Burns Flashcards
types of thermal burns
- scald
- flame
- flash
- contact
severity of scald burns depend on:
– Time and Temperature.
– Nature of Substance (eg Steam,
Hot Water, Hot Oils).
– Depth and Extent of burn.
what types of burns require reporting
symmetrical burns– indicative of abuse in children
1st, 2nd, 3rd and 4th degree burns
- superficial burns. paiful and red but no blistering
- partial thickness; epidermis and dermis affected, blistering seen
- full thickness, significant scarrin, probably doesn’t really hurt at this point because nerves are dead
- burn involveing underlying muscle and bone.
3rd and 4th often requires skin graft
T/F; scarring and blistering happens in first degree burn.
false.
• Inflammation only.
– Red, little swelling, NO blisters.
– Painful. • Healing:
– Within 2-5 days.
– No scar. No permanent pigment changes.
examples of first degree burn
sunburn, short flash fire
burn degree
SECOND DEGREE BURNS
• All of epidermis and into papillary dermis; some retepegs spared.
– Pink/red, moist, moderate
swelling, blisters. – Painful.
• Healing:
– Within 7-10 days without scarring.
• Example:
– Some scald burns
two types of second degree burns
- superficial
- deep
superficial vs deep thickness burns of the second degree
superficial: all of epidermis and into the papillary dermis
deep: all of epidermis and into reticulard dermis. takes longer to heal and may need grafting. will often result in hypertrophic scarring.
burn degree
third degree– full thickness
- all of the epidermis and dermis and into the subcutaneous tissue
- white or black, charred and leathery, doesn’t blanch and isn’t painful because nerve damage
- healing: long time to heal; by secondary healing if at all
- example: flame burns, electrical burns.
explain the rule of nines
method of burn assessment for calculating total body surface area in adults.
head = 9%
chest/abdomen = 18%
back = 18%
upper extremities = 9+9
legs = 18 + 18
genitals = 1
which chart to use for burn assessment in children
lund and browder chart
cause of the systemic effects of burns
seen in major burns
- due to inflammatory mediators: histamine, prostaglandins, cytokines
- effects on non-burned tissue
- fluid leaks from intravascular space
physiology behind burn shock
open burn wounds causes fluid loss and decreased cardiac output.
burn shock has effects on multiple organ systems:
– Decreased cardiac output. – Increased systemic vascular resistance. – Decreased numbers of RBCs. – Impaired host defense. – Decreased perfusion of kidneys. – Decreased perfusion of gut – ileus.
3 mechanisms of inhalation injury
- carbon monoxide poisoning
- direct heat injury to upper airway/ hot air inhalation
- chemical injury to lower airways.
often due to fire in enclosed space or loss of consciousness
CO inhalation causes the O2-Hb dissociation curve to go to the ___
right.
CO has much greater affinity for Hb than does O2. this deprives tissues of O2.
treatment for CO poisoning
100% oxygen or hypervaric O2
if you suspect a smoke inhalation injury, you should order a :
bronchoscopy
- look for mucosal inflammation, subglottic edema, carbonaceous particles
therapy: clears the soot from the lower airways
indications of an inhalation injury
- hoarsness
- soot on face
- being unconscious in burning area
- soot in sputum
- singed facial hair
- face and neck burns
- redness and swelling of the oropharynx
first thing you should do when someone is presenting with major burns and what do you monitor?
RESUSCITATION with ringers lactate and maybe a colloid (large molecule substances) like albumin or dextran
- monitor: urine output, mental status, capillary refill, temperature of extremities
- electrolytes, base deficit, serum lactate
- intensive hemodynamic monitoring
what degree burns require escharotiomies
3rd
purpose of escharotomies
life and limb saving– presents constriction of skin which would result in deformities/loss of function/circulation cut off– preventing comparment syndrome to allow muscles to breathe/ prevent ischemia
occurs in 3rd degree
wound care
- stop burning process and cover with warm blanket
- in ED, cover with warm saline-gauze
- after complete assessment, due burn dressings
- possible topical antimicrobials - gentle debridement and cleaning of wount.
- splinting of extremities
T/F when someone presents with burns we should use systemic antibiotics to prevent infection since theres a lot of open skin
false. use topical antimicrobials to prevent colonization, but Abx is unnecesary
examples of topical antimicrobials
silver sulfadiazine/silver dressing
- polysporin
- mupriocin/bactroban
leading cause of death post resuscitation phase
sepsis.
often in larger burns in under 16 or over 60.
what kind of nutrition should be given in burns
high protein and high calorie!
burns cause significant ___ and ___ response until healed and often for many months after.
- nutritional support is key to reducing morbiidity and mortality in burn patients (ex/ stress ulvers, ileus, infection/sepsis would/graft complications)
burns cause significant hypermetabolic and hypercatabolic response until healed and often for many months after.
outline the process of operative treatment for <20 and >20% TBSA
for burns <20%; usually decide between 7-10 days if it will heal before 3 weeks. usually able to do in one operation
for larger burns: earlier debridgement and grafting decreases mortality, infection, hospital stay, and complications. THEY WILL PROBABLY NEED MULTIPLE OPERATIONS
purpose of tangential excision
using a shave razor to debride to healthy tissue – the healthy tissue is most likely to accept the graft (in deep 2nd or 3rd degree burns)
a split thickness graft has all of the ___ layer nad a portion of the __- layer
a split thickness graft has all of the EPIDERMIS layer nad a portion of the DERMIS layer
what are contractures and when do they form
a healing process when the muscles and ligaments get constricted and lose their function. contractures develop slowly during the process of scar contraction/maturation
