Burns, Shock, Sepsis

Question 1

Second Degree Burn

Answer 1

Involve partial thickness
Very deep sunburn, contact with hot liquids, flash burns from gasoline flames
Usually much more painful than third degree
Skin appears: Red or mottled; blisters with broken epidermis; considerable swelling; wet/weeping surfaces; painful; sensitive to the air

Question 2

First Degree Burn

Answer 2

Erythema of skin
Possibly minimal surrounding edema
Minimal pain

Question 3

Third Degree Burn

Answer 3

Damage to all skin layers, subcutaneous tissues, and nerve endings
Skin appears: Pale white or charred appearance, leathery; broken skin with fat exposed; dry surface; painless to pinprick; edema.

Question 4

Inhalation Burns

Answer 4

Carbon around nose
Burns involving mouth
Significant Resp problems
Fires in enclosed areas
Remember CO exposure
CYANIDE!!!!!
Intubate early

Question 5

Chemical Burns

Answer 5

Alkali or acids can cause
DO NOT TRY TO NEUTRALIZE
“The solution to pollution is dilution” - - IRRIGATE, IRRIGATE, IRRIGATE!
Alkali burns are more serious than acid burns because the alkalis penetrate deeper

Question 6

Electrical Burns

Answer 6

Always more serious than they appear
Occult destruction of muscle can cause rhabdomyolysis which causes the release of myoglobin and can lead to acute renal failure
If urine is dark, assume myoglobin and increase fluids to achieve a urine output of 100ml/hr

Question 7

Signs of shock

Answer 7

Tachycardia (The EARLIEST manifestation)
Hypotension
Decreased urine output

Question 8

Cardiogenic Shock

Answer 8

Shock resulting from some abnormal cardiac function
Hallmark is hypotension with signs of increased PVR
Weak, thready pulse
Cool, clammy skin
Inadequate organ perfusion: Altered mental status and decreased UO

Question 9

Septic Shock

Answer 9

Usually due to a Gram Negative bacteria causing “endotoxic shock”
Toxic Shock Syndrome is the exception and is caused by staphylocccal toxin
Predisposing co-morbid states are common: Diabetes, leukemia, immunosupression
Relative hypovolemia occurs due to pooling of blood in microcirculation and loss of fluid into interstital spaces due to increased capillary permeability
Wide Pulse Pressure