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68wm6 p2 Burns
Burns
| Question | Answer |
|---|---|
| What two factors do the effects of burns depend on? | *Extent of body surface burned, total body surface area (TBSA) *Depth of burn injury |
| How strong of an electrical current can cause ventricular fibrillation? | A current of only 0.1 AMP |
| How does an electrical burn typically appear? | mottled, feathery, or patchy; appearing in a scattered pattern, kind of resembling flowers |
| What is a superficial (1st degree) burn? | The epidermis injured, but the dermis unaffected. Heals < 5 days, (Sunburn, brief scald, low intensity flash burn). Appears as dry surface without vesicles; minimal or no edema red; blanches on pressure and refills when pressure is removed |
| What is a partial thickness (2nd degree) burn? | Affects both the epidermis and the dermis, can heal within 2 weeks with only some pigmentation changes but no scarring, may need debridement and skin graft. Appears blistered, moist, mottled pink or reddened, blanches on pressure and refills |
| What is a full thickness (3rd degree) burn? | All the layers of the skin are destroyed and thus there is no pain. If not debrided burn leads to sepsis. Skin grafts are necessary because skin cells no longer alive to regenerate. Can also reach the muscle and bone |
| In the rule of 9s, what % is the head? | Entire head is 9% (ant 4.5%, pos 4.5%) |
| In the rule of 9s, what % is each upper extremity? | Each upper extremity is 9% (ant 4.5 %, pos 4.5%) |
| In the rule of 9s, what % is the anterior torso? | 18% |
| In the rule of 9s, what % is the posterior torso? | 18% |
| In the rule of 9s, what % is each lower extremity? | Entire lower extremity is 18% (ant 9%, pos 9%) |
| In the rule of 9s, what % is the perineum? | 1% |
| In the rule of nines for children, what % is the lower extremities? | 14% (ant 7%, pos 7%) |
| In the rule of nines for children, what % is the head and neck? | 18% (ant 9%, pos 9%) |
| More than half of all fire related deaths are caused by what? | Smoke inhalation |
| What happens when noxious fumes are inhaled? | (Respiratory edema) Mucosa in the lungs swell and break, leaking fluid into nearby alveolar spaces and damaging cilia. Mucus builds up and plugs passages. |
| A inhalation burn PT who does not suffer respiratory edema is still at risk for what? | Pneumonia |
| You must assume an unconscious burn victim is suffering from what? | Carbon Monoxide poisoning |
| What are late signs of carbon monoxide poisoning? | *Cherry red coloring to unburned skin *Changes in color of mucus membranes *Unconscious *Obvious neurological damage |
| What S/Sx of inhalation burns is indicative of a medical emergency? | Stridor |
| What position must an inhalation burn victim be placed in for easier breathing? | Semi-fowlers |
| What is the modified brook formula for fluid replacement? | *(4cc RL) x (% BSA burned) x (weight in KG) = initial 24 hour fluid replacement *1st 8h give 50% calculated fluids *2nd 8h give 25% calculated fluids *3rd 8h give 25% calculated fluids *!!! LP says 2mL RL for Brooke, 4mL for Parkland-Baxter |
| Patient is a 24 year old male who was burned by a chemical. He sustained second and third degree burns covering 35% of his body. He weighs 165 lbs. Calculate the fluid needed for the first 24hrs, then the fluid needed for the first 8hrs of that 24hrs. | *(165lbs=75kg) x 4cc x35% BSA *75 x 4 x 35 *10,500cc/24h *5,250cc for the first 8 hours *!!! LP says 2mL RL for Brooke, 4mL for Parkland-Baxter |
| What are the methods of open wound care of burns? | *PT placed in isolation *Room is kept warm and humidified *Bed cradle with sterile sheets *Whirlpool baths *Escharotomy |
| What are the advantages of open method of burn care? | *Can be observed more easily *Movement is less restrictive *Circulation is less restricted *Exercises to prevent contractures can be done more easily |
| What are the disadvantages of open method of burn care? | *Painful *Body can chill more easily *Potential for contamination *Appearance is unattractive and may cause emotional distress *Protective isolation is required |
