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Unit 3 Emerg/Surg > L12: Burns > Flashcards

L12: Burns Flashcards

1
Q

__ (M/F) get burns more often, and most deaths result from _____

A

M>F

Deaths from house fires

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2
Q

Burn risk

A

Inadequate or faulty electrical wiring
Lack of or non-functioning smoke detectors
Arson
Water heater temps set too high
Carelessness with cigarettes
Young children and older adults
Workplace exposure to chemicals, electricity or irradiation
ETOH or other substances that alter function/mental status

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3
Q

First degree burn aka

A

Superficial burn

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4
Q

Second degree burn aka

A

Partial thickness burn

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5
Q

Third degree burn aka

A

Full thickness burn

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6
Q

4th degree burn aka

A

Beyond full thickness burn

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7
Q

Examples of a first degree burn

A

sunburn, mild scalds, mild electrical burn

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8
Q

Examples of a 3rd degree burn

A

Flame burn

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9
Q

Damage from a 1st degree burn

A

Epidermal→ Only outer layer of skin, not all the way through.

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10
Q

Damage from a superficial 2nd degree burn

A

Burned through 1st layer of skin and part of 2nd layer

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11
Q

Damage from deep 2nd degree burn

A

Burned all the way through 1st and 2nd layers of skin.

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12
Q

Damage from a 3rd degree burn

A

Extends through all layers of skin. Skin charring.

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13
Q

Damage from a 4th degree burn

A

Extends through all layers of skin, sub-dermal tissue, into muscle, bone, tendon, blood vessels, nerves

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14
Q

Appearance of a 1st degree burn

A

Red, swollen

Blanch with pressure. No blisters.

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15
Q

Appearance of a superficial 2nd degree burn

A

Intense and splotchy redness, pink, wet blisters

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16
Q

Appearance of a deep 2nd degree burn

A

Red and white, bloody blisters

Decreased cap refill

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17
Q

Appearance of a 3rd degree burn

A

White and brown

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18
Q

Appearance of a 4th degree burn

A

Black, charred, dead tissue

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19
Q

Skin texture for varying degrees of burns

A 
1st: dry
Sup 2nd: moist
Deep 2nd: moist
3rd: stiff, dry, leathery
4th: dry
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20
Q

Pain sensation for varying degrees of burns

A 
1st: painful
Sup 2nd: painful
Deep 2nd: pain with pressure
3rd: painless
4th: painless
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21
Q

Healing time for varying degrees of burns

A

1st: 7 days
Sup 2nd: 7-21 days
Deep 2nd: 3-12 weeks

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22
Q

Complications of a 1st degree burn

A

Repeated sunburns→ cancer

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23
Q

Complications of a superficial 2nd degree burn

A

Local infection, cellulitis

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24
Q

Complications of a deep 2nd degree burn

A

Scarring +/- skin grafting

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25
Q

Complications of a 3rd degree burn

A

Scarring, contractures, +/- amputation

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26
Q

Complications of a 4th degree burn

A

Amputation
Functional impairment
Gangrene
Death

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27
Q

For all burns, consider ________

A

Td booster

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28
Q

1st degree burn treatment

A

Cool: running water, cold compress. Clean.
Topical calamine/aloe vera gel, topical polysporin.
OTC acetaminophen or NSAIDS

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29
Q

2nd degree burn treatment

A

Keep moist, debride→ re-epithelialization

Cool: running water, cold compress

Cover: loose, sterile gauze, occlusive dressing (Xeroform)

Petroleum based moisturizer vs Bacitracin

Change dressing 1-2X daily, wash wound each time, +/- opioids

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30
Q

Deep 2nd degree burn with eschar treatment

A

silver sulfadiazine cream on 4x4 covered with gauze

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31
Q

Eschar

A

slough or piece of dead tissue that is cast off from the surface of the skin

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32
Q

Burns starting at _____ and beyond require “immediate medical attention”

A

Deep 2nd degree (partial thickness)

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33
Q

Treatment for 3rd degree burns

A

will not heal well spontaneously→ surgical repair and skin grafting

Wash, debride, silver sulfadiazine

Change dressing 2x daily, opioids

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34
Q

Treatment for 4th degree burns

A

“Immediate medical attention”

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35
Q

Superficial burn prevention

A

Reduce sun exposure, Protective clothing, SPF > 30
Unplug appliances, Plugs for outlets
Do not leave stove when cooking, Use back burners
Avoid hot liquids near children→ supervise infants and toddlers

36
Q

ABA Referral criteria for burns

A

Partial-thickness burns of > 10% of total body surface area

Third-degree burns in any age group

Burns that involve the face, hands, feet, genitalia, perineum, or major joints

Electrical burns, including lightning injury

Chemical burns
Inhalation injury

Burn injury in patients with preexisting medical disorders that could complicate management, prolong recovery, or affect mortality (DM included during pharm)

