Burns part 1 Flashcards
What causes burns?
Are they preventable?
heat, chemicals, electrical current, and radiation
usually avoidable
Types of burn injuries
thermal burns
chemical burns
smoke inhalation injury
electrical burns
cold thermal injury
What causes thermal burns?
What determines the severity of thermal burns?
flame, flash, scald, or contact with hot objects
Severity depends on temp of burning agent and duration of contact
What causes chemical burns?
Which is harder to deal with- acidic or alkali burns? why?
acids, alkalis, and organic compounds –> batteries
alkali is harder bc they cause protein hydrolysis and melting –> draino
Where are alkalis found?
What are organic compounds?
Alkalis: in cement, oven and drain cleaners, heavy metal cleaners
Org. compounds: phenols and petroleum products
What are smoke inhalation injuries?
What do smoke inhalation injuries predict?
Why is rapid/ongoing assessment critical?
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
3 types of smoke and inhalation injuries
upper airway injury
lower airway injury
metabolic asphyxiation
Metabolic asphyxiation
Brain injury accompaniement?
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
Upper airway injury
-which areas are affected?
What types of burns are common here?
Mucosal burns signs and symptoms
mouth, oropharynx, and larynx
thermal burns or inhalation of hot air/steam/smoke
redness, blistering, edema
Upper airway injury
-swelling
Obstruction
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
Lower airway injury
-which areas?
-what affects the degree of tissue damage here?
-what’s weird about the swelling pattern?
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)
What should you assess for in a lower airway injury?
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
What causes electrical burns?
Where does it cause damage?
heat from electric current
nerves and vessels –> may lead to tissue anoxia
what determines the severity of an electrical burn?
amount of voltage
tissue resistance (density)
current pathways (go through vital organs?)
surface area
length of time current was sustained
How can electrical burns cause thermal burns?
How can electrical burns cause fractures?
-sparks could ignite clothing and cause thermal flash injury
-current can cause muscle spasms that fracture bones
Why is it hard to determine extent of electrical injury?
damage is below the skin
What are other risk factors from electrical burns?
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
Classification of burn injuries
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
Depth of burn
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
Extent of burn: 2 tools to use DON’T NEED TO CALCULATE- JUST KNOW NAME OF EQUATION
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%
Severity based on location
face, neck, chest = respiratory obstruction from edema/eschar
hands, feet, joints, eyes = self-care difficulties
ears, nose, butt, and perineum = high infection risk
What do circumferential burns do?
What is compartment syndrome?
Circumferential burns of extremeties cause circulation problems distal to burns
pressure within muscles gets out of control –> nerve damage to affected extremity
Risk factors for severity of burn injuries
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
Prehospital care steps for a small thermal burn
-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
Prehospital steps for large thermal burns
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
prehospital phase for chem burns
remove chemicals and flush area with water
prehospital phase for inhalation injury
watch for signs of respiratory distress
-treat fast
-100% humidified oxygen in CO poisoning is suspected
(EVEN IF SAT IS NORMAL)
Phases of burn management (after prehospital)
emergent (resuscitative)
acute (wound healing)
rehabilitation (restorative)
Emergent phase
what is it?
how long does it last?
What are the main concerns?
What ends this phase?
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
Why does hypovolemic shock happen with burns? (EP)
-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
Red Blood Cells post burn (EP)
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)
Electrolyte shifts post burn (EP)
K shift develops first because injured cells and hemolyzed RBCs release it
Na rapidly moves into interstital space until edema formation endsep)
Inflammation and healing post burn (EP)
Neutrophils and monocytes go to injury site
Fibroblasts and new collagen fibrils start wound repain within 6-12 hrs
Immunologic changes post burn (EP)
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
Clinical manifestations of severe burn (EP)
shock from hypovolemia
pain
blisters
paralytic ileus
shivering - heat loss, anxiety, pain
altered mental status (usually from hypoxia)
Complications to Cardiovascular system (EP)
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
What’s an escharotomy?
its when you cut through full-thickness eschar to restore circulation to to an extremety or improve chest expansion
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?
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
Other cardiopulmonary problems EP
preexisting heart and lung conditions are at higher risk for
heart failure
pulmonary edema
pneumonia
Urinary sytem complications (EP)
acute tubular necrosis (ATN)
Less bloodflow to kidneys = renal ischemia
