Chapter 11, Surface & Burn Trauma Flashcards
How long before compartment syndrome results in permanent damage?
How long before compartment syndrome results in possible amputation?
6 hours
12 hours
What is the difference between a contusion and a hematoma?
Contusion (bruise): a closed wound in which a ruptured blood vessel or capillary bed hemorrhages into the surrounding tissue as a result of blunt trauma.
Hematoma: occurs when blood leaks under the skin surface and often forms a palpable mass (blood clot) under the skin.
Where should lidocaine with epinephrine be avoided?
Fingers
Toes
Areas where vasoconstriction could cause impaired distal blood circulation
What are patients that present with thermal burns from an enclosed space at risk for?
Inhalation injury
Carbon monoxide poisoning
When should a patient be intubated based on body surface area burned?
40-50% TBSA
How should a patient with CO poisoning be treated?
Treat with oxygen until carboxyhemoglobin levels drop to less than 10%.
What type of poisoning can result from incomplete combustion of synthetic products such as carpeting, upholstered furniture, plastics, or draperies?
Cyanide
Treat with hydroxocobalamin cyanide antidote kit.
Burns with what TBSA are most commonly vulnerable to capillary leak?
> 20% TBSA
Burns are divided into what three zones?
Zone of coagulation
Zone of stasis
Zone of hyperemia
Why does hypothermia and a core temperature of 95 degrees F worsen the burn?
It causes vasoconstriction.
What are the hydration guidelines for burns > 20% TBSA prior to calculation?
5 yrs and under: 125 mL of LR per hour
6-13 yrs: 250 mL of LR per hour
14 yrs and over: 500 mL of LR per hour
For burns > 20% TBSA, how should fluids be calculated in the adult?
Thermal burns: 2 mL/kg per percentage of TBSA
Electrical burns: 4 mL/kg per percentage of TBSA
Half of the fluid should be given in the first 8 hrs.
How should urinary output be maintained in the adult burn patient?
0.5 mL/kg/hour (~30-50 mL/hour)
How should urinary output be maintained for patients with electrical burns and evidence of myoaglobinuria?
1-1.5 mL/kg/hour (~75-100 mL/hour)
What is the fluid of choice for burn patients?
LR
What are the fluid replacement guidelines for children under the age of 14?
3 mL/kg/TBSA
Half given in the first 8 hours
Infants/young children 30 kg or less should be placed on maintenance fluids of D5LR
What is a common HR associated with adult burn patients who have received adequate resuscitation?
110-120 BPM
HR of 140 or greater should be investigated
What are two monitoring considerations for burn patients?
Cardiac monitoring
Urinary catheter
How should burns be covered?
With clean dry dressings or sheets.
How should the burn patient be positioned?
Head of bed 45 degrees
Extremities above the level of the heart
What finding is a sign of severe injury in the patient who has an electrical burn?
Contractures
How should an electrical burn be labeled?
“Contact point”
