Burns

Question 1

types of thermal burns

Answer 1

1. scald
2. flame
3. flash
4. contact

Question 2

severity of scald burns depend on:

Answer 2

– Time and Temperature.
– Nature of Substance (eg Steam,
Hot Water, Hot Oils).

– Depth and Extent of burn.

Question 3

what types of burns require reporting

Answer 3

symmetrical burns– indicative of abuse in children

Question 4

1st, 2nd, 3rd and 4th degree burns

Answer 4

1. superficial burns. paiful and red but no blistering
2. partial thickness; epidermis and dermis affected, blistering seen
3. full thickness, significant scarrin, probably doesn’t really hurt at this point because nerves are dead
4. burn involveing underlying muscle and bone.

3rd and 4th often requires skin graft

Question 5

T/F; scarring and blistering happens in first degree burn.

Answer 5

false.

• Inflammation only.
– Red, little swelling, NO blisters.
– Painful. • Healing:
– Within 2-5 days.
– No scar. No permanent pigment changes.

Question 6

examples of first degree burn

Answer 6

sunburn, short flash fire

Question 7

burn degree

Answer 7

SECOND DEGREE BURNS

• All of epidermis and into papillary dermis; some retepegs spared.
– Pink/red, moist, moderate
swelling, blisters. – Painful.

• Healing:
– Within 7-10 days without scarring.
• Example:
– Some scald burns

Question 8

two types of second degree burns

Answer 8

1. superficial
2. deep

Question 9

superficial vs deep thickness burns of the second degree

Answer 9

superficial: all of epidermis and into the papillary dermis
deep: all of epidermis and into reticulard dermis. takes longer to heal and may need grafting. will often result in hypertrophic scarring.

Question 10

burn degree

Answer 10

third degree– full thickness

• all of the epidermis and dermis and into the subcutaneous tissue
• white or black, charred and leathery, doesn’t blanch and isn’t painful because nerve damage
• healing: long time to heal; by secondary healing if at all
• example: flame burns, electrical burns.

Question 11

explain the rule of nines

Answer 11

method of burn assessment for calculating total body surface area in adults.

head = 9%

chest/abdomen = 18%

back = 18%

upper extremities = 9+9

legs = 18 + 18

genitals = 1

Question 12

which chart to use for burn assessment in children

Answer 12

lund and browder chart

Question 13

cause of the systemic effects of burns

Answer 13

seen in major burns

• due to inflammatory mediators: histamine, prostaglandins, cytokines
• effects on non-burned tissue
• fluid leaks from intravascular space

Question 14

physiology behind burn shock

Answer 14

open burn wounds causes fluid loss and decreased cardiac output.

burn shock has effects on multiple organ systems:

– Decreased cardiac output. – Increased systemic vascular resistance. – Decreased numbers of RBCs. – Impaired host defense. – Decreased perfusion of kidneys. – Decreased perfusion of gut – ileus.

Question 15

3 mechanisms of inhalation injury

Answer 15

1. carbon monoxide poisoning
2. direct heat injury to upper airway/ hot air inhalation
3. chemical injury to lower airways.

often due to fire in enclosed space or loss of consciousness

Question 16

CO inhalation causes the O2-Hb dissociation curve to go to the ___

Answer 16

right.

CO has much greater affinity for Hb than does O2. this deprives tissues of O2.

Question 17

treatment for CO poisoning

Answer 17

100% oxygen or hypervaric O2

Question 18

if you suspect a smoke inhalation injury, you should order a :

Answer 18

bronchoscopy

• look for mucosal inflammation, subglottic edema, carbonaceous particles
  therapy: clears the soot from the lower airways

Question 19

indications of an inhalation injury

Answer 19

• hoarsness
• soot on face
• being unconscious in burning area
• soot in sputum
• singed facial hair
• face and neck burns
• redness and swelling of the oropharynx

Question 20

first thing you should do when someone is presenting with major burns and what do you monitor?

Answer 20

RESUSCITATION with ringers lactate and maybe a colloid (large molecule substances) like albumin or dextran

• monitor: urine output, mental status, capillary refill, temperature of extremities
• electrolytes, base deficit, serum lactate
• intensive hemodynamic monitoring

Question 21

what degree burns require escharotiomies

Answer 21

3rd

Question 22

purpose of escharotomies

Answer 22

life and limb saving– presents constriction of skin which would result in deformities/loss of function/circulation cut off– preventing comparment syndrome to allow muscles to breathe/ prevent ischemia

occurs in 3rd degree

Question 23

wound care

Answer 23

1. stop burning process and cover with warm blanket
2. in ED, cover with warm saline-gauze
   - after complete assessment, due burn dressings
   - possible topical antimicrobials
3. gentle debridement and cleaning of wount.
4. splinting of extremities

Question 24

T/F when someone presents with burns we should use systemic antibiotics to prevent infection since theres a lot of open skin

Answer 24

false. use topical antimicrobials to prevent colonization, but Abx is unnecesary

Question 25

examples of topical antimicrobials

Answer 25

silver sulfadiazine/silver dressing - polysporin - mupriocin/bactroban

Question 26

leading cause of death post resuscitation phase

Answer 26

sepsis. often in larger burns in under 16 or over 60.

Question 27

what kind of nutrition should be given in burns

Answer 27

high protein and high calorie!

Question 28

burns cause significant ___ and ___ response until healed and often for many months after. - nutritional support is key to reducing morbiidity and mortality in burn patients (ex/ stress ulvers, ileus, infection/sepsis would/graft complications)

Answer 28

burns cause significant **hypermetabolic and hypercatabolic** response until healed and often for many months after.

Question 29

outline the process of operative treatment for \<20 and \>20% TBSA

Answer 29

for burns \<20%; usually decide between 7-10 days if it will heal before 3 weeks. usually able to do in one operation for larger burns: earlier debridgement and grafting decreases mortality, infection, hospital stay, and complications. THEY WILL PROBABLY NEED MULTIPLE OPERATIONS

Question 30

purpose of tangential excision

Answer 30

using a shave razor to debride to healthy tissue -- the healthy tissue is most likely to accept the graft (in deep 2nd or 3rd degree burns)

Question 31

a split thickness graft has all of the ___ layer nad a portion of the \_\_- layer

Answer 31

a split thickness graft has all of the EPIDERMIS layer nad a portion of the DERMIS layer

Question 32

what are contractures and when do they form

Answer 32

a healing process when the muscles and ligaments get constricted and lose their function. contractures develop slowly during the process of scar contraction/maturation