Week 9- BURNS !! Flashcards
Functions of the Skin:
Protection against….
microorganisms, dehydration, UV light, and mechanical damage
1st physical barrier that the human body has against the external environment
Functions of the Skin:
Sensation of…
pain, temp, touch, deep pressure starts w/ skin
Functions of the Skin:
Mobility allows…
SMOOTH movement of the body
Functions of the Skin:
Endocrine activity initiates the biochemical processes involved in ____ production! Which is essential for ____ absoprtion and normal bone metabolism.
Vitamin D
Calcium
Functions of the Skin:
Exocrine activity: the release of ____
water, urea and ammonia
Functions of the Skin:
IMMUNITY:
developement against _____ !!
developement against pathogens
Function of the Skin:
Regulation of Temperature: Skin participates in temp regulation by ____ or _____ heat!
conserving or releasing
What is the outermost layer of the skin called?
epidermis
What layer of the skin is the middle one and what does it consist of?
DERMIS
- nerve endings
- cutaneous blood vessels
- sweat glands
- hair follicles
- sebaceous glands
What is the most inner layer of the SKIN?
subcutaneous layer adipose tissue
What heat temperature causes burns?
higher than 44 degrees
What are the TWO major componenets that depend on the severity of the burn???
heat energy and duration of exposure
In severe burns, what happens to the capillary permeability? (and how does it cause edema?)
it increases causing intravasular proteins and fluid to move into intersistial space which increases edema
Due to the loss of volume caused from severe burns what does this result in?
cardiac output wise
REDUCED cardiac output
What is the goal of burn resuscitiation???
to restore and perseve tissue perfusion
What are the three zones of a burn?
zone of coagulation
zone of stasis
zone of hyperemia
What is the zone of coagulation?
source of MOST damaged! little to NO blood flow (irreversible tissue loss, necrosis!!!)
What is the zone of stasis?
decreased blood flow and inflammation, necorsis can develop after 48 hours . this spot can be reverses earlier on!
What is zone of hyperemia?
the least affected area, cells typically recover in 7-10 days (ischemia may progress to full necrosis if not addressed)
What is a 1st degree burn?
superficial burn, epidermis only, skin is red, painful
ex: sunburn
we do nothing!!!
How do we treat 1st degree burns?
Moist sterile dressings!!
What is a 2nd degree burn?
SUPERFICIAL PARTIAL THICKNESS
epidermis and dermis
SKIN is red usually involves blisters or moisture
painful will heal on its own
Whats a 2nd degree burn?
deep partial thickness burn:
extends into dermis, damages hair follicles and sweat and sebaceous glands
very painful
How do we treat 2nd degree burns?
ALS- treat for PAIN!
BLS- <15% moist sterile dressings
>= 15% dry sterile dressings
How do we treat 3rd degree burns?
dry sterile dressings
What is a full thickness burn (3rd degree)?
all layers of the skin are destroyed
skin is white and pale, brown and leathery or charred
no pain sensation
usually requires skin grafting
What is a fourth degree burn?
destroying skin plus bone tissue and tendons
CHARRED
Are eyes super sensitive to burns?
yes!!
What is the definition of thermal burns?
caused by fires or other causes of heat injury
What are the four types of thermal burns?
flame burns
scald burns
contact burns
flash burns
What are FLAME burns?
often associated with trauma
ex. house fire
(partial or full thickness burns)
What are SCALD burns?
almost 2/3 of burns in children are from scalds from hot drinks/bath water
most tend to be superficial/partial thickness
What are CONTACT burns?
be prolonged contact or extremely hot objects! they are common in industrial accidents or where a LOC caused prolonged contact
What are FLASH burns?
occur from explosions with no sustained fire, there is normally a single wave of heat but in larger explosions blast injuries, fracture and internal trauma can occur
What are the two types of shocks that can occur from burns?
hypovolemic shock
distributive shock
When does burn shock happen?
what fraction of the body is burned?
1/3 of the body is burned
Why does hypovolemic shock occur during burns?
INTERSISTAL fluid leaking out of the cells!!
caused by serious leakage of intravascular fluid to body surface and interstitial spaces in the early stage of burns
Why does burns cause distrubutive shock?
Large burns cause VASODILATION that result in systemic capillary leakage. Cardiac output is decreased by circulating factors that depress myocardial function, which may lead to shock.
