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Special Topics 1 > Burns A&B > Flashcards

Burns A&B Flashcards

1
Q

1 pediatric burn type

A

Scalding

In kitchen or bathroom

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2
Q

Depth of burn may not be observable

A

For 3-5 days

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3
Q

Burn depth assessment

A 
Cause
Appearance
Sensation
Blanching
Hair follicle viability
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4
Q

Burn depth classification

A

Superficial
Superficial partial thickness
Deep partial thickness
Full thickness

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5
Q

Superficial (1st degree) burn

A

Damage of epidermis
Dry, red, blanches
Painful
Resolves in 3-6 days w/out scarring

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6
Q

Superficial partial thickness (superficial 2nd degree) burn

A 
Damage into papillary dermis
Blisters
Moist, red, weeping, blanches
Sever pain to touch 
Resolves in 1-3 weeks
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7
Q

Deep partial thickness (deep 2nd) burn

A

Damage into reticular dermis, most skin appendages destroyed
Blisters
Wet or dry waxy w/ poor blanching
Decreased sensation to light touch but intact to deep pressure
Usually scars, likely to need surgical incision and possibly grafting

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8
Q

Full thickness (3rd degree) burn

A 
Damage into subcutaneous tissue
Waxy white to leathery dry and inelastic
Does not blanch
Absent sensation to light pressure, intact to deep pressure
Will need sx excision and grafting
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9
Q

Fourth degree burn

A

Damage into fascia, muscle and/or bone
Usually eschar
Pain w/ deep pressure
Will need sx

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10
Q

%TBSA - burns

A

% total body surface area
Rule of nines
Lund browder-more accurate

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11
Q

Burns - rule of nines

A

Based on an atomic region
Burn area is calculated to estimate the exten of injury and prognosis
Superficial burns are not included in calculation
Less accurate for children

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12
Q

Burn classification by TBSA - minor

A

2nd degree 15% in adult
2nd degree 10% in child
3rd deg 2%

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13
Q

Burn classification by TBSA - moderate

A

2nd degree 15-30% in adult
2nd degree 10-30% in child
3rd deg 2-10%

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14
Q

Burn classification by TBSA - major

A 
Critical 
2nd degree >30% in adult
3rd degree >10% 
Burn complicated by inhalation injury 
Electrical burn
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15
Q

Burns -critical area

A 
Face
Hands
Feet
Genitalia
Perineum
Joints
Ears/eyes
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16
Q

Thermal burns

A

Flame
Scald
Radiation

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17
Q

Chemical burns - effects

A

Tissue damage may continue until chemical is inactivated
May become flammable, causing additional thermal burns
Often full thickness

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18
Q

Chemical burns - first aid

A

Usually copious irrigation
Phenols are irrigated w/ polyethylene glycol
Keep victim warm/calm, monitor vitals often
Monitor vitals frequently

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19
Q

Electrical burns can cause

A 
Cardiac arrhythmia
Respiratory arrest
LOC
Seizures
Tetany of skeletal muscles
More severe in extremities
May cause CRPS/other NS disorders
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20
Q

Burn like conditions

A

Stevens-Jonson syndrome - Toxic epidermal necrolysis syndrome: variants of same condition

Other exfoliating skin conditions
Frostbite

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21
Q

SJS/TEN

A 
Reaction to medication, 1-3 weeks after starting
Fever—>sore throat, HA, couch
Rash begins, progress to blisters
Diffuse skin necrosis and detachment
Skin exfoliation
Mucous membrane Bullae and sores
May cause sepsis and death
1-14 days active skin rash and skin loss
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22
Q

Burns and hemodynamics-injury

A 
Histamine release
Capillary permeability increase
Plasma protein leak out, pulled out
Hypovalemia 
Decreased BP
Vasoconstriction and increased HR
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23
Q

Burns - respiratory

A

Smoke inhalation
Damage to airways and lungs
CO inhalation —> blood, hypoxia, confusion, brain damage
24-48 hours to develop

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24
Q

Pt w/ central facial burns

A

Should be evaluated for hospital admission

25
Q

Burn - respiratory - neck or chest eschar

A

May cause restricted chest expansion

Eschar onto my or fasciotomy may be required

26
Q

Burns - respiration - Pulm edema

A

Fluid rescucitation may cause fluid overload
May be candidate for hyperbaric oxygen
Pt will be monitored in burn unit for respiratory changes during fluid rescuscitation

27
Q

Burns - renal

A

Urine output closely monitored, generally 30-50 ml/hr
Due to decrease in circulation and BP, kidney fix decrease in burn injury
Glomerular filtration rate decreases, then will return to normal w/ adequate fluid resuscitation

