Burns A&B Flashcards
1 pediatric burn type
Scalding
In kitchen or bathroom
Depth of burn may not be observable
For 3-5 days
Burn depth assessment
Cause Appearance Sensation Blanching Hair follicle viability
Burn depth classification
Superficial
Superficial partial thickness
Deep partial thickness
Full thickness
Superficial (1st degree) burn
Damage of epidermis
Dry, red, blanches
Painful
Resolves in 3-6 days w/out scarring
Superficial partial thickness (superficial 2nd degree) burn
Damage into papillary dermis Blisters Moist, red, weeping, blanches Sever pain to touch Resolves in 1-3 weeks
Deep partial thickness (deep 2nd) burn
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
Full thickness (3rd degree) burn
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
Fourth degree burn
Damage into fascia, muscle and/or bone
Usually eschar
Pain w/ deep pressure
Will need sx
%TBSA - burns
% total body surface area
Rule of nines
Lund browder-more accurate
Burns - rule of nines
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
Burn classification by TBSA - minor
2nd degree 15% in adult
2nd degree 10% in child
3rd deg 2%
Burn classification by TBSA - moderate
2nd degree 15-30% in adult
2nd degree 10-30% in child
3rd deg 2-10%
Burn classification by TBSA - major
Critical 2nd degree >30% in adult 3rd degree >10% Burn complicated by inhalation injury Electrical burn
Burns -critical area
Face Hands Feet Genitalia Perineum Joints Ears/eyes
Thermal burns
Flame
Scald
Radiation
Chemical burns - effects
Tissue damage may continue until chemical is inactivated
May become flammable, causing additional thermal burns
Often full thickness
Chemical burns - first aid
Usually copious irrigation
Phenols are irrigated w/ polyethylene glycol
Keep victim warm/calm, monitor vitals often
Monitor vitals frequently
Electrical burns can cause
Cardiac arrhythmia Respiratory arrest LOC Seizures Tetany of skeletal muscles More severe in extremities May cause CRPS/other NS disorders
Burn like conditions
Stevens-Jonson syndrome - Toxic epidermal necrolysis syndrome: variants of same condition
Other exfoliating skin conditions
Frostbite
SJS/TEN
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
Burns and hemodynamics-injury
Histamine release Capillary permeability increase Plasma protein leak out, pulled out Hypovalemia Decreased BP Vasoconstriction and increased HR
Burns - respiratory
Smoke inhalation
Damage to airways and lungs
CO inhalation —> blood, hypoxia, confusion, brain damage
24-48 hours to develop
Pt w/ central facial burns
Should be evaluated for hospital admission
Burn - respiratory - neck or chest eschar
May cause restricted chest expansion
Eschar onto my or fasciotomy may be required
Burns - respiration - Pulm edema
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
Burns - renal
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
Burns - renal failure
Uncorrected burn shock Hemorrhage Electrolyte imbalance Sepsis CHF
Burns - GI
Fluid resuscitation
Early enteric nourishment w/ staged food intake
Mobility
Abx use alteration of bacterial flora in intestines
Burns - metabolism
Burn trauma increases metabolic demands
Ketoacidosis
Rapid weight loss
Nutritional supplements, close nutritional monitoring to promote burn healing
Most common cause of mortality in burn pts
Infection
Key to preventing infection - burns
Isolate burn pts to reduce hospital aquifer infections
Staff wear protective garments
Sterile procedures
Burn survival rate estimate - revised baux score
% mortality = pt age + %TBSA (+17 for inhalation injury)
Burn tx
Initial stabilization and triage Med management Local burn tx Moisture - tendons moist Rehab
Initial burn tx
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
Fluid resuscitation for burns
W/in 2 hours for burns >20% TBSA, use parkland or brooke formula
Burn admission criteria
<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
Local burn tx
Debridement if necrosis present Appropriate dressings Negative pressure wound therapy as needed Biosynthetic dressings Skin grafting
Biobrane - pros
Biosynthetic dressing Non reactive Readily available for burn centers Less pain for pt Spares skin grafts
Biobrane cons
Very extensive
SJS
<10% TBSA
Death rate 1-5%
TEN
>30% TBSA Death rate 25% in adults Large amount of fluid and electrolyte loss Infection risk Possible organ failure
Respiratory effects of hot air, hot steam
Larynx
Laryngeal obstructure
Bronchospasm
Respiratory effects of smoke, hot particles, aspiration
Trachea Mucosal slough Infection Bronchiolar plugging Atelectasis Bronchospasm
Respiratory effects of irritant gases
Primary and secondary bronchus
Pneumonia
Pulmonary edema
Alveolar capillary defect
Common burn dressings
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
Burn dressings w/ better outcomes than silver sulfadiazene
Silver
Biosynthetic
Silicone
Hydrogel dressings
Features of non contracted group
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
Splint position - neck
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
Splinting chest/ab
Trunk ext, shoulder retraction
Lower top of bed, towel roll beneath spine, clavicle staps
Splinting - shoulder
Flexion/ab 90-100
Horizontal add 20,
ER
Splinting elbow/forearm
Full ext, forearm neutral
Splinting wrist/hand
Wrist ext 15-20 deg
MP flex 70-90,
PIP DIP full ext
Thumb radial ext, palmar ab
Burn position - hip/thigh
0 flex
0 rotation
15-20 abd
Elevate w/ pillows
Pillows b/n knees
Wedges
Burn position - knee
Full ext
Ant burn: slight flex
Splinting ankle/foot
Neutral assignment b/n 90 or greater DF
AFO
Burn rehab - acute
PROM/AROM daily
Exercises to unaffected area
Bed mobility, transfers, standing, gait
Consistent w/ therapy 1-2/day
Teach educate train
Immobilize grafted areas
4-5 days, until takedown and receive order from surgeon
Get clear orders regarding mobility immediately after grafting