Any patients with burns and concomitant trauma

Children in hospitals without qualified personnel or equipment to care for their burn injuries

Burn injury in patients who will require special social, emotional, or rehabilitative intervention

37
Q

Number one cause of fire related deaths

A

SMOKE INHALATION

so you gotta intubate them before edema compromises the airway

38
Q

Indications for intubation

A

History suggests airway compromise:

Closed space smoke exposure
Carbonaceous sputum
Facial burns, Singed facial hair
COHb>5
Hoarse voice
Patient unable to protect airway: 
Trauma, Opioids
39
Q

______ is responsible for most prehospital deaths

A

Carbon monoxide inhalation

40
Q

Labs for CO inhalation

A

Pulse ox not reliable→ use carboxyhemoglobin (COHb) levels

41
Q

Delayed neurologic sequelae of CO inhalation likely if….

A

Symptomatic initial clinical picture
Elderly patients
Prolonged exposure

42
Q

The deadly product of combustion is

A

cyanide inhalation/poisoning

43
Q

Symptoms of cyanide poisoning

A

HA to AMS

Hypotension, Arrhythmia, Cardiovascular collapse, Shock

44
Q

Treatment for cyanide poisoning

A

Hydroxocobalamin (Cyanokit)

Heme-like molecule with a complex cobalt atom
Binds to CN forming cyanocobalamin (vitamin B-12)
Renal excretion

45
Q

Symptoms of inhalation

A

Upper airway inhalation→ hoarseness, stridor, substernal retractions

Lower airway inhalation→ tachypnea, decreased breath sounds, wheezing/rales/rhonchi, accessory muscle use

46
Q

Managing inhalation

A

mechanical ventilation
aggressive pulmonary toilet (mucus clearance)
pneumonia tx/prevention
supplemental nutrition

47
Q

Managing circulation (in order)

A
  1. 2 large bore IVs→ in unburned skin
  2. Calculate total body surface area (TBSA)
    Rule of 9s or Lund-Browder
  3. > 20% TBSA→ Parkland resuscitation
    Increased risk of shock
    Magnitude influenced by: depth and extent of burn, pre-existing illness, inhalation injury
48
Q

Goals of Circulation Resuscitation

A

Maintain tissue perfusion to end organs

49
Q

Monitor urine output to monitor the effects of circulation resuscitation

A

Foley catheter
• Adults: 0.5 mL/kg/hr
• Children: 1 mL/kg/hr
• Electrical burns: 1-2mL /kg/hr

50
Q

Are diuretics indicated in acute setting for circulation resuscitation?

A

No???? Why is this even mentioned

51
Q

Parkland formula for fluid replacement

A

IF >20% TBSA

4mL LR x kg x TBSA = 24 hour post burn total

Half of volume in first 8 hours post burn
Other half in remaining 16 hours
Calculate mL/hr

52
Q

Factors influencing fluid requirements

A 
Burn depth
Inhalation injury→ increase needs by 30-50%
Delay in resuscitation
Compartment syndrome 
Electrical burns
53
Q

Complications from under-resuscitation

A

Intravascular volume depletion→ Hemoconcentration

Suboptimal tissue perfusion→ End organ failure, Death

54
Q

Complications from over-resuscitation

A

Results in resuscitation morbidity

Abdominal compartment syndrome→ Decreased renal blood flow leading to renal failure, Intestinal ischemia, Airway obstruction leading to respiratory failure

Compartment Syndrome→ Extremities

Pulmonary edema

55
Q

Abdominal compartment syndrome presentation

A

Decreased urine output
Elevated bladder pressure (>25 mmHg)

Increased Peak Expiratory Pressure,
Poor ventilation

56
Q

Abdominal compartment syndrome monitoring

A

Hourly bladder pressures
Decrease IV fluids

+/- Continuous renal replacement therapy
+/- intraperitoneal catheter for
decompression

57
Q

Abdominal compartment syndrome treatment

A

If unable to reverse→ decompressive

laparotomy

58
Q

C tetani

A

anaerobic, motile, G+ rod
Oval, colorless, terminal spore→ survive for years in some environments
Resistant to disinfectants and to boiling for 20 minutes
acquired outdoors or indoors

59
Q

Major complication from burns

A

Tetanus

60
Q

Tetanus incubation

A

4-14 days

61
Q

______ is prognostic for a more severe course of tetanus

A

Being symptomatic in the first week

62
Q

Infection sources for tetanus

A

Minor wounds from wood, metal splinters or thorns (65%)
Chronic skin ulcers (5%)
No obvious source is identified

63
Q

Wounds prone to tetanus

A 
Present >6 hours
Deep >1 cm wounds
Grossly contaminated wounds
Exposed to saliva or feces
Avulsions, punctures, crush injuries
BURNS
Complication of chronic conditions→ abscess or gangrene
64
Q

