Burns and Inhalation Injuries Flashcards
What demographic is most likely to die of burn injuries?
Males 20-40 years old.
What are the two layers of the skin?
The epidermis and the dermis.
What is the epidermis?
The thinner outer layer providing protection from environment.
What is the dermis?
The thicker inner layer of the skin providing sensory, sweat glands, oils, etc. Vasculature is here.
What is the zone of coagulation?
Necrosis of skin; this is where irreversible cellular death occurs.
Proteins denature, things coagulate.
What is the zone of stasis?
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.
What is the zone of hyperemia?
Inflammatory mediators causing increased blood to this area. This sustains the least damage. Usually does well.
What is a first degree burn?
Superficial burns. Minor tissue damage to epidermis. Most common in sunburns.
Skin is red/painful and dry. Will heal without scarring.
What is a second degree burn -partial thickness?
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.
What is a second degree burn - full thickness?
Deeper into the dermis area, can be yellow/white, and will be dry. Pain level may not be appropriate given severity of burn.
What is a third degree burn?
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.
What is a fourth degree burn?
Some texts classify these burns as destroying skin, plus bone, tissue, and tendons.
How do severe burns cause hypotension?
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.
What is the goal of burn resuscitation?
To restore or preserve tissue perfusion.
What are types of burn injuries?
- Thermal
- Chemical
- Electrical
- Radiation
How do contact thermal burns happen?
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.
What often results from flame contact thermal burns?
Often partial or full thickness burns; associated with trauma or inhalation injury. ex. House fire
What types of burns result from scalds? What population are they most common in?
Almost ⅔ of burns in children are from scalds from hot drinks/bath water. Most tend to be superficial/partial thickness.
What results from flash burns?
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.
What is unique about chemical burns?
They continue to burn the patient until the chemical is removed completely. The burns tend to be deep in tissue because of this.
Do bases (alkali) or acids typically cause worse burns?
Bases
What is considered high voltage?
> 500 volts
What should we be aware of with electrocution patients?
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
How many volts are lightening strikes?
> 10,000,000 volts, but with only a millisecond of duration.
What happens to patients whose clothes are wet when they are struck by lightening or are near water that has been struck?
The fluid will vapourize causing 1st or 2nd degree burns.
What causes arrest in lightening strike patients?
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.
What is this called and what does it mean?
A Lichtenberg figure, a rare but telltale sign that someone has been struck by lightening.
What causes radiation burns?
Most common cause is from UV light (sunburn). Can also be caused by x-ray, radiating therapy, or nuclear energy.
How severe are radiation burns?
Severity is based on amount of radiation + time spent during exposure. Most develop over days, but they cannot be differentiated from thermal burns.
What is the Parkland Burn formula?
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.
How many fire related deaths are due to inhalation injuries?
Half of them.
What causes inhalation injuries?
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.
What are signs and symptoms of inhalation injuries?
- Burns to face or mouth
- Soot in mouth, nose or sputum
- Facial/oral edema
- Inability to swallow
- Stridor
- Coughing
How many more times affinity does CO have for hemoglobin than O2?
257x
