ppt 8 Burns

Question 1

Describe the pathophysiology of burns.

Answer 1

Characteristic “Ebb and Flow”

Burns a/w release of inflamm. mediators
Increased capillary permeability
Leak proteins into interstitium
Get edema in burned & non-burned skin
Large fluid loss due to fluid shifts & also losses from exposed burned skin
Albumin loss accentuates fluid loss –> Albumin usually helps keep fluid in the vessels

Question 2

Describe the classification of burn depth.

Answer 2

1st degree: localize to epidermis (sunburn)

2nd degree: injury to both dermis/epidermis
*Superficial 2nd: papillary dermis
Typically red, painful, blister, “wet” appearing Regen in 7-14 days from hair follicles/sweat
glands
*Deep 2nd: reticular dermis
Typically more pale/mottled, dry, ↓sensation

3rd degree: full thickness epidermis/dermis
Hard, leathery eschar, painless

4th degree: involves muscle, bone, etc.

Question 3

Describe the rule of 9s

Answer 3

Head & Neck = 9%
Each upper extremity (Arms) = 9%
Each lower extremity (Legs) = 18%
Anterior trunk= 18%
Posterior trunk = 18%
Genitalia (perineum) = 1%
* Way to figure out burn size

Question 4

When should you suspect airway damage and how should you treat?

Answer 4

Suspect airway injury if:
Facial burns, singed nasal hairs, wheezing, carbonaceous sputum, tachypnea

Give pt oxygen & put on pulse oximetry
Progressive hoarseness is a sign of impending airway obstruction

Pre-emptively intubate anyone with:
Respiratory distress, inhalational injury, large burns (due to inevitable edema from resusc)

Bronchoscopy to help dx inhalational injury

Question 5

What fluid should you use with burn patients?

Answer 5

LR

Question 6

Parkland formula:

Answer 6

Parkland formula:
4 x patient’s wieght (kg) x % TBSA involvement
= mL to give in one day

Give first half in the first 8 hours and the second half in the next 16 hours

In reality, titrate to UOP of 0.5mL/kg/hr in adults and 1mL/kg/hr in children

Question 7

What are the 6 Ps to assess for in burn management?

Answer 7

Pain, pallor, pulselessness (check Doppler), paresthesias, paralysis, poikilothermia (ability to maintain body temp)

Question 8

How do you treat compartment syndrome?

tissue pressure > 30 mmHg

Answer 8

Escharotomy

Question 9

What are the ABCDEs of burn management?

Answer 9

Airway
Breathing
Circulation
Disability (GCS less than 8 = intubate) - coma scale
Exposure (remove all clothing)

(Remember – while starting A, don’t forget to “quench” burns by cooling affected tissues before starting oxygen)

Question 10

Define superficial burn.
Cause?
Pain?

Answer 10

Epidemal, first degree, brisk capillary return
Sun, flash, minor scald
Painful

Question 11

Define partial thickness superficial burn.
Cause?
Pain?

Answer 11

superficial dermal = second degree burns, brisk capillary return
Scald
Painful

Question 12

Define partial thickness deep burn.
Cause?
Pain?

Answer 12

deep dermal, sluggish capillary return
Scald, minor flame contact
PainLESS

Question 13

Define full thickness burn.
Cause?
Pain?

Answer 13

third degree, no capillary return
Flame, severe scald or flame contact
PainLESS

Question 14

The palm is ___% of the body area?

Answer 14

1%

Question 15

lb –> kg conversion

Answer 15

lbs/2.2 = kg

Question 16

How would you decrease infection risk in burn wound patients?
In general?

Superficial?
Deep?

Answer 16

Initially clean/debride & cover with topical antimicrobial (no data for oral or IV abc)

Superficial 2nd: can use temporary pigskin

3rd & (most) deep 2nd need early excision & grafting, except palm/soles/face/genitals
Perform at ~3-7 days post-burn

Question 17

Topical antimicrobials:

Which are good for ears?

Answer 17

Sulfamylon

Good at penetrating eschar & is painful
Side effect: metabolic acidosis via carbonic anhydrase inhibition

Question 18

Topical antimicrobials:

Which are good for face?

Answer 18

Bacitracin

Few side effects

Question 19

Topical antimicrobials:

Which are good for trunk/neck/extremities?

Answer 19

Silvadene

Does not penetrate eschar very well
Side effects: neutropenia/thrombocytopenia

Question 20

What is the most common infection in the burn unit?

What are characteristic features of this infection?

Answer 20

Pseuomonas Infection

Blue/green exudates
Characteristic odor

Question 21

Electrical Burn Complications?

Answer 21

Most significant injury is within deep tissue
Edema can compromise circulation
Conduction path may be compromised
Rhabdomyolysis - breakdown of muscle fibers, releasing myoglobin

Question 22

How do you treat electrical burns?

Answer 22

Be ready to perform eschar-/fasciotomies
Explore & debride necrotic tissue
May have to re-explore questionable areas
EKG if heart was in conduction path
Follow serial CPK & urine myoglobin due to possibility of rhabdomyolysis

Question 23

What is essential with chemical burns?

Answer 23

Speed is essential!

ABCDE – remove all clothing

Question 24

How do you treat chemical burns?

Answer 24

ABCDE – remove all clothing
Irrigate with 15-20L of water
Brush off any dry powder before irrigation

Alkalis generally cause worse damage
Do not attempt to counteract acid burns using alkali or alkali burns using acid

Question 25

What is a HUGE concern in burn patients?

not related directly to injury - pain, infection, etc

Answer 25

NUTRITION

FYI: Patients with major thermal injury develop a hypermetabolic state characterized by increased basal metabolic rate, increased oxygen consumption, negative nitrogen balance, and weight loss. Subsequently, these patients have increased caloric requirementsto prevent delayed wound healing, decreased immune competence, and cellular dysfunction.