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X Emergency Med Exam 3 > Burns > Flashcards

Burns Flashcards

You may prefer our related Brainscape-certified flashcards:
Royal College: Emergency Medicine 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
Q

Treatments for inhalation

A

Mechanical ventilation (intubate)
Aggressive pulmonary toilet (proper coughing)
Supplemental nutrition
Pneumonia prevention and tx

26
Q

Management algorithm for burns

A

2 large bore IVs (unburned skin)
Calculate total body surface area
If >20% TBSA, Parkland Resuscitation

27
Q

Rule of nines in adult for TBSA

A 
Head is 9
Chest 18
Back 18
Each leg is 18
Each arm is 9
Groin is 1
28
Q

Rule of nines in kid for TBSA

A 
Head is 18
Chest 18
Back 18
Each leg is 13.5
Each arm is 9
29
Q

Goals of circulation resuscitation

A

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
Q

Parkland formula for resuscitation

A

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
Q

What might affect the amount of fluids needed?

A 
Burn depth
Inhalation injury (increases need)
Delay in resuscitation
Compartment syndrome
Electrical burns
32
Q

What can happen with under resuscitation?

A

Intravascular vol depletion (hemoconcentration)

Suboptimal tissue perfusion (end organ failure, death)

33
Q

What can happen with over resuscitation?

A

Resuscitation morbidity
Abd compartment syndrome (renal failure from decreased BF, intestinal ischemia, obstruction)
Compartment syndrome
Pulmonary edema

34
Q

Presentation of abd compartment syndrome

A

Decreased urine output
Elevated bladder pressure (>25 mmHg)
Increased peak expiratory pressure
Poor ventilation

35
Q

What to monitor with abd compartment syndrome

A

Hourly bladder pressures
Decrease IV fluids
Continuous renal replacement therapy if need
Intraperitoneal cath to decompress

36
Q

What to do if cannot reverse abd compartment syndrome

A

Decompressive laparotomy

37
Q

Complications of burns

A

Tetanus

38
Q

When is there a more severe clinical course with tetanus?

A

Symptomatic in first week

39
Q

Sxs of tetanus

A

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
Q

Vaccines for tetanus prophylaxis

A 
Tetanous toxoid (Td, Tdap, DT, DTaP)
Every 10 yrs
41
Q

Wounds prone to tetanus

A 
Present longer than 6 hrs
>1 cm wound deep
Grossly contminated
Exposed to saliva or feces
Avulsions, punctures, crush
Burns
42
Q

Tetanus immunization schedule

A

DTaP: 2 mo, 4 mo, 6 mo, 15-18 mo, 4-6 yrs
Adults: sub Tdap once (Td booster every 10 yrs)

43
Q

Pain control of burns

A

IV opioids and transition to oral ASAP (not IM!)

44
Q

Tx for chemical burns

A

Copious irrigation with water (do not neutralize, litmus paper)

45
Q

Management of electrical burns

A

Monitor for cardiac abnorms
Injuries may be worse than appear
Risk of rhabdo
Fluid resuscitate small injuries

46
Q

What burns are at high risk for compartment syndrome?

A

Circumferential (6 ps- pain, paresthesia, pallor, paralysis, poikilothermia, pulselessness)

47
Q

Procedures for circumferential burns

A

Escharotomy (through burned skin to underlying subQ tissue)

Fasciotomy (incision through fascia overlying muscle compartment of extremity)

48
Q

What is used for pts with circumferential torso burns?

A

Shield escharotomy to improve ventilation

49
Q

Definitive coverage for burns

A

Autografts (pts own skin)-but needs donor site and very painful

50
Q

When to use skin grafting?

A

Large or deep burn wounds

51
Q

Tx for infection with burns

A

Wounds colonized in 3-5 days (gram +-s aureus)

Fever, edema, erythema, increased pain

52
Q

Types of nutritional support

A

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
Q

Chronic complications of burns

A

Chronic ulceration
Scar contractures
Hypertrophic scarring

54
Q

Chronic ulcerations

A

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
Q

Keloid scars

A

Overgrowth of scar tissue
Beyond area of injury!!!
Raised and thick

56
Q

Hypertrophic scars

A

Thick, raised red (not as thick as keloid ten)

Doesn’t extend beyond original injury

57
Q

Scar contractures

A

Connective tissue replaced with fibrotic tissue

Decreased ROM leads to shortening of muscle

X Emergency Med Exam 3 (5 decks)

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