Burns

Question 1

• Pediatric burn injuries most often d/t

Answer 1

scalding (NAT?) (non-accidental trauma)

Question 2

1st degree burn

Answer 2

superficial thickness

epidermis

erythma, minor pain, no blisters

Question 3

2nd degree superficial

Answer 3

partial thickness - superficial

superficial (papillary) dermis

blisters, clear fluid, & painful

Question 4

2nd degree deep

Answer 4

deep reticular dermis

whiter appearance with decreased pain, difficult to distinguish from full thickness

Question 5

3rd/4th degree

Answer 5

dermis and underlying tissue and possibly fascia, bone, or muscle

hard leather like eschar, purple fluid, no sensation (insensate)

Question 6

ABA Severity Grading System - major burn

Answer 6

o 2° burn, >20% TBSA (adult) or 10% (age extremes)
o 3° burn, > 10% TBSA (adult)
o All electrical burns
o All with inhalation injury (regardless of degree)

Question 7

National Burn Registry

Answer 7

• If patient age + %TBSA is >115 –> >80% mortality
• Mortality doubles with added inhalation injury

Question 8

4 types of burns

Answer 8

chemical
electrical
thermal
inhalational

Question 9

electrical burns

Answer 9

o Damage concentrated at entry & exit wounds
o Major internal tissue damage not seen
o Significant electrical burn –> myoglobin –> risk of renal failure

Question 10

classifications of inhalation injury

Answer 10

upper a/w
lower airway
metabolic asphyxiation (CO or cynaide)

Question 11

what is most lower airway damage related to regarding inhalation?

Answer 11

toxins

Question 12

warning signs of inhalation burn

Answer 12

Hoarseness,
sore throat,
dysphagia,
hemoptysis,
tachypnea,
respiratory distress,
elevated carbon monoxide levels

Question 13

airway burn treatment

Answer 13

• Airway Exam: Direct visualization via laryngoscopy or fiberoptic bronchoscopy (FOB) considered “gold standard”
• If upper a/w damage present, EARLY intubation is indicated (even when asymptomatic).
• AVOID SUCCINYLCHOLINE IF > 24 HRS POST-INJURY **

Question 14

why must succs be avoided if >24 hrs post burn injury?

Answer 14

o Burn –> receptor up-regulation (increased acetylcholine receptors) –> massive hyperkalemia –> cardiac arrest/death
o Significant up-regulation occurs after 1st 24 hours

Question 15

o Progressive air leak around ETT indicates what from a inhalation burn patient?

Answer 15

a/w swelling subsiding

Question 16

what should be suspected if victim rescued from enclosed space?

Answer 16

CO poisoning

Question 17

• Symptoms of HCN toxicity

Answer 17

Changes in LOC,
seizures,
dilated pupils,
hypotension,
apnea,
high lactate levels

Question 17

Burn Treatment – Cyanide
what can this cause?

Answer 17

• HCN blocks intracellular O2 use –> metabolic acidosis

Question 18

• Treatment of CO toxicity

Answer 18

100% O2 untill levels of COHgb <5% for 6 hours

Question 19

• Treatment for HCN toxicity

Answer 19

Hydroxocobalamin (vit B12a)

Question 20

Burn Treatment - Shock

Answer 20

• After securing a/w, aggressive fluid resuscitation begins

Question 21

Burn Treatment - Shock S/S

Answer 21

hemoconcentration, massive edema, decreased urine output, CV depression –> collapse

Question 22

when is fluid loss greatest in burn/shock?

Answer 22

• Fluid loss greatest during 1st 12 hrs; begins to stabilize after 24 hrs.
• Fluid resuscitation required to prevent hypovolemic shock –> increased edema formation (“fluid creep”).
• Beware of compartment syndrome