burns

Question 1

epi of burns

Answer 1

• high morbidity
• survival now at 94%
• M and M highest at extremes of age

Question 2

2 most common causes

Answer 2

flame - superheated air

scalp - superheated liquids

Question 3

classification of burns

Answer 3

1st - local to epidermis
2nd  - thru epi into dermis
- superficial - epi and dermis
- deep - into deep dermis
3rd - into subcutaneous fat
4th - into muscle and bone

Question 4

what are 3 zones and where effects can be made

Answer 4

coagulation - burn
stasis - can help
hyperemia - can help

Question 5

which are painful

Answer 5

1, 2 and 3rd to pin prick

Question 6

what is rule of 9s

Answer 6

abdo - 9% chest and stomach
legs - 18% each
arms 9% each
head - 9%
perineum - 1%

Question 7

how to class severity of burns in terms of BSA

Answer 7

mild - 20

also severe if 5% full thickness burns, or to eyes, ears, genitals

Question 8

who to send to burn center

Answer 8

• all severe
• electrical and chemical
• inhalation
• complicationg factors

Question 9

3 reasons inhalation burns are an issue

Answer 9

1. edema of upper airway - can occur rapidly
2. edema of lower airway - pulmonary infiltrates
3. CO toxicity a concern

Question 10

4 phases of treatment

Answer 10

1. initial eval and rescus
2. initial would mgmt
3. def. wound closure
4. rehab

Question 11

what is mgmt

Answer 11

ABCDE

• may need def. airway do to edema
• after AB are met, volume resus is important

Question 12

when to suspect airway burns

Answer 12

• facial burns
• carbon sputum
• nasal hairs
• tachypneic

Question 13

when to intubate

Answer 13

early

• 40% BSA
• resp. distress
• usual other crit.

Question 14

what may interfere with B (5)

Answer 14

1. airway obst.
2. thoracic trauma
3. eschars
4. CO poisoning
5. abdo ACS

Question 15

what is special about C in burns

Answer 15

• will tend to be hypotensive
• volume loss
• can also get myocardial dep for first few days
• can get ACS with lots of fluid

Question 16

what is parkland formula for fluid resus

Answer 16

4ml/kg/% BSA
- 1/2 in first 8hrs
- 1/2 in next 16hrs
use ringers lactate

Question 17

3 aspects of DandE in burns

Answer 17

1. all the usual
2. can also have CO poinsoning
3. loss of skin> loss of heat> hypothermia

Question 18

3 processes of inhalation injury

Answer 18

1. upper airway injury
2. subglottic
3. chemical asphyxia

Question 19

what is issue with CO

Answer 19

Hb has stronger affinity for it

• not picked up on pulse oxymeter
• no effect of pO2

Question 20

how to treat CO

Answer 20

100% O2

- possible hyperbaric O2

Question 21

how is CO diagnosed

Answer 21

clinically

• Hx of exposure
• Sx of
• increase COHb in blood

Question 22

Sx of CO

Answer 22

HA, confusion, nausea, vomiting, LOC, diszzyness

Question 23

what are abnormal CO Hb levels

Answer 23

> 3% in normals

>10% in smokers

Question 24

what is best predictor of outcomes

Answer 24

NOT COHb levels

- neurologic outcome