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Clin Med Peds > Peds Thermal Injuries > Flashcards

Peds Thermal Injuries Flashcards

1
Q

what does burn survival depend on?

A
  • burn size/depth
  • patient age (very young/very old)
  • comorbidities
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2
Q

in < 2y/o, what type of burns are the most common cause of serious burns?

A

flame burns

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3
Q

most severe burns are from…

A

flame, liquid scald burns

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4
Q

what are scald burns?

A

spill burns, immersions, steam

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5
Q

what are fire burns?

A

flash burns, flame burns

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6
Q

3 types of burns?

A

scalds, contact burns, fire burns

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7
Q

what does severity of burn relate to?

A

rate of heat transfer to the skin

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8
Q

what are the 5 factors that relate to how much you get burned?

A

(1) heat capacity of the agent
(2) temperature of agent
(3) duration of contact
(4) transfer coefficient
(5) specific heat/conductivity of local tissues

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9
Q

what holds heat longer, water or copper?

A

water

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10
Q

how long can skin tolerate contact with agent <111F?

A

up to 6 hours

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11
Q

what is a poor conductor of heat? who’s skin is more thin thus better conductor of heat?

A

skin

young and elderly have thin epidermis

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12
Q

what is SIRS?

A

systemic inflammatory response

burns >30% of TBSA (total burn surface area)

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13
Q

what are first degree/superficial burn causes?

A

flash burns, sun burns

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14
Q

what damage occurs in first degree/superficial burns?

A

minor epithelial damage to dermis

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15
Q

what is the presentation of first degree/superficial burns?

A

redness, tenderness, pain

NO BLISTERING

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16
Q

how long does healing take for first degree/superficial burns?

A

several days w/out scarring

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17
Q

what are second degree burn causes?

A

splash scalds

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18
Q

what are the 2 types of second degree burns?

A

superficial partial thickness and deep partial thickness

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19
Q

what’s the presentation of superficial partial thickness (2nd degree type) burns?

A

blisters that are thin walled, fluid filled, pink, moist, soft, tender to touch

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20
Q

how long is the healing for superficial partial thickness (2nd degree type) burns? is there scarring?

A

2-3 weeks for healing

usually no scarring

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21
Q

where does the damage occur in deep partial thickness second degree burns?

A

deeper dermis

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22
Q

what’s the presentation of deep partial thickness second degree burns?

A
  • skin is red/blanches white
  • slow cap refill
  • thick walled blisters
  • decline in 2 point discrimination
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23
Q

how long is the healing for deep partial thickness second degree burns? is there scarring?

A

3-6 weeks for healing

scarring is likely

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24
Q

what are 3rd degree/full thickness burn causes?

A

immersions, scalds, flame burns, chemical burns, high voltage electrical injuries

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25
Q

what’s the presentation like in 3rd degree/full thickness burns?

A
  • white or leathery appearance with underlying clotted vessels
  • no sensation
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26
Q

what’s the healing like for 3rd degree/full thickness burns?

A

burns ≥ 1 cm in size require grafting to heal

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27
Q

what are 4th degree burn causes?

A

prolonged exposure to causes of 3rd degree burns

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28
Q

what’s damaged in 4th degree burns?

A

full thickness destruction of skin/SQ tissues including fascia, muscle, bone

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29
Q

what’s the healing like for 4th degree burns?

A

requires surgical debridement and repair

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30
Q

what’s the relationship b/w age and survival for any burn size?

A

inverse relationship b/w age and survival for any burn size

mortality from a 40% TBSA burn in 20 y/o is 8%

mortality from a 40% TBSA burn in a 70 y/o is 94%

31
Q

how much TBSA is for each arm in adult?

A

9% for each arm

32
Q

how much TBSA for each arm in child?

A

9% for each arm

33
Q

how much TBSA for each leg in adults?

A

18% for each leg

34
Q

how much TBSA for each leg in child?

A

14% for each leg

35
Q

how much TBSA for front of chest in adults?

A

18%

36
Q

how much TBSA for front of chest in child?

A

18%

37
Q

how much TBSA for back in adults?

A

18%

38
Q

how much TBSA for back in child?

A

18%

39
Q

how much TBSA for head in adult?

A

9%

40
Q

how much TBSA fore had in child?

A

18%

41
Q

pam is how much TBSA?

A

1%

42
Q

subdivide TBSA into ___ %age’s but DON’T include ___

A

subdivide TBSA into partial and full-thickness %age’s but DON’T include 1st degree burns

43
Q

After PE of burn how do you categorize the severity of the burn in order to report to the burn center?

