Burns

Question 1

Causes of burns

Answer 1

1. Thermal
   
   2. Radiation
   3. Chemical
   4. Electrical

Question 2

Cell damage occurs at temps >______F

Answer 2

113F (45C)

Question 3

How do you get radiation burns?

Answer 3

UV light or non-solar
- Sunlight
- tanning beds
- XRs
- radiation trmnts

Question 4

what can cause chemical burns?

Answer 4

• strong acids
• Strong bases (Alkalines like cement, lye, paint thinner, gas)
• can cause deep tissue necrosis that progresses several hrs after exposure

Question 5

SS of impending airway obstruction

Answer 5

Stridor
Hoarseness
Respiratory distress, tachypnea, hyperpnea
Cough

Question 6

SS of internal injury

Answer 6

• Tachycardia
• Oropharyngeal burns– These are important when identified; however, significant esophageal involvement may occur in the absence of oropharyngeal lesions
• Drooling
• Subcutaneous air
• Acute peritonitis– Abdominal guarding, rebound tenderness, and diminished bowel sounds
• Hematemesis

Question 7

Consult ____ for chemical burns

Answer 7

MSDS and poison control

Question 8

Complications of chemical burns

Answer 8

• Airway obstruction due to tissue edema
• Bowel perforation
• Fluid loss from vomiting, third spacing, GI bleeding
• Metabolic acidosis is acid is ingested
• Hypocalcemia if hydrogen fluoride (gasoline)
• Later: Strictures, fistulas, motility issues(hypo), GI CA

third spacing = pulling fluid from vasculature and putting it towards tissues needing help

Question 9

Trmnt of chemical burns

Answer 9

Symptomatic Patients:
ABC
Emergent GI consult for EGD

Minimally symptomatic:
Can be D/C after 2-4 hrs observation, tolerating oral fluids, has normal labs, speech and mentation

Question 10

What are electrical burns?

Answer 10

Burns at the cellular level due to electroporation of the cell membranes from a massive current of electrons.
High voltage, >1000V, will cause damage to deep tissue, especially conductive tissues such as muscles, nerves, and blood vessels.
Look for source and ground points, may have both

Question 11

Severity of electrical burns depends on

Answer 11

Type of current (direct [DC] or alternating [AC])
Voltage
Duration of exposure
Body resistance
Pathway of current (which determines the specific tissue damaged)

Question 12

AC vs DC

Answer 12

AC travels in various directions (Alternating current)

DC travels in 1 direction (Direct current)
Is found in defibrillators/batteries
Often throws person off source, stronger, but shorter exposure

Question 13

where is AC found?

Answer 13

Is found in plug ins
Lower voltage and causes muscle contraction, so it is difficult to pull away, lower voltage, longer exposure
AC traveling through the heart for even 1 sec can cause VF
Arm to arm or to foot cross the heart

Question 14

The following symp are most likely to occur from which type of burn?
* Muscular contractions
* Seizures
* Ventricular fibrillation
* Respiratory arrestdue to central nervous system (CNS) damage or muscle paralysis may occur.
* Cardiac arrest

Answer 14

Electrical burns

Question 15

Burn WU

Answer 15

• ECG and cardiac enzymes if any potential for contact with heart
• UA for myoglobin
• CT/MRI for unconscious patients, due to possible other injuries

Question 16

Pathophys of burns

Answer 16

Heat denatures proteins -> coagulative necrosis, around this tissue platelets aggregate -> vessels constrict, this reduces blood supply to the edges of the damaged area, which can further the damage

Damage to skin results in:
Possible bacterial invasion
Fluid loss
Impaired thermoregulation

Question 17

Burn classification

Answer 17

1st degree
2nd degree
3rd degree (healing is only poss from outside->IN. usu only feel pain on superficial edges bc you fried the deep nerves)

Question 18

Rule of 9s

Answer 18

Question 19

Which degree burn?

These burns are red, blanch markedly and widely with light pressure, and are painful and tender. Vesicles or bullae do not develop.

