December 3, 2015 - Burns

Question 1

Burn Depth

Answer 1

Superficial - epidermis

Superficial partial thickness - epidermis and upper part of the dermis

Deep partial thickness - epidermis and into the lower dermis

Full thickness - burn into the subcutaneous tissue

Question 2

Superficial Burns

Answer 2

A sunburn is a good example.

Typically heals in 2-5 days.

(Not included in burn calculations)

Question 3

Superficial Partial Thickness

Answer 3

Blistering is evident. Pink-red, moist, moderate swelling.

Extremely painful as the papillary layer of the dermis has been destroyed, but the reticular layer (where the nerves are) is intact.

Healing within 7-10 days usually does not produce scarring. Healing of longer than 3 weeks typically produces scarring.

Question 4

Deep Partial Thickness

Answer 4

All of the epidermis is burnt and into the reticular dermis.

Skin is red to white (white because the blood vessels in the reticular dermis have been destroyed so the tissue no longer has blood supply).

Usually takes 3-8 weeks to heal and will result in hypertrophic scarring.

Question 5

Full Thickness Burns

Answer 5

All of the epidermis, dermis, and subcutaneous tissue.

White or black (blood vessels are gone), charred, and leathery.

Healing will take a long time, if at all. Will definitely scar.

Question 6

Calculating Burn Size - Adult

Answer 6

Rule of nines.

Head: 9

Chest / Abdomen: 18

Back: 18

Arms: 9 + 9

Legs: 18 + 18

Genitals: 1

Question 7

Calculating Burn Size - Scattered Areas

Answer 7

The patient’s palmar surface of their hand is approximately 1% of their total body surface area.

Question 8

Major Burn Definition

Answer 8

Greater than 10% of the total body surface area constitutes a major burn in children under 10 years old or in patients over 50 years old.

Greater than 20% of the total body surface area constitutes a major burn in patients between 10 and 50 years old.

Question 9

Zone of Coagulation

Answer 9

The area at the center of a burn.

The zone of stasis (good) and the zone of hyperaemia (bad) can change. With proper resuscitation, the goal is to get the zone of stasis to be maintained and allow easier healing.

With inadequate resuscitation, the zone of stasis will disappear and the zone of coagulation will increase in size.

Question 10

Burn Physiology - Before and During Fluid Resuscitation

Answer 10

Decreased cardiac output

Increased systemic vascular resistance

Decreased number of RBCs

Impaired host defenses

Decreased perfusion of kidneys

Decreased perfusion of gut

Fluid leaks out. If you do not treat the patient adequately, the patient will go into hypovolemic shock and die.

Question 11

Burn Physiology - After Fluid Resuscitation

Answer 11

Hypermetabolic response

Hypercatabolic response

In this second stage, usually around day 2 or 3, the body goes through a LOT of nutrients. You need to adequately replace proteins and fats.

Question 12

Initial Management of Major Burns

Answer 12

1) Airway and breathing
2) Circulation
3) Wound management

Question 13

Parkland Formula

Answer 13

Used worldwide to calculate the amount of fluid given to a burn patient…

Amount of Ringer’s Lactate = 4cc x weight (kg) x %TBSA burn

Half of the fluid is given in the first 8 hours of the burn, and the other half is given over the following 16 hours.

Be aiming for 0.5 - 1.0 cc/kg/hr urine output.

Question 14

Urine Output - Foley Catheter

Answer 14

Aiming for 0.5 - 1.0 cc/kg/hr

If you are getting more than this, you need to reduce your fluids. Otherwise, you can induce life-threatening edema to the patient.

Question 15

Escharotomy

Answer 15

Surgically cutting the skin along its folds to prevent the swelling from the burn from compressing arterial circulation and causing death.

The burnt skin becomes leathery and loses its elasticity. The subsequent swelling from the burn as well as the fluid can compress arteries and cause distal portions to undergo necrosis and require amputation. Escharotomy releases pressure and prevents this from occuring.