ppt 8 Burns Flashcards
Describe the pathophysiology of burns.
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
Describe the classification of burn depth.
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.
Describe the rule of 9s
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
When should you suspect airway damage and how should you treat?
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
What fluid should you use with burn patients?
LR
Parkland formula:
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
What are the 6 Ps to assess for in burn management?
Pain, pallor, pulselessness (check Doppler), paresthesias, paralysis, poikilothermia (ability to maintain body temp)
How do you treat compartment syndrome?
tissue pressure > 30 mmHg
Escharotomy
What are the ABCDEs of burn management?
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)
Define superficial burn.
Cause?
Pain?
Epidemal, first degree, brisk capillary return
Sun, flash, minor scald
Painful
Define partial thickness superficial burn.
Cause?
Pain?
superficial dermal = second degree burns, brisk capillary return
Scald
Painful
Define partial thickness deep burn.
Cause?
Pain?
deep dermal, sluggish capillary return
Scald, minor flame contact
PainLESS
Define full thickness burn.
Cause?
Pain?
third degree, no capillary return
Flame, severe scald or flame contact
PainLESS
The palm is ___% of the body area?
1%
lb –> kg conversion
lbs/2.2 = kg
How would you decrease infection risk in burn wound patients?
In general?
Superficial?
Deep?
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
Topical antimicrobials:
Which are good for ears?
Sulfamylon
Good at penetrating eschar & is painful
Side effect: metabolic acidosis via carbonic anhydrase inhibition
Topical antimicrobials:
Which are good for face?
Bacitracin
Few side effects
Topical antimicrobials:
Which are good for trunk/neck/extremities?
Silvadene
Does not penetrate eschar very well
Side effects: neutropenia/thrombocytopenia
What is the most common infection in the burn unit?
What are characteristic features of this infection?
Pseuomonas Infection
Blue/green exudates
Characteristic odor
Electrical Burn Complications?
Most significant injury is within deep tissue
Edema can compromise circulation
Conduction path may be compromised
Rhabdomyolysis - breakdown of muscle fibers, releasing myoglobin
How do you treat electrical burns?
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
What is essential with chemical burns?
Speed is essential!
ABCDE – remove all clothing
How do you treat chemical burns?
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
What is a HUGE concern in burn patients?
not related directly to injury - pain, infection, etc
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.
