Thermal Injuries Flashcards
What are the risk factors of cold injuries?
- lack of insulating body fat
- old age
- homelessness
- drug and alcohol use
- cardiac disease
- psychiatric illness
- motor vehicle problems
- inadequate clothing
- smoking in combination w/cold exposure
- endocrine conditions
- diabetes
- SCIs
What area of the brain controls heat conservation?
The hypothalamus
Does ___ cause peripheral and visceral vasoconstriction?
a) parasympathetic activity
b) sympathetic activity
b) sympathetic activity
Who is at risk of developing frostbite?
- military personnel
- athletes using cryotherapy or participation in outdoor sports
What is superficial frost bite?
skin and subcutaneous tissue affected that when rewarmed, develops clear blisters
What is deep frostbite?
Affects bones, jones, and tendons where the skin remains white until thawed and when rewarmed, the skin forms hemorrhagic blisters.
T or F: Deep frostbite is more common on the face, ears, and extremities
False - that is superficial frostbite. Deep is on hands and feet
What are the favorable prognostic factors for frostbite?
- retained sensation
- normal skin color
- clear fluid in blisters (not cloudy)
What are negative prognostic factors for frostbite?
- non-blanching cyanosis
- firm skin and dark
- fluid-filled blisters
What are the functions of the epidermis?
- protection, insulation, cosmesis
- immune response
- keratinocytes and melanocyte synthesis
What are the functions of the dermis?
- thermoregulation
- mechanical protection
- hair folicles
- conservation of fluids, electrolytes, and proteins
What is the function of the subcutaneous layer
- Energy storage
- trauma protection
What is the Zone of coagulation
The tissue that is destroyed at the time of injury
What is the zone of stasis
It surrounds the zone of coagulation with inflammation and low levels of perfusion
What is the zone of hyperemia
The zone where microvascular perfusion is not impaired although it may appear red
Which zone becomes necrotic within 48 hours following injury resulting in an expansion of the burn
Zone of stasis
What are the symptoms of a thermal burn?
- red, blistered, or peeling skin
- pain
- shock (clammy skin, weakness, bluish lips/fingernails, and dec. alertness)
- edema
- white/charred skin
When should you suspect a chemical burn?
If an otherwise healthy person becomes ill for no apparent reason (and works in an environment chemicals could be present//you find chemical containers in the area)
What are the symptoms of a chemical burn?
- Red/bluish skin and lips
- breathing difficulty
- convulsions or seizures
- dizziness and headache
- skin changes (hives, itching, swelling, N/V)
- unconsciousness
- abdominal pain
T or F: an electric burn may be more severe than it appears
True
What are the 3 methods that an electrical burn causes injury by?
1 - CA due to electrical effect on heart
2 - massive muscle destruction from current thru body
3 - thermal burns from contact w/electrical source
What are the symptoms of electrical burns
- fatigue
- fractures
- H/A and unconsciousness
- hearing impairment/vision loss
- heart attack
- hyperventilation and respiratory failure
- loss of reflex control
- muscle contraction and muscular pain
- skin burns
Which type of current is more dangerous and why?
AC current bc the patient becomes frozen and can’t withdraw
What are potential complications from electrical burns
- compartment syndrome
- cardiac arrhythmias
- renal failure
- sepsis
- neurological damage
- hemorrhage
- cataracts
What are the characteristics of a superficial burn?
- DRY
- Epidermis only
How long does a superficial burn typically take to heal?
3-7 days, with no scarring
What are the characteristics of a superficial partial thickness burn?
- epidermis and superficial dermis
- blisters, moist, weeping
- hair present
- possible edema
How long do superficial partial thickness burns take to heal?
- 7-21 days, possibility of scarring but sensation still intact
What are the characteristics of a deep partial thickness?
- involves epidermis and most of the dermis
- Cherry red or white
- DRY
- some hair
How long does it take for a deep partial thickness burn to heal?
-3 -6 weeks with scarring present
What do we need to be concerned about with deep partial thickness burns?
Can convert to full thickness burns if infected or if there is poor tissue perfusion
What are the characteristics of a full thickness burn?
- epidermis, dermis, and subcutaneous tissue
- black, yellow, brown, or white
- leather like
- no sensation
- may require amputation
What tests and measures (general) do you want to complete post burn?
- size
- depth
- inhalation?
- edema
- ROM
- Gait
What is the adult rule of nines?
