Management of Burn and Thermal Injuries

Question 1

What are functions of the skin

Answer 1

Thermoregulation, sensory perception, maintenance of fluid electrolyte balance, Immune defense, Vitamin D metabolism

Question 2

What are the degrees of burn and what do they effect

Answer 2

First degree burn: only effects the epidermis (redness and swelling)
Second degree burn/partial thickness burn: effects the epidermis and the dermis (blistering)
Third degree burn/full thickness burn: effects all layers of the skin and may effect the subcutaneous tissue (white or blackened, numb)
Fourth degree burn: effects all layers of the skin including the subcutaneous tissue (burn muscle and bone)

Question 3

What is usually associated with burn injury

Answer 3

Inhalation injury (need intubation)

Question 4

What must a patient have to be referred to a burn center

Answer 4

Partial thickness burns greater than 10% BSA in patients under the age of 10 or older than the age of 50/ Partial thickness burns greater than 20% BSA in other age groups/ Burns that involve the hands, feet, face, genitalia, perenium or major joints/ Any third degree burns/ Electrical burns (including lightning), chemical burns, inhalation injury/ Burn injury with prexisting conditions, children without the right personnel, burns that require long term care

Question 5

What are the type of burn injury

Answer 5

Thermal injury, chemical injury, electrical injury

Question 6

What happens to the local tissue due to the burn

Answer 6

Inflammation, swelling, and necrosis

Question 7

What happens systemically due to burn injury

Answer 7

Interstitial edema, activation of the coagulation system, release of histamine/bradykinin, anti-inflammatory response, hypermetabolic state (release of catecholamines, prostaglandins, glucagons, and gluccocorticosteroids)

Question 8

What is assessed initially for a burn injury

Answer 8

TBSA affected, inhalation injury, trauma, carbon monoxide, cyanide, pediatric issues

Question 9

What are the initial treatments of burn injury

Answer 9

secure airway access, initiation of fluid resuscitation, initiation of wound stabilization, initiation of treatment of the non burn issues (toxicology, trauma), pain management

Question 10

For initial fluid resuscitation what formula is used to treat patients, which patients are treated (give adult and children), what fluid is given

Answer 10

Parkland Formula: 2-4 ml/kg/% burned for 24 hours giving HALF in the first 8 HOURS (adults and pediatrics greater than 20) OR 2-3 ml/kg/% burned for 24 hours giving HALF in the first 8 hours/ greater than 20% TBSA burned regardless of type of burn, Ringers Lactate solution

Question 11

What labs are presented when a patient is determined whether or not to go to a burn unit

Answer 11

Chem 7, Mg, Phos, CBC, CPK, carboxyhemoglobin

Question 12

What are the most most toxic chemical involved in burns

Answer 12

Cyanide and carbonmonoxide

Question 13

What is eschar. escharoctomy

Answer 13

Tough and inelastic mass of burnt tissue, the surgical division of the nonviable eschar allowing the underlying tissues have an increased available volume to expand into preventing further tissue injury or functional compromise

Question 14

In the OR what happens in initial debridement

Answer 14

Removing dead tissue and contaminated material from and around a wound to expose health tissue, hydrotherapy, surgical execision

Question 15

T/F: Full thickness and deep partial thickness burns should be treated ASAP

Answer 15

True

Question 16

What are the benefits of removing necrotic tissue

Answer 16

Decreased wound inflammation, decreased systemic response, reduce the development of scarring

Question 17

What are the steps for treating non-operative burn wounds

Answer 17

Continued debridement, wound care, topical antibiotics

Question 18

How are operative burns treated

Answer 18

Surgical debridement and wound/donar site care

Question 19

What should be given to aid dealing with a patients anxiety and pain, when should it be given

Answer 19

Opiods (hydromorphone and morphine) and BZDs (lorazepam and midazolam)/ prior to hydrotherapy

Question 20

T/F: To prevent infection antibiotics should be given systemically

Answer 20

False: To prevent infection antibiotics should be given topically

Question 21

What are the benefits of giving antibiotics systemically to a burn wound patient

Answer 21

Decreased bacterial overgrowth, prevention of burn wound sepsis

Question 22

What are the antibiotics that are used for infection prophylaxis for patients who have been burned

Answer 22

Silver nitrate, Silver sulfadiazine, mafenide acetate, Nanocrystalline silver dressing

Question 23

What are the organisms of concern for for burn patients

Answer 23

Staph aureaus, pseudomonas aeruginosa, acinetobacter, klebsiella, proteus, candida

Question 24

What are organisms that are known for having antibiotic resistance

Answer 24

VRE, MRSA, ESBL

Question 25

What is nutritional support for that is given to burn patients (caloric intake and vitamin supplementation)

Answer 25

Caloric intake: 30-35 kcal/kg/day

Vitamin supplementation: oxandrine, Vitamin A, Vitamin C, Zinc

Question 26

When discussing an electrical source for an electrical burn what is considered high voltage, intermediate voltage

Answer 26

High voltage: greater than 1000 volts,

Intermediate voltage: greater than 220 volts

Question 27

What should be monitored if a patient is has electrical burns

Answer 27

Cardiac rhythm for 24 to 72 hours after high or intermediate exposure, delayed neurologic and ocular sequelae, intracompartamental edema, pigmenturia

Question 28

When someone has a chemical wound what is done to them

Answer 28

Decontamination and irrigation of wounds

Question 29

What is the risk of getting a chemical burn from anhydrous hydroflouric acid, what needs to be

Answer 29

Life threatening hypocalcemia, calcium levels, give calcium supplementation