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SPECON LEC > LEC 1.2 (BURNS) > Flashcards

LEC 1.2 (BURNS) Flashcards

1
Q

Most common cause of burns for Children (1-5 years)
A. Accidents from hot liquids
B. Scalds from hot liquids
C. Fires in homes and structural dwellings
D. Inhalation injury

A

B

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2
Q

Most common cause of burns for Adolescent and adults
A. Accidents from hot liquids
B. Scalds from hot liquids
C. Fires in homes and structural dwellings
D. Inhalation injury

A

A

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3
Q

Leading cause of burns in other age groups
A. Accidents from hot liquids
B. Scalds from hot liquids
C. Fires in homes and structural dwellings
D. Inhalation injury

A

C

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4
Q

Common cause of death
A. Accidents from hot liquids
B. Scalds from hot liquids
C. Fires in homes and structural dwellings
D. Inhalation injury

A

D

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5
Q

Males between 16-40 have the highest injury (T/F)

A

T

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6
Q

SLIDE 4-5

A

-

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7
Q

RISK FACTORS OF FIRE

A

-Occupations that increase exposure to fire
-Poverty, overcrowding, and lack of safety measures
-Placement of young girls in household roles such as
cooking and care of small children
-Underlying medical conditions including epilepsy,
peripheral neurophathies, physical and cognitive
disabilities
-Alcohol abuse and smoking
-Easy access for chemicals used for assault (such as
acid violence attacks)
-Use of kerosene as a fuel source for non-electric
domestic appliances
-Inadequate safety measures for liquefied petroleum gas and electricity

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8
Q

SLIDE 8-12

A

-

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9
Q

Largest organ

A

Skin

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10
Q

Functions of the skin:

A

-Protective shield against heat, light, injury, and
infection
-Regulation of body temperature
-Storage of water and fat
-Prevents entry of bacteria

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11
Q

SLIDE 14

A

-

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12
Q

Surface or outer layer; also serves as a barrier between our body and the environment

A

Epidermis

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13
Q

Layers of the Epidermis:

A

Stratum Corneum
Stratum Lucidum
Stratum Granulosum
Stratum Spinosum
Stratum Germinativum/Basale

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14
Q

SLIDE 16

A

-

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15
Q

Layer of the skin beneath the dermis

A

Dermis

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16
Q

How many times does the Dermis thicker
A. 10-20
B. 20-30
C. 30-40
D. 40-50

A

B

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17
Q

The dermis contains DERMAL appendages (T/F)

A

F, EPIDERMAL

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18
Q

The dermis is comprised mainly of ____ and _____
fibers

A

interwoven collagen
elastin

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19
Q

TWO LAYERS OF DERMIS

A

PAPILLARY AND RETICULAR

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20
Q

KRAUSE END BULB
A. Pain & itch
B. Touch
C. Warm Receptors
D. Cold Receptors
E. Pressure and Vibration

A

D

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21
Q

MERKEL’S DISKS
A. Pain & itch
B. Touch
C. Warm Receptors
D. Cold Receptors
E. Pressure and Vibration

A

B

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22
Q

PACINIAN CORPUSCLES
A. Pain & itch
B. Touch
C. Warm Receptors
D. Cold Receptors
E. Pressure and Vibration

A

E

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23
Q

FREE NERVE ENDINGS
A. Pain & itch
B. Touch
C. Warm Receptors
D. Cold Receptors
E. Pressure and Vibration

A

A

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24
Q

RUFFINI’S ENDINGS
A. Pain & itch
B. Touch
C. Warm Receptors
D. Cold Receptors
E. Pressure and Vibration

A

C

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25
Q

MEISSNER’S CORPUSCLES
A. Pain & itch
B. Touch
C. Warm Receptors
D. Cold Receptors
E. Pressure and Vibration

A

B

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26
Q

FREE NERVE ENDINGS
A. Epidermis and Dermis
B. Epidermis (Stratum
Spinosum)
C. Papillary Dermis
D. Reticular Dermis

