Integumentary Conditions

Question 1

4 Functions of the skin?

Answer 1

1) Protects from outside exposure
2) Temperature regulation —> prevents heat loss
3) Watertight seal —> prevents excessive loss of water
4) Sensory —> keeps brain informed about external environment

Question 2

Above what temperature do thermal burns occur?

Answer 2

Above 44 degrees

Question 3

What happens during burn shock? What are the types of injury?

Answer 3

Fluid loss across damaged skin and volume shifts within body: capillary leakage leads to intravascular volume comes out of circulation and into the extra vascular spaces.

Question 4

When does burn shock set in?

Answer 4

6-8 hours after initial burn, (it is not normally seen in the prehospital field)

Question 5

What is important to be aware of in a hypotensive patient with burns.

Answer 5

Burn shock is delayed, search for other sources of injury causing shock.

Question 6

What is burn shock the result of?

Answer 6

Massive fluid shifts and electrolyte disturbances within the body

Question 7

What limitations to the body does burn shock cause?

Answer 7

Limits the effective distribution of oxygen to the tissues and hampers the circulations ability to remove waste products

Question 8

What do you look for when trying to assess airway burns? When should immediate intubation be considered?

Answer 8

Inhalation burns —> serious airway compromise

Soot in nares, oral cavity, throat, coughing, wheezing, stridor = swelling of upper airway potentially

Laryngeal edema/ swelling = aggressive airway intervention

Question 9

Features to look for in smoke inhalation?

Answer 9

Be aware it can cause burns in airway from breathing in super heated gases

Hypoxia from lack of O2

Tissue damage and toxic effects by chemicals in smoke

Question 10

Carbon Monoxide Intoxication Features

Answer 10

Consider it when a group of people in same place complain of the same symptoms, specifically H/A, N/V, dizziness

SpO2 will read 100% ( co displaces o2 from alveoli and hemoglobin and binds to hemoglobin 250x more easy then O2)

Hyperbaric therapy may be indicated based on level of exposure

Question 11

Rules of Chemical Burns?

Answer 11

Burns continues as long as irritant remains in contact with body —> move ASAP

Patient must be decontaminated —> follow handbook

Question 12

2 most common deaths from electricity burns are?

Answer 12

Asphyxiation and Cardiac arrest due to conduction abnormalities or arrhythmias

Question 13

Neuro complications from electrical burns?

Answer 13

Seizures, delirium, coma, temporary paralysis, confusion

Question 14

Other injuries to keep in mind in the setting of electrical burns?

Answer 14

Kidney damage ( can resemble crush injury), fxs or dislocations and spinal precautions

Question 15

What is a general rule in regards to vomiting in patients that have been exposed to radiation?

Answer 15

Pts unconscious or vomiting ten mins post exposure don’t survive, how soon the patient vomits usually correlates with the severity of the exposure.

Question 16

Initial assessment of Burns?

Answer 16

1) evaluate airway -> stridor, swelling, sob, burns, soot, consider early tube
2) Evaluate mental status
3) Breathing?
4) Circulation?
5) Burn severity?
6) disability

Question 17

Zone of Coagulation?

Answer 17

central area of skin, suffers most damage, no blood flow in this area to tissues.

Question 18

Zone of Stasis?

Answer 18

peripheral area around zone of coagulation, decreased blood flow and inflammation

Question 19

Zone of Hyperemia

Answer 19

least effected by thermal injury, cells recover in 7-10 days.

Question 20

Superficial burns?

Answer 20

Epidermis only, thermal burns

Question 21

Partial Thickness burns?

Answer 21

2nd degree, involves epidermis and varying degrees of the dermis. Sub divides into superficial partial and deep partial thickness

Question 22

Superficial partial thickness features?

Answer 22

skin red when touched
blisters or moisture present
extreme pain

Question 23

Deep partial thickness features?

Answer 23

extends into dermis

damages hair follicles, and sweat glands

hot liquids or steam or grease caused burns

Question 24

Full thickness burns?

Answer 24

third degree, destruction of both layers of skin including basement membrane of dermis (which produces new skin cells)

Question 25

Features of 3rd degree burns?

Answer 25

skin white, pale, leathery, brown or charred, no cap refill, no pain due to nerve destruction.

Question 26

Fourth degree burns?

Answer 26

Burns extending through the skin to underlying tissues or fascia or muscle.

Question 27

Major burns definition?

Answer 27

greater than 20% partial and or full thickness, any age
greater than 10% TBSA partial and or full thickness ages 10-50
greater than 5% full thickness of any age
burns to face, hands, genitalia, or joints
electrical burns
chemical burns
inhalation injury
any burns associated with major trauma

Question 28

What is critical to prevent in burn patients?

Answer 28

Heat loss

Question 29

What is important parts of the history and physical in burns?

Answer 29

Assess for circumferential burns –> can obstruct airway due to edema and restrict breathing in the chest

monitor distal pulses in burned extremities

Question 30

Management and TX in burn patients?

Answer 30

ABC’s, RBS, cooling, keep warm, airway management (if indicated), aggressive fluid resus (due to fluid shift), pain management with fentanyl and or ketamine

Question 31

Treatments in Electrical or Lightning afflicted patients?

Answer 31

Consider C- Spine immobilization
Large bore iv w NS wide open –> flush out the kidneys
surface burns –> dry sterile dressings

Question 32

Definition of allergic reaction?

Answer 32

Abnormal immune response the body develops when re-exposed to a substance or allergen can be local or systemic

Question 33

Anaphylaxis definition

Answer 33

Systemic reaction to an an exposure of an allergen involving 2 or more.

Question 34

Define cellular immunity?

Answer 34

Body produces special white blood cells (T cells) that attack and destroy invaders

Question 35

Define humoural immunity?

Answer 35

Antibodies dissolved in the blood plasma and lymph attack invading organisms

Question 36

What is a mast cell?

Answer 36

Cell involved in the immune system response of the body

Question 37

Define hypersensitivity to an allergen?

Answer 37

Abnormal reaction to allergen results in the immune system becoming hypersensitive to substances, it identifies harmless substances as threatening and overreacts to it resulting in an allergic reaction.

Question 38

What are the chemical mediators mast cells release when they recognize a substance as harmful?

Answer 38

Histamine - localized dilation and capillary leakage
Leukotrienes - increased dilation and leakage
WBC - engulf and destroy the substance they indentify as invader.

Question 39

How does histamine release clinically present as?

Answer 39

Vasodilation, flushed skin, hypotension

Question 40

What is the dosage of Benadryl in adults for an allergic reaction.

Answer 40

50mg IM/IV or 1mg/kg to max of 50mg

Question 41

MOA of Benadryl?

Answer 41

Anti-Histamine with anti cholinergic and sedating effects

Question 42

Adverse Effects of Benadryl

Answer 42

Mucosal membrane dryness, nervousness, irritability, fatigue, adverse effects are dose dependent.

Question 43

Peds dose of Benadryl?

Answer 43

1mg/kg to max dose of 50 mg

Question 44

Contraindications of Benadryl?

Answer 44

Hypersensitivity, neonates, premature infants.