| What is the preferred method of burn care? | Closed method |
| What are the advantages of closed method of burn care? | *It protects the burn area from further injury *It prevents contamination of the burn area |
| What are the disadvantages of closed method of burn care? | Painful |
| What is an autograft? | Autograft uses the patient’s own skin, which is transplanted from one part of the body to another. PERMANENT. |
| What is an allograft/homograft? | Allograft or homograft is human skin obtained from a cadaver. This is a TMPORARY graft, which is used to cover a large area |
| What is a heterograft? | Heterograft is obtained from animals, principally pigs. TEMPORARY. |
| What is the caloric needs of a bunr PT? | 4000 - 5000 calories qday |
| When is antimicrobial therapy for burn PTs needed in the field? | If movement to treatment installation will take longer than 72 hours |
| When is Silver Sulfadiazine (Silvadine) most effective? | If applied to burns immediately |
| What are the advantages of Silver Sulfadiazine (Silvadine)? | Pain free *Does not require occlusive dressing *Joint motion unimpeded *Penetrates the eschar *Broad antimicrobial agent |
| What are the disadvantages of Silver Sulfadiazine (Silvadine)? | May delay epithelialization *Bone marrow suppression *Hypersensitivity reaction *Delayed eschar separation *Certain gram-negative organisms resistant |
| What are the disadvantages of Mafenide Acetate (Sulfamylon)? | *Exaggerates post-burn hyperventilation *Painful application for 30 minutes *Delayed eschar separation |
| What are the disadvantages of Silver Nitrate? | *Causes losses of sodium, potassium, chloride and calcium *Does NOT penetrate eschar *Ineffective if the infection is already established |
| When is the emergent phase (stage 1) of burns? | Initial 24 to 48 hours |
| What happens in the emergent phase of burns? | *Capillaries beecome hyperpermiable causing shift of fluids to interstitial space (Edema and vesiculation/blistering) *BP drops (Hypovolemic shock) *Blood flow to kidneys decreases * |
| When does the greatest fluid loss occur in the emergent phase? | 1st 12 hours |
| Most deaths from burns result from what? | Shock (Burn shock) |
| When is the intermediate/acute/diuretic Phase (stage 2) of burns? | 48 to 72 hours after the burn injury |
| What happens in the intermediate/acute/diuretic phase of burns? | *Potential for circulatory overload as a result of fluid shifting back from the interstitial spaces into the capillaries *Kidneys begin to excrete large volumes of fluid *Increased workload of the heart due to circulatory overload |
| When is the long term rehabilitation Phase (stage 2) of burns? | begins when the burn wound treatment begins |
| What is the goal of IV therapy in burn PTs? | to maintain a urine output of 50 ml per hour |
| How often is an assessment performed on a burn victim in the emergent phase? | q30min |
| If morphine is required for sever burn pain, how should it be administered? | Small, frequent doses for pain control rather than one large dose. Given IV because IM has poor absorption. |
| What is a Curlings ulcer? | A duodenal ulcer that develops 8 to 14 days after a severe burn. The first sign is vomiting bright red blood |
| With partial thickness burns, how long does it take for it the wound to develope a hard outer crust, and how long does it take for epithelialization (Regrowth of skin) to occur under it? | 2-3 days, 2-3 weeks for epithelialization. |
| What is the hard hard leathery crust of dehydrated skin that grows over full thickness burns? | Eschar |
| How long does it take for new skin to form under the eschar of full thickness burns like skin under the crust in partial thickness burns? | New skin cannot form under eschar. Eschar can harbor microorganisms and cause infection and can compromise circulation. |
| What is the temporary skin substitute made from neonatal human fibroblast cells? | TransCyte |
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Shanejqb
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