A

A

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27
Q

RUFFINI’S ENDINGS
A. Epidermis and Dermis
B. Epidermis (Stratum
Spinosum)
C. Papillary Dermis
D. Reticular Dermis

A

C

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28
Q

KRAUSE END BULB
A. Epidermis and Dermis
B. Epidermis (Stratum
Spinosum)
C. Papillary Dermis
D. Reticular Dermis

A

C

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29
Q

MERKEL’S DISKS
A. Epidermis and Dermis
B. Epidermis (Stratum
Spinosum)
C. Papillary Dermis
D. Reticular Dermis

A

B

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30
Q

PACINIAN CORPUSCLES
A. Epidermis and Dermis
B. Epidermis (Stratum
Spinosum)
C. Papillary Dermis
D. Reticular Dermis

A

D

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31
Q

MEISSNER’S CORPUSCLES
A. Epidermis and Dermis
B. Epidermis (Stratum
Spinosum)
C. Papillary Dermis
D. Reticular Dermis

A

C

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32
Q

SLIDE 20

A

-

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33
Q

Lies below the dermis
It consists of loose connective tissue and elastin

A

Hypodermis/Subdermis

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34
Q

WATER serves as padding and insulation for the body (t/f)

A

F; FAT

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35
Q

MOI OF BURNS

A

Alteration of vascular integrity → Edema → LOM

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36
Q

Skin Destruction will depend on:

A

Temperature
Length of Time
Type of Insult (Flame, liquid, chemical, electrical)
Extremes of age

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37
Q

*THERMAL BURNS
A. Scalds
B. Flames

  1. Spilling hot drinks/liquid, hot water in baths
  2. 50% of adult burns
  3. Inhalation and concomitant trauma
  4. Cause superficial to superficial dermal burns
  5. 70% of burns in children
  6. Deep or full thickness
A
  1. A
  2. B
  3. B
  4. A
  5. A
  6. B
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38
Q

-The depth of heat injury depends on the degree of
heat exposure and depth of heat penetration
-Deep dermal or full thickness

A

Contact

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39
Q

SLIDE 25 PIC

A

-

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40
Q

Most devastating type of burn

A

Electrical burn

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41
Q

An electric current will travel through the body from
one point to another, creating “_____” or “_____” points

A

entry/exit

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42
Q

Electrical burns vary according to:

A

Type of current
Intensity of the current
Area of the body that the current passes through

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43
Q

SLIDE 27 PIC

A

-

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44
Q

Ranking of the electrical resistance of various tissues
(Most Resistant to Least Resistant)

A

a. Bone
b. Cartilage
c. Tendon
d. Skin
e. Muscle
f. Blood
g. Nerve

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45
Q

Two types of electrical burns

A

Low voltage E.B.
High voltage E.B.

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46
Q

A. Low voltage E.B.
B. High voltage E.B

  1. Greater than 1000volts
  2. Apnea, deep tissue destruction, renal failure
  3. Exposure to 500-1000 volts of current
  4. True/Flash
  5. VFib
A
  1. B
  2. B
  3. A
  4. B
  5. A
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47
Q

SLIDE 30

A

-

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48
Q

MECHNAICAL burns cause extensive muscle and soft tissue necrosis often
result in amputation (T/F)

A

F; Electrical

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49
Q

UE most common, (R) UE for electrical burns (T/F)

A

T

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50
Q

At high voltage, PNS and CNS problems may not be present initially but may occur late after (T/F)

A

T

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51
Q

Electrical burns d/t Lightning

A

-Myelopathy
-Sensorineural and Mechanical hearing loss

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52
Q

Electrical burns d/t Ocular complications

A

-Cataracts
-Macular holes

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53
Q

SLIDE 33

A

-

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54
Q

SLIDE 34

A

-

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55
Q

Electrical burns d/t Cardiac manifestations

A

-Immediate cardiac arrest
-Pseudo infarction
-Myocardial ischemia without necrosis
-Dysrhythmia
-Conduction abnormalities
-Acute hypertension
-Nonspecific ECG abnormalities
-Sinus tachycardia

