Burns and Smoke Inhalation

Question 1

Classification of 1st degree burn

Answer 1

superficial, limited to the epidermis, wound is red, painful, and well demarcated

Question 2

Classification of 2nd degree burn

Answer 2

partial thickness, involves the epidermis and part of the dermis. May involve hair & glands. Wounds are painful, blister, & blanch with pressure. Tends to be wet & slippery to touch.

Question 3

Classification of 3rd degree burn

Answer 3

Full thickness. Involves all epithelial and dermal elements. Specific wound is painless (but will often be surrounded by painful tissue so patients may report pain). It is depressed, non-edematous, and leathery. May be white, brown, or black

Question 4

Classification of 4th degree burn

Answer 4

Deep tissue. Extends through all layers of skin and involves underlying tissue. Wound is painless but injury is extensive and often requires amputation

Question 5

Electrical burns

Answer 5

Electrical energy is converted to heat which causes thermal injury and burns. However, unlike conventional thermal burns, the electricity may flow in unpredictable pattern and significant injury may not be evident at site of entry. Therefore, a detailed skin exam, including evaluation of the palms and soles is essential. Cardiac arrhythmias are common in electrical burns if the flow of electricity crosses through the thorax and across the heart. Extent of injury is determined by voltage type, voltage strength, the resistance of tissue, and the duration of contact.

Question 6

Temperature related inhalation injury

Answer 6

Heat tends to affect the upper airway more than the lower airways.
Patients will develop edema, erythema, and ulcerations of lips, tongue, posterior oropharynx, and upper airway. Onset may be delayed for up to 24hrs & resolve in 4-5 days. May require early intubation before edema develops and tracheostomy if edema continues

Question 7

Smoke related inhalation injury

Answer 7

Smoke tends to affect the lower airways more than the upper airways.
Reduced mucociliary function. Patients may develop pneumonia in part due to impaired clearance.

Question 8

Gas-related inhalation injury

Answer 8

• Oxygen is consumed during combustion. Fires create hypoxic environments and patients may be hypoxic on scene as well as on arrival in the ED. Carbon dioxide (CO2) & carbon monoxide (CO) are produced by combustion.
• Water soluble chemicals (ammonia, chlorine, etc.) can lead to bronchospams, edema. Lipid soluble chemicals (phosgene, nitrous oxide, etc) ? direct cell damage, impaired ciliary clearance

Question 9

Minor Burn Treatment

Answer 9

• First, stop burning process. Remove clothes. Run warm water over the area until the skin temperature normal
• Next pain control
• Next wash burn area thoroughly with soap and water
• Dry
• Cover with topical ointment and sterile dressing
• Tetanus
• Don’t give antibiotics routinely

Question 10

Significant burn treatment

Answer 10

Fluid Resuscitation. Give IV fluids

Question 11

Why do massive burns lead to lots of fluid loss and electrolyte imbalances?

Answer 11

• increased microvascular permeability that leads to extracellular edema and cell membrane defects that contribute to intracellular swelling
• have increased metabolic and respiratory rates that lead to increased evaporation and other insensible losses and often become hypoproteinemic leading to decreased intravascular oncotic pressures.

Question 12

What is the Parkland formula?

Answer 12

%TBSA burn x wt in kg x 4cc/kg = volume of LR that should be administered over the first 24 hours

Question 13

What kind of fluid should you give to burn patients?

Answer 13

LR

Question 14

How should the fluid be given?

Answer 14

Half should be given in the 8 hours following the burn and the remaining half should be given over next 16 hrs (24hrs total). Remember, this is extra fluid in addition to the patient’s baseline fluid requirements.

Question 15

What is the target urine output to monitor for?

Answer 15

Adult urine output: 0.5cc/kg/hour

Pediatric urine output: 1-2cc/kg/hour

Question 16

What is the leading cause of death in burn patients?

Answer 16

Sepsis

Question 17

What are the three forms of prevention and control of infection in burn patients?

Answer 17

• Debridement of devitalized tissue: cut away dead, necrotic tissue and exposure underlying viable tissue,
• Wound management: Limit bacterial invasion by covering affected areas with antibiotic dressings and through early wound closure with skin grafting and/or commercial products.
• Preventing the delayed development of pneumonia and sepsis: universal precautions and general infection control practices are of paramount importance. Contact isolation with gown, gloves, and mask. Frequent changing of central lines, etc. Aggressively evaluate fevers by pan-culturing and initiating broad-spectrum antibiotics.

Question 18

When do you transfer patients to a burn ICU?

Answer 18

Adult patients with >20% TBSA burns are generally transferred to a regional burn center for evaluation. Pediatric patients with >10% TBSA burns are generally transferred to a regional pediatric burn center for evaluation.

Question 19

What should you cover burns with?

Answer 19

Just cover burns with Xeroform or SSD dressings and gauze