Unit 3: Burns (MST 2) Flashcards
What are the 5 types of burns?
- Thermal (flame, flash, heat, scold)
- Chemical (acid)
- Electrical (takes path of least resistence)
- Smoke and inhalation
- Cold thermal injury or frostbite
Superficial burns involves what skin structures?
Epidermis
Superficial partial thickness burns include what structures of the skin?
Epidermis
Deep partial thickness burns include what structures of the skin?
- Epidermins
- dermis (hair follicle & sweat glands)
Full thickness burns include what skin structures?
- epidermis
- dermis
- fat
- muscle
- bone
How does a superficial partial thickness burn heal?
Usually without interventions
What should we know about superficial partial-thickness burns
- Typically your sunburns
- Superficial
- Epidermal layer
- Pink to red
- Uncomfortable to touch
After 24 hours you may have a blister pop up.
Pain sensation still intact
What do we need to know about deep-partial thickness burns
- Epidermal and dermal layer involved
- Red mottled pink edges, hair remains intact
- VERY painful
- Takes 2-4 weeks to heal
- Sensitive to temp
What should we know about our full-thickness burns?
- Full dermal layer involved
- White, dry, leather like texture (if they have skin)
- No PAIN
Nerve endings are gone. NO PAIN
If a patient has burns on arms, chest, face and neck what are priorities out of these options?
1. Oxygen
2. 2 large bore IVs
3. Pain meds
4. Cool room
5. Intubation
- Oxygen (Yes)
- 2 Large bore ivs (YES)
- Pain meds (YES)
- Cool room (NO)
- Intubation (YES)
If you have a patient with burns on both arms from an accidental grease fire what are our priorites out of the following options?
1. Obtain 12 lead ekg
2. inititate large bore IV
3. Admin oxygen
4. Pain management
5. Tetnus shot
6. Assist in shower
- Obtain 12 lead EKG (NO)
- Initiate large bore IV (YES)
- Administer O2 (NO)
- Pain management (YES)
- Tetnus (YES)
- Assist in shower (NO) contraindicated
When assessing a patient to determine if they have an inhalation injury what are we looking for?
- Blisters, Edema
- Difficulty swallowing
- hoarseness
- stridor
- Restractions
- Toal airway obsturctions
- Look for soot around nose and mouth
Whats happening in inhalation injuries?
Burnt skin and mucosa become tight and cause a mechanical obstruction
anytime you have a burn victim that breaths in heated air it will damage the mucosa… most death in fires are caused by inhalation injuries
Whats important to remeber about electrical burns?
Electricity takes the path of least resistance. What you see on the outside skin may just be a spot but on the inside it is a tunneling mess.
Path of least resistance is skin, vessels, muscle, bone
In the RO9s for burns what percentage is the anterior chest and abd?
Both are 9%
In the RO9s what % is the posterior chest and back?
Both are 9%
In the RO9s what % is each anterior arm?
Each arm is 4.5%
In the RO9 what % is the posterior arms
Each arm is 4.5%
In total what % does the arm account for in the RO9s
Each arm accounts for 9% if the burn affects the anterior, posterior side.
What % is the anterior and posterior head in the RO9?
Anterior: 4.5%
Posterior: 4.5%
Total of 9%
What % on the RO9 is a burn to the private area?
1%
In the RO9s what % is each leg anteriorly and posteriorly?
Each leg is 9% Anteriorly and posteriorly
Total of 18% if the entire leg is burned.
How do we calculate splatter burns?
Palmar method- using the patients on palm we use this to cover the burn each area covered is 1%
What is the referral criteria for burns?
- Partial thickness burns of more than 10% of total body surface area (TBSA)
- Burns that involve the face, hands, feet, genitalia, perineum or major joints
- 3rd degree burns in any age group
- electrical burns including lightning injury
What do we need to keep in mind about associated trauma?
- Remember the ABCs of trauma
- Burns and inhalation injury frequently mask other injuries
- Fractures
- spinal cord injury
- Other trauma
Always look for hidden trauma in a burn patient
What pathophysiology concepts whould we keep in mind for burns?
- Fuid and electrolyte shifts
- inflammation and healing
- immunologic chnages
- decrease in vascular volume
- decreased cardiac output
- increase blood viscosity
Which patient would we asses first?
1. Big partial thickness burn pt
2. Pt who just arrived with facial burns
3. Pt who just returned post anesthsia following skin graft
4. Full thickness burn about to have dressing change
Patient 2 with facial burns likely requires intubation
What are care do we provide in the emergent phase of burns?
- Care mainly focuses on airway managment
- Fluid therapy
- Wound care
- Emotional support
- teaching- how to take care of burn, how not to get burned again, how to take meds, and when to see doctor
What is the formula for fluid resuscitation?
Weight in kg x tbsa burned x 4ml
What is our fluid resuscitation protocol for burns?
- Administer lactated ringers
- replace 1/2 of calculated volume in the first 8 hours
- Replace remaining half of calculated volume within next 16 hours
Reparative phase of burns includes?
- Wound care
- Nutritional support
- Management of pain
- Prevention of contractures- passive and active ROM, Pain meds
- Wound managment- scrubbed with brush to take off scab and keep debriefed give pain meds
- Psychosocial issues- counseling, antidepressants