A
  • Extent, depth, location of burns
  • Age of pt
  • Etiologic agents involved
  • Presence of inhalation injury
  • Co-existing injuries/pre-existing illness
44
Q

imaging/lab testing for burns is driven by ___

A

the severity, comorbidities and associated injury

-if have hx of cardiac issues -> do an EKG, etc.

45
Q

what is the FIRST thing to assess for burn patient?

A

ABCs

46
Q

what is a marker for inhalation injury?

A

soot around nose

47
Q

what do you do if patient has soot around nose?

A

realize they have inhalation injury

intubate ASAP b/c their airway will swell usually 12-24 hrs after injury

48
Q

what can carbon monoxide/cyanide poisoning lead to?

A

metabolic acidosis, poor evidence of oxygenation

49
Q

what is Eschar formation?

A

commonly seen with burns on thorax (can occur on other body parts)

skin becomes fibrotic and less stretchy so can’t breathe as well/you can’t push in enough air via vent

50
Q

what is tx of Eschar formation from burn injury?

A

cut through necrotic tissue

51
Q

how do you treat circulation problems with burn injury?

A

fluid resuscitation

-don’t fluid overload b/c can increase risk of ARDS 3-5 days post burn

52
Q

what are options for fluid resuscitation (TBSA <20%, moderate burn, severe burn)?

A

TBSA <20% → Oral and IV fluids

Moderate burn → 1 large bore IV

Severe burn → 2 large bore IVs

53
Q

how do you monitor fluid ins and outs?

A

foley

<2yo → 2 ml/kg/hr

> 2yo → 1ml/kg/hr

Adults → 30-40 ml/h in adults

54
Q

what is the Parkland formula?

A

estimates the amount of fluid a pt will need for hydration

55
Q

children and fluid loss d/t burn injury

A

Greater evaporative fluid losses

Immature kidneys → poor concentrating ability until 9-12mos

56
Q

why is dextrose included in Galveston formula for kids?

A

b/c kids don’t have as good glycogen storage as adults

57
Q

what is an immediate beneficial tx for burns?

A

cold water - helps reduce inflammation

58
Q

what does cold water inhibit and suppress for tx of burns?

A

Inhibits:

  • Lactate production and acidosis
  • Wound histamine release reducing vascular permeability

Suppresses thromboxane production:
-Reducing vascular occlusion and progressive dermal ischemia

59
Q

must keep the patient ___ with burn injury

A

warm w/ blankets

60
Q

what’s the wound care for a burn injury?

A

debridement if dead tissue, irrigation

x2 daily dressing changes

61
Q

if partial thickness burn <24 hrs old and clean, what’s the wound care tx?

A

topical antimicrobials or occlusive dressings

62
Q

when is surgery required for burns?

A

Not healed in 3 weeks d/t increased risk for hypertrophic scar and contracture formation

63
Q

when are partial thickness burns considered major burns in adults?

A

> 25% TBSA

64
Q

when are partial thickness burns considered major burns in children <10 y/o and adults > 50 y/o?

A

> 20% TBSA

65
Q

when is a full thickness burn considered a major burn?

A

> 10% TBSA

66
Q

if a burn involves what body parts is it considered a major burn?

A

If the burn involves the face, eyes, ears, hands, feet, perineum and may result in fxn/ cosmetic impairment

67
Q

burns from what agents are considered major burns/what patients?

A

Burns from caustic agents, high voltage electrical injury, complication by inhalation injury or major trauma, high risk pts

68
Q

how are moderate burn patients managed?

A

they are hospitalized

69
Q

what is considered a moderate burn?

A

Adults w/ 15-25%
TBSA in adults

10-20% TBSA in kids and older adults

Full thickness burns 2-10% TBSA that don’t fit major burn criteria

70
Q

how are minor burn patients managed?

A

at home

71
Q

what is considered a minor burn?

A

Adults w/ partial thickness burn <15% TBSA

Partial thickness burn <10% TBSA in kids or older adults

Full thickness burn <2% TBSA that don’t meet major criteria

72
Q

what are 2 complications of burns?

A

infection and burn shock

73
Q

what is a major cause of death of burns?

A

infection

74
Q

how does burn shock occur?

A

Severe burns

Coagulation necrosis

Increased capillary permeability

Fluid loss

Clin Med Peds (10 decks)

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