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APA 3 - Wolfe > Thermal Injury > Flashcards

Thermal Injury Flashcards

1
Q

Define 1st degree burn

A

Limited to epidermis

Heal spontaneously with no medicaltreatment

Sunburn, Flash flame

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2
Q

Define 2nd degree burn

A

Extends to dermin
(AKA deep, superficial partial thickness)

May need skin grafting

Appears wet and blistering

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3
Q

Define 3rd degree burn

A

Extends to subcutaneous
(AKA full thickness)

Skin grafting required

Waxy, white leathery appearance, no pain d/t nerve injury

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4
Q

Define 4th degree burn

A

Muscle, Fascia, Bone

Extensive

Electrical injuries, limb loss common

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5
Q

Major burn classification
2nd degree
3rd degree
electrical

A

2nd degree >10% for adults, >20% extremes of age
3rd degree >10% (regardless of age)
Electrical Burn (always labeled as a major burn)
One complicated with inhalation

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6
Q

How is mortality estimated?

A

Age + TBSA% = (>115 mortality is >80%)

Doubled if inhalation injury

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7
Q

Rule of 9s for children

A 
Head 18%
Anterior trunk 18%
Posterior trunk 18%
Each arm 9%
Each leg 14%
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8
Q

Rule of 9s for adults

A 
Head 9%
Anterior trunk 18%
Posterior trunk 18%
Each arm 9%
Each leg 18%
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9
Q

Chemical burns will continue until what happens?

A

until chemical removed from skin or neutralized

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10
Q

What is the initial treatment for chemical burns?

A

Copious water or saline

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11
Q

What is the damage like for electrical burns?

A

May have entry and exit injury
May be much worse than appears to be
Muscles, bone, nerve, blood vessels

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12
Q

What can be an outcome electrical injuries?

A

Myoglobinuria and renal failure

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13
Q

What is the most common type of burn in children

A

Thermal injury
2nd leading cause of death for 1-4 yrs.
Scalding is common

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14
Q

In inhalation injuries, what is the upper vs the lower airway usually injured from?

A

Upper airway may be thermal from air, steam, and smoke, or chemical from toxins

Lower airway usually from chemical or soot particles

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15
Q

What is the first thing you do in the resuscitative phase after an inhalation injury?

A

1st Diagnose and treat airway injury

EARLY Intubation****
May be Extremely difficult
Consider awake and fiberoptic
Surgical airway
Succs?
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16
Q

Why is Succs questionable after a burn

A

there is a denervation phenomenon which causes proliferation of acetylcholine receptors which causes K to be released

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17
Q

Succs should not be administered after a burn after ____ hrs

A

25 hours

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18
Q

What is special with NDNMB after a burn

A

you will need high dose NDNMB (2-3X)

they will eat through your roc

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19
Q

50-60% of fire victims die from

A

CO poisoning

20
Q

CO binds to HGB with a ____ affinity more than O2

A

200X

21
Q

With CO2 poisoning, tissues are unable to extract O2 d/t

A

Disrupts oxidative phosphorylation

Metabolic acidosis at cellular level

22
Q

Labs for CO poisoning
SaO2
ABG
Co-Oximetry

A

SaO2 - normal
ABG - decreased total O2
Co-Oximetry - true O2 saturation

23
Q

What is the treatment for CO poisoning

A

100% O2

Decreases CO half life from 4 hrs. to 40 min

24
Q

Minimum urinary output for burn patients
Adults
Children
Electrical Burns

A

Adults 0.5-1 mg/kg/hr
Children (weight <30kg) 1mg/kg/hr
Electrical Burns 1-1.5 mg/kg/hr

25
Q

Parkland formula

A 
Crystalloid
First 24 hr:
4ml LR/ % burn per kg
1/2 in first 8 hrs
1/2 in next 16 hrs
NO COLLOID in first 24

Second 24
D5W maintenance
Colloid: 0.5ml/% burn per kg

26
Q

Modified Brooke formula

A 
Crystalloid
First 24 hr:
2ml LR/ % burn per kg
1/2 in first 8 hrs
1/2 in next 16 hrs
NO COLLOID in first 24

Second 24
D5W maintenance
Colloid: 0.5ml/% burn per kg

27
Q

What is the hypermetabolic/hyperdynamic phase after burn?

A

Usually after 48 hours

Manifestations:
Hyperthermia
Tachypnea
Tachycardia
Increased serum catecholamines
Increased O2 consumption
Increased Catabolism
Increased basal metabolic rate
Decreased SVR
28
Q

CV Patho changes after a burn

A

Immediate intravascular fluid loss up to 36 hours

Hypovolemia with hypotension and circulatory compromise

29
Q

What is the CV hallmark of burn shock

A

Decreases Cardiac Output
Occurs within minutes
Initially preserve by catecholamine release
Increased HR and vasoconstriction
Loss overcomes and downward spiral
Myocardial depressants also thought to be released from burned tissue

30
Q

T/F: Pulmonary function can decrease even without inhalation injury

A

TRUE

31
Q

WIth a burn - FRC, lung and chest wall compliance are

A

Reduced

Circumferential Burn
Escharotomy

32
Q

WIth a burn, ventilation can increase from 6l/min to

A

40L/min**

Pt may have pulmonary edema and long term ventilation

33
Q

Durning a burn, the main immune protective barrier (skin) is gone. Eschar is the prime area for what?

A

bacterial growth

34
Q

What is the leading cause of death in burn patients?

A

Sepsis
adults 75%
Peds near 100%

Strick asepsis (reverse asepsis)

35
Q

ARF in burns increases mortality d/t

A

Hypovolemia, Decreased Cardiac Output, Increased Catecholamines
Myoglobinemia

36
Q

What is the treatment for myoglobinemia

A

sodium bicarb

37
Q

After a burn, is there increased or decreased caloric need?

A

INREASED 40%

132% higher energy expenditure

38
Q

What are the guidelines for enteral feedings on the intubated vs non-intubated patient?

A

Non intubated - stop for 4 hours

intubated - don’t stop feedings

39
Q

What are the guidelines for parenteral feedings on the intubated vs non-intubated patient?

A

DO NOT STOP for either

DO NOT USE SAME LINE

40
Q

T/F: ileus is common in burns

A

true if >20% burned

41
Q

Room set up for burn patient, what should you do?

A

WARM EVERYTHING – room, fluids, bed, humidivent, bear hugger, drape exposed areas

42
Q

Fluid and blood replacement for burns

A

200-400 mL EBL for each 1% debridement

At least 2 large bore IV’s

43
Q

Pain management for burns

A

IV recommended, IM may absorb abnormally
May require large amounts
NSAIDS? - May inhibit platelet aggregation

44
Q

Anesthetic agents with burns

A

Profound depressant effects 2nd to hypovolemia

45
Q

Wound grafting: donor site vs grafting site

A

Donor site more painful than grafted site

46
Q

After a burn, fluid loss is greatest within…

Begins to stabilize after…

A

wishing the first 12 hours

stabilize after 24 hours

47
Q

Fluid is shifted from ____ to ____

A

Intravascular to interstitium

APA 3 - Wolfe (11 decks)

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