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56
Q

Electrical burns d/t Other manifestations

A

-Diaphragm paralysis
-Inhibition of the breathing centers in the midbrain
-Extensive fluid loss
-Loss of consciousness
-Impaired recall and PTSD
-Blood clotting
-Compartment syndrome
-Rhabdomyolysis

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57
Q

Burn usually as a result of an industrial accident

A

Chemical burn

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58
Q

May occur with household chemical products

A

Chemical burn

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59
Q

For chemical burns:
_____ products > _____ products

A

Alkali; acidic

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60
Q

-Classified as carbon monoxide poisoning, heat, or
smoke inhalation injuries
-Account for more than half of the burn related deaths
per year
-One of the leading causes of death

A

Inhalation Injuries

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61
Q

Signs of inhalation injuries:

A

-Facial burn
-Singed nasal burn
-Harsh cough
-Hoarseness
-Abnormal breath sounds
-Respiratory distress
-Carbonaceous sputum
-Hypoxemia

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62
Q

SLIDE 41

A

-

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63
Q

A. Zone of coagulation
B. Zone of stasis
C. Zone of Hyperemia

  1. Occurs at the point of maximum damage
  2. Goal: Increase perfusion
  3. Irreversible tissue loss
  4. Outermost zone
  5. Decreased tissue perfusion
  6. Tissue will recover unless there is severe sepsis
A
  1. A
  2. B
  3. A
  4. C
  5. B
  6. C
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64
Q

SLIDE 43

A

-

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65
Q

SLIDE 44

A

-

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66
Q

-Superficial injury
-Epidermis
-Red and sometimes painful

A

FIRST DEGREE (OLD CLASSIF)

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67
Q

-Epidermis and parts of the dermis
-Skin may be red and blistered and swollen
-Very painful

A

SECOND DEGREE (OLD CLASSIF)

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68
Q

-Epidermis and dermis
-Whitish, charred or translucent
-No pin prick sensation on burned area

A

THIRD DEGREE (OLD CLASSIF)

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69
Q

-Deep and potentially life-threatening
-Extend into skin and underlying tissues

A

FOIURTH DEGREE (OLD CLASSIF)

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70
Q

Min. edema

A. Epidermal
B. Superficial Partial thickness Burns
C. Deep Partial thickness Burns
D. Full thickness burns
E. Subdermal Burns

A

A

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71
Q

DRY

A. Epidermal
B. Superficial Partial thickness Burns
C. Deep Partial thickness Burns
D. Full thickness burns
E. Subdermal Burns

A

A

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72
Q

BLANCHING
A. Epidermal
B. Superficial Partial thickness Burns
C. Deep Partial thickness Burns
D. Full thickness burns
E. Subdermal Burns

73
Q

MARKED EDEMA
A. Epidermal
B. Superficial Partial thickness Burns
C. Deep Partial thickness Burns
D. Full thickness burns
E. Subdermal Burns

74
Q

Muscle and bone → Necrosis (when burned)

A. Epidermal
B. Superficial Partial thickness Burns
C. Deep Partial thickness Burns
D. Full thickness burns
E. Subdermal Burns

75
Q

Eschar - Hard, parchment like, black/brown covering the area

A. Epidermal
B. Superficial Partial thickness Burns
C. Deep Partial thickness Burns
D. Full thickness burns
E. Subdermal Burns

76
Q

Mod. erythema & Extremely painful

A. Epidermal
B. Superficial Partial thickness Burns
C. Deep Partial thickness Burns
D. Full thickness burns
E. Subdermal Burns

77
Q

Discrimination but retains deep pressure

A. Epidermal
B. Superficial Partial thickness Burns
C. Deep Partial thickness Burns
D. Full thickness burns
E. Subdermal Burns

78
Q

Peels of and desquamates in 3-4 days

A. Epidermal
B. Superficial Partial thickness Burns
C. Deep Partial thickness Burns
D. Full thickness burns
E. Subdermal Burns

