TRAUMATIC BURN INJURIES Flashcards
Approximately __ to __% of injuries during military operations involves significant burns
5-10%
Burns may represent only one of the casualties injuries especially if what was the primary mechanism ?
Explosion
The most challenging time in the resuscitation of a burn patient is typically the first ___ hours
48 hours
The skin serves what complex functions?
- Protection
- Regulation of fluids
- Thermoregulation
- Sensation
What layer of the skin is the outer layer?
Epidermis
What is the deeper later of the skin that is up to 10mm thick?
Dermis
What layer of the skin is made up of adipose and connective tissue, keeps outer layers attached to underlying structures?
Subcutaneous (hypodermis)
contains some of the larger blood vessels and nerves
A full thickness (3rd degree) burn has what 3 zones of tissue injury?
- Zone of coagulation
- Zone of stasis
- Zone of hyperemia
What zone of tissue injury associated with a 3rd degree burn is the central zone, the region of greatest destruction resulting in necrosis and not capable of repair?
Zone of coagulation
What zone of tissue injury associated with a 3rd degree burn is adjacent to the zone of necrosis, immediately after injury blood flow is stagnant; cells injured but it is not irreversible, will be become necrotic if deprived of blood flow, timely burn care and resuscitation will preserve blood flow and oxygen delivery?
Zone of stasis
What zone of tissue injury associated with a 3rd degree burn is the outermost zone; minimal cellular injury and characterized by increased blood flow secondary to inflammatory reaction initiated by the burn injury?
Zone of hyperemia
Burns can be deceptive and evolve over time, withhold final judgment on classification until approximately ___ hours after injury
48 hours
What burns are classified as the following?
- Historically referred to as 1st degree
- Involve ONLY THE EPIDERMIS
- Red and painful
- Rarely clinically significant except in the situation of large sunburns which can increase the risk of dehydration
- Heal within a week without a scar
- Not included when calculating percentage of TBSA of burns
Superficial burns
What burns are classified as the following?
- Once referred to as second degree.
- Involve epidermis and varying portions of the DERMIS.
- Can be classified as superficial or deep.
- Will appear as BLISTERS or “denuded” burned areas with glistening or wet
appearing base. - Zone of necrosis involves entire epidermis and varying depths of superficial dermis, can progress to full thickness if not properly treated.
Partial thickness burns
What burns are classified as the following?
- May have several appearances.
- Most often appear thick, dry, white, and leathery regardless of skin color.
- Thick leathery damaged skin referred to as eschar.
4 .Common, misconception that these burns are pain free because nerve endings are destroyed. These patients have varying degrees of pain, surrounding areas have superficial and partial thickness burns. These nerves are intact. These burns can be disabling and life threatening.
Full thickness
What is the initial point of injury care for a burn injury?
STOP THE BURNING PROCESS
- extinguish flames
- move patient to safe location
- remove burnt clothing
- if electrical remove from electrical source
- remove chemical agents with copious irrigation
True or False
Burn injuries
If white phosphorous, cover areas with moist saline soaked dressing to prevent ignition on contact with air.
True
True or False
Patients with large surface area burns are at a decreased risk of hypothermia
False
Increased risk
What is the starting rate for resuscitation for a burn patient?
500ml/hr for afults
Are the priorities for management of burn casualties the same as those for other injured patients with addition of burn physiology?
Yes
True or False
Patients with inhalation injuries may need to be preemptively intubated or may require cricothyroidotomy prior to transport
True
Inhalation injuries occur in ___% of combat casualties
15%
What should be performed on a patient with full thickness burns to the chest?
Immediate escharotomy
How do you calculate the hourly fluid rate for a burn patient?
% of TBSA x 10ml/hr
What is the primary index of adequate resuscitation in burn patients?
Urinary output
What are some burn center referral criteria? (1/2)
- Partial-thickness burns greater than 10% TBSA
- Burns that involve the face, hands, feet, genitalia, perineum, or major joints
- Third-degree burns in any age group
- Electrical burns, including lightning injury
What are some burn center referral criteria? (2/2)
- Chemical burns
- Inhalation Injury
- Burn injury in patients with preexisting medical disorders that could complicate
management, prolong recovery, or affect mortality - Burned children in hospitals without qualified personnel or equipment for the
care of children - Burn injury in patients who will require special social, emotional, or rehabilitative intervention
If available NG decompression for prolonged care in patients with over ___% TBSA due to gastric ileus
20%
What is the target urinary output for a burn patient ?
0.5ml/kg/hr
Over resuscitation in burn patients may lead to what complications?
- Compartment syndrome
2. Pulmonary Edema
What are some indicator of effective resuscitation in burn patients?
Improving tachycardia and mental status
What are some adequate wound care procedures for burn patients?
- Topical antibiotic agents after cleaning
- Silver nylon dressings which provide antimicrobial coverage
- Topical antimicrobial solution or creams
How often should burned extremities be exercised ?
Hourly
