Thermal Injury Flashcards
Define 1st degree burn
Limited to epidermis
Heal spontaneously with no medicaltreatment
Sunburn, Flash flame
Define 2nd degree burn
Extends to dermin
(AKA deep, superficial partial thickness)
May need skin grafting
Appears wet and blistering
Define 3rd degree burn
Extends to subcutaneous
(AKA full thickness)
Skin grafting required
Waxy, white leathery appearance, no pain d/t nerve injury
Define 4th degree burn
Muscle, Fascia, Bone
Extensive
Electrical injuries, limb loss common
Major burn classification
2nd degree
3rd degree
electrical
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
How is mortality estimated?
Age + TBSA% = (>115 mortality is >80%)
Doubled if inhalation injury
Rule of 9s for children
Head 18% Anterior trunk 18% Posterior trunk 18% Each arm 9% Each leg 14%
Rule of 9s for adults
Head 9% Anterior trunk 18% Posterior trunk 18% Each arm 9% Each leg 18%
Chemical burns will continue until what happens?
until chemical removed from skin or neutralized
What is the initial treatment for chemical burns?
Copious water or saline
What is the damage like for electrical burns?
May have entry and exit injury
May be much worse than appears to be
Muscles, bone, nerve, blood vessels
What can be an outcome electrical injuries?
Myoglobinuria and renal failure
What is the most common type of burn in children
Thermal injury
2nd leading cause of death for 1-4 yrs.
Scalding is common
In inhalation injuries, what is the upper vs the lower airway usually injured from?
Upper airway may be thermal from air, steam, and smoke, or chemical from toxins
Lower airway usually from chemical or soot particles
What is the first thing you do in the resuscitative phase after an inhalation injury?
1st Diagnose and treat airway injury
EARLY Intubation**** May be Extremely difficult Consider awake and fiberoptic Surgical airway Succs?
Why is Succs questionable after a burn
there is a denervation phenomenon which causes proliferation of acetylcholine receptors which causes K to be released
Succs should not be administered after a burn after ____ hrs
25 hours
What is special with NDNMB after a burn
you will need high dose NDNMB (2-3X)
they will eat through your roc
50-60% of fire victims die from
CO poisoning
CO binds to HGB with a ____ affinity more than O2
200X
With CO2 poisoning, tissues are unable to extract O2 d/t
Disrupts oxidative phosphorylation
Metabolic acidosis at cellular level
Labs for CO poisoning
SaO2
ABG
Co-Oximetry
SaO2 - normal
ABG - decreased total O2
Co-Oximetry - true O2 saturation
What is the treatment for CO poisoning
100% O2
Decreases CO half life from 4 hrs. to 40 min
Minimum urinary output for burn patients
Adults
Children
Electrical Burns
Adults 0.5-1 mg/kg/hr
Children (weight <30kg) 1mg/kg/hr
Electrical Burns 1-1.5 mg/kg/hr
Parkland formula
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
Modified Brooke formula
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
What is the hypermetabolic/hyperdynamic phase after burn?
Usually after 48 hours
Manifestations: Hyperthermia Tachypnea Tachycardia Increased serum catecholamines Increased O2 consumption Increased Catabolism Increased basal metabolic rate Decreased SVR
CV Patho changes after a burn
Immediate intravascular fluid loss up to 36 hours
Hypovolemia with hypotension and circulatory compromise
What is the CV hallmark of burn shock
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
T/F: Pulmonary function can decrease even without inhalation injury
TRUE
WIth a burn - FRC, lung and chest wall compliance are
Reduced
Circumferential Burn
Escharotomy
WIth a burn, ventilation can increase from 6l/min to
40L/min**
Pt may have pulmonary edema and long term ventilation
Durning a burn, the main immune protective barrier (skin) is gone. Eschar is the prime area for what?
bacterial growth
What is the leading cause of death in burn patients?
Sepsis
adults 75%
Peds near 100%
Strick asepsis (reverse asepsis)
ARF in burns increases mortality d/t
Hypovolemia, Decreased Cardiac Output, Increased Catecholamines
Myoglobinemia
What is the treatment for myoglobinemia
sodium bicarb
After a burn, is there increased or decreased caloric need?
INREASED 40%
132% higher energy expenditure
What are the guidelines for enteral feedings on the intubated vs non-intubated patient?
Non intubated - stop for 4 hours
intubated - don’t stop feedings
What are the guidelines for parenteral feedings on the intubated vs non-intubated patient?
DO NOT STOP for either
DO NOT USE SAME LINE
T/F: ileus is common in burns
true if >20% burned
Room set up for burn patient, what should you do?
WARM EVERYTHING – room, fluids, bed, humidivent, bear hugger, drape exposed areas
Fluid and blood replacement for burns
200-400 mL EBL for each 1% debridement
At least 2 large bore IV’s
Pain management for burns
IV recommended, IM may absorb abnormally
May require large amounts
NSAIDS? - May inhibit platelet aggregation
Anesthetic agents with burns
Profound depressant effects 2nd to hypovolemia
Wound grafting: donor site vs grafting site
Donor site more painful than grafted site
After a burn, fluid loss is greatest within…
Begins to stabilize after…
wishing the first 12 hours
stabilize after 24 hours
Fluid is shifted from ____ to ____
Intravascular to interstitium