79
Q

Desquamation d/t topical agents

A. Epidermal
B. Superficial Partial thickness Burns
C. Deep Partial thickness Burns
D. Full thickness burns
E. Subdermal Burns

80
Q

Complete destruction of all tissue from the epidermis to the subcutaneous tissue

A. Epidermal
B. Superficial Partial thickness Burns
C. Deep Partial thickness Burns
D. Full thickness burns
E. Subdermal Burns

81
Q

All nerve endings destroyed

A. Epidermal
B. Superficial Partial thickness Burns
C. Deep Partial thickness Burns
D. Full thickness burns
E. Subdermal Burns

82
Q

Mixed or Waxy white

A. Epidermal
B. Superficial Partial thickness Burns
C. Deep Partial thickness Burns
D. Full thickness burns
E. Subdermal Burns

83
Q

Hair follicles (completely destroyed)

A. Epidermal
B. Superficial Partial thickness Burns
C. Deep Partial thickness Burns
D. Full thickness burns
E. Subdermal Burns

84
Q

Most of the nerve endings, hair follicles and sweat ducts will be injured

A. Epidermal
B. Superficial Partial thickness Burns
C. Deep Partial thickness Burns
D. Full thickness burns
E. Subdermal Burns

85
Q

(-) blisters

A. Epidermal
B. Superficial Partial thickness Burns
C. Deep Partial thickness Burns
D. Full thickness burns
E. Subdermal Burns

86
Q

Residual skin color change d/t melanocytes destruction

A. Epidermal
B. Superficial Partial thickness Burns
C. Deep Partial thickness Burns
D. Full thickness burns
E. Subdermal Burns

87
Q

Heals in 3-5 weeks (not infected)

A. Epidermal
B. Superficial Partial thickness Burns
C. Deep Partial thickness Burns
D. Full thickness burns
E. Subdermal Burns

88
Q

Cell damage (epidermis only)

A. Epidermal
B. Superficial Partial thickness Burns
C. Deep Partial thickness Burns
D. Full thickness burns
E. Subdermal Burns

89
Q

Large amount of evaporative water loss (15-20x)

A. Epidermal
B. Superficial Partial thickness Burns
C. Deep Partial thickness Burns
D. Full thickness burns
E. Subdermal Burns

90
Q

A. Epidermal
B. Superficial Partial thickness Burns
C. Deep Partial thickness Burns
D. Full thickness burns
E. Subdermal Burns

91
Q

(+) Intact blisters

A. Epidermal
B. Superficial Partial thickness Burns
C. Deep Partial thickness Burns
D. Full thickness burns
E. Subdermal Burns

92
Q

Prolonged contact c heat source & result of contact c electricit

A. Epidermal
B. Superficial Partial thickness Burns
C. Deep Partial thickness Burns
D. Full thickness burns
E. Subdermal Burns

93
Q

Epidermis → papillary layer of the dermis

A. Epidermal
B. Superficial Partial thickness Burns
C. Deep Partial thickness Burns
D. Full thickness burns
E. Subdermal Burns

94
Q

↓ sensation to light touch or sharp/dull

A. Epidermal
B. Superficial Partial thickness Burns
C. Deep Partial thickness Burns
D. Full thickness burns
E. Subdermal Burns

95
Q

Min. scarring

A. Epidermal
B. Superficial Partial thickness Burns
C. Deep Partial thickness Burns
D. Full thickness burns
E. Subdermal Burns

96
Q

Spontaneous healing

A. Epidermal
B. Superficial Partial thickness Burns
C. Deep Partial thickness Burns
D. Full thickness burns
E. Subdermal Burns

97
Q

Peripheral vascular system damage

A. Epidermal
B. Superficial Partial thickness Burns
C. Deep Partial thickness Burns
D. Full thickness burns
E. Subdermal Burns

98
Q

Healing occurs through scar formation and re-epithelialization

A. Epidermal
B. Superficial Partial thickness Burns
C. Deep Partial thickness Burns
D. Full thickness burns
E. Subdermal Burns

