WVSOM skin System 2012
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| What is the role of the skin? | Prevents heat and water loss as well as invasion by bacteria
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| What is the result of a burn? | Loss of vascular integrity, increased capillary permeability, increased interstitial volume, diminution of blood volume
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| What is the rule about fluid loss? | It is proportional to the depth of the burn
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| what is the result of fluid loss? | Hypovolemia, hypotension, tachycardia, decreased CO, vasoconstriction, Kindey ischemia
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| What are the most common burns in the following age groups? 3-14 15-60 60 | 3-14: flame burns
15-60: industrial accidents
60: Accidents
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| What is burn severity dependant on? | Temperature, Duration, Conduction
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| What is a first degree burn? | Epidermal involvement ONLY
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| What is a second degree burn? | Partial thickness into dermis
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| What is a third degree burn? | Dermis though to adipose
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| What is a fourth degree burn? | Passes into muscle
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| treatment of first degree burns | remove clothing, apply cool compress and soothing lotion
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| how do you treat a second degree burn? | cool compress, leave blisters intact, cleanse wounds, occulsive dressing
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| what is the purpose of occlusive dressings? | Absorptive, bulky, eliminate dead space, give vascular support, splinting effect
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| How do we treat a third degree burn? | remove dead tissue, cleanse the burn area, grafting if bigger 3-4cm
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| Skin grafting is priority for what areas? | Face, neck, hands and flexion creases
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| what does ABCDE | Airway
Breathing
Circulation
Disability
Exposure
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| When would you send a patient to a burn unit? | If they had facial burns, singed eyebrows or nasal hairs, confinement in a burning building, impaired mentation, explosion, or CO levels greater than 10%
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| how do we evaluate breathing? | 100% O2 and tension pneumothorax, or flail chest
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| How do we evaluate circulation? | 16 gauge catheter in a peripheral vein
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| How do we evaluate Disability? | AVPU
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| How do we replace lost fluid? | 2-4ml IV/kg/%BSA in 24 hrs
1/2 in 8hrs, then second half in 16hrs
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| What is the secondary survey? | A- allergies
M- medications
P- past history
L-last meal
E-event
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| Rules of nine | each leg is 9%, each arm is 4.5%, torso is 18%, head is 4.5 %, genitalia is 1%
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| How can you estimate BSA? | anterior surface of palm of the hand= 1% BSA
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| How do we Assess Peripheral Circulation | Capillary refill,cyanosis, doppler
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| What do we look for in the blood work of a burn victim? | CBC, CO levels, electrolytes, ABG, prothrombin, carboxyhemoglobin, pregnancy test in females of childbearing age
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| what other labs would you order? | Chest-Xray not before 48hrs, NG if 25% BSA, Urinary cath X 72hrs,
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| criteria for hospitalization | full thickness (3-4 degree) >2% BSA
Partial thickness (2 degree) >10% BSA
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| Criteria for Burn Unit | full thickness >5% BSA
Partial thickness >20%BSA or 10% if under 10 or over 50
high voltage electrical burn
significant chemical burn
inhalation injury
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| What complications should you be aware of for a burn victim? | Infection, gastric distention, paralytic ileus, fecal impaction, curlingulcer, URI obstruction.
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| which is worse: Alkali burn or acid burn? | ALKALI
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| How do you irrigate chemical burns | Acid: neutral solution for 20-30 minutes
Alkali- irrigate for 8 hrs
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| how do you deal with electrical burns? | make sure urine is clear if not increase fluids to 100ml per hour and add 25 gms of mannitol then 12.5 gms to each liter of fluid
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