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Patho > Burns part 1 > Flashcards

Burns part 1 Flashcards

1
Q

What causes burns?

Are they preventable?

A

heat, chemicals, electrical current, and radiation

usually avoidable

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2
Q

Types of burn injuries

A

thermal burns
chemical burns
smoke inhalation injury
electrical burns
cold thermal injury

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3
Q

What causes thermal burns?
What determines the severity of thermal burns?

A

flame, flash, scald, or contact with hot objects

Severity depends on temp of burning agent and duration of contact

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4
Q

What causes chemical burns?
Which is harder to deal with- acidic or alkali burns? why?

A

acids, alkalis, and organic compounds –> batteries

alkali is harder bc they cause protein hydrolysis and melting –> draino

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5
Q

Where are alkalis found?
What are organic compounds?

A

Alkalis: in cement, oven and drain cleaners, heavy metal cleaners

Org. compounds: phenols and petroleum products

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6
Q

What are smoke inhalation injuries?
What do smoke inhalation injuries predict?
Why is rapid/ongoing assessment critical?

A

From breathing noxious chems or hot air, causing damage to respiratory tract (swelling)

Major predictor of mortality in burn victims

Important bc airway compromise and pulmonary edema can quickly develop

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7
Q

3 types of smoke and inhalation injuries

A

upper airway injury
lower airway injury
metabolic asphyxiation

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8
Q

Metabolic asphyxiation

Brain injury accompaniement?

A

Inhalation of CO or hydrogen cyanide impairs oxygen consumption by tissues –> hypoxia

Death can happen when PaO2 blood levels less than 20%

not always brain injury

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9
Q

Upper airway injury
-which areas are affected?
What types of burns are common here?
Mucosal burns signs and symptoms

A

mouth, oropharynx, and larynx

thermal burns or inhalation of hot air/steam/smoke

redness, blistering, edema

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10
Q

Upper airway injury
-swelling
Obstruction

A

Swelling can be extensive and happen fast
-eschar and edema may compromise breathing
-edema from face and neck burns can be lethal
-internal pressure from edema can narrow airway

Obstruction of airway

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11
Q

Lower airway injury
-which areas?
-what affects the degree of tissue damage here?
-what’s weird about the swelling pattern?

A

affects trachea, bronchioles, and alveoli

Damage is related to duration of exposure to toxic fumes/smoke

Pulmonary edema might not happen for 12-48 hours after burn -> might manifest as acute respiratory distress syndrome (ARDS)

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12
Q

What should you assess for in a lower airway injury?

A

facial burns
singed nasal hairs
hoarseness –> talk to them so you know their airway is good
painful swallowing
dark oral/nasal membranes
carbonaceous sputum
history of being burnded in enclosed space
clothing burns around neck and chest

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13
Q

What causes electrical burns?

Where does it cause damage?

A

heat from electric current

nerves and vessels –> may lead to tissue anoxia

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14
Q

what determines the severity of an electrical burn?

A

amount of voltage
tissue resistance (density)
current pathways (go through vital organs?)
surface area
length of time current was sustained

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15
Q

How can electrical burns cause thermal burns?

How can electrical burns cause fractures?

A

-sparks could ignite clothing and cause thermal flash injury

-current can cause muscle spasms that fracture bones

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16
Q

Why is it hard to determine extent of electrical injury?

A

damage is below the skin

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17
Q

What are other risk factors from electrical burns?

A

dysrhythmias/ cardiac arrest
Severe metabolic acidosis
Myoglobinuria

Acute tubular necrosis and acute kidney injury
-myoglobin from damaged muscles and hemoglobin from damaged RBCs go to kidneys and block renal tubules

18
Q

Classification of burn injuries

A

Determined by:
depth of burn
extent of burn in percent of TBSA (total body surface area)
location of burn
Age of patient, previous burns, circumstances/complications

19
Q

Depth of burn

A

first, second, third, and fourth
Partial thickness = first and second
full thickness = third and fourth

Superficial partial thickess = 1st degree - involves epidermis

Deep partial-thickness burn = 2nd degree - involves dermis

Full-thickness burn = 3rd and 4th - involves all skin, nerve endings, fat, muscle, and bone
- 3rd is muscle, 4th is bone

20
Q

Extent of burn: 2 tools to use DON’T NEED TO CALCULATE- JUST KNOW NAME OF EQUATION

A

Lund-Browder chart (more accurate)
-head = 7
-neck = 2
-arms = 4, 3, 3
-chest = 13
-back = 13
-butt = 5
- legs = 9.5, 7, 3.5

Rule of nines (for initial assessment)

In kids, palms are 1%

21
Q

Severity based on location

A

face, neck, chest = respiratory obstruction from edema/eschar

hands, feet, joints, eyes = self-care difficulties

ears, nose, butt, and perineum = high infection risk

22
Q

What do circumferential burns do?

