Trauma and Trauma Systems > Burns > Flashcards

Burns Flashcards

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1
Q

introduction to burn injuries

A
  • 1.25-2 million Americans treated for burns annually
  • 45,000 require hospitalizations
  • 90% of burns can be prevented
  • 3-5% considered life threatening
  • 2nd leading cause of death for children <12
  • half of all tap water burns occur to children <5
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2
Q

greatest risk for burn injuries

A
  • very young -> greater BSA/weight ratio and thinner skin
  • very old -> thinner and doesn’t heal as well
  • infirm
  • firefighters
  • metal smelters
  • chemical workers
  • drugs and alcohol play major role
  • uncle rob
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3
Q

reduction in burn injuries

A
  • improved building codes
  • safer construction techniques
  • sprinkler systems
  • use of smoke detectors
  • educational campaigns aimed primarily at school children
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4
Q

layers of skin

A
  • epidermis - dead
  • dermis - nerves, hair
  • subcutaneous
  • underlying structures:
  • fascia
  • nerves
  • tendons
  • ligaments
  • muscles
  • organs
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5
Q

functions of the skin

A
  • protection from infection
  • sensory organ- temperature, touch, pain
  • controls loss and movement of fluids
  • temperature regulation
  • insulation from trauma
  • flexible to accommodate free body movement
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6
Q

emergent phase (stage 1)

A
  • pain response
  • catecholamine release:
  • tachycardia
  • tachypnea
  • mild hypertension
  • mild anxiety
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7
Q

fluid shift phase (stage 2)

A
  • length 18-24 hours
  • begins after emergent phase- reaches peak in 6-8 hours
  • damaged cells initiate inflammatory response:
  • vasodilation:
  • increased capillary permeability
  • intravascular hypovolemia
  • extravascular edema
  • burns over 30% BSA present with system immune response *****
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8
Q

hypermetabolic phase (stage 3)

A
  • lasts for days to weeks
  • large increase in the body’s need for nutrients as it repairs itself
  • fluid and electrolytes begin to move back into the vasculature
  • influx of fluid within vascular space causes the GFR to increase, leading to diuresis
  • fluid shifts may lead to hypernatremia and hypokalemia
  • cardiac workload and O2 consumption increase
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9
Q

resolution phase (stage 4)

A
  • scar formation

- general rehabilitation and progression to normal function

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10
Q

stages of pathophysiology of burns

A
  • emergent phase
  • fluid shift phase
  • hypermetabolic phase
  • resolution phase
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11
Q

types of burns

A
  • thermal
  • electrical
  • chemical
  • radiation
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12
Q

thermal burns

A
  • heat changes the molecular structure of tissue -> denatures proteins
  • extent of burn damage depends on:
  • temperature of agent
  • concentration of heat
  • duration of contact
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13
Q

jacksons theory of thermal wounds: zone of coagulation

A
  • area in a burn nearest the heat source that suffers the most damage as evidenced by clotted blood and thrombosed blood vessels
  • center of burn
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14
Q

jacksons theory of thermal wounds: zone of stasis

A
  • area surrounding zone of coagulation characterized by decreased blood flow
  • middle portion
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15
Q

jacksons theory of thermal wounds: zone of hyperemia

A
  • peripheral area around burn that has an increased blood flow
  • outermost area
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16
Q

burn infection

A

-people dont come in because they think the skin is intact but really a whole layer is burned off and an infection has already developed

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17
Q

electrical burns

A
  • greatest heat occurs at the points of resistance:
  • entrance and exit wounds
  • dry skin = greater resistance
  • wet skin = less resistance
  • longer the contact, the greater the potential of injury -> increased damage inside body
  • smaller the point of contact, the more concentrated the energy, the greater the injury
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18
Q

electrical current flow

A
  • tissue of less resistance - blood vessels and nerve
  • tissue of greater resistance - muscle and bone
  • results in:
  • serious vascular and nervous injury
  • immobilization of muscles
  • flash burns
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19
Q

chemical burns

A
  • destroy tissues
  • acid
  • alkalis
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20
Q

