Burns- Ross

Question 1

List the layers of skin in order of superficial to deep

Answer 1

epidermis, dermis and subcutaneous

Question 2

Taking a burn Pt’s hx:

-severity of burn depends on _______

Answer 2

Extent depth, location
Age of patient

Type of agent: flash or immersion

• Presence or possibility of inhalation burn
• coexisting injury

Question 3

A burn is classified into these categories: ________

Answer 3

first, second superficial/deep and third degree

Question 4

First degree burn:
-includes which skin layer?
provide an example

Answer 4

superficial epidermis*
-ex: sunburn
(minor damage to epidermis, red/painful, heals in several days)

Question 5

2nd degree burn=

Answer 5

superficial partial thickness***

• blistered**
• red associated blisters

can also be DEEP partial thickness–> more pink/white thick skin texture

Question 6

2nd degree burns heal within: _____ weeks

Answer 6

3-6 weeks, can form hypertrophic scars

Question 7

3rd degree is considered a _____ burn

Answer 7

MAJOR burn regardless of size

-NO sensation, NO spont. healing

Question 8

If a burn involves bone, tendon, or underlying tissue it’s considered a ____

Answer 8

4th degree burn

Question 9

A commonly used rule to quantify the amount a person is burned=

Answer 9

Rule of nines

–The size of a burn can be quickly estimated by using the “rule of nines.” This method divides the body’s surface area into percentages. The front and back of the head and neck equal 9% of the body’s surface area. The front and back of each arm and hand equal 9% of the body’s surface area.

Question 10

zone of coagulation=

Answer 10

dead tissue

Question 11

zone of stasis=

Answer 11

blood flow is impaired potential for cell death

Question 12

zone of hyperemia=

Answer 12

inflamed tissue around the border

Question 13

The best first treatment for any burn=

Answer 13

?–> cool water/drape

DONT USE ICE!

Question 14

First degree or partial thickness second degree tx

Answer 14

• home and ED tx overlap
• cooling (room temp) is beneficial for small burns if started immediately and continued for the first few hours. (decreases thromboxane formation)

-remove jewelry and clothing
dressing

-tetanus burn wounds are prone

Question 15

Treatment of second degree full thickness (20% BSA) and third degree=

Answer 15

IVF

Question 16

The fluid of choice and the amount given to treat burn patients (2nd or 3rd degree) =

Answer 16

• *lactated ringers, and parkland formula –> 2ml x body weight (kg) x % burn
• -> give half in 8 hours, then the rest over the next 16

Question 17

For Immediate wound care for blisters is to do this

Answer 17

If treated < 48 hours after burn–> leave intact blisters alone

-If already ruptured debride

7 days after burn–> debride all blisters completely

Question 18

The correct order for dressing a burn is:

Answer 18

clean/cream/xerform/fluff and snug

• clean area with chlorhexidine or saline, no need for vigorous washing
• layer of antibiotic cream or 1%silver sulfadiazine
• fine mesh gauze or non adherent gauze adaptic or impregnanted xeroform
• cover and pad with loose gauze fluffs then wrap with a snug dressing
• keep limb elevated (super important)

Question 19

Do 2nd degree burns that go home after tx in ED require follow-up?

Answer 19

Yes. All 2nd degree burns that you send home regardless of size need 48 hour follow up

Antibiotics are not necessary

Question 20

Patients with singed facial hairs involved in a flash burn need what on physical exam

Answer 20

view of airway (check for inhalation injury)

• Hoarse voice, stridor very concerning
• Carbonaceous sputum, drooling are emergent

Question 21

High voltage burns:

> ______ volts is a deep tissue injury

Answer 21

1000

Question 22

Patients with _____ burns need discussion/transfer to a specialist

Answer 22

2nd degree circumferential and 20%bsa or 10% bsa in a child

Question 23

A patient in a fire has had a long transport time and now is having difficulty breathing with tight skin around chest you do this: ______

Answer 23

escharotomy

=Release of tissue at depth of sq fat only, Especially over joints

Question 24

A patient dumps tar onto their hands you should do this?

Answer 24

apply an emulsifier (polysorbate based ,triple antibiotic cream, Wrap area and send home bring back next day, Luckily rarely full thickness)

Question 25

the physical exam finding consistently present with abdominal organ injury=

Answer 25

peritonitis

test for rebound, distenion, leakage of gastric contents

Question 26

Referred pain:
-left shoulder from _____ injury

-testicle pain can be from ______ injury

-

Answer 26

splenic

duodenal

Question 27

MC injured abdominal organ in blunt trauma …. in penetrating trauma=

Answer 27

• spleen then liver

- liver, then SB

Question 28

indications for laparotomy

Answer 28

blunt injury with hypo or pos fast
post dpl
gunshot
evisceration
bleeding from stomach or rectum with penetrating
peritonitis
free air
Ct positive

Question 29

Rib fractures 9-12 on the right side may indicate–>

Answer 29

hepatic injury

Question 30

Where are the 4 places we look for blood on US=

Answer 30

pericardial (heart)
RUQ- hepatorenal pouch
LUQ–spleen/kidney
suprapubic

Question 31

T/F: Injury to the retroperitoneal area not seen on US nor DPL

Answer 31

T

Question 32

which organ tolerate cavitation injuries the best

Answer 32

lungs