Chapter 29: Burns Flashcards
risk factors for burn injury
- extreme age group
- poverty
- african and native americans
- living in rural area
BSA
body surface area
burn shock
develops only after the first few hours, results from extensive vascular bed damage that allows both fluid and protein molecules in the plasma to leak into surrounding tissues, blood plasma seeps out everywhere due to fluid imbalance, there is a large fluid shift out of vessels
laryngeal edema
swelling of the larynx lining
eschar
tough, leathery burned skin
ARDS
acute respiratory distress syndrome
superficial burns
aka first degree, only involves epidermis, usually by flash, hot liquid, sun. skin appears pink/red, is dry, slight swelling, no blisters, soft and tender
partial thickness burns
aka a second degree burn, involves epidermis and dermis, from fire, hot liquids/objects, chemical substances, sun. plasma/tissue fluids collect between skin layers, form blisters, painful
superficial partial-thickness burns
- think walled blisters
- skin red and weeping
- skin blanches with pressure
- skin is soft and tender to touch
deep partial thickness burns
- thick-walled blisters often rupture
- skin can be a variable color, patchy areas that are red to cheesy white
- skin doesn’t blanch under pressure
- skin is wet or waxy dry
- patient can still feel pressure at site
- poor capillary refill to burn site
full-thickness burns
aka third degree, involves all skin layers, from extreme heat sources. skin becomes dry, hard, tough, leathery, can appear white and waxy to dark brown/black and charred, does not blanch to pressure
eschar
tough and leathery dead soft tissue formed in the full-thickness burn injury
most important factors to consider for burn severity
- depth of burn
- location of burn
- patient’s age
- preexisting medical conditions
- percentage of body surface area involved
circumferential burns
encircle a body area, critical because of circulatory compromise
compartment syndrome
develops when the edema is so extensive under the burned area that it starts to compress the nerves and vessels
rule of nines
standardized way to quickly determine the amount of skin surface (BSA) percentage of a burn, aka the TBSA, applied only to partial-thickness or full-thickness
Lund and Brower system
more accurate way of determining BSA by mapping the burned area on a chart that is appropriate for the patient’s age
rule of ones
aka rule of palms, a way to calculate BSA by comparing it to the patient’s palm surface area with the finger closed, which represents about 1% BSA
thermal burns
associated with heat applied to body, severity is related to exposure duration, temperature, and potential for inhalation injury
scalds
thermal burns caused by hot water, caused by contact with hot liquid, more severe burns from more viscous liquid due to longer contact time, can be child abuse
inhalation burns
high temperature air or steam that is inhaled, causes damage to the mucosa of upper airway, results in edema that could restrict airflow or lead to airway obstruction
chemical burns
produced by acids, alkalis, other heat-generating chemicals, severity depends on type of chemical, concentration, exposure duration
electrical burns
result from resistance to electrical current flow in the body, primarily internal, can result in cardiac arrest
radiation burns
from absorption of radiation into the body
flame burn
patient comes into contact with open flame
contact burn
occurs from contact with a hot object, burn normally localized to area of contact
steam burn
from hot steam, more severe than flame burns, can cause thermal burns to distal airways in lungs
gas burns
hot gasses, can cause upper airway burns, not likely to cause distal airway burns
electrical burns
causes mostly internal burns, clothing can ignite
flash burn
type of flame burn, result of a flammable gas or liquid that ignites quickly, areas of body covered by clothing normally are not burned
emergency medical care for burns
- remove patient from the source of burn and stop the burning process
- establish and maintain airway, breathing, oxygenation
- classify the severity of the burn and transport immediately if critical
- cover the burned area with a dry sterile dressing or a burn sheet
- keep patient warm and treat other injuries as needed
- transport patient to appropriate medical facility
burn sheet
sterile particle free and disposable
special considerations for burns of hands and toes
remove all rings and jewelry, separate digits with dry sterile dressing
special considerations for burns of eyes
do not attempt to open eyelids, determine whether burn is thermal or chemical. thermal: apply a dry sterile dressing to both eyes. chemical: flush with water from medial to lateral side en route to hospital
rules for chemical burns
- protect yourself first
- dry chemicals should be brushed off before flushing with water
- most chemical burns can be flushed with copious amounts of water
dry lime
brush off all dry lime before flushing with water, it can react with water and produce a corrosive and harmful substance
hydrofluoric acid
used to etch glass, can penetrate skin and cause delayed burn so patient might not have symptoms, flush with water regardless
carbolic acid (phenol)
can cause severe burns, it is quickly absorbed into skin, vapor is highly toxic, can first be flushed with isopropyl alcohol and then water
sulfuric acid
can react with water to produce heat, need to use large quantity of water
guidelines for electrical burn injuries
- never attempt to remove a patient from an electrical source unless trained and equipped
- never touch a patient still in contact with the electrical source
- once the patient has been removed from the electrical source, establish and maintain a patent airway
- administer supplemental oxygen if needed
- monitor patient for cardiac arrest
- assess patient for muscle tenderness
- assess for a source and ground injury
- transport the patient ASAP
