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Patho 2 (Path 311) > Mod 8 Burns > Flashcards

Mod 8 Burns Flashcards

1
Q

What is a surface burn?

A

Anything that affects the body

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2
Q

What is a inhalation injury?

A

Anything that affects the respiratory tract

  • URT mainly
  • LRT possible, but not often because the body goes into laryngospasm as a protective measure
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3
Q

What is Pyrolysis?

A

Smouldering in a low O2 environment

  • Fact check later
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4
Q

Etilology of Burns?

A

Smoke can result from pyrolysis or combustion

  • composition of smoke (particulates, toxic gases, and vapor’s) does…something lol check later
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5
Q

What factor can double mortality rate of burns?

A

Smoke inhalation injury followed by a full thickness or 3rd degree burn .

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6
Q

What factors determines the prognosis of Burn injuries?

A
  1. Extent and duration of smoke exposure
  2. Chemical composition of the smoke
  3. Size and depth of body surface burns
  4. Temperature of gases inhaled
  5. Age (the prognosis worsens in the very young or old)
  6. Pre-existing health status
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7
Q

What are characteristics of First Degree Burns?

  • Damage and healing time?
A

Minimal depth in skin; damage limited to the outer layer of epidermis.

  • First 2-5 layers of epidermis only
  • Blisters are not present;healing time is about 6-10 days.
  • Result of healing is normal skin
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8
Q

Colour/appearance of first degree burns?

  • Skin texture
  • Cap refill
  • Sensation?
A

Colour/appearance: Red

Skin texture: Normal

Capillary refill : Yes

Pinprick sensation: Yes (tenderness & pain)

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9
Q

What are characteristics of Second degree burns?

  • Damage and healing time?
A

Damage extends through the epidermis and into the dermis, but is not of sufficient extent to interfere with regeneration.

  • Blisters usually are present. Healing time is 7-21 days.
  • If secondary infection results, the damage from a 2nd degree burn may be = to a 3rd degree burn
  • Healing ranges from normal to hairless and depigmented skin.
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10
Q

Colour/appearance of Second Degree Burns?
- Skin texture

  • Cap refill
  • Sensation?
A
  • Colour/appearance; Red, may be blistered
  • Skin texture: Edematous
  • Capillary refill : Yes
  • Pinprick sensation: Yes (++ pain)
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11
Q

What depth of skin is involved in second degree burns?

A

Involves epidermis and the upper third of dermis

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12
Q

What are characteristics of third degree burns?

  • Damage and healing?
A

Both epidermis and dermis are destroyed, with damage extending into underlying tissues.

  • Resultant damage heals w/hypertrophic scars (keloids) and chronic granulation
  • Tissue may be charred or coagulated
  • Healing may occur after 21 days or may never w/o skin grafting if the burn area is large.
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13
Q

Colour/appearance of third degree burns?

  • Skin texture?
  • Cap refill?
  • Sensation?
A

Colour/appearance: White / black or brown

Skin texture: Leathery/ charred

Capillary refill: No

Pinprick sensation: No

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14
Q

How do do you determine area of surface buns?

A

Rule of 9s

  • 9% front & Back
  • Torso counts 4x (36 in total)
  • Upper limbs 18% in total and 18 for lower limbs
  • Head is 9%
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15
Q

What is the snowball affect of Large third degree burns?

  • what results
A

Large fluid shifts from the vascular compartment due to hyperpermeability of microvasculature (From cell mediated toxin release). Results in:

  • Widespread edema (burn edema)
  • Hypovolemic shock (burn shock)
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16
Q

What are complications of burned skin?

A

Less elastic which:

  • Can impair local tissue perfusion
  • May cause tissue necrosis
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17
Q

What are complications of burns if they are circumferential around the thorax?

A

Burns can decrease chest wall compliance “third spacing” if it surrounds the thorax

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18
Q

How can burns around the thorax lead to third spacing?

  • Needs fact check and clarification
A

Fluid shifts out of circulation and into the spaces between cells, organs, and tissues (the interstitial space.

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19
Q

Generally, what does the pathophysiology of surface burns present as?

A
  • Tissue hypoxia
  • Hypovolemia from fluid shifting
  • Widespread edema
  • Cardiac instability (decreased CO, Early Increased SVR than decreases later)
  • Coagulopathic changes such as Hemolysis and DIC
  • Pts temp resets thermo-homeostatic point (38)
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20
Q

How do burns lead to coagulpathic changes like hemolysis and DIC

  • need to edit
A
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21
Q

How do burns progress to tissue Hypoxia?

A
  • inhalation of toxic gases
  • Inhalation burns
  • inadequate perfusion
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22
Q

What are secondary issues that could appear in later stages of burns?

A
  • Risk of pulmonary thromboembolism (PTE)
  • Infection, sepsis, and gangrene can all occur
  • Multi organ system failure and death (MODF)
  • ARDS
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23
Q

What is a thermal injury?

A

Refers to injury caused by inhalation of hot gases

  • Usually confined to upper airway
  • Manifests in the Nasal cavity, oral cavity, pharnyx
  • the resultant swelling can cause an emergency airway problem
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24
Q

What are clinical manifestations of Thermal Injury?

