Burns Lecture Powerpoint

Question 1

All burns regardless of cause have a single common denominator:

Answer 1

Denaturation of protein and cell death

Question 2

Degrees that can cause burn

Answer 2

Temps below 111.2F or 44C usually well tolerated, temps above 140F or 60C almost always causes some degree of burn dependent on duration of exposure

Question 3

Eschar

Answer 3

Dark dry scab or falling away of dead skin caused by a burn

Question 4

Electrical burns can pass thru skin and thus we need to consider…

Answer 4

….damage done to internal organs as well

Question 5

Conduction

Answer 5

Hot solid coming in contact with skin

Question 6

Convection

Answer 6

Hot liquid/steam comes in contact with skin, offers much higher heat transfer and has far more capacity to damage skin than conduction

Question 7

3 zones of a burn

Answer 7

• Zone of coagulation - tissue is dead and no circulation, full thickness type burn
• Zone of stasis - reduced circulation but tissue might not be dead but can still occur
• Zone of hyperemia - circulation is intact but inflamed

Question 8

Burn classification (2)

Answer 8

• Partial (1st and 2nd degree) - erythema and vesicle formation, painful, either superficial (dry red like sunburn), superficial partial thickness (blisters but blanches), or deep partial (blister and does not blanch)
• Full thickness (3rd degree) - painless, almost never recovers, if extends to fascia or muscle then 4th degree

Question 9

What qualifies as a minor burn (7)

Answer 9

• partial thickness burn <10% 10-50 y/o
• partial thickness burn <10% under 10 or greater than 50 y/o
• full thickness burn <2% on any patient without other injury
• must be isolated injury
• does not involve face, hands, perineum, or feet
• does not cross major joint
• not circumferential (circumferential can lead to compartment syndrome

Question 10

Estimation of extent of burn injury rule of 9’s in an adult

Answer 10

Face - 9%
neck - 1%
Front core - 18%
back core - 18%
arm - 9%
leg - 18%

Question 11

Estimation of extent of burns injury rule of 9’s in a child

Answer 11

Face - 18%
front core - 18%
back core - 18%
arm - 9%
leg - 14%

Question 12

What qualifies as a major burn (5)

Answer 12

• Partial thickness burn involving >25% body surface area in 10-50y/o
• partial thickness burn involving >20% body in less than 10 or older than 50
• full thickness burn >10%
• hands, face, perineum, eyes, ears, feet involvement
• burns involving smoke inhalation, caustic chemicals, high voltage, comorbidities, trauma

Question 13

4th degree burns might see what renal manifestation?

Answer 13

Myoglobinuria

Question 14

Chemical burns treatment (3)

Answer 14

• irrigate vigorously
• brush away dry particulate matter
• morgan lens for eyes

Question 15

Electrical burns treatment (2)

Answer 15

• refer to burn center

- require cardiac monitoring

Question 16

General burns treatment (9)

Answer 16

• cooling with saline gauze around 55 degrees
• bacitracin/aloe vera
• debridement
• wound dressing
• silver sulfadiazone antimicrobial and nystatin for fungus
• early surgical intervention such as dermagraft or allograft
• airway intubation at any symptoms of compromise
• CO level
• IV morphine

Question 17

Fluid resuscitation in burn victims and nutritional support

Answer 17

• 1-2 large bore IV cannulas for lactated ringer solutions (hypotonic) in adults and ringers lactate with dextrose in children, parkland formula estimates fluid amount used in adults and galveston in children, monitoring I/O helps determine as to NOT over hydrate***
• high calorie requirements as well as elevated protein levels