Burns Flashcards
epidemiology of burns
69% male
chuldren <5yr old - 20%
seniors >60yr old - 12%
most occur at home
etiology of thermal burns
scald
flame
flash
contact
etiology of other burns
electrical
chemical
less common than thermal
severity of scald burn depends on:
length of contact and temperature
nature of substance (steam, hot water, hot oils)
depth and extent of burn
what may indicate a non-accidental burn in pediatrics
symmetrical burns
cigarette burns
mandatory to report
burn severity assessment with depth
superficial - 1st degree
partial thickness -2nd degree
full thickness - 3rd degree (epi, dermis, subcut fat)
underlying muscle and bone - 4th degree
don’t underestimate depth
signs of superficial burn
only inflammation
no blisters
heal within 2-5days
no scar/pigment changes
signs of superficial partial thickness
all of epidermis and into paillary dermis
pink/red, moist, swelling, blisters
7-10 days w/o significant scarring
e.g. scald burns
signs of deep partial thickness
all of epidermis and into reticular dermis
red to white, blistered, moist, moderate swelling
painful
longer than 14 days to heal
hypertrophic scarring
signs of full thickness burns
all of epidermis and dermis and into subcut tissue white or black, charred, leathery does not blanch NOT painful long time to heal by secondary healing e.g. flame burns, electrical burns
how to calculate total body surface area (TBSA) in adults
rule of nines head: 9 chest/abd: 18 back: 18 arms: 9+9 legs: 18+18 genitals: 1 caution over-estimating TBSA
how to calculate total body surface area (TBSA) in children
Lund & Browder chart
local effects of burns
barrier to evaporation lost
increased cellular vascular permeability in area of burn
zones of thermal injury
zone of coagulation (necrosis)
zone of stasis (alive, microvascular damage, can convert to necrosis)
zone of hyperemia (inflammation)
systemic effects of major burns
inflammatory mediators (histamine, prostaglandins, cytokines) causes fluid leaks from intravascular space
physiology of burn shock
fluid loss and decreased cardiac output increased systemic vascular resitance decreased RBCs impaired host defense decreased perfusion of kidneys
what occurs after acute resuscitation
hypermetabolic and hypercatabolic response
impaired cellular and humoral immune response (no rejection of graft)
mechanism of inhalation injury
CO poisoning
direct heat injury (upper airway)
chemical injury (lower airways)
pathophysiology of CO poisoning
greater affinity for Hb than oxygen, oxygen deprivation
measure carboxyhemoglobin levels (ABGs)
presentation of smoke inhalation injury
face and neck burn singed facial hair soot in sputum redness and swelling of oropharynx increase mortality from burns
Tx for smoke inhalation
intubate immediately
Bronchoscopy: Dx
therapeutic: clear soot away from lower airways
guidelines for fluid resuscitation for burns
first 24h
Parkland formula
4cc/kg/%TBSA burn/day
1/2 first 8hrs, 1/2 next 16 hrs from time of burn
for children add isotonic maintenance fluids
first 10kg: 4cc/kg/hr
second 10kg: 2cc/kg/hr
after 20kg: 1cc/kg/hr
what to monitor during fluid resuscitation
urine output (0.5-1cc/kg/hr) mental status cap refill temp of extremities lytes, base deficit, serum lactate
what is escharotomy
checkerboard cuts to release tension on skin
wound care for burns
pre hospital: stop burning process, clean coverings, warm blanket
ED: warm saline-gauze, dressings, topical antimicrobials
add splint so no joint contractures occur
topical antimicrobials for burns
silver sulfadiazine
polymyxin B
mupirocin
silver dressings
describe sepsis in burns
leading cause of death post-resuscitation
larger burns
preexisting disease
nutrition requirements in burns
high protein, high calories
vitamins and minerals
monitor blood sugar, albumin
indications for debridement and skin grafting
deep partial thickness burns and full thickness burns
surgery is the ‘conservative’ treatment in severe burns
timing of operative burn treatment
<20% TBSA: decide bw 7-10 days if it will heal
burns >20%: within first week
describe complications with electrical burns
cardiac monitoring
compartment syndrome
myoglobinuria
can be unrecognized
