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SD- ER pt 1 > Intro/Burns Lecture > Flashcards

Intro/Burns Lecture Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

What is the MC reason people visit the ER?

A

No access to other healthcare providers

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2
Q

Thermal
Chemical
Radiation
Electrical

A

Types of burns

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3
Q

MC type of burns?

A

Thermal

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4
Q

Soft tissue is typically burned when it is exposed to temperatures above…

A

115 degrees F

(46 degrees C)

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5
Q

The extent of damage with a burn is dependent on…

A

Surface temperature

Contact duration

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6
Q

_________ energy denatures and coagulates protein, resulting in irreversible tissue destruction. Surrounding this zone of coagulation is an area of decreased tissue perfusion.

A

Thermal

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7
Q

Tissue that is damaged by thermal energy is potentially salvageable, provided that resuscitative efforts are successful in….

A

Restoring perfusion to the area

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8
Q

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.

A

outer margins

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9
Q

What is the most center/damaged part of a thermal burn?

A

Zone of coagulation

(then zone of stasis, then zone of hyperaemia)

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10
Q

Immediately following the burn injury, vasoactive mediators (such as cytokines, prostaglandins, and oxygen radicals) are released from….

A

damaged tissue

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11
Q

Patients with large burns (≥15 to ≥20%) develop systemic responses to….

A

vasoactive mediators (ie cytokines, prostaglandins, oxygen radicals)

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12
Q

For pts with 40% TBSA or more, ________ depression can occur

A

Myocardial

as a result, pts with major burns may become hypotensive (burn shock) and edematous (burn edema)

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13
Q

After a burn,

systemic capillary leak usually persists..

A

18-24 hours

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14
Q

Because myocardial depression may occur with major burns, these 2 things can develop…

A

Hypotension (burn shock)

Edema (burn edema)

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15
Q

After a burn,

protein is lost from the intravascular space during the first…

A

12-18 hours

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16
Q

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.

A

True

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17
Q

Thermoregulation

Prevention of fluid loss

Barriers to infection

Sensory information about environment

A

Functions of skin

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18
Q

Layers of skin:

Epidermis
Dermis
_______

A

Hypodermis

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19
Q

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.

A

Epidermis

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20
Q

This is the middle layer of skin composed of primarily connective tissue. It contains capillaries that nourish the skin, nerve endings, and hair follicles.

A

Dermis

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21
Q

This is a layer of adipose and connective tissue between the skin and underlying tissues.

A

Hypodermis

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22
Q

Age <5
Age >55
Volar surface of arms
Medial thighs
Perineum
Ears

…may need to re-evaluate burn depth in the first..?

A

24-72 hours

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23
Q

AKA 1st degree burn

Involves only epidermis

Skin is red, dry, painful

No blisters, blanches with pressure

Heals in 4-7 days without scarring

A

Superficial burn

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24
Q

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

A

Superficial partial burn

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25
Q

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

A

Deep partial thickness

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26
Q

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

A

Full thickness burn

27
Q

Extends into deeper tissue (fat, bone, muscle)—may require amputation.

A

4th degree burn

28
Q

Cause: UV exposure. very short flash

Appearance: dry, red, blanches with pressure

Sensation: painful

Healing time: 3-6 days

A

Superficial burn

29
Q

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

A

Superficial partial-thickness

30
Q

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

A

Deep-partial thickness

31
Q

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)

A

Full thickness

32
Q

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.

A

Lund and Bowder Diagram

33
Q

A person’s hand (including fingers) can be used to estimage __% total BSA

A

1%

34
Q

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

A

“minor” burns

35
Q

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

A

Refer to burn center!

36
Q

<10% TBSA burn in adults
<5% TBSA burn in young or old
<2% full thickness burn

A

Minor burn

(outpatient tx)

37
Q

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)

A

Moderate burn

(admit to hospital)

38
Q

>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)

A

Major burn

(refer to burn center)

39
Q

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

A

Management of mild burns

40
Q

Silver sulfadiazine (1%) [silvadene]

A

MC topical abx used for burns

41
Q

True or False…

in addition to Silver Sulfadiazine, you can also use bacitracin, triple abx ointment or honey

A

true

42
Q

What immunization should you make sure you have up to date in a burn pt?

A

Tetanus

43
Q

During what phase of healing can you use non-scented moisturizing cream (ie Vaseline)

A

Final phase of healing

44
Q

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

A

Dressing for minor burns

45
Q

When should you change a burn dressing?

A

No clear recommendation
Once daily
Whenever soaked with exudates

46
Q

Signs of infection of a burn?

A

Lymphangitis
Fever
Malaise
Anorexia

(infection should be treated aggressively with IV abx)

47
Q

________ burns have higher risk of infection 2/2 decreased neutrophil activity, impaired T lymphocyte activity and cytokine imbalance

A

Non-superficial

48
Q

Initial management of moderate or severe burns includes…

A

Stabilizing airway, breathing and circulation

49
Q

What history questions are crucical to get on a burn pt?

A
  • *A**llergy (to drugs)
  • *M**eds
  • *P**revious (significant PMH, surgeries, etc)
  • *L**ast (intake and output)
  • *E**vent (events leading up to)

AMPLE

50
Q

Smoke inhalation can rapidly lead to….

A

airway edema

51
Q

MC cause of death in burn victims?

A

Inhalation injury

52
Q

Inhalation injury is present in about 2/3 of patients with burns greater than __% BSA

A

70%

53
Q

Carbonaceous sputum

Singed facial or nasal hairs

Facial burns

Oropharyngeal edema

Voice changes

A

Signs of smoke inhalation

54
Q

Management of smoke inhalation injury?

A

Intubation as indicated

other wise, high flow O2

55
Q

Best way to get fluids to a burn victim?

A

IO!

(this is essential bc these ppl need fluids!)

56
Q

What type of fluid do burn victims need?

A

Lactate Ringers

57
Q

2-4mL x %BSA x W in Kg = volume of fluid within ___hours of injury

A

24 hours

58
Q

How can you monitor hydration status of a burn pt?

A

Foley cath

59
Q

if burned area is >10% BSA, what must you monitor for?

A

Hypothermia

60
Q

Pulmonary dysfunction causes more than __% of fire related deaths

A

75%

61
Q

Pts with high voltage injury are at risk of…

A

ST-T wave changes

62
Q

What must you usually do with a circumferential burn?

A

Excise the eschar

63
Q

Pt with severe burns have metabolic rates of…

A

100-150% higher than normal

SD- ER pt 1 (8 decks)

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