99
Q

Pain delay

A. Epidermal
B. Superficial Partial thickness Burns
C. Deep Partial thickness Burns
D. Full thickness burns
E. Subdermal Burns

100
Q

Complete healing in 7-10 days

A. Epidermal
B. Superficial Partial thickness Burns
C. Deep Partial thickness Burns
D. Full thickness burns
E. Subdermal Burns

101
Q

Epidermal & dermal layers (completely destroyed)

A. Epidermal
B. Superficial Partial thickness Burns
C. Deep Partial thickness Burns
D. Full thickness burns
E. Subdermal Burns

102
Q

(-) scar tissue

A. Epidermal
B. Superficial Partial thickness Burns
C. Deep Partial thickness Burns
D. Full thickness burns
E. Subdermal Burns

103
Q

Epidermis & papillary dermis with damage to reticular dermal layer

A. Epidermal
B. Superficial Partial thickness Burns
C. Deep Partial thickness Burns
D. Full thickness burns
E. Subdermal Burns

104
Q

Hypertrophic scar formation

A. Epidermal
B. Superficial Partial thickness Burns
C. Deep Partial thickness Burns
D. Full thickness burns
E. Subdermal Burns

105
Q

Skin is erythematous

A. Epidermal
B. Superficial Partial thickness Burns
C. Deep Partial thickness Burns
D. Full thickness burns
E. Subdermal Burns

106
Q

SLIDE 52

107
Q

SLIDE 53

108
Q

SLIDE 54

109
Q

SLIDE 55

110
Q

SLIDE 56

111
Q

The Rule of 9
-Divides the body into areas of 9%
-More practical in the emergent triage of a patient with an acute burn injury

A

TOTAL BODY SURFACE AREA (TBSA)

112
Q

SLIDE 58

113
Q

-Tool divides the body into much smaller areas and gives you sizes that are associated with differently aged patients
-Modified the percentages of body surface area to account for a continuum age and to accommodate for growth of different body segments
-More accurate means to determine extent of burns

A

Modified Lund and Browder Method

114
Q

SLIDE 60

115
Q

SLIDE 61

116
Q

CRITERIA FOR ADMISSION

A

-Partial and full thickness burns >10% TBSA in patient <10 and >50
-Partial and full thickness burns >20% of TBSA in other age groups
-Full thickness >5% TBSA in any age group
-Partial and full thickness burns involving the hand, feet, face, perineum, or skin overlying major joints
-Electrical burns and lightning injuries
-Chemical burns
-Patient with inhalation injury

117
Q

Leading cause of mortality of burns

A

Infections (Pseudomonas aeruginosa and Staphylococcus aureus)

118
Q

Pulmonary complications

A

-Suspected in patients burned in a close space
-Inhalation injury
-Primary complications include carbon monoxide poisoning, tracheal damage, upper airway obstruction, pulmonary edema, pneumonia
-Damage to the lungs = lethal

119
Q

Metabolic complications

A

-Thermal injuries cause a great metabolic and catabolic change to the body
-Rapid decrease in body weight and decrease in energy stores that are vital to the healing process

120
Q

Cardiovascular complications

A

-Severe burns where there are hemodynamic changes from the loss/shifting of fluids
-15% decrease in cardiac output

121
Q

Heterotrophic Ossification

A

->20% TBSA
-Occurs in areas of full thickness burns or sites that remain unhealed for a prolonged period of time
-Immobilization, microtrauma, high protein intake, sepsis
-Elbow (most common), hips, shoulders

122
Q

Neuropathy

A

-Compression bandages applied to tight, poorly fitted splints, inappropriate positioning
-Brachial plexus, ulnar, common peroneal

123
Q

SLIDE 66

124
Q

Pathologic Scar

A

-Deep partial thickness burns allowed to heal
-Full thickness burns that have been skin grafted
-Hypertrophy, contracture, or both

125
Q

Epithelial healing - If there are viable cells lining the skin appendages

Contact inhibition

A

Epidermal healing

126
Q

Epidermal healing is most clinically evident in _______ wounds
that have intact____ and ______

