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EM Burns
| Question | Answer |
|---|---|
| Most common burn cause in adults | flame burns adn ignition of clothing |
| Most common burn cause in children | scald burns |
| Depth classifications | superficial, partial thickness, deep partial thickness, full thickness |
| First Degree burns | epidermal only, caused by sun or minor flash, no metabolic alteration or edema, skin is pink or red and is dry or has only small blisters, hypersensitivity, rapid healing: 3-6 days |
| Second degree burns | Involves dermis, superficial or deep, appearance and healing time vary on severity of burn |
| Superficial Second Degree burns | flame, scalding, chemicals. Minimal damage to skin appendages, edema formation, skin is pink or red & often blisters. Hypersensitivity, healing: 10-21 days |
| Deep Second Degree burns are dermal, but more destruction and involves some skin appendages (follicles). Caused by | scalds, longer exposure to flame or chemical. Moderate edema. Large blisters or bulle, often ruptured, skin may be red or pale. Decreased sensation and circulation. Healing takes longer than 21 days |
| Start losing sensation with which burn? | deep second degree burn |
| Third degree burns: full thickness destruction of epidermal and dermal layers. Caused by | prolonged exposure to heat or severe exposure. Edxtensive edema, skin often moist and weeping, charred skin or pale. NO sensation, circulation. will not heal spontaneously, requires grafting |
| Blister formation not found in | full-thickness burns. |
| Pre-Hospital Management: First Aid | Remove causative agent, cool the burn surface (not with ice b/c it can cause ischemia; can use wet sheets/towel) cover/protect burn wound to prevent heat loss and keep clean |
| Airway assessment | assess for patency, smoke inhalation injury, constantly reassess for upper airway edema (develops as fluid resuscitation progresses). Intubate preemptively, anticipate need for surgical airway |
| Breathing assessment | for spontaneous respiration, for bilateral airflow |
| Circulation assessment | assess circulatory status, establish IV access |
| Adding fluid to someone with airway inflammation/damage | will incresae airway edema. May want to intube prophylactically |
| Go to pain med in burn patients | Morphine |
| Secondary Survey | Nasogastric decompression, urinary catheter to monitor fluid output |
| Labs in burn | Obtain 02 sat, calculate weight for resuscitation volumes, ABG, CBC, electrolytes, glucose, urinalysis, carbon monoxide level, tetanus booster or Ig and immunization |
| Calculation of 9's | Percentage of body surface affected by 2nd and 3rd (1st don't count) degree burns. each thigh -9, each arm-9, bilateral chest - 18, whole leg -18% |
| Palm is approximately what % of BSA? | 1% |
| Major Burns | Partial thickness>25% BSA, Full thickness>10% BSA, Specialized tissue. Transfer to nearest Burn Center (UNC) |
| Moderate Burns | Partial thickness 15-25%, full thickness 2-10% (unless special tissues). This excludes high voltage electrical injury, inhalation, high risk , or multi-trauma. Admit, but not necessarily to burn unit |
| Parkland Formular for fluid | 4cc of LR x wt in Kg x %BSA = total volume over first 24 hours. monitor urine output, pulmonary status, BP and pulse |
| ____ is the most common cause of morbidity in smoke inhalation patients | pneumonia |
| Tx of Smoke inhalation injury | humidified O2, Pulmonary physiotherapy, mucolytic agents and bronchodilators |
| MOA of CO | displaces O2 from hemoglobin. PaO2 remains normal. MUST check the CO level for diagnosis. O2 sat will be reduced. Tx by administering 100% O2 |
| The most commonly utilized and most accurate method to diagnose smoke inhalation injury is: | Fiberoptic bronchoscopy of upper airway and trancheobronchial tree |
| Concern with Electrical Injury | extensive muscle damage. Fasciotomy may be warranted. Compartment syndrome (do a frequent neuro exam! and monitor circulation: appearance, pulses) |
| Patients with electrical burns should be closely monitored with: | Observation for myoglobinuria |
| Escharatomy | An escharotomy is a surgical procedure used to treat full thickness (third-degree) circumferential burns. |
| Which is better to be burned with? Acid or Alkali? | acid. (severe occular injury from alkali will cause conjunctival pallor) |
| Most common burn injury to the eyes | chemical burn |
| Assessment of all burn pts should include | an eye exam with flourescein exam of cornea if indicated |
| Blisters on the palms or the soles are | left alone. Anywhere else are typically broken and drained. Topical abx, vasoline gauze dressing AFTER exudative phase (for minor burns) |
| Most common pathogens post burns | S. aureus and Pseudomonas. |
| Colonization | all burn wounds will become colonized. Difference between colonization and infection. Topical abx prevent invasion. Usually apply BID |
| Which Abx is used to penetrate an eschar? | Mafenide Acetate |
| ABX | Routine systemic antibiotics use is controversial and not indicated as part of routine, emergency care. If indicated, use broad spectrum with Gram positive activity: PCN, Cephalosporins, Macrolides |
| What kinds of burns may skin grafting be indicated for? | deep second degree or third degree |
| Biological dressings | Gold Standard: human allograft: lasts 2-3 weeks until rejection. Porcine xenografts (cheap, available, lasts about 1 week), Synthetic skin substitutes |
| coagulative necrosis involving the subcutaneous blood vessels is pathognomonic for | third degree burns/full-thickness injury |
| incision through the burn wound is termed | escharatomy; may be required to relieve this compression and restore distal circulation |
| Special tissue that requires burn center tx | face, eyes, ears, hands, feet, or perineum |
Created by:
ltm12