A
  • Blistering
  • Mucosal edema
  • Vascular congestion
  • Epithelial sloughing
  • Thick secretions
  • Acute upper airway obstruction
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25
Q

Are distal airways affected by Thermal Injury?

A

They are usually spared because:

  • Ability of upper airways to cool gases
  • Reflex laryngospasm
  • Glottis closure
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26
Q

What are usual causes of distal thermal injuries?

A

Harmful products found in smoke

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27
Q

When does thermal injury affect distal airways?

  • hint not as common
A

steam inhalation, but usually don’t occur below the level of the larynx

  • mostly caused by harmful products found in smoke
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28
Q

What part of the airway is affected by smoke inhalation?

  • how does smoke inhalation injury change the lungs? (5)
A

Tracheobronchial tree and alveoli go through anatomic change due to smoke injury, the following can be expected:

  • Tracheobronchial tree inflammation
  • Bronchospasm
  • Excessive bronchial secretions and mucous plugging
  • Decreased mucociliary transport
  • atelectasis
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29
Q

What are pathological changes in distal airways caused by? (3)

A

Smoke inhalation injury with the following particles within the gas:

  • irrational and toxic gas
  • suspended soot particles
  • vapors associated w/incomplete combustion and smoke
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30
Q

What are the 3 progressive stages of smoke inhalation injuries?

  • what’s the timeline of each?
A
  • Early (0-24 hrs after inhalation)
  • Intermediate (2-5 days after inhalation)
  • late stage (5 or more days after inhalation)
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31
Q

Pathophysiology of early stage smoke inhalation injury?

  • onset?
  • manifestations and problems?
A
  1. Pulmonary symptoms can have a delayed presentation up to 24 hrs.
  2. The tracheobronchial tree manifests with
    inflammation, bronchospasm, and Increased bronchial secretions. If untreated, can lead to pulmonary edema and early ARDS
32
Q

Why are increased bronchial secretions a problem?

A

Can lead to airway obstruction

33
Q

how do toxins affect the tracheobronchial tree?

A

Toxins can slow activity of mucociliary secretion transport

  • further exacerbate secretion retention
34
Q

How does inhalation injury lead to non cardiogenic pulmonary edema? (2)

A
  1. Secondary to inflammatory response and leaky AC membrane.
  2. Fluid overload caused by overhydration, results from overzealous fluid resuscitation
35
Q

What happens to the bronchial tree during the intermediate stage of inhalation injury?

A
  • Improvement/resolution of upper airway thermal injuries
  • Pathological chances associated with smoke inhalation peak
36
Q

What are the primary signs and symptoms of intermediate stage smoke inhalation injury? (4)

A
  • Mucous production continues to increase, while mucociliary transport activity continues to decrease
  • mucousa of tracheobronchial tree can become necrotic and sloughs (3-4 days)
  • Leads to mucous plugging and atelectasis
  • mucous accumulation leads to infection
37
Q

How do burns affect the chest wall?

A
  1. Increases airway resistance
  2. Decreases lung and chest wall compliance
  3. Pain reduces cough and ability of deep respirations in Pts.
38
Q

What are secondary pathological issues that can develop during the intermediate stage of smoke inhalation injury? (3)

A
  • Pneumonia
  • If not present already, ARDS
  • Worsening of pain and reduction of deep respirations/cough if burns are present on chest
39
Q

What are the primary concerns of Late Stage smoke inhalation injury?

A
  • Infection (and subsequent sepsis)
  • Pneumonia
  • pulmonary embolism (secondary to hypercoagulable stage)
40
Q

How can pulmonary embolisms develop from burns?

A

PEs could develop from DVT secondary to hypercoagulable state and prolonged immobility

41
Q

What is the usual cause of death in smoke inhalation injury patients if they survive the early stages?

A

Infection, sepsis is very common in severe burn patients

42
Q

What are long term concerns of late stage inhalation injury?

A

They can Lead to restrictive and obstructive lung disorders

43
Q

How are restrictive lung disorders caused by inhalation injury in the long term?

A

They can develop from alveolar fibrosis and chronic atelectasis

44
Q

How are obstructive lung disorders caused by inhalation injury in the long term?

A

Generally caused by increased and chronic bronchial secretions, bronchial stenosis, bronchial polyps, bronchiectasis, and bronchiolitis

45
Q

Generally, what are the 5 mechanisms that can be expected to happen for inhalation burns?

A
  1. Atelectasis
  2. Alveolar consolidation
  3. Increased AC membrane thickness
  4. Bronchospasm
  5. Excessive bronchial secretions
46
Q

What happens to vital signs during burn injuries?

A

Increased RR, HR, and BP

47
Q

Clinical manifestations of a thermal injury in the assessment of the upper airway?

A
  • Pharyngeal edema and swelling
  • Inspiratory stridor
  • Hoarsness
  • Painful swallowing
48
Q

What can be expected on auscultation of a burn patient?

