Chapter 17 - Burns Flashcards
What is a first degreen burn?
sunburn- epidermis only
What is are the two types of second degree burns?
superficial dermis (papillary)- painful to touch; blebs and blisters; hair follicles intact; blanches -Deep dermis (reticular) - Decreased sensation; loss of hair follicles (need graft)
What are 3rd degree burns?
Leathery feeling (charred parchment); down to subcutaneous fat
What are 4th degree burns?
Down to bone, into adjacent adipose or muscle tissue
What are admission criteria for 2nd and 3rd degree burns?
- > 10% BSA in pts 50yo
- > 20% in all other pts
- burns to significant portions of hands, face feet, cock and balls, perineum, or skin on joints
- 3rd degree in >5% any age
Other than the criteria for 2nd and 3rd degree burns, what are some criteria for burn admission?
electrical and chemical concomitant inhalation injury trauma social/emotional issues child abuse or neglect
Why are kids and elderly highest mortality
bitches cant get away
what are most common types of burns?
scalds
what are the most common types of burns to cum to hospital and get admitted?
flamers
What is the rule of 9’s?
- Head 9
- arms 9/9
- chest 18
- back 18
- legs 18/18
- Taint, cock and balls, lady junk 1%
What is the parkland formula?
For burns >20% give 4cc/kg x %burn in first 24 hours; give have in the first 8 (LR)
-can grossly underestimate in inhalation injury, etoh, electrical, post escharotomy
Indications for escharotomy?
- circumferential burns
- low temperature, weak pulse, low cap refill, low pain sensation, decreased neuro function in extremity
- problems ventilating with chest torso burns
Lung injury from smoke caused by what?
carbonaceous materials and smoke, not heat
What are the risk factors for airway injury? What are the signs and symptoms of possible airway injury?
Risks: etoh, trauma, closed space, rapid combustion, delayed extrication
signs: facial burns, wheezing, carbonaceous sputum
What are the indications for intubation in smoke lung injury?
upper airway stridor or obstruction, worsening hypoxemia
What is the most common infection in burn patients?
Pneumonia. Also most common cause of death
What do you do with acid and alkali burns?
copious water irrigation.
- alkalis produce deeper burns than acid due to liquefaction necrosis
- acud burns produce coagulation necrosis
What do you do with hydrofluoric acid burns?
spread calcium on wound
What do you do with powder burns?
wipe away before irrigation
What do you do with tar burns?
cool, then wipe away with a lipophilic solvent
What do you do with electrical burns?
- cardiac monitoring
- can cause rhabdo and compartment syndrome
- polyneuritis
- polyneuritis
- intestinal/gallbladder perf, pancreatic nec.
- liver necrosis
How do smiting lightning bolts kill you?
cardiopulmonary arrest secondary to electrical paralysis of brainstem