Answer 19

1st degree

Question 20

_______ thickness burn

These burns blanch with pressure and are painful and tender. Vesicles or bullae develop within 24 hours. The bases of vesicles and bullae are pink and subsequently develop a fibrinous exudate.

Answer 20

Superficial partial-thickness

Question 21

______ thickness burns

These burns may be white and pliable, black and charred, brown and leathery, or bright red, pale burns may simulate normal skin except the skin does not blanch to pressure. usually not painful.
Hairs can be pulled
easily from their follicles.
No vesicles.

Answer 21

Full-thickness

Question 22

why does a pt with a large burn suddenly get sever hypovolemia at about 6-8hrs after injury?

Answer 22

Intravascular fluid loss and large fluid shifts takes time

Question 23

IV fluids are required for burns >____% TBSA

TBSA = total body surface area

Answer 23

10

Question 24

Trauma protocol for burns?

Answer 24

1. ABC – Airway, Breathing, Circulation
2. Smoke inhalation get 100% oxygen
3. Remove all clothing
4. All chemical are flushed with water except powders, (dust off powder before flushing)
5. Acid burns are flushed for 20 minutes
6. calculate TBSA quickly (if >10% -> give IV fluids)
7. Adjust IVF rate based on urinary outpt (goal is 30-50ml/hr for adults)
8. +/- give albumin
9. clean the burn
10. transger to burn center
11. Discharge with wound care

Question 25

If no shock is observed, use the _______ formula to determine how much fluid needs to be given within first 24hrs

Answer 25

Parkland formula (4 mL/kg) × % TBSA burned ## Footnote to estimate fluid volume needs in the first 24 hours after the burn. Half the calculated amount is given over the first 8 hours; the remainder is given over the next 16 hours. Fluid is lactated Ringer's solution because large amounts of normal saline could result in hyperchloremic acidosis.

Question 26

what type of fluids need to be given?

Answer 26

lactated ringers bc its gonna be a large volume ## Footnote more isotonic than saline

Question 27

IVF rate is adjusted based on _____

Answer 27

urinary output Goal is to maintain 30-50ml/hr in adults .5-1ml/kg/hr in children

Question 28

When to give albumin

Answer 28

Some clinicians give albumin, after 12 hours to patients who have larger burns, are very young or very old, or have heart disease and require large fluid volumes.

Question 29

how to clean wounds

Answer 29

use analgesia, topical, oral, IV, depending on severity of burn remove all loose debri use room temp water to flush Debride all ruptured blisters, leave others intact

Question 30

consult burn center for what type of burns?

Answer 30

* Full-thickness burns > 1% TBSA * Partial-thickness burns > 5% TBSA * Burns of the hands, face, feet, or perineum (partial-thickness or deeper) * old >60 and young <2

Question 31

Should you treat burns if you plan on sending them to burn center?

Answer 31

only if you ask them what they want! dont ruin their plans

Question 32

Silver Sulfadiazine, Silvadene treats ____ thickness burns and requires to be damp to be wet

Answer 32

partial-thickness ## Footnote change dressings daily update tetnus FU outpt in 24-48hrs

Question 33

We usu let burns that will heal within a few weeks do their own thing w/o Sx

Answer 33

Question 34

Sx indications

Answer 34

* Expected for most deep partial and full thickness burns. Those expected to not heal within 2-3 weeks. * Eschar is removed within 3 days, excision of damaged material occurs, then grafting * Fasciotomy is done when edema within a muscle compartment elevates compartment pressure > 30 mm Hg. Compartment syndrome is rare in burns other than high voltage electrical burns

Question 35

Sx indications

Answer 35

* Expected for most deep partial and full thickness burns. Those expected to not heal within 2-3 weeks. * Eschar is removed within 3 days, excision of damaged material occurs, then grafting * Fasciotomy is done when edema within a muscle compartment elevates compartment pressure > 30 mm Hg. Compartment syndrome is rare in burns other than high voltage electrical burns