Intro/Burns Lecture Flashcards by Cassidy Ruocco

What is the MC reason people visit the ER?

No access to other healthcare providers

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Thermal
Chemical
Radiation
Electrical

Types of burns

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MC type of burns?

Thermal

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

115 degrees F

(46 degrees C)

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The extent of damage with a burn is dependent on…

Surface temperature

Contact duration

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

Thermal

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

Restoring perfusion to the area

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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

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

Zone of coagulation

(then zone of stasis, then zone of hyperaemia)

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

damaged tissue

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

vasoactive mediators (ie cytokines, prostaglandins, oxygen radicals)

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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)

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After a burn,

systemic capillary leak usually persists..

18-24 hours

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

Hypotension (burn shock)

Edema (burn edema)

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After a burn,

protein is lost from the intravascular space during the first…

12-18 hours

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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

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Thermoregulation

Prevention of fluid loss

Barriers to infection

Sensory information about environment

Functions of skin

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Layers of skin:

Epidermis
Dermis
_______

Hypodermis

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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

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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

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

Hypodermis

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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

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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

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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

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**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) ## Footnote **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

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) ## Footnote **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