What are clinical features of burn shock?
hypovolemia
increased blood viscosity due to increased
ratio of red blood cells to plasma
reduced cardiac output
What are some signs of a inhalation burn?
singed hairs
black sout
swollen neck
burns
sore throat
How do we treat severe airway burns?
give them O2 and transport fast!!
no SGA cause of airway trauma
What happens chemically during a carbon monoxide posioning?
HINT- talk about CO and O2
CO can displace O2 from the alveolar air and the blood hemoglobin, CO has a higher affinity than O2
When a group of people all in the same area complain of headache or nausea, it could potentially be what?
carbon monoxide poisoning
What is it called when CO combines with RBCs?
carboxyhemoglobin
Smoke Inhalation:
What are the three vast majority of deaths caused from?
- inhalation of toxic gases
- upper airway compromise
- pulmonary injury
What is worse for the eye?? Acids or alkalis??
ALAKLIS are most dangerous
What are the TWO important things to know during a chemical exposure?
HOW MUCH
HOW LONG
Where do acids usually damage? And what are some examples?
only the very front of the eye
ex: nail polish, vinegar, car battery acid
What are alkalis chemicals?
Examples?
have a HIGH PH concentration
penetrate the surface of the eye and can cause severe injury to the external structures like the cornea and internal structures like the lens
drain cleaners, bleach, oven cleanrs cemet
What are phenols?
Examples?
concentrated solutions can cause severe eye damage inlcuding clouding of the eye surface, inflammation of the eye and eyelid burns
mouthwash, household cleaners
What are electrical burns?
caused by heat from electricity following from the source entry wound to exit wound
High voltage = ____ outcomes!
WORSE
What is high voltage considered?
> 500 volts
What patient population is more likely to have a better outcome after being electricuted?
YOUNG pts
doesnt damage cardiac muscle, they have no preexisiting diseases
What are non burn realted electricution injuries?
asphyxia
cardiac arrest
neurologic complications (seizures, delirium, confustion, coma, and temporary quadriplegia)
kidney damage
severe muscle spasms leading to # or dislocations
What are good ways to prevent lightning strikes?
theres 4
Do not be the tallest object that is a good conductor.
Do not stand under or near the tallest object that is a good conductor.
Take shelter in a substantial structure.
Avoid touching good conductors during a lightning storm.
How many volts does a lightning bolt carry?
100 million volts!!
What causes arrest in a lightning burn victim?
normally secondary to HYPOXIA as the body recieves global depolarization
the myocardium normally recovers on its own while there is A DELAY in the respiratory center to recover or throracic tetany (spasm) causing resp arrest!!!!
What are the 3 types of ionizing radiation burns?
alpha- mild
beta- moderate
gamma- severe caused by an X-RAY and accounts for majority of injuries
What determines severeness of radiaiton burns?
amount of radiation!
time spent during exposure
(most develop over days)
What is acute radiation syndrome?
causes hematologic, CNS and GI system changes
(from radiation contact burns, can cause local soft tissue injury or develop hours later)
What are circumferential burns?
full thickness burns causeing eschar tissue to form that is tough and not capable of expansion
if present on extremity this can cause extreme pressure, limiting blood flow, therefore PULSE CHECKS frequent
What is the purpose of an escharotomy?
formed to allow for expansions for the chest lungs or affect extremitiy (makes space for everything to expand and GROW!!)
general assessment of burns
What is the MOST important thing to remember?
SCENE ASSESSMENT
YOUR SAFETY!!
wear appropiate PPE
general assessment of burns
During your inital assessment what are some things to remember?
evaluate: (four things)
evaluate:
1.LOA
2. AIRWAY
3. breathing!!
4. circulation
How fast CAN burn shock develop?
24-48 hours (slowly)
What is TBSA?
total body surface area
What is the rule of NINES?
divide body into 11 sections each worth 9% (1% for gentilia)
How do we modify rule of 9’s for pediatrics? and infants?
peds:
head- 12%
legs - 16.5 each
arms- 9%
infants :
legs- 13.5 %
arms- 9%
What is the rule of PALMS? When can we use it?
pts palm is = 1% of pts body TBSA
calculation is helpful only when burns overs less than 10% of TBSA or irregulary shaped
How do you treat burns of the EYES?
covere injured eyes with moist sterile pads.
if one eye is injured, cover BOTHHH!
Who should we contact when talkign about radiation burns?
hazardous materials response team!!
RADIATION BURNS:
burns over ___% of the TBSA are usually fatal?
70%!!!
What are the four catergories of airway management for burn patients?
