces burn related increase in secretion of catabolic hormones) Duodenal (better than gastric) TPN (not recommended!!) High carb, low fat diets (improve lean body mass, may reduce infection)
53
Chronic complications of burns
Chronic ulceration Scar contractures Hypertrophic scarring
54
Chronic ulcerations
Grafted skin lacks many support structures of normal tissue Can get chronic non healing ulcers in grafted burns Can be open for yrs Major concern developing of Marjolin ulcer
55
Keloid scars
Overgrowth of scar tissue Beyond area of injury!!! Raised and thick
56
Hypertrophic scars
Thick, raised red (not as thick as keloid ten) | Doesn't extend beyond original injury
57
Scar contractures
Connective tissue replaced with fibrotic tissue | Decreased ROM leads to shortening of muscle

X Emergency Med Exam 3 (5 decks)

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