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WVSOM - Burns
Burns and Trauma
| Question | Answer |
|---|---|
| Role of skin | Prevent heat loss, water loss, invasion of bacteria |
| Typical water loss of skin | ~15mL/m2/hr |
| Water loss in full thickness burn | ~200mL/m2/hr |
| Burns result in | Loss of vascular integrity, increased capillary permeability, increased interstitial fluid volume, reduction in blood volume |
| Fluid loss results in | Hypovolemia, hypotension, tachycardia, decreased CO, vasoconstriction, kidney ischemia |
| Fluid loss is __________ to the ______ and _______ of the burn | Proportional, size, depth |
| Cause of burns in 3-14 year olds | Flame burns |
| Cause of burns in 15-60 year olds | Industrial accidents |
| Cause of burns in 60+ year olds | Accidents |
| Cause of burns in < 3 year olds | Skull burns |
| ____% of burns occur at home; ____ are preventable | 50, 1/2 |
| Burn severity is dependent on 3 things | Temperature of heat source, duration of application of heat, conduction of tissue |
| What affects conduction of tissue? | Pigments, thickness, moisture, oils / secretions |
| First degree burn | Involves the epidermis |
| Second degree burn | Partial thickness; burn down into dermis; will have bulla (blister) |
| Third degree burn | Full thickness; fat and into muscle |
| First degree burn clinical presentation | Erythema, pain (~40 hours), minimal edema, dry; capacity to prevent infection remains intact |
| Causes of first degree burns | Gas explosions, brief contact with hot liquids, prolonged sunlight exposure |
| Treatment of first degree burns | Remove clothing, apply cool compress (helps with pain and burning EXCEPT when it involves large areas = likelihood of hypothermia), soothing lotion; ~10 days for skin to scale off |
| Clinical presentation of second degree burns | Blisters (bulla), edema, mottled red / pink (underneath bulla), moist, painful |
| Causes of second degree burns | Short exposure to flash heat, contact with hot liquid, periphery of deep flame burn |
| Treatment of second degree burns | < 10% body surface area = cool compress, leave blisters intact, cleanse wound, occlusive dressing; > 10% body surface area = hospitalize |
| Occlusive dressing | Absorptive, bulky, eliminate dead space (air will cause pain), give vascular support, produce splinting effect |
| Cause of third degree burns | Flame injury, contact with hot object |
| Clinical presentation of third degree burns | Dry, white / charred, leathery appearance, almost painless, involve the hypodermis, whole skin destruction |
| Treatment of third degree burns | Remove dead tissue, cleanse burn area, initial excision and grafting if small (3-4 cm = grafting; < 3 cm = no grafting), tangential excision and wound closure if large |
| Priority is given to which areas during skin grafting | Face, neck, hands, flexion creases |
| Types of skin grafts | Allografts (human), homografts (cadaver), xenografts (pig), biologic and biosynthetic dressings |
| What are the ABCDEs of primary survey | A - airway and c-spine control, B - breathing, C - circulation, D - disability, E - exposure |
| "A" in ABCDE of primary survey | Upper airway very susceptible, indications subtle, may take 24-48 hours to develop, CO baseline, don't depend on x-ray |
| Related to airway, when should a patient be intubated and transferred to a burn unit? | If there are facial burns, singed eyebrows and nasal hairs, carbonaceous deposits in oropharynx / sputum, confinement in burning building, impaired mentation, explosion to head / torso, CO levels > 10% |
| "B" in ABCDE of primary survey | Look for pneumothorax, flail chest (indicate broken ribs), provide 100% O2 if not breathing |
| "C" in ABCDE of primary survey | Evaluate pulses = BP (radial->femoral->carotid), place IV 16 gauge catheter in both antecubital veins |
| "D" in ABCDE of primary survey | mini neurologic exam; perform AVPU (A - alert, V - voice, P - pain, U - unresponsive) |
| "E" in ABCDE of primary survey | Undress patient; decrease exposure to chemicals, etc. |
| Time-frame for completing ABCDE of primary survey | < 2 minutes |
| What should the fluid replacement be in a burn patient? | 2-4mL IV solution/kg body weight/% BSA in 24 hours; 1/2 over first 8 hours; rest over next 16 hours; should be adjusted as needed |
| ______ output should be maintained during fluid replacement | Urine |
| Urine output of adult | 30-50mL/hr |
| Urine output of child (< 30kg) | 0.7-1mL/kg body weight/hr |
| Secondary survey | A (allergies), M (medications), P (past history), L (last meal), E (event - what happened) |
| Besides AMPLE, the secondary survey should also include | complete physical, associated injuries, extent and depth of burn (anterior surface of palm = 1%; rule of 9s) |
| Rule of 9s | Equal % front and back = Adult: head - 4.5%, arms - 4.5%, torso - 18%, legs - 9%, genitals - 1%; child: head - 9%, arms - 4.5%, torso - 18%, legs - 7%, genitals - 1% |
| ___________, ____________, and ________ can be used to assess peripheral circulation | Capillary refill, cyanosis, doppler |
| A flow sheet should be maintained to keep track of (4) | Vitals, fluid replacement, ventilator settings, blood gasses and lab |
| Why should blood be obtained in a burn victim? (7) | CBC, type and cross match / screen, carboxyhemoglobin (unlikely that < 20% will present with symptoms), chemistry profile, prothrombin, electrolytes, ABG (arterial blood gas) |
| Evaluation and treatment of burn victim | Chest x-ray; NPO x 48 hours; NG tube if > 25% BSA; narcotics, analgesics, sedatives in small, frequent doses; urinary catheter x 72 hours |
| Criteria for hospitalization | Full thickness (third degree burn) > 2% BSA; partial thickness (second degree burn) > 10% BSA; serious lesions of face, feet, peritoneal, genital area; burns that cross flexion creases |
| Transfer to burn unit | Full thickness > 5% BSA; partial thickness > 20% BSA (10% in < 10 or > 50); all 2nd / 3rd degree burns involving face, eyes, hands, peritoneum; burns associated w/ fractures / other injuries |
| Transfer to burn unit | High voltage electrical burns; significant chemical burns; inhalation burns; lesser burns w/ pre-existing conditions |
| Complications associated with burns | Infection, gastric distention, paralytic ileus, fecal impaction, curling ulcer, upper respiratory tract obstruction, intubation injury, pulmonary insufficiency, atelectasis (collapsed lung), pneumonia, decubiti (ulcers from pressure) |
| Chemical burns | Alkali WORSE than acidic |
| What should you do for acidic chemical burns? | Irrigate with neutral solution for 20-30 minutes (stops burn from progressing) |
| What should you do for alkali chemical burns? | Irrigate for 8 hours! |
| What do electrical burns travel along? | Nerves and vessels |
| Are electrical burns as damaging as they appear on the surface? | NO, they are much worse |
| Amount of myoglobin present in urine after electrical burn | > 100mL/hr |
| How do you treat an electrical burn patient with myoglobinuria? | Give 25 grams of mannitol then 12.5 grams/L fluid |
| Osteopathic considerations for burn victims | Rule of the artery is supreme (maintain circulation), decrease lymphatic congestion (lymph pump), prolonged bedrest (rib raising, lymphatic drainage) |
Created by:
JaneO
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