What is compartment syndrome?

A

Circumferential burns of extremeties cause circulation problems distal to burns

pressure within muscles gets out of control –> nerve damage to affected extremity

23
Q

Risk factors for severity of burn injuries

A

Preexisting, heart, lung, or kidney disease

Also diabetes and peripheral vascular disease –> delayed healing

Physical weakness due to alc/ drugs/ malnutrition make healing harder

Concurrent injuries lead to more dif time recovering

24
Q

Prehospital care steps for a small thermal burn

A

-remove person from burn source and stop burning
-protect yourself while doing this
-cover with clean, cool, tap water-dampened towel
-cooling within 1 min helps minimize depth of injury

25
Q

Prehospital steps for large thermal burns

A

remove patient, stop burning, protect self
-if unresponsive, check CAB (elevate limbs above heart)
-if responsive, check ABC
-cool for no more than 10 mins
-don’t submerge in cool water or cover with ice (vasoconstriction)
-remove burned clothing
-wrap in dry, clean sheet or blanket

26
Q

prehospital phase for chem burns

A

remove chemicals and flush area with water

27
Q

prehospital phase for inhalation injury

A

watch for signs of respiratory distress
-treat fast
-100% humidified oxygen in CO poisoning is suspected
(EVEN IF SAT IS NORMAL)

28
Q

Phases of burn management (after prehospital)

A

emergent (resuscitative)
acute (wound healing)
rehabilitation (restorative)

29
Q

Emergent phase
what is it?
how long does it last?
What are the main concerns?
What ends this phase?

A

the time required to resolve immediate problems from injury

lasts up to 72 hrs

Main concerns are hypovolemic shock and edema

it ends when fluid mobilization and diuresis begins

30
Q

Why does hypovolemic shock happen with burns? (EP)

A

-fluid shifts out of blood vessels bc increased capillary permeability (can happen as soon as 20 mins aft burn)
-permeability causes sodium and plasma proteins go into interstital spaces too
-colloid osmotic pressure of blood vessels gets even lower and so it loses even more fluid
-Third spacing, causing exudate, blisters, and edema

PLUS more insensible loss due to denuded skin and lungs –> way exceeds the usual 30-50 mL per hour

INTRAVASCULAR VOLUME DEPLETION = edema, low BP, high HR

31
Q

Red Blood Cells post burn (EP)

A

They’re hemolyzed by circulating factors released at time of burn and as result of insult of burn injury

Thrombosis can occur in capillaries of burned tissue

High hematocrit caused by hemoconcentration (bc fluid loss)

32
Q

Electrolyte shifts post burn (EP)

A

K shift develops first because injured cells and hemolyzed RBCs release it

Na rapidly moves into interstital space until edema formation endsep)

33
Q

Inflammation and healing post burn (EP)

A

Neutrophils and monocytes go to injury site

Fibroblasts and new collagen fibrils start wound repain within 6-12 hrs

34
Q

Immunologic changes post burn (EP)

A

Kinda fucks everything up –> big infection risk
-skin barrier is destroyed
-bone marrow depression occurs
-circulating levels of immune globulins go down
-defects occur in the WBC function

35
Q

Clinical manifestations of severe burn (EP)

A

shock from hypovolemia
pain
blisters
paralytic ileus
shivering - heat loss, anxiety, pain
altered mental status (usually from hypoxia)

36
Q

Complications to Cardiovascular system (EP)

A

dysrhythmias and hypovolemic shock

-impaired circulation due to circumferential burns can lead to
-tissue ischemia
-paresthesia
-necrosis

bad microcirculation (damaged small skin capalaries) and increased viscocity = sludging –> correct with fluid replacement

Venous thromboembolism risk –> administer anticoagulants

37
Q

What’s an escharotomy?

A

its when you cut through full-thickness eschar to restore circulation to to an extremety or improve chest expansion

38
Q

Complications of the respiratory system (EP)
-where does the damage occur?
-what investigative tests should you do?
-what time related stuff should you be aware of?

A

Upper airway burns –> with or w/o smoke inhalation
Lower airway injury

Should do fiberoptic bronchoscopy and corboxyhemoglobin blood levels –> also aerial blood gas analysis (ABGs) and chest x ray

Watch out for respiratory distress - ABGs and chest xray could look fine at first and then change over the next 24-48 hrs

39
Q

Other cardiopulmonary problems EP

A

preexisting heart and lung conditions are at higher risk for
heart failure
pulmonary edema
pneumonia

40
Q

Urinary sytem complications (EP)

A

acute tubular necrosis (ATN)
Less bloodflow to kidneys = renal ischemia

Patho (44 decks)

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