The patient with an acutely decompensating airway who requires intubation in the prehospital environment (call for assistance)
Cardiac or respiratory arrest (intervene)
Swelling that is visibly increasing (actively swelling, actively LEAVE)
May require surgical airway if intubation is not successful
Pts with burns covering more than ___ % of the TBSA will need fluid resuscitation:
20%!!!!
What is the parkland burn formula?
(amount of fluid needed in first 24hrs)
4mL x weight in Kgs x % of TBSA burned
HALF of this in first 8HRS
second half is in the next 16HRS
How do we manage pain?
Anaglesia medical directive
ibuprofen, acetominophen and ketoralac
According to the BLS how long should we cool down burns for??
< 3o mins!!
Chemical burn treatment: What should we be doing first??
GO FAST AND FLUSH IT OUT!!
What is something to consider when dealing with chemical burns?
be aware of WHAT the substance is!!!!!!!!!!!!
What should we do first for chemical burns in the eye!!!?
same as if it is on the skin!
FLUSH IT OUT AND IRRIGATE WITH STERILE WATERRRRR
What is considered LOW voltage?
HIGH voltage
and then lightening voltage?
<500V - low
>500-1000V- HIGH
up to 1 billion - LIGHTNING
Why is fluid resuscitation more challenging in pediatrics?
due to oncreased body surface to weight ratio!!
may require more fluid per kg than adults
Geriatric pts have poor ____ stores so what needs to be checked for burn management?
glycogen stores!!
HYPOGLYCEMIA (BS levels)
Long Term Consquences of Burns:
Consquences for the PATIENT:
Serious burns are life-changing events.
Many die from secondary complications ex. sepsis
One day of inpatient treatment is needed for each 1% of TBSA burns.
Extensive rehabilitation may be necessary.
Consequences for survivors: thermoregulation, motor function, and sensory function problems
Long Term Consquences of Burns:
Consquences for the paramedic:
Can be one of the most horrifying tasks undertaken by paramedics
Fire scenes are chaotic and dangerous.
Your initial response and actions will have a long-term effect.
Don’t get BURNED.
According to the BURNS STANDARD- BLS:
What is the first thing to do when in a situation with a pt with a thermal burn?
if the patient is in a smoke/fume/ filled environment , request assistance from fire personnel and ensure that the patient is moved quickly as possible to a FRESH air zone!!!!
According to the BURNS STANDARD- BLS:
What is the second thing to do when in a situation with a pt with a thermal burn?
consider life/limb/ function threats:
- airway burns
- asphyxia (smoke inhalation)
- CO/cyanide
- shock!!
According to the BURNS STANDARD- BLS:
What is the THIRD thing to do when in a situation with a pt with a thermal burn?
attempt to determine:
source of burn & if burn is due to fire:
- wether fire was in an enclosed space
- pt was unconcious? or lost conciousness? during exposure to fire/fumes/smoke
ACCORDING TO BURNS STANDARD- BLS:
What is the FOURTH thing to do when in a situation with a pt with a thermal burn?
STOP THE BURNING PROCESS
ACCORDING TO BURN STANDARD-BLS:
What is the FIFTH thing to do when in a situation with a pt with a thermal burn?
Remove clothing surronding area, do not cut if the clothes is STUCK to the burn
ACCORDING THE BURNS STANDARD- BLS:
What is the sixth thing to do when in a situation with a pt with a thermal burn?
PERFORM A SECONDARY SURVEY:
- estimate the severity to include: area burned (location, circumferntial), burn depth (degree), % of TBSA burned!!
- assess distal neurvascular status
- signs of smoke inhlation and upper aiway injury!
- if burns involve eye follow “visual disrubance standard”
- if burns involve eye but it is swollen shut, LEAVE IT SHUT!
ACCORDING TO BURNS STANDARD - BLS:
What is the seventh thing to do when in a situation with a pt with a thermal burn?
- FOR BURNS INVOLVING <15% OF BODY SURFACE AREA:
COOL burns and limit to <30 mins of cooling to prevent hypothermia
ACCORDING TO THE BURNS STANDARD- BLS:
If remoistening of the dresssing is required to continue cooling the burn… what do we do?
REMOVE THE DRY SHEET OR BLANKET AND REMOISTEN THE PREVIOUSLY APPLIED STERILE DRESSING
ACCCORDING TO BURNS STANDARD- BLS:
When dressing a hand what do we need to remember?
dress each digit individually !!
ACCCORDING TO BURNS STANDARD- BLS:
What are some problems we should expect?
airway obstruction
if airway burns: bronchospasm, and orolingual/laryngeal edema
resp distress/ arrest
agitation/ combativeness !!!!