A
  • Cough and sputum production.
  • Early b/s would be normal progressing to wheezes, crackles, and rhonchi
  • Pt would be cyanotic
49
Q

How would early stage burns present on a ABG compared to late stage burn victim ?

A
  • Early stage = Acute respiratory alkalosis w/hypoxemia
  • Late stage = Acute respiratory acidosis
50
Q

What could be expected on a ABG for a victim with severe smoke inhalation and burns?

A

Combined respiratory acidosis and metabolic (lactic) acidosis

  • PaO2 may be normal, but tissue hypoxia secondary COHb
51
Q

Left off at slide 34

A
52
Q

How do burns present on a CxR?

  • hint stage dependant
A
  • Early = normal
  • Intermediate = Pulmonary Edema/ARDS
  • Late = patchy or segmental infiltrates
53
Q

What should be immediately assessed on burn patients?

A

Assess Airway and Respiratory status

  • Frequently check; Swelling can take time
  • Look for significant airway burns i.e facial burns, nasal burns, singed hair, debris around the mouth etc.
54
Q

What does general management usually assess on a burn patient? (4)

A
  1. Airway and respiratory status
  2. Cardiovascular status
  3. Percentage of body burned
  4. Depth of burns
55
Q

What are considerations and priorties for fluid resuscitation?

A
  • IV access
  • Fluid Resuscitation w/ringers lactate solution based on parkland formula (4ml/kg of bw for each percent area burned over 24hr period)
  • The above formula keeps the pt hemodynamically stable
56
Q

What is parklands formula for fluid resuscitation?

  • expected values with the calculated rate of infusion?
A

4ml/kg of bw for each percent of body surface area burned over 24 hour period

  • remains stable at fluid rate w/average urine output of 30-50ml/hr and CVP target of 2-6 mmHg
57
Q

What should you expect to maintain with the calculated fluid resuscitation rate?

A
  • urine output (u/o) of 30-50ml/hr
  • CVP 2-6 mmHg
58
Q

Why is it important to frequently monitor fluid and electrolyte status in burn patients?

A

The treatment process (Fluid resuscitation) leads to overhydration and acute upper airway obstruction and pulmonary edemas.

59
Q

What is early management for burns patients?

A
  • Remove clothing and should be soaked before hand
  • present burn wounds should be covered to prevent shock, fluid loss, heat loss, and pain
  • infection control (isolation etc. more cards on this!)
  • Gather info on exposure elements in fire
  • Patient status when received
60
Q

What are examples of infection control for burn patients?

A
  • Includes isolation, room pressurization, air filtration,
  • Wound coverings. Wound care is a sterile procedure.
61
Q

What is involved in airway management treatments for burn patients?

A
  • Early intubation
  • Heated active humidity
  • Bronchoscopy
  • Hyperbaric O2 therapy
  • Treatment for cyanide poisoning
  • Antibiotics and Analgesics
  • Prophylactic anticoagulants
62
Q

Why is early intubation important for burn patients?

A
  • Presence of smoke inhalation could demonstrate impending signs of upper airway obstruction/failure
  • Burns are usually critical airways (difficult)
  • Usually awake intubation w/fibre optic bronchoscopy in the OR (bc critical)
63
Q

What are Escahrs?

A

A type of necrotic tissue that can develop on severe wounds.

  • usually black, firm, dry
  • appear on full thickness burns
64
Q

Why is heated active humidity used on burn patients?

A

Treats hypothermia and thick secretions

  • prevents mucous plugs and eschar
65
Q

What are Expectorant agents?

A

Used to facilitate the movement of secretions, aka treat coughs

66
Q

When are Prophlactic anticoagulants used?

A

Heparin and other anticoagulants are used for severe long term fire related injuries

67
Q

Why would a Bronchoscopy be used for burn patients?

A

Often used to clear the airway of mucous plugs and eschars

68
Q

What are the benefits of hyperbaric o2 therapy on burn patients?

A

Can rapidly eliminate CO and enhance skin graft viability

69
Q

What are treatments for Cyanide poisoning?

A

Amyl nitrite inhalation and IV sodium thiosulfate

70
Q

What is typically done for a burn patient who will likely require prolonged mechanical ventilation?

A

Early Tracheostomy

71
Q

How are ETT secured for patients with severe facial burns?

A

Burn ties or the ETT could be secured to the gums.

  • the above would also apply for broken jaws
72
Q

What does general respiratory care involve for burn patients?

A
  • O2 therapy
  • Mech ventilation
  • Bronchopulmonary hygiene
  • Lung expansion therapy
  • Aerosolized medication
73
Q

What are hemoglobin’s more attracted to, CO or O2?

A

CO

74
Q

What patients will have elevated CO levels with no exposure to flames?

A

Smokers

75
Q

What should you do if CO is suspected?

A
  • Get an ABG and compare with a SpCO monitor (if available)
  • closely monitor the patient
  • Give as much O2 as possible to flush out CO (NRBM + HFNP combo)
  • Consider HBOT (hyperbarics)
76
Q

Indications for CO poisoning?

A

Make slide on levels of CO poisoning

Patho 2 (Path 311) (15 decks)

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