chemical burns: acids

A
  • form a thick, insoluble mass where they contact tissue

- coagulation necrosis - limits burn damage

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21
Q

chemical burns: alkalis

A
  • destroy cell membrane through liquefaction necrosis

- deeper tissue penetration and deeper burns

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22
Q

radiation

A
  • transmission of energy
  • nuclear energy
  • ultraviolet light
  • visible light
  • heat
  • sound
  • x-rays
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23
Q

radioactive substance

A
  • emits ionizing radiation

- radionuclide or radioisotope

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24
Q

alpha particles

A
  • slow moving
  • low energy
  • stopped by clothing and paper
  • penetrate a few cell layers on skin
  • minor external hazard
  • HARMFUL if ingested
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25
beta particles
- smaller than alpha - higher energy than alpha - stopped by aluminum or similar materials - less local damage than alpha - HARMFUL if inhaled or ingested
26
gamma rays
- highly energized - penetrate deeper than alpha or beta - EXTREMELY DANGEROUS - penetrate thick shielding - pass entirely through clothing and body- extensive cell damage - indirect damage- cause internal tissue to emit alpha and beta particles - LEAD SHIELDING
27
neutrons
- more penetration than other radiation - 3-10 times greater penetration than gamma - less internal hazard when ingested than alpha or beta - direct tissue damage - only present in nuclear reactor core
28
clean accident
- exposed to radiation - not contaminated by products - properly decontaminated - little danger to personnel
29
dirty accident
- associated with fire at scene of radiation accident | - trained decontamination personnel
30
radiation injury management
- park upwind - notify radiation response or hazmat response team - look for radioactive placards - measure radioactivity - decontamination patients before care - routine medical care (ABCs, etc.)
31
inhalation injury: toxic inhalation
- synthetic resin combustion - cyanide and hydrogen sulfide - systemic poisoning - more frequent than thermal inhalation burn
32
carbon monoxide poisoning
- colorless, odorless, tasteless gas - byproduct of incomplete combustion of carbon products - suspect with faulty heating unit
33
pulse oximetry
- clinical assessment of hypoxia is very difficult in the prehospital setting - cyanosis typically occurs with O2 saturation <70% - may be falsely positive in the patient with significant blood loss or CO poisoning - CO -> 200x greater affinity for hemoglobin than oxygen - hypoxemia and hypercarbia -> force the oxygen on rather than CO - measures hemoglobin saturation, NOT oxygenation
34
airway thermal burn
- supraglottic structures absorb heat and prevent lower airways burns - moist mucosa lining the upper airway - injury is common from superheated steam - symptoms: - stridor or "crowing" inspiratory sounds - singed facial and nasal hair - black sputum or facial burns - progressive respiratory obstruction and arrest due to swelling
35
burn depth
- superficial burn- epidermis - partial thickness burn- epidermis and dermis - full thickness burn- epidermis, dermis, fat, and muscle
36
superficial burn
- 1st degree - red - painful - dry (no blisters) - epidermis
37
partial thickness burn
- 2nd degree burn - red or white - painful - blisters (wet) - ultraviolet keratitis should be suspected in welders - epidermis and dermis
38
full thickness burn
- 3rd degree - leathery skin - white, dark brown - charred - minimally painful - dry - hard - epidermis, dermis, fat, muscle
39
rule of nines
- best used for large surface areas - expedient tool to measure extent of burn - head and neck- 9% - upper posterior trunk- 9% - lower posterior trunk- 9% - upper anterior trunk- 9% - lower anterior trunk- 9% - each upper extremity- 9% - external genitalia- 1% - posterior lower extremity- 9% - anterior lower extremity- 9% - if you had anterior part of arm and chest -> 22.5% burnt
40
rule of palms
- irregular or splash burns - best used for burns <10% BSA - a burn equivalent to the size of the patients hand is equal to 1% body surface area (BSA)
41
hypothermia
- disruption of skin and its ability to thermoregulate | - ironic but true
42
hypovolemia
- shift in proteins, fluids, and electrolytes to the burned tissue - general electrolyte imbalance
43
eschar
- hard, leathery product of a deep full thickness burn - dead and denatured skin - escharotomy- slicing the skin to allow it to expand
