E3: Burns Flashcards
What is the clinical presentation of a superficial burn (AKA first degree)?
- Confined to the epidermal layer
- red, dry, and painful
- Blanches with pressure
- Pain and erythema resolve in 2-3 days and injured epithelium peels around day 4
What is the management of a superficial burn?
- Remove clothing and debris
- cool with water that is room temp or slightly cooler
- gentle cleansing
- topical calamine or aloe
- topical polysporin
- OTC Tylenol and NSAIDs PRN
What is the clinical presentation of a superficial partial thickness burn?
- Extends into the dermis
- pink, moist, blusters
- painful and blanches
- Most heal in 7-21 days
What is the clinical presentation of a deep partial thickness burn?
- Mottled color from patchy white to red
- non blanching, pain with pressure, blisters
- most heal in 2-9 weeks
- hypertrophic scarring is common
What is the treatment of a superficial partial thickness burn?
- petroleum based moisturizer vs bacitracin
- occlusive dressing such as xeroform
What is the treatment of a deep partial thickness burn?
- Same as superficial partial thickness burn, unless eschar is present
- If eschar is present, silver sulfadiazine cream on 4x4 covered with roll gauze
What is the clinical presentation of a full thickness burn?
Epidermis and full thickness dermis
- Eschar (skin charring)
- dry and non blanching
- hard, leathery texture
- painless
- will not heal spontaneously and requires surgical repair and skin grafting
What is the treatment of a full thickness burn?
- Wash with mild soap and water
- silver sulfadiazine cream
- change dressing twice daily
- surgical debridement and wound closure
- opioids
- tetanus booster
- restoration and close follow up
If a burn involves muscle, tendon, bone, blood vessels, and/or nerves, what kind of burn is it?
Beyond full thickness (4th degree
-Life threatening
What physical exam findings are present if a patient was struck by lightning?
Lichtenberg figures
If a patient has a circumferential burn, what are they at increased risk for?
Compartment syndrome (6Ps: pain, paresthesias, pallor, paralysis, poikilothermia, and pulselessness)
What are the two procedures often performed if there is a circumferential burn?
-Escharotomy or a fasciotomy
What is the number one cause of death related to fires?
Smoke inhalation
What is the clinical presentation of cyanide poisoning?
- Headache, AMS
- Skin may have cherry red appearance
- hypotension, arrhythmia, shock
What is the treatment of cyanide poisoning?
- Hydroxocobalamin is the preferred treatment
- Heme like molecule with complex cobalt atom that binds to cyanocobalamin
When should you intubate for burns?
if history suggests airway compromise:
- closed space smoke exposure
- carbonaceous sputum
- facial burns
- COHb >5
- hoarse voice
- singed facial hair
- If patient is unable to protect their own airway (trauma, opioids)
What are the factors that can influence fluid requirements in burns?
- Burn depth
- inhalation injury
- delay in resuscitation
- compartment syndrome
- electrical burns
When is parkland resuscitation required?
If TBSA >20
What is the parkland formula?
4ml LR x kg x TBSA = 24 hours post burn total
-half volume given in first 8 hours post burn and rest given in the remaining 16
What are the symptoms of under-resuscitation in burns?
- Intravascular volume depletion
- suboptimal tissue perfusion
What are the symptoms of over-resuscitation in burns?
- Results in resuscitation morbidity
- Abdominal compartment syndrome
- compartment syndrome
- pulmonary edema
What is the benefit on enteral nutritional support for burns?
- Reduces burn related increase in secretion of catabolic hormones
- Helps maintain gut mucosal integrity
Is TPN recommended for burns?
No, it does not prevent the catabolic response to burns, impairs immunity and liver function, and increases mortality
What are the protein needs for burn patients?
1.5 to 2.0 grams/kg
**vs 0.8 g/kg in a healthy adult