28
Q

Burns - renal failure

A 
Uncorrected burn shock
Hemorrhage
Electrolyte imbalance
Sepsis 
CHF
29
Q

Burns - GI

A

Fluid resuscitation
Early enteric nourishment w/ staged food intake
Mobility
Abx use alteration of bacterial flora in intestines

30
Q

Burns - metabolism

A

Burn trauma increases metabolic demands
Ketoacidosis
Rapid weight loss
Nutritional supplements, close nutritional monitoring to promote burn healing

31
Q

Most common cause of mortality in burn pts

A

Infection

32
Q

Key to preventing infection - burns

A

Isolate burn pts to reduce hospital aquifer infections
Staff wear protective garments
Sterile procedures

33
Q

Burn survival rate estimate - revised baux score

A

% mortality = pt age + %TBSA (+17 for inhalation injury)

34
Q

Burn tx

A 
Initial stabilization and triage
Med management
Local burn tx 
Moisture - tendons moist
Rehab
35
Q

Initial burn tx

A

Stabilize airway, breathing and circulation
-check of resp distress and evidence of smoke inhalation
Check carotid pulse
Eval depth and extent of burn injury
Remove all burned clothing and foreign material
Transfer to burn unit f needed
Appropriate abx dressing as needed

36
Q

Fluid resuscitation for burns

A

W/in 2 hours for burns >20% TBSA, use parkland or brooke formula

37
Q

Burn admission criteria

A

<10% TBSA
3rd degree, electrical, chemical
Inhalation
Will require social/emotional or long term rehab
Comorbidities that complicate management
W/ concomitant trauma
In children where pediatric care is not available

38
Q

Local burn tx

A 
Debridement if necrosis present
Appropriate dressings
Negative pressure wound therapy as needed
Biosynthetic dressings
Skin grafting
39
Q

Biobrane - pros

A 
Biosynthetic dressing
Non reactive
Readily available for burn centers
Less pain for pt
Spares skin grafts
40
Q

Biobrane cons

A

Very extensive

41
Q

SJS

A

<10% TBSA

Death rate 1-5%

42
Q

TEN

A 
>30% TBSA
Death rate 25% in adults
Large amount of fluid and electrolyte loss
Infection risk 
Possible organ failure
43
Q

Respiratory effects of hot air, hot steam

A

Larynx
Laryngeal obstructure
Bronchospasm

44
Q

Respiratory effects of smoke, hot particles, aspiration

A 
Trachea
Mucosal slough
Infection
Bronchiolar plugging
Atelectasis
Bronchospasm
45
Q

Respiratory effects of irritant gases

A

Primary and secondary bronchus
Pneumonia
Pulmonary edema
Alveolar capillary defect

46
Q

Common burn dressings

A 
Silver sulfadiazene w/ gauze or ab bands
Made idle acetate w/ gauze/ ab pads
Xeroform
Silver foam
Nanocrystalline silver
Silver hydrofiber
Hydrogel sheer dressings w/ or without silver
47
Q

Burn dressings w/ better outcomes than silver sulfadiazene

A

Silver
Biosynthetic
Silicone
Hydrogel dressings

48
Q

Features of non contracted group

A 
Male
Educationed
Few associated physcial, medical, social problems
Longer length of stay than expected
Received rehab 80% of hospital days
High pain tolerance
Compliant w/ rehab
49
Q

Splint position - neck

A

Netural/slight ext
No pillows unless burn on posterior of neck
Tilt head laterally to opposite side if burns are one side of neck
Neck conformers bust bein full contact w/ neck

50
Q

Splinting chest/ab

A

Trunk ext, shoulder retraction

Lower top of bed, towel roll beneath spine, clavicle staps

51
Q

Splinting - shoulder

A

Flexion/ab 90-100
Horizontal add 20,
ER

52
Q

Splinting elbow/forearm

A

Full ext, forearm neutral

53
Q

Splinting wrist/hand

A

Wrist ext 15-20 deg
MP flex 70-90,
PIP DIP full ext
Thumb radial ext, palmar ab

54
Q

Burn position - hip/thigh

A

0 flex
0 rotation
15-20 abd

Elevate w/ pillows
Pillows b/n knees
Wedges

55
Q

Burn position - knee

A

Full ext

Ant burn: slight flex

56
Q

Splinting ankle/foot

A

Neutral assignment b/n 90 or greater DF

AFO

57
Q

Burn rehab - acute

A

PROM/AROM daily
Exercises to unaffected area
Bed mobility, transfers, standing, gait
Consistent w/ therapy 1-2/day

Teach educate train

58
Q

Immobilize grafted areas

A

4-5 days, until takedown and receive order from surgeon

Get clear orders regarding mobility immediately after grafting

Special Topics 1 (12 decks)

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