44
infection
-greatest risk of burn is infection
45
organ failure
- release of myoglobin | - blocks the kidneys -> stops function
46
special factors
-age and health
47
physical abuse
-elderly, infirm, or young
48
scene size up
- fire department | - SCBA and protective clothing
49
primary assessment
- ABCs MUST be intact - consider ET or RSI early with airway burns - rapid evacuation of patient if scene is unstable
50
focused and rapid trauma assessment
- accurately approximate extent of burn injury: - rule of nines or rule of palms - depth of burn - area of body affected- any burn to the face, hands, feet, joints, or genitalia considered a serious burn - circumferential burns- wrap around a limb -> do not allow for expansion - age of patient affected
51
general signs and symptoms of thermal burns
- pain - changes in skin condition at affected site - adventitious lung sounds - blisters - sloughing of skin - hoarseness - dysphagia - dysphasia - burnt hair - edema - paresthesia - hemorrhage - other soft tissue injury - musculoskeletal injury - dyspnea - chest pain
52
rule of nine: infant
- posterior head/neck- 9% - anterior head/neck 9% - posterior trunk: upper and lower- each 9% - arms- 9% each - legs- 14% each
53
minor/moderate burn severity
- superficial are less than 50% BSA - partial thickness less than 15% BSA - full thickness less than 2% BSA
54
critical burn severity
- partial thickness less than 30% BSA | - full thickness less than 10% BSA
55
ongoing assessment
- non critical- reassess 15 mins - critical reassess 5 mins - burn center care
56
management of local and minor burns
- local cooling - partial thickness <1% of BSA - full thickness <2% BSA - remove clothing - cool or cold water immersion - consider analgesics: - morphine sulfate - fentanyl (sublimaze)
57
management of moderate to severe burns
- dry sterile dressings - partial thickness >10% BSA - full thickness - maintain warmth- prevent hypothermia - consider aggressive fluid therapy - burns over IV sites- place IV in partial thickness burn site - consider analgesics: - morphine sulfate - fentanyl (sublimaze)
58
parkland formula
- 4 mL x weight X% burn - 1/2 volume in first 8 hours - second 1/2 over last 16 hours
59
management of moderate to severe burns
- caution for fluid overload - frequent auscultation of breath sounds - consider analgesics for pain: - morphine - fentanyl - prevent infection
60
management of inhalation injury
- provide high flow O2 by NRB - consider intubation if swelling - carbon monoxide poisoning- consider hyperbaric oxygen therapy - cyanide exposure- hydroxocobalamin
61
electrical injuries
- safety - turn power off - energized lines act as whips - establish a safety zone - lightning strikes: - high voltage, high current, high energy - last fraction of a second - no danger of electrical shock to providers
62
assessment and management of electrical, chemical, and radiation burns
- entrance and exit wounds - remove clothing, jewelry, and leather items - treat and visible injuries- thermal burns - ECG monitoring- bradycardia, tachycardia, VF or asystole: ACLS protocols - treat cardiac and respiratory arrest - aggressive airway, ventilation, and circulatory management - consider fluid bolus for serious burns- 20 mL/kg
63
chemical burns: scene size up
- hazardous material team - establish hot, warm, and cold zones - prevent personnel exposure from chemical
64
phenol: chemicals
- industrial cleaner - alcohol dissolves phenol - irrigate with copious amounts of water
65
dry lime: chemicals
- strong corrosive that reacts with water - brush off dry substance - irrigate with copious amounts of cool water- prevents reaction with patient tissues
66
sodium
- unstable metal - reacts vigorously with water - releases- extreme heat, hydrogen gas, ignition - decontaminate- brush off dry chemical - cover the wound with oil substance
67
riot control agents
- CS, CN (mace), oleoresin, capsicum (OC, pepper spray) - irritation of the eyes, mucous membranes, and respiratory tract - no permanent damage - general signs and symptoms: - coughing, gagging, and vomiting - eye pain, tearing, temporary blindness - management- irrigate eyes with normal saline
68
radiation burns
-Notify hazardous materials team. -Establish safety zones- Hot, warm, and cold – Personnel positioned upwind and uphill. – Use older rescuers for recovery. – Decontaminate ALL rescuers, equipment, and patients
69
look at RAD chart *
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