- Head: 9%
- Arms: 9% each
- Trunk: 36% total
- Legs: 18% each
- groin: 1%
What are three tests and measures that measure total body surface area?
- rule of the palm
- rule of nines
- Lund Browder scale
What is the abbreviated burn severity index?
A 5 variable scale to assess burn severity & survival percentage
(Sex, age, presence of inhalation injury, presence of full-thickness burn, percent of TBSA burned)
When should someone go to a specialized burn center?
- ABSI >= 6
- High-voltage electrical burns
- burns associated w/other injuries
- Most full thickness burns
What is Phase 1 of medical management of burns?
- establish and maintain airway
- prevent cyanosis
- prevent fluid loss
- clean the wounds
- prevent cardiopulmonary complications
How much urine do we want our burn patients to produce per hour in order to know if they are getting enough?
20-30 cc/hour
Why do we care about shock risk (PT)
- Carefully monitor BP during exercise activity (it would decrease)
- Monitor and manage edema
How much does an inhalation injury increase risk of death?
20%
When should you be concerned there may have been an inhalation injury?
- closed space fire
- soot in mouth/nasal passages
- SOB, respiratory distress, wheezing, coughing
- length of exposure
- dark, carbon-stained mucus
How is an inhalation injury dx?
- breath sounds
- spirometry
- ABGs
- bronchoscopy
What is a secondary lung injury
- unilateral smoke inhalation damages the contralateral lung
What are the possible treatments for inhalation injuries?
- ventilation
- supplemental O2
- airway control
- bronchial hygiene
- suctioning
- therapeutic bronchoscopy
- ventilatory strategies
- pharmacologic adjuncts
What is the most common complication from an inhalation injury?
Pneumonia
What is the number one cause of death in patients with burns?
Infections
What is the most common causative agent for infections
a) early
b) later
a) Staph Aureus
b) Pseudomonas and MRSA
How do we control/prevent infections in burn pts?
- Sterile technique if large/immunocompromised
- clean for small/superficial
- topical antibiotics
- monitor for s/s of infection
What are the purposes of wound dressings?
1 - comfort
2- metabolic
3- protection
4 - topical medications (hold them on)
What is primary excision/debridement
Removal of eschar surgically to dec. need for repeated debridement and allow for more rapid healing
What type of skin graft do they typically do?
Split thickness skin grafts (STSG) - meshed, sheet, or donor site
Why might you use a meshed graft?
- it stretches up to 10x the size of what it was
- less coverage needed
- allows blood and body fluids to drain from under the skin graft
What are some disadvantages of meshed grafts?
- less durable than sheet graft
- larger slits = greater scarring
When would you use a full thickness skin graft?
- only for small areas bc it leaves the donor site as a full thickness wound
What are some reasons a skin graft might fail?
- poor wound bed
- sheer
- hematoma/seroma
- infection
How do skin grafts (both Full and split thickness) survive?
- Plasmatic Imbibition
- Inosculation (at day 3)
- Angiogenesis (at day 5)
How long does it take for a donor site to heal
8-14 days
Why may you use artificial skin?
Temporary treatment of full thickness burns to help promote growth and protection of the skin, but will need to be replaced in 14 days
When can you begin ROM post allograft/xenograft?
Day 1
When can you begin ROM post autograft?
POD Day 5 - gentle
What can occur (pathophys) in the cardiovascular system as a result of burns?
- increased capillary permeability
- edema
- hypovolemia
- impaired perfusion
- burn shock
- resting tachycardia
- hypotension
- dysrhythmias
- compartment syndrome
What can occur (pathophys) in the pulmonary system as a result of burns?
- smoke inhalation
- carbon monoxide inhalation
- pulmonary edema
- increased pulmonary vascular resistance
- hypoxia
- dyspnea
- pneumonia
- ARDS
What can occur (pathophys) in the GI system as a result of burns?
- higher caloric requirements
What can occur (pathophys) in the metabolism as a result of burns?
- Increased rate
- Sustained hyperglycemia
What can occur (pathophys) in the Immune system as a result of burns?
Impaired
What psychological dysfunctions can occur as a result of burns?
- sleep disruption
- confusion/delirium
- depression
- inappropriate behaviours
- depression
- PTSD
What is an important consideration when doing the subjective of an eval?
- make sure you know before what the MOI of the fire was/extent of damage so you avoid asking about house set up/who they live with if something occured
