Thermal Injury Flashcards by Kelsey Fuller

Define 1st degree burn

Limited to epidermis

Heal spontaneously with no medicaltreatment

Sunburn, Flash flame

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Define 2nd degree burn

Extends to dermin
(AKA deep, superficial partial thickness)

May need skin grafting

Appears wet and blistering

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Define 3rd degree burn

Extends to subcutaneous
(AKA full thickness)

Skin grafting required

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

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Define 4th degree burn

Muscle, Fascia, Bone

Extensive

Electrical injuries, limb loss common

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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

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How is mortality estimated?

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

Doubled if inhalation injury

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Rule of 9s for children

Head 18%
Anterior trunk 18%
Posterior trunk 18%
Each arm 9%
Each leg 14%

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Rule of 9s for adults

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

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Chemical burns will continue until what happens?

until chemical removed from skin or neutralized

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What is the initial treatment for chemical burns?

Copious water or saline

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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

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What can be an outcome electrical injuries?

Myoglobinuria and renal failure

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What is the most common type of burn in children

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

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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

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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?

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Why is Succs questionable after a burn

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

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Succs should not be administered after a burn after ____ hrs

25 hours

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What is special with NDNMB after a burn

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

they will eat through your roc

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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