Burns- Ross Flashcards
List the layers of skin in order of superficial to deep
epidermis, dermis and subcutaneous
Taking a burn Pt’s hx:
-severity of burn depends on _______
Extent depth, location
Age of patient
Type of agent: flash or immersion
- Presence or possibility of inhalation burn
- coexisting injury
A burn is classified into these categories: ________
first, second superficial/deep and third degree
First degree burn:
-includes which skin layer?
provide an example
superficial epidermis*
-ex: sunburn
(minor damage to epidermis, red/painful, heals in several days)
2nd degree burn=
superficial partial thickness***
- blistered**
- red associated blisters
can also be DEEP partial thickness–> more pink/white thick skin texture
2nd degree burns heal within: _____ weeks
3-6 weeks, can form hypertrophic scars
3rd degree is considered a _____ burn
MAJOR burn regardless of size
-NO sensation, NO spont. healing
If a burn involves bone, tendon, or underlying tissue it’s considered a ____
4th degree burn
A commonly used rule to quantify the amount a person is burned=
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.
zone of coagulation=
dead tissue
zone of stasis=
blood flow is impaired potential for cell death
zone of hyperemia=
inflamed tissue around the border
The best first treatment for any burn=
?–> cool water/drape
DONT USE ICE!
First degree or partial thickness second degree tx
- 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
Treatment of second degree full thickness (20% BSA) and third degree=
IVF
The fluid of choice and the amount given to treat burn patients (2nd or 3rd degree) =
- *lactated ringers, and parkland formula –> 2ml x body weight (kg) x % burn
- -> give half in 8 hours, then the rest over the next 16
For Immediate wound care for blisters is to do this
If treated < 48 hours after burn–> leave intact blisters alone
-If already ruptured debride
7 days after burn–> debride all blisters completely
The correct order for dressing a burn is:
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)
Do 2nd degree burns that go home after tx in ED require follow-up?
Yes. All 2nd degree burns that you send home regardless of size need 48 hour follow up
Antibiotics are not necessary
Patients with singed facial hairs involved in a flash burn need what on physical exam
view of airway (check for inhalation injury)
- Hoarse voice, stridor very concerning
- Carbonaceous sputum, drooling are emergent
High voltage burns:
> ______ volts is a deep tissue injury
1000
Patients with _____ burns need discussion/transfer to a specialist
2nd degree circumferential and 20%bsa or 10% bsa in a child
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: ______
escharotomy
=Release of tissue at depth of sq fat only, Especially over joints
A patient dumps tar onto their hands you should do this?
apply an emulsifier (polysorbate based ,triple antibiotic cream, Wrap area and send home bring back next day, Luckily rarely full thickness)
