Intro/Burns Lecture Flashcards
What is the MC reason people visit the ER?
No access to other healthcare providers
Thermal
Chemical
Radiation
Electrical
Types of burns
MC type of burns?
Thermal
Soft tissue is typically burned when it is exposed to temperatures above…
115 degrees F
(46 degrees C)
The extent of damage with a burn is dependent on…
Surface temperature
Contact duration
_________ energy denatures and coagulates protein, resulting in irreversible tissue destruction. Surrounding this zone of coagulation is an area of decreased tissue perfusion.
Thermal
Tissue that is damaged by thermal energy is potentially salvageable, provided that resuscitative efforts are successful in….
Restoring perfusion to the area
With a thermal energy burn, perfusion is increased at the ___________ of the burn. Tissue in this zone will recover as long as the patient does not experience prolonged hypoperfusion.
outer margins
What is the most center/damaged part of a thermal burn?
Zone of coagulation
(then zone of stasis, then zone of hyperaemia)
Immediately following the burn injury, vasoactive mediators (such as cytokines, prostaglandins, and oxygen radicals) are released from….
damaged tissue
Patients with large burns (≥15 to ≥20%) develop systemic responses to….
vasoactive mediators (ie cytokines, prostaglandins, oxygen radicals)
For pts with 40% TBSA or more, ________ depression can occur
Myocardial
as a result, pts with major burns may become hypotensive (burn shock) and edematous (burn edema)
After a burn,
systemic capillary leak usually persists..
18-24 hours
Because myocardial depression may occur with major burns, these 2 things can develop…
Hypotension (burn shock)
Edema (burn edema)
After a burn,
protein is lost from the intravascular space during the first…
12-18 hours
True or False…
In large burns, up to 15 percent of red blood cells may be destroyed locally and an additional reduction of 25 percent of the red blood cell mass may occur due to decreased red cell survival time. This reduction in oxygen carrying capacity may exacerbate burn shock.
True
Thermoregulation
Prevention of fluid loss
Barriers to infection
Sensory information about environment
Functions of skin
Layers of skin:
Epidermis
Dermis
_______
Hypodermis
This is the outermost layer of skin composed of cornified epithelial cells.
Outer surface cells die and are sloughed off as newer cells divide at the stratum germinativum/basale.
Epidermis
This is the middle layer of skin composed of primarily connective tissue. It contains capillaries that nourish the skin, nerve endings, and hair follicles.
Dermis
This is a layer of adipose and connective tissue between the skin and underlying tissues.
Hypodermis
Age <5
Age >55
Volar surface of arms
Medial thighs
Perineum
Ears
…may need to re-evaluate burn depth in the first..?
24-72 hours
AKA 1st degree burn
Involves only epidermis
Skin is red, dry, painful
No blisters, blanches with pressure
Heals in 4-7 days without scarring
Superficial burn
AKA 2nd degree burn
Involves epidermis and extends into dermis
Skin is red, moist, painful, and blisters may be present
Blanching is still present
Heals in 14-21 days without scarring
Superficial partial burn
Involves epidermis and deeper into dermis
Skin is whitish or yellowish, pressure can be felt but there is usually no overt pain.
Blanching is absent, 2-point discrimination is diminished.
Healing may take 21 days to three months, and scarring is common.
May be difficult to differentiate from full thickness
Deep partial thickness
Charred and black to pale and waxy white, leathery, painless (except surrounding area of more superficial burns)
will not heal spontaenously-skin grafting is required
Full thickness burn
Extends into deeper tissue (fat, bone, muscle)—may require amputation.
4th degree burn
Cause: UV exposure. very short flash
Appearance: dry, red, blanches with pressure
Sensation: painful
Healing time: 3-6 days
Superficial burn
Cause: scald (spill or splash). short flash
Apperance: blisters, moist, red, weeping. blanches with pressure
sensation: painful to temp and air
healing time: 7-20 days
Superficial partial-thickness
Cause: scald (spill), flame, oil, grease
Appearance: blisters (easily unroofed), wet or waxy dry, variable color (patchy to cheesy white to red). does not blanch w pressure
Sensation: perceptive of pressure only
Healing time: >21 days
Deep-partial thickness
Cause: scald (immersion), flame, steam, oil, grease, chemical, electrical
Appearance: waxy white to leathery gray to charred and black, dry and inelastic, no blanching with pressure
Sensation: deep pressure only
Healing: never (if >2% BSA)
Full thickness
This diagram improves estimations for children as their head size relative to the rest of the body is of a higher percentage than in adults.
