Burns and Inhalation Injuries

Question 1

What demographic is most likely to die of burn injuries?

Answer 1

Males 20-40 years old.

Question 2

What are the two layers of the skin?

Answer 2

The epidermis and the dermis.

Question 3

What is the epidermis?

Answer 3

The thinner outer layer providing protection from environment.

Question 4

What is the dermis?

Answer 4

The thicker inner layer of the skin providing sensory, sweat glands, oils, etc. Vasculature is here.

Question 5

What is the zone of coagulation?

Answer 5

Necrosis of skin; this is where irreversible cellular death occurs.
Proteins denature, things coagulate.

Question 6

What is the zone of stasis?

Answer 6

Surrounds the zone of coagulation. There is decreased blood flow due to inflammation and tissue injury; tissue will die if not corrected. Area of treatment.

Question 7

What is the zone of hyperemia?

Answer 7

Inflammatory mediators causing increased blood to this area. This sustains the least damage. Usually does well.

Question 8

What is a first degree burn?

Answer 8

Superficial burns. Minor tissue damage to epidermis. Most common in sunburns.
Skin is red/painful and dry. Will heal without scarring.

Question 9

What is a second degree burn -partial thickness?

Answer 9

Through the epidermis and in varying depths of dermis. Will heal without scarring as skin will heal/rejuvant. Skin will be red, painful, wet and blister.

Question 10

What is a second degree burn - full thickness?

Answer 10

Deeper into the dermis area, can be yellow/white, and will be dry. Pain level may not be appropriate given severity of burn.

Question 11

What is a third degree burn?

Answer 11

Full thickness. Causes damage to all layers of skin and subcutaneous tissue. There are no skin cells left, therefore there is no healing. Burn will scar, contract and limit mobility. Because nerve fibers are severed there is no pain/loss of sensation.
Denatured skin protein becomes hard, forms eschar tissue.

Question 12

What is a fourth degree burn?

Answer 12

Some texts classify these burns as destroying skin, plus bone, tissue, and tendons.

Question 13

How do severe burns cause hypotension?

Answer 13

Severe burns cause an increase in capillary permeability, causing intravascular proteins and fluid to move into interstitial space, which increases edema. Due to loss of volume (the greatest lost of intravascular fluid is within 8-12 hours) there is a decrease in cardiac output. This causes hypotension and end organ failure.

Question 14

What is the goal of burn resuscitation?

Answer 14

To restore or preserve tissue perfusion.

Question 15

What are types of burn injuries?

Answer 15

• Thermal
• Chemical
• Electrical
• Radiation

Question 16

How do contact thermal burns happen?

Answer 16

From prolonged contact, or short contact with an extremely hot object. These are common in industrial accidents or where a LOC occurred causing prolonged contact.

Question 17

What often results from flame contact thermal burns?

Answer 17

Often partial or full thickness burns; associated with trauma or inhalation injury. ex. House fire

Question 18

What types of burns result from scalds? What population are they most common in?

Answer 18

Almost ⅔ of burns in children are from scalds from hot drinks/bath water. Most tend to be superficial/partial thickness.

Question 19

What results from flash burns?

Answer 19

Occur from explosions with no sustained fire. There is normally a single wave of heat, but in larger explosions blast injuries, fracture and internal trauma can occur.

Question 20

What is unique about chemical burns?

Answer 20

They continue to burn the patient until the chemical is removed completely. The burns tend to be deep in tissue because of this.

Question 21

Do bases (alkali) or acids typically cause worse burns?

Answer 21

Bases

Question 22

What is considered high voltage?

Answer 22

> 500 volts

Question 23

What should we be aware of with electrocution patients?

Answer 23

Cardiac arrhythmias are common, therefore patients must be monitored. Young patients normally have good prognosis as electricity doesn’t damage cardiac muscle and they typically have no preexisting diseases.

*Obviously, this isn’t comprehensive

Question 24

How many volts are lightening strikes?

Answer 24

> 10,000,000 volts, but with only a millisecond of duration.

Question 25

What happens to patients whose clothes are wet when they are struck by lightening or are near water that has been struck?

Answer 25

The fluid will vapourize causing 1st or 2nd degree burns.

Question 26

What causes arrest in lightening strike patients?

Answer 26

Arrest is normally secondary to hypoxia as the body receives global depolarization. The myocardium normally recovers on own, while there is a delay for respiratory center to recover or thoracic tetany causing respiratory arrest.

Question 27

What is this called and what does it mean?

Answer 27

A Lichtenberg figure, a rare but telltale sign that someone has been struck by lightening.

Question 28

What causes radiation burns?

Answer 28

Most common cause is from UV light (sunburn). Can also be caused by x-ray, radiating therapy, or nuclear energy.

Question 29

How severe are radiation burns?

Answer 29

Severity is based on amount of radiation + time spent during exposure. Most develop over days, but they cannot be differentiated from thermal burns.

Question 30

What is the Parkland Burn formula?

Answer 30

Used to guide fluid replacement for burn patients over a 24 hr period based on percentage of body burned; only for partial and full thickness burns.

Total fluid = 4 ml/kg x % of burned area

50% the fluid is given over the first 8 hours, then 25% over the next 8 hours and 25% over the last 8 hours.

Question 31

How many fire related deaths are due to inhalation injuries?

Answer 31

Half of them.

Question 32

What causes inhalation injuries?

Answer 32

Due to the inhalation of smoke and the toxic byproducts within it.
Can also occur from breathing flames/hot gases. Some heat can be absorbed in bronchial tree due to water vapour. This being stated, if patient inhales steam, gas, or is subject to an explosion all lungs fields can be involved.

Question 33

What are signs and symptoms of inhalation injuries?

Answer 33

• Burns to face or mouth
• Soot in mouth, nose or sputum
• Facial/oral edema
• Inability to swallow
• Stridor
• Coughing

Question 34

How many more times affinity does CO have for hemoglobin than O2?

Answer 34

257x