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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
what's the presentation like in 3rd degree/full thickness burns?
- white or leathery appearance with underlying clotted vessels - no sensation
26
what's the healing like for 3rd degree/full thickness burns?
burns ≥ 1 cm in size require grafting to heal
27
what are 4th degree burn causes?
prolonged exposure to causes of 3rd degree burns
28
what's damaged in 4th degree burns?
full thickness destruction of skin/SQ tissues including fascia, muscle, bone
29
what's the healing like for 4th degree burns?
requires surgical debridement and repair
30
what's the relationship b/w age and survival for any burn size?
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
how much TBSA is for each arm in adult?
9% for each arm
32
how much TBSA for each arm in child?
9% for each arm
33
how much TBSA for each leg in adults?
18% for each leg
34
how much TBSA for each leg in child?
14% for each leg
35
how much TBSA for front of chest in adults?
18%
36
how much TBSA for front of chest in child?
18%
37
how much TBSA for back in adults?
18%
38
how much TBSA for back in child?
18%
39
how much TBSA for head in adult?
9%
40
how much TBSA fore had in child?
18%
41
pam is how much TBSA?
1%
42
subdivide TBSA into ___ %age's but DON'T include ___
subdivide TBSA into partial and full-thickness %age's but DON'T include 1st degree burns
43
After PE of burn how do you categorize the severity of the burn in order to report to the burn center?
- Extent, depth, location of burns - Age of pt - Etiologic agents involved - Presence of inhalation injury - Co-existing injuries/pre-existing illness
44
imaging/lab testing for burns is driven by ___
the severity, comorbidities and associated injury -if have hx of cardiac issues -> do an EKG, etc.
45
what is the FIRST thing to assess for burn patient?
ABCs
46
what is a marker for inhalation injury?
soot around nose
47
what do you do if patient has soot around nose?
realize they have inhalation injury intubate ASAP b/c their airway will swell usually 12-24 hrs after injury
48
what can carbon monoxide/cyanide poisoning lead to?
metabolic acidosis, poor evidence of oxygenation
49
what is Eschar formation?
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
what is tx of Eschar formation from burn injury?
cut through necrotic tissue
51
how do you treat circulation problems with burn injury?
fluid resuscitation -don't fluid overload b/c can increase risk of ARDS 3-5 days post burn
52
what are options for fluid resuscitation (TBSA <20%, moderate burn, severe burn)?
TBSA <20% → Oral and IV fluids Moderate burn → 1 large bore IV Severe burn → 2 large bore IVs
53
how do you monitor fluid ins and outs?
foley <2yo → 2 ml/kg/hr >2yo → 1ml/kg/hr Adults → 30-40 ml/h in adults
54
what is the Parkland formula?
estimates the amount of fluid a pt will need for hydration
55
children and fluid loss d/t burn injury
Greater evaporative fluid losses Immature kidneys → poor concentrating ability until 9-12mos
56
why is dextrose included in Galveston formula for kids?
b/c kids don't have as good glycogen storage as adults
57
what is an immediate beneficial tx for burns?
cold water - helps reduce inflammation
58
what does cold water inhibit and suppress for tx of burns?
Inhibits: - Lactate production and acidosis - Wound histamine release reducing vascular permeability Suppresses thromboxane production: -Reducing vascular occlusion and progressive dermal ischemia
59
must keep the patient ___ with burn injury
warm w/ blankets
60
what's the wound care for a burn injury?
debridement if dead tissue, irrigation x2 daily dressing changes
61
if partial thickness burn <24 hrs old and clean, what's the wound care tx?
topical antimicrobials or occlusive dressings
62
when is surgery required for burns?
Not healed in 3 weeks d/t increased risk for hypertrophic scar and contracture formation
63
when are partial thickness burns considered major burns in adults?
>25% TBSA
64
when are partial thickness burns considered major burns in children <10 y/o and adults > 50 y/o?
>20% TBSA
65
when is a full thickness burn considered a major burn?
>10% TBSA
66
if a burn involves what body parts is it considered a major burn?
If the burn involves the face, eyes, ears, hands, feet, perineum and may result in fxn/ cosmetic impairment
67
burns from what agents are considered major burns/what patients?
Burns from caustic agents, high voltage electrical injury, complication by inhalation injury or major trauma, high risk pts
68
how are moderate burn patients managed?
they are hospitalized
69
what is considered a moderate burn?
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
how are minor burn patients managed?
at home
71
what is considered a minor burn?
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
what are 2 complications of burns?
infection and burn shock
73
what is a major cause of death of burns?
infection
74
how does burn shock occur?
Severe burns Coagulation necrosis Increased capillary permeability Fluid loss

Clin Med Peds (10 decks)

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