Lund and Bowder Diagram
A person’s hand (including fingers) can be used to estimage __% total BSA
1%
Partial thickness <10% of BSA in patients 10-50yrs old
Partial thickness <5% of BSA in patients under 10 or over 50yrs old
Full thickness burns <2% of BSA in any patient without other injury
Isolated injury
May NOT involve face, hands, feet, perineum or genitalia
May NOT cross major joints
May NOT be circumferential
“minor” burns
Partial thickness burns >10% of BSA (>5% if young/old)
Burns that involve the face, hands, feet, genitalia, perineum
Any electrical or chemical burns
Burns with associated smoke inhalation injuries
Burns in patients with pre-existing medical conditions that could complicate the management, could prolong the recovery or could affect mortality
Any patients with burns and associated trauma (fractures) in which the burn injury poses the greater risk of mortality or morbidity
Burned children in hospitals WITHOUT qualified personnel or equipment for the care of children
Burn injury in patients who require special social, emotional or long-term rehabilitative intervention
Refer to burn center!
<10% TBSA burn in adults
<5% TBSA burn in young or old
<2% full thickness burn
Minor burn
(outpatient tx)
10-20% TBSA in adults
5-10% TBSA burn in young or old
2-5% full thickness burn
High voltage injury
Suspected inhalation injury
Circumferential burn
Medican problem predisposing to infection (ie DM, sickle cell)
Moderate burn
(admit to hospital)
>20% TBSA burns in adults
>10% TBSA burn in young or old
>5% full thickness burn
High voltage burn
Known inhalation injury
Any significant burn to face, eyes, ears, genitalia or joints
Other injuries (fx or major source of trauma)
Major burn
(refer to burn center)
Cool burns immediately in cool/room temp water
Pain management (NSAIDs, opiods)
Clean burns with mild soap and water
Topical antibiotics
Drain blisters >2cm or blisters that may rupture
Management of mild burns
Silver sulfadiazine (1%) [silvadene]
MC topical abx used for burns
True or False…
in addition to Silver Sulfadiazine, you can also use bacitracin, triple abx ointment or honey
true
What immunization should you make sure you have up to date in a burn pt?
Tetanus
During what phase of healing can you use non-scented moisturizing cream (ie Vaseline)
Final phase of healing
NON-adherent dressing (adaptic) after abx ointment
Second layer of fluffed gauze
Third layer of elastic gauze
Must individualy wrap fingers/toes to prevent adherence
Dressing for minor burns
When should you change a burn dressing?
No clear recommendation
Once daily
Whenever soaked with exudates
Signs of infection of a burn?
Lymphangitis
Fever
Malaise
Anorexia
(infection should be treated aggressively with IV abx)
________ burns have higher risk of infection 2/2 decreased neutrophil activity, impaired T lymphocyte activity and cytokine imbalance
Non-superficial
Initial management of moderate or severe burns includes…
Stabilizing airway, breathing and circulation
What history questions are crucical to get on a burn pt?
- *A**llergy (to drugs)
- *M**eds
- *P**revious (significant PMH, surgeries, etc)
- *L**ast (intake and output)
- *E**vent (events leading up to)
AMPLE
Smoke inhalation can rapidly lead to….
airway edema
MC cause of death in burn victims?
Inhalation injury
Inhalation injury is present in about 2/3 of patients with burns greater than __% BSA
70%
Carbonaceous sputum
Singed facial or nasal hairs
Facial burns
Oropharyngeal edema
Voice changes
Signs of smoke inhalation
Management of smoke inhalation injury?
Intubation as indicated
other wise, high flow O2
Best way to get fluids to a burn victim?
IO!
(this is essential bc these ppl need fluids!)
What type of fluid do burn victims need?
Lactate Ringers
2-4mL x %BSA x W in Kg = volume of fluid within ___hours of injury
24 hours
How can you monitor hydration status of a burn pt?
Foley cath
if burned area is >10% BSA, what must you monitor for?
Hypothermia
Pulmonary dysfunction causes more than __% of fire related deaths
75%
Pts with high voltage injury are at risk of…
ST-T wave changes
What must you usually do with a circumferential burn?
Excise the eschar
Pt with severe burns have metabolic rates of…
100-150% higher than normal
