S16C210-213 - burns/lightning Flashcards
Burn zones
- zone of coagulation (destroyed tissue, thrombosed blood vessels)
- zone of stasis: stagnation of microcirculation
- zone of hyperemia: increased blood flow (recovery likely in this zone)
BSA - rule of nines
- arm 9%
- front 18%
- back 18%
- head 9%
- leg 18% (back and front each 9%)
- perinium 1%
-or pts hand = 1%
Burn depth
- superfical partial-thickness: epidermis and superficial dermis, blisters, painful, erythematous, cap refill present, no scar
- deep partial-thickness: epidermis and deep dermis, sweat glands, hair follicles, blisters, exposed dermis is pale white/yellow color, burned area does not blanch, absent CR, absent pain sensation, permanent scar
- full-thickness: all epidermal and dermal structures destroyed, skin is charred, pale, painless and leathery, skin graft necessary
- 4th degree: involves bone/muscle/fat, life-threatening
Indications for referral to burn facility:
- children 50
- comorbidities
- deep-partial in any age group
- electrical burns
- chemical burns
- inhalation injury
Carbon monoxide poisoning
-tx: 100% O2 NRB
Cyanide poisoning
- from burning wool, silk, vinyl
- disrupts oxidative phosphorylation (tissue hypoxia)
Inhalation injury w/u:
- carboxyhemoglobin level
- ABG
- intubate if necessary: full-thickness burn of face, circuferential neck burns, resp distress, progressive hoarseness or air hunger, resp dpn or AMS, supraglottic edema and inflm on bronchoscopy
- inspect for edema, singed hairs/mucosa
Burn injury tx:
- IV, O2, monitor
- early intubation if airway burn, swelling, inhalation injury
- bronch
- parkland formula for fluids
- foley
- NG (for partial-thickness burn >20% BSA b/c of ileus)
- tetanus
- analgesia
Parkland Formula
=4ml LR x wt (kg) x % BSA burned
1/2 over first 8h from time of burn
then half over 16h
% BSA written as 36 (not 0.36)
children = 3ml LR x wt (kg) x %BSA over initial 24h PLUS maintenance
1/2 over first 8h then other half over next 16h
Minor burn: defn and tx
- should not involve hands, face, feet, perineum
- should not cross major joint or be circumferential
- cleanse with mild soap/water/antiseptic, debride PRN, topical antimicrobial (1% silver sulfadiazine cream - not on face or sulfa allergy - bacitracin, triple abx ointment)
- tetanus
- r/a at 24h
Alkali vs acid burn
- alkali burns are worse
- b/c acid burns quickly create and eschar preventing further acid from penetrating deeper
- alkalis cause liquefaction necrosis and saponification of lipids and ongoing burning and deeper penetration
-if possibly, irrigate alkaline burns with 5% acetic acid (vinegar)
When not to irrigate/put water on a chemical wound:
- if there is dry powder present, brush it off first
- sodium metal and other metals should be covered with mineral oil or excised b/c water can cause an exothermic rxn
- phenol/carbolic acid: water may enhance penetration
-otherwise wash with water quickly!
Hydrofluoric acid
- used to make octane fuel, glass etching, germicides, plastics, tanning, rust remover
- 2 mechanisms of burn: hydrogen causes cellular damage causing deep burns, fluoride cuases release of Ca and Mg causing enzymatic rxns
- causes release of K resulting in depolarization and nerve pain
- lethal systemic toxicity: hypocalcemia, hypomagnesemia, hyperkalemia
- tx: irrigate then replace lytes, IV calcium and magnesium (they bind fluoride)
- calcium gluconate is better (topical, SC or intra-arterial infusion)
Corneal burn tx
-irrigate until pH 7.4 in conjunctival sac
Chemical burns with systemic effects: (7)
- hydrofluoric acid (hypoca, hypomag, hyperka, arrhyhtmia death
- chromic/formic/tannic acid: hepatic necrosis, nephrotoxicity
- cresol: methemoglobinemia, hemolysis
- gasoline: pulmo, cardio, neuro, renal, hepatic complications
- phenol: hemolysis, CNS/cardio/pulm toxicity
- sodium nitrate, potassium nitrate: methemolglobinemia, cyanosis
- dichromate soln: liver failure, AKI, death