A

Partial Thickness wounds
Hair follicles
Glands

127
Q

Slide 69

128
Q

Three phases of Dermal Healing

A

Inflammatory, Proliferative, Maturation

129
Q

A. Inflammatory
B. Proliferative
C. Maturation

  1. > Collagen breakdown (Hypertrophic scarring)
  2. Ratio of collagen breakdown to production determines the type of scar that forms
  3. Characterized by redness, edema, warmth, pain,and decreased ROM
  4. Fibroblast formation
130
Q

A. Inflammatory
B. Proliferative
C. Maturation

  1. Wound Contraction
  2. = or slightly > than collagen breakdown (Pale, flat and pliable scar)
  3. Re-epithelialization is occurring at the surface of the wound, while deep within the wound, fibroblasts are migrating and proliferating
  4. 3-5 days
131
Q

A. Keloid Scars
B. Contracture scar
C. Hypertrophic

  1. Are characterized by extremely tight skin that can restrict your ability to move
  2. Excessive collagen deposits appear raised, but not to the degree observed with keloids
  3. Can appear as a firm, rubbery lesion or shiny fiber nodules
132
Q

LTG

A

To restore skin integrity, function and appearance

133
Q

Immediate goal (post resucitation)

A

-Prevent infection
-Decrease pain
-Prepare wounds for grafting
-Prevent contracture and scarring
-Maintain strength and function

134
Q

Acute of Initial Medical Management

A

-Transport
-Fluid replacement
-Determining the extent and depth of injury
-Wound cleansing
-Proper positioning for optimal joint placement

135
Q

Goal of Acute Medical Management

A

-To remove dead tissue, prevent infection, and promote revascularization/reepithelialization

136
Q

To help reduce the number of bacteria

A

Topical Antibacterial Agent

137
Q

-Most commonly used
-against pseudonomas

A

Silver sulfadiazine

138
Q

-Antibacterial
-against gram-negative/positive
-diffuses easily c eschar

A

Mafenide acetate (sulfamylon)

139
Q

-Antimicrobial
-Moist environment
-Antiseptic germicide/astringent
-penetrate 1-2 mm eschar
-useful for surface area
-black

A

Mafenide acetate solution (sulfamylon 5% solution)
silver nitrate

139
Q

-bland ointment
-against gram positive

A

Bacitracin/Polysporin

140
Q

-Enzymatic selectively debrides necrotic tissue
-no antibac action

A

Collagenase, Accuzyme

140
Q

-Removal of eschar
-Removal of necrotic tissue
-Helps by preventing bacterial proliferation

A

Debridement (Wound Cleansing)

Wound coverage

141
Q

DRESSING

A

-To prevent wound contamination
-Keep microorganisms at bay
-Prevent further injuries
-Apply pressure to control the hemorrhage
-Absorb wound drainage
-Assist in wound healing

142
Q

Open Technique

A

-Applying a topical cream or ointment with or without dressings
-Allows for ongoing inspection of the wound and
examination of the healing process
-The topical medication must be reapplied
throughout the day

143
Q

SLIDE 80

144
Q

SLIDE 81

145
Q

Acute or Initial Medical Management that is wound coverage by applying dressings over topical agents

A

Closed Technique

146
Q

Purpose of closed technique

A

-Hold topical antimicrobial agents on the
wound
-Reduce fluid loss
-Protect the wound

147
Q

SLIDE 83

148
Q

Closed technique should be changed one or twice a day (T/F)

149
Q

Closed technique layers

A

1st - Non-adherent
2nd - Cotton padding
3rd - Gauze or elastic bandage
4th - Roller gauze
5th - Elastic wrap

149
Q

SLIDE 85

150
Q

Types of grafting

A

Autograft
-Patient’s own skin, taken from an unburned area
-Permanent coverage

Homograft/Allograft
-Taken from cadaver of own species

Heterografts/Xenografts
-Non-human (Pigs)

151
Q

A.
B.
C.
D.

151
Q

A.
B.
C.
D.

152
Q

A.
B.
C.
D.

SPECON LEC (6 decks)

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