Trauma Flashcards
Burn Types according to cause:
Thermal (includes electrical burns)
50% of all pediatric burns were caused by scalding hot liquids and vapour
Radiation - ie UV radiation causes sunburn, X-rays cause radiation burns
Chemical - exposure to corrosive substance
Burn type according to burn depth:
Superficial partial-thickness injuries
Deep partial-thickness injuries
Full-thickness injuries
Superficial partial-thickness burn (similar to 1st degree burn)
- epidermis is destroyed or injured and a portion of the dermis may be injured
- May be painful and appear red and dry ie sunburn
- May blister
Deep partial-thickness burn (similar to 2nd degree burn)
- Destruction of epidermis and upper layers of dermis, injury to deeper portions of dermis
- Painful and is red
- Exudes fluid
- Cap refill follows tissue blanching
- Hair follicles and other dermal appendages remain intact
- More likely to result in hypertrophic scars
Full-thickness burn (similar to 3rd degree burn)
- Total destruction of epidermis and dermis, and sometimes other tissue
- Painless as nerve fibers are destroyed
- Colour is white, red, brown or black
- Appears leathery, and hair/sweat glands are destroyed
Deep full-thickness burn (Fourth-degree burns)
burn to muscle, tissue, bone
appears black and sensation is absent
no pain as nerve endings are destroyed
Why is the Total body surface area (TBSA) important to burn care?
Rule of the nines - good estimation
Lund and Browder method - more precise, recognizes that changes in body proportion occur with growth, as such, TBSA changes with age of patient
Children have proportionally larger heads and smaller legs than adults
palm method - for patient’s with scattered burns, the size of the patient’s palm is approx 1% of TBSA
25% TBSA may produce both a local and a systemic response. Is considered a major burn.
Describe the impacts and care of inhalation injury..
several categories: upper airway injury (due to heat or edema), inhalation injury below the glottis (includes carbon monoxide poisoning) and restrictive defects
1) Inhalation injury below glottis results from inhaling products such as carbon monoxide, sulfur oxides, nitrogen oxides, aldehydes, cyanide, ammonia, chlorine, phosgene, benzene and halogens
injury results from chemical irritation of tissue at the alveolar level
2) expectoration of carbon particles in the sputum in a cardinal sign of this injury
3) Carbon monoxide - has an affinity for hemoglobin that is 200 times greater than oxygen => tissue hypoxia occurs
treatment: early intubation and mechanical ventilation with 100% oxygen (need 100% to accelerate the removal of carbon monoxide from hemoglobin)
S/S of fluid loss due to burn
Pallor, sweating, thirst; Anxious, disorientated state; Collapsed veins, poor refill; Tachycardia and weak pulse; Hypotension and tachypnoea; Oliguria.
Assessing adequacy of fluid resusication
Monitoring of vital signs/hemodynamic parameters (such as central venous pressure, arterial blood pressure);
Heart rate;
Mean arterial pressure;
Signs of circulation in general (showing adequate fluid resuscitation), such as skin colour/perfusion and tissue perfusion;
Ventilatory parameters – for example changes in tidal volumes, minute volumes, spontaneous tidal and minute volumes, end tidal CO2, breathing rate and tube position;
Airway management;
Core peripheral temperature;
Signs of visceral circulation;
Urine output – aim for: adults 0.5ml/kg/hr = 30–50ml/hr; children (<30kg) 1.0ml/kg/hr (range 0.5–2.0ml/kg/hr) – children’s fluid requirements are greater;
Gut function (observe for gastric distension in children);
Blood tests – hemoglobin (Hb)/hematocrit (Hct) blood products may be required following surgical debridement;
Electrolytes within normal ranges, especially potassium and sodium;
Arterial blood gases;
Absence of metabolic acidosis – blood pH below 7.35 confirms the condition. Levels of other blood components, including potassium, glucose, ketones or lactic acid, may also be above normal ranges;
Burns dressing for signs of bleeding;
The patient’s general condition.
Complications of fluid resusitation
Electrolyte disturbances; Red cell loss; Renal failure; Peptic ulcers; Acute respiratory distress syndrome (ARDS); Burn encephalopathy; Hyponatremia.
FAST
FAST: focussed assessment for sonographic examination of the trauma
Trauma assessment
when injury occurred mechanism of injury level of responsiveness specific injuries estimated blood loss recent drug/alcohol use prehospital treatment
When is fluid resuscitation needed for a burn patient?
Burns of more than 15% of surface body area in adults and of over 10% in children warrant formal resuscitation.
Parkland formula
The formula
The Parkland formula for the total fluid requirement in 24 hours is as follows:
4ml x TBSA (%) x body weight (kg);
50% given in first eight hours;
50% given in next 16 hours.
This advocates the guideline for total volume of the first 24 hours of resuscitation at approximately 4 ml per kilogram of body weight per percentage burn of TBSA. Half the volume is given in the first eight hours post burn, with the remaining volume delivered over 16 hours.
The Parkland formula has the advantage of being easy to use. It leads to fewer respiratory problems later on, although there may be pronounced general edema in the first stages of its use as large volumes of fluid are required.