Tetanus may complicate

A 
Frostbite
middle ear
infections
dental or surgical
procedures
abortion
childbirth
SQ/IVDU
65
Q

Tetanus symptoms

A

+/- Sore throat with dysphasia

Localized tetanus→ 1 limb or where the wound is located

Generalized tetanus→ trismus (75%)

Subsequently:
Muscle rigidity
Descending pattern from the jaw and facial muscles
Extend within 24-48 hours→ extensor muscles of the extremities

Other signs:
Temperature, sweating, elevated blood pressure,
episodic rapid heart rate, neck rigidity, restlessness,
reflex spasms

66
Q

Secondary prevention of tetanus

A

wound cleansing and debridement

67
Q

Recommended vaccine prophylaxis for tetanus

A

Tetanus toxoid if >5 years since last shot: Td, Tdap, DT, DPT, DTap
+/- TIG

68
Q

Pin control for tetanus? burns? idk

A

IV opioids, transition to oral

avoid IM

69
Q

Types of pain

A

background
breakthrough
procedural

70
Q

Immunization schedule for tetanus

A

Children:
DTaP-2mo, 4mo, 6mo, 15-18mo, 4-6yrs

Adults:
Substitute Tdap once
Td booster every 10 year

71
Q

Chemical burns management

A

Acids/bases
Identify agent→ material safety data sheet (MSDS)
May not appear to be as deep initially
Copious irrigation with water→ delay transport for decontamination, do not try to neutralize
Monitor progress with litmus paper

72
Q

Electrical burns management

A 
History
Monitor for cardiac abnormalities
Injuries may be much worse than they
appear
Current follows path of least resistance→ damage may be hidden under good skin
Risk of rhabdomyolysis→ Muscle damage
Fluid resuscitate even small appearing
injuries→ Goal 1-2 cc urine/kg/hour
73
Q

Lightning burns management

A

2/3 deaths occur within 1 hour of injury→ fatal arrhythmia or respiratory failure
Most survivors have permanent injury
DC current lasting from 1/10-1/1000 or a second→ Often exceeds 10 million V
Feathering skin injuries

74
Q

Do you transport or decontaminate first for a chemical burn?

A

Delay transportation to copiously irrigate with water

75
Q

Feathering skin injuries:

A

Pathognomic for lightning burns

“Lichtenberg figures/flowers”
Keraunographic markings, Arborescent burns
Not true burns→ fade within a few hours

76
Q

Goal urine output for electrical burns

A

1-2 cc urine/kg/hour

even small burns need fluid resuscitation

77
Q

Which kind of burn has a high risk for compartment syndrome?

A

Circumferential ubrns

78
Q

Preventing/treating compartment syndrome in circumferential burns

A

Escharotomy→ Incision through burned skin to underlying subcutaneous tissue

Fasciotomy→ Incision through the fascia overlying muscle compartments of an extremity
Extend incisions through unburned tissue proximally and distally if possible→ mid-medial and mid-lateral incisions on extremity

Shield escharotomy→ used in patients with circumferential torso burns→ improve ventilation

Unstable→ Do at bedside

79
Q

Lightning burns are so likely to cause death because of….

A

fatal arrhythmia or respiratory failure

80
Q

Skin grafts

A

Large or deep burn wounds, Necessary for wound coverage

+/- Temporary skin covering→ Allograft, Xenograft

Autograft only definitive coverage, requires a donor site

Partial thickness donor skin→ 1/1000-1/1200” thick
Donor site→ Very painful, 7-10 days to heal

81
Q

Infection in a burn patient

A

Fever not always indicative of infection
Increased edema, erythema
+/- increased pain

82
Q

Preventing infection in a burn patient

A

Prophylaxis→ wounds become colonized in 3-5 days with G+ organisms

83
Q

Nutrition methods for a burn patient

A

Enteral support
Reduces burn–related increase in secretion of catabolic hormones
Helps maintain gut mucosal integrity

Duodenal route
Better tolerated than gastric feeding which has 18% failure rate from regurgitation

Total parenteral nutrition
Not recommended:
Does not prevent the catabolic response to burns, Impairs immunity and liver function
Increases mortality

84
Q

Burn patients need a ______ diet because _____

A 
High carb, low fat diets
Less proteolysis
More improvement in lean body mass
\+/- reduce infectious morbidity
Shortens hospitalization time
85
Q

Chronic complications of burns include….

A 
Chronic ulceration
Keloid scars
Hypertrophic scars
Scar contractures
Pigment changes
86
Q

Keloid scars, unlike hypertrophic scars…

A

Overgrowth of scar tissue beyond area of injury

87
Q

Chronic ulceration occurs due to

A

Grafted skin lack support structures of normal tissue→ chronic non-healing ulcers in grafts→ remain open for years
Concern: development of Marjolin ulcer

Unit 3 Emerg/Surg (5 decks)

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