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Burns
Week 8
| Term | Definition |
|---|---|
| Prevention strategies for burns | smoke alarms (check battery q6months), phone at bedside, fire escape plan, windows/doors free of clutter, no water heater above 120F, working fire extinguisher, teach strop/drop/roll, matches secured, no smoking with O2, avoid loose clothes while cooking |
| Burn injury: depth | can be difficult to determine at time of initial injury. 1st, 2nd and 3rd degree not used anymore |
| Superficial burn | only epidermis. Resolves in 24-72 hours with no scarring / med intervention necessary. S/s: mild erythema, no blisters, hypersensitivity |
| Superficial burn treatment | do not submerge in ice water, use cool compress, no dressing, lotion 2x daily, NSAIDs/acetaminophen, oral fluids and rest |
| Partial thickness burn | epidermis and superficial layers of dermis involved (painful). S/S: wet, weeping blisters with erythema and mild edema. Resolve 1-2 weeks, may need med intervention |
| Partial thickness treatment | do not pop blisters, thin layer of bacitracin and nonadherent bandage, clean and dress wound at least 1xdaily, elevate extremities, watch for infection, PCP follow up |
| Deep partial thickness burn | epidermis and bottom layers of the dermis. S/S: pain, decreased sensation, waxy appearance, light pink/cherry red, decreased cap refill; resolve in 3-6 weeks |
| Full thickness burn | destruction of epidermis, dermis and subq tissue/muscle/bone. Destroys hair follicles, sweat glands and nerves (cannot feel). S/S: no blisters, dry/leathery, contracted (muscle involvement). Burn admission |
| Circumferential burns | encircles limb, torso, extremity. Eschar can act as tourniquet that can lead to compartment syndrome. Involves chest - pulmonary function issues. Treat with escharotomy |
| Rule of Palms | 1% is size of patient's palm including fingers. Good for quick assessment |
| Rule of Nines | Body surface broken down in 9% areas or multiples of 9. Head 9% (anterior/posterior total), arms 9% total, front torso 18%, back torso 18%, genitals 1%, legs 18% (9 anterior/ 9 posterior). |
| Severity factors | presence of inhalation. age, past med hx, presence of concomitant injury, anatomical location of burn |
| Inhalation injury | toxic effects of heat/toxins in airway. S/s: facial burns, singed hairs, hypersecretion of sputum, naso/oropharynx edema, anxiety/agitation (hypoxia), inability to swallow, nasal flaring/retractions, voice changes |
| Inhalation injury above glottis | naso/oropharynx or larynx; usually thermal/chemical. Can have airway swelling and will hear stridor (EMERGENT INTUBATION). |
| Inhalation injury below glottis | Mostly chemical, prolonged exposure (unconsc.), wheezing |
| Carbon monoxide poisoning patho | Binds to hemoglobin; gas that has no odor, color or taste. COHb is lab used to measure carbon monoxide (under 2% is normal, smoker up to 10%) |
| Signs / symptoms of carbon monoxide poisoning | cherry red discoloration of skin, headache, dizziness, dyspnea, confusion, nausea and vomiting |
| Treatment of carbon monoxide poisoning | 100% O2 by mask until COHb is below 10% |
| Burn shock | both distributive and hypovolemic shock. Massive fluid shift with blood more viscous, decreased O2 and CO. 8-36hrs post injry. Prevention is fluid resuscitation. Hypercalcemia/hypokalemia can occur. |
| Renal effects from burns | Sluggish blood flow leads to decrease perfusion in kidneys. Release of myoglobin and destruction of RBCs - causes acute tubular necrosis |
| GI effects from burns | Decrease nutrient absorption and GI motility. Intra-abd compartment syndrome |
| Metabolic effects from burns | Hypermetabolic state for 1-3 years post injury. Body heat lost through open wounds. Ambient temp in room/OR |
| Immune effects from burns | high infection and sepsis risk |
| Burn center transfer criteria | partial thickness burns more than 10% TBSA, burns of the hands, face, feet, genitals, perineum or major joints; full thickness burns, burn injury with comorbidities, electrical/chemical burns, trauma, children |
| Emergent phase | prehospital, airway management, prevent hypothermia. Stabilization first before wound care. |
| Intermediate phase | Resuscitated and stabilized; wound healing and pain, nutrition, prevention of infection |
| Rehab phase | Can last several years. Physical/emotional recovery |
| Burns: Primary Interventions | Airway, cspine stabilization, high flow O2, elevate extremities, neurovascular checks (remove jewelry and tight clothing), burn assessment, fluid resuscitaiton |
| Fluid resuscitation formula | LR is fluid of choice. 2-4 ML of LR (4 mL for electrical) x body weight in kg x % of TBSA (HALF is given first 8 hours, rest is over 16hrs). Insert foley (urine - 0.5mL/kg/hr). |
| Secondary interventions for burns | obtain more info, full head to toe, medical hx, pain management, cover wounds, tetanus, maintain core temp |
| Burn topical meds | Silver sulfadiazine, bacitracin, mafenide acetate. Mild soap or chlorohexidine and sterile water/normal saline with gentle debridement |
| Surgical grafts | autograft (pts own skin), culture epithelial autograft (own skin grown in lab), dermal substitute(grown in lab), allograft (cadaver skin), xenograft (pig/cow/fish) |
| Nutritional treatment for burns | 20% TBSA or above cannot keep up with calories/protein (needed for wound healing). TPN rarely used due to infection risk/hyperglycemia. Prophylactic abx not recommended (tx based on cultures) |
| Interventions for burns | daily weights, protein/albumin/WBC levels, treat pain/anxiety, ADLs, nonpharm techniques, wound care, rehab exercises (compliance) |
| Steven Johnson's syndrome | serious skin peeling condition caused by severe allergic reaction to med/illness. Develops rashes, blisters (peel). Commonly seen under 30yrs old, infections are common cause in children. Stop meds and hospitalization needed |
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