LO9 Burns (Chapter 17)

Question 1

epidermis

dermis

Answer 1

epidermis is the surface layer

dermis is a thick layer of collagen connective tissue under the epidermis
–Contains the important sensory nerves and also support structures such as hair follicle sweats glands and oil glands

Question 2

Superficial (first degree)

Answer 2

minor tissue damage to the outer epidermis layer only

Question 3

Partial thickness (second degree)

Answer 3

cause damage through the epidermidis and into a variable depth of the dermis

Will heal often without scarring because the cell lining the deeper portions of the hair follicle and sweat glands when multiplying grow new skin for healing

Emergency care involves cooling the burn and covering it with a clean dry dressing

Question 4

full thickness (third degree)

Answer 4

caused damage to all layers of the epidermidis and dermis no more skin cells are left so healing by regrowth is impossible

Leave scars usually result in skin proteins becoming hard and forming a firm leather like covering

Question 5

Critical problems in burn patients that require immediate intervention:

Answer 5

Airway compromise

Altered LOC

Prescence of major injuries

Question 6

Rapid trauma for burns

Answer 6

Directed towards identification of causes of breathing and circulatory compromise after controlling any possible major haemorrhage

Question 7

Clues from the mechanism of injury finding such an alert to respond to potential airway problems

Answer 7

are the presence of facial and scalp burns Sooty septum and singed nasal hair and eyebrows

Question 8

Ask a patient to speak

Answer 8

hoarseness, strider and persistent cough suggest involvement of deeper airway structure and indicate the need for aggressive airway management

Question 9

Wheezing or rails

Answer 9

should alert you to the presence of lower airway injury from inhalation

Question 10

Patient management

Answer 10

Cool burn with tap water at room temperature for no more than 5 to 10 minutes

Managed to burn by covering the patient with a clean dry sheets and blankets to help keep the patient warm

Patient should never be transported on wet sheets wet towels or wet clothing and ice is absolutely contraindicated

If available lactated ringer’s solution is preferred for fluid resuscitation and major burns

Question 11

Circumferential burns

Answer 11

Full thickness burns result in the formation of an eschar that is tough and unyielding if the full thickness burn is circumferential the eschar can act like a tourniquet and result in loss of circulation to the extremity it burn Edema develops

Question 12

Flash burns

Answer 12

Virtually always superficial partial thickness burns the flash burn occurs when there is some type of explosion but no sustained fire a single heat wave travelling from the exposure results in short patient he contact that full thickness burns almost never occur

Question 13

Inhalation injury

Answer 13

Inhalation injuries are classified as carbon monoxide poisoning, heat inhalation injury or smoke inhalation injury

Occur when a patient is injured in a confined space or trapped

Question 14

Carbon monoxide poising

Answer 14

And asphyxiation are by far the most common causes of early death associated with burn injury

Spo2 will remain high and cannot be used to assess patients for carbon monoxide poisoining

Death usually occurs because of either cerebral for myocardial ischaemia myocardial infarction due to progressive cardiac hypoxia

Question 15

It takes up to — hours to reduce the carbon monoxide

Answer 15

It takes up to seven hours to reduce the carbon monoxide/hemoglobin complex to a safe level having patients breathe 100% oxygen decreases this time to about 90 to 120 minutes

Question 16

Cyanide and smoke inhalation

Answer 16

Highly toxic and causes cellular hypoxia by preventing the cell from using oxygen to generate energy to function

Question 17

Heat inhalation injuries

Answer 17

Confined to the upper airway because breathing in flamen hot gases does not result in heat transport down to the lung tissue itself

Steam inhalation is an exception to this rule because steam is super heated water vapour

If the patient has inhaled a flammable gas that then ignites and causes thermal injury to the level of the alveoli

Question 18

airway swelling

Answer 18

Hypopharynx is where the swelling occurs and it can easily progressed to complete airway obstruction

Be aware that once the swelling begins the airway can obstruct rapidly

Development of a horse voice or strider is an indication for immediate protection of the airway an endotracheal intubation if possible the oxygen being administered should be humidified air

Aggressive fluid resuscitation can cause faster swelling of the airway

Question 19

Smoke inhalation injuries

Answer 19

The results of inhale toxic chemicals that cause structural damage to the lungs

They can precipitate bronchospasm or coronary artery spasm

Question 20

Chemical burns

Answer 20

May not only injure the skin but can also absorb into the body and cause internal organ failure

Factors that lead to tissue damage include chemical concentration, amount, manner and duration of skin contact, and the mechanism of action of the chemical agent

The pathological process causing the tissue damage continues until the chemical is either consumed in damage process, detoxify by the body or physically removed

Question 21

Electrical burns

Answer 21

Damage is caused by electricity entering the body and travelling through the tissues

Injury results from the effects of electricity on the function of the body organs and from the heat generated by the passage of the current

Question 22

Determine severity of electrical injury include the following:

Answer 22

Type and amount of current

Path in current through the body

Duration of contact with the current source

Question 23

The most serious immediate injury that results from electrical contact

Answer 23

is cardiac arrhythmia
PVCs, V tach and V fib
Continuous monitoring of cardiac activity

Due to the potential for arrhythmia development IV access should be initiated along with continuous cardiac monitoring IV fluid resuscitation should be started during transport

Question 24

Lightning injuries

Answer 24

Lightning injuries very different from the other electrical injuries in that lightning produces extremely high voltage and current but has a very short duration

The most serious effect of lightning strike is cardio respiratory arrest

The respiratory drive centres of the brain are depressed by the current discharge and take longer to recover and resume the normal respiratory drive patient remains in spite her arrest which is followed by cardiac arrest

Essential component of the management of lightning strike patient is restoration of cardiorespiratory function while protecting the C-spine

Question 25

Radiation burn

Answer 25

Skin burns and radiation look exactly like thermal burns and cannot be differentiated by their parents however radiation burns develop slower over days and heals very slowly

Not radioactive unless they are contaminated with radioactive material

Non-contaminated radiation burn patients are initially treated the same way as any burn patient

Question 26

Circumferential burns

Answer 26

Circumferential full thickness burns can lead to neurovascular compromise

Burns that are circumferential on an extremity can act as a tourniquet as edema

Question 27

Parkland burn formula

Answer 27

4ml x %burn area x body weight kg= amount for first 24hrs half given in first 8hrs

Question 28

Rule of 10s fluid resuscitation

Answer 28

Estimate Burnside to the nearest 10%

Multiply percent of burn times 10 = initial fluid rate in ml/hr patient weighing 40 to 80 kg

For every 10 kg above 80 kg increase the rate by 100 mL per hour