Ch. 46 Burns to the Face, Trunk, and Extremities

Question 1

What are the different levels of burn injury and how do they present?

Degree? Involves? Presentation?

Answer 1

Question 2

How does one determine the severity of a burn injury?

Answer 2

Calculate TBSA affected by second- or third-degree burns using the rule of nines:

• head, 9%
• each arm, 9%
• anterior torso, 18%
• posterior torso, 18%
• each leg, 18%
• genitalia, 1%

Question 3

What are the three components of inhalational injury?

Answer 3

1. Upper airway edema
2. Acute respiratory failure (2/2 chemical pneumonitis from products of combustion)
3. CO poisoning

Question 4

What is the significance of cherry-red skin in a patient rescued from a house fire?

Answer 4

CO poisoning

Pts initially present with headaches and other nonspecific constitutional sx i.e. nausea, dizziness

Question 5

What is the significance of a circumferential burn in the extremity? How about if on the chest?

Answer 5

significantly increases the risk of developing compartment syndrome

Burn pts with circumferential extremity full-thickness burns with evidence of compromised distal perfusion should undergo ESCHAROTOMY

Circumferential burns of the chest can compromise pt’s respiratory efforts due to inflexible exchar and underlying tissue edema –> prevent chest wall motion –> limit ventilation –> ESCHAROTOMY

Question 6

DC electrocution vs. AC electrocution

What is a long-term complication of electrical injury?

Answer 6

DC electrocution (e.g., lightning) puts patients at risk for asystole, while AC electrocution (e.g., wall socket) puts pts at risk for v-fib

Cataracts = long-term complication of electrical injury

Question 7

Why are burn patients at higher risk for GI ulcers (Curling’s ulcer)?

Answer 7

Diminished intravascular volume –> decreased perfusion to GI tract –> subsequent ischemic necrosis of gastric mucosa –> increased risk for ulcer formation

Question 8

What organisms are clasically involved in burn wound infections?

Answer 8

• Pseudomonas aeruginosa***
• Staph aureus
• Strep pyogenes
• Candida albicans
• HSV

Question 9

How is inhalational injury definitively diagnosed?

Answer 9

Fiberoptic bronchoscopy

Question 10

What is the best way to evaluate for CO poisoning?

Answer 10

CO has nearly 200x more affinity for Hgb than oxygen

• CO pulse oximetry** (although not readily available)
• ABG –> normal PaO2, dec. SaO2

Question 11

Mgmt:

1. How would you manage a pt with inhalational injury?
2. How do you calculate appropriate volume of fluid resuscitation for a burn victim in the first 24 hrs?
3. What is the mgmt for CO poisoning
4. What type of fluid should be used acutely in a burn pt?
5. What electrolyte abnormality must be closely monitored in burn pt?

Answer 11

Mgmt:

1. How would you manage a pt with inhalational injury? early intubation
2. How do you calculate appropriate volume of fluid resuscitation for a burn victim in the first 24 hrs? Parkland formula
   
   1. ​Total fluid volume = 4 cc/kg * weight (kg) * TBSA (%)
   2. 1/2 of total fluid volume should be administered in the first 8 hrs from the time of injury and the 2nd half in the subsequent 16 hrs
3. What is the mgmt for CO poisoning: 100% oxygen via non-rebreather face mask
4. What type of fluid should be used acutely in a burn pt? LR
   
   1. ​Use of NS will lead to hyperchloremic metabolic acidosis as high volumes will be required
5. What electrolyte abnormality must be closely monitored in burn pt? Abnormalities in serum sodium and potassium
   
   1. ​Hyponatremia can inc. risk of developing seizures
   2. Hyperkalemia can develop from destruction of cells/tissues –> cardiac abnormalities

Question 12

What to do if you have a chronic nonhealing wound?

Answer 12

Increased risk for development of SCC of skin (Marjolin’s ulcer)

Evaluate with skin biopsy