9.1 Burn Injuries Flashcards

1
Q

Highest Risk for Burn Injuries

A
  • Young children and older adults
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2
Q

Goals of Managing Burns

A
  • Prevention
  • Institution of life saving measures for severely burned patients
  • Prevention of disability and disfigurement through early specialized and individualized care
  • Rehabilitation through reconstructive surgery and rehabilitation programs
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3
Q

Thermal Burn

A
  • Caused by dry heat (fire) or moist heat (steam/hot liquids)
  • Cause cellular destruction that result in charring of vascular, bony, muscle and nervous tissue.
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4
Q

Chemical Burn

A
  • Caused by direct skin contact with acids, alkaline, or organic compounds
  • Destroy tissue protein resulting in necrosis
  • ALKALINE ARE MORE DIFFICULT TO NEUTRALIZE, HAVE DEEPER PENETRATION AND DO MORE DAMAGE THAN ACIDS
  • Organic Compounds (Petroleum Distillates) cause cutaneous damage through fat solvent (may cause renal/hepatic failure if absorbed)
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5
Q

Electrical Burn

A
  • Severity depends on how much voltage and duration of current
  • Electricity follows the path of least resistance (muscle, bone, bone vessels, nerves) so it is difficult to assess extent of injury
  • Alternating currents are worse (person clamps down due to tetanic muscle contractions)
  • Direct currents (lightning) is very high voltage but short lasting.
  • MOST COMMON CAUSE OF DEATH FROM LIGHTNING INJURIES IS CARDIOPULMONARY ARREST
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6
Q

Radiation

A
  • Sunburns or radiation treatment in cancer.
  • Usually only superficial

Nuclear Power Accidents
- Leads to same degree of tissue damage and multisystem effects

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7
Q

Patterned Burns

A
  • Always a suspicion for abuse and should be reported to CPS or APS
  • Zebra stripe or doughnut hole burns are signs of abuse (scalding water)
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8
Q

Toasted Skin Burns

A
  • People who work extremely close to high heat
  • Can also be a sign of abuse from heated pads or blankets
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9
Q

1st Degree Burn

A

1st degree
- Superficial
- Only epidermis

Manifestations
- Tingling/, soothed by cooling, peeling, itching

Appearance
- Blanchable with pressure
- Dry

Examples
- Sun burn, superficial scald

Treatment
- Complete recovery within a few days
- Oral pain medication
- Cool compress
- Skin lubricants
- NO NEED FOR ANTIMICROBIALS

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10
Q

2nd Degree Burn

A

2nd degree
- Entire epidermis and parts of dermis

Manifestations
- Pain
- Sensitive to air currents
- Hyperesthesia

Appearance
- Blisters
- Mottled red skin
- Weeping surface
- Edema

Examples
- Scalds, Flash Flame, Contact

Treatment
- Recovery 2-3 weeks
- Some scarring and depigmentation
- May require grafting

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11
Q

3rd Degree Burn

A

3rd degree
- Total destruction of epidermis and dermis

Manifestations
- Insensate (no sensation)
- Shock
- Myoglobinuria (red pigmented urine) and possible hemolysis
- There may be entrance or exit wounds from electrical shock

Appearance
- Dry
- White/Red/Brown
- Leathery/Charred
- Coagulated Vessels may be noticed

Examples
- Flame, prolonged exposure to hot liquids, electrical currents, chemical, contact

Treatment
- Eschar may be slough
- Grafting necessary
- Scarring and loss of contour and function

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12
Q

4th Degree Burn

A

4th degree
- Deep tissue, muscle, and bone (tissue necrosis)

Manifestations
- Shock
- Myoglobinuria (red pigmented blood)
- Hemolysis

Appearance
- Charred

Examples
- Prolonged exposure to high voltage electricity

Treatment
- Amputation
- Grafting may not benefit depending on depth and severity

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13
Q

Minor Burn Injuries (ABA)

A
  • Partial thickness less than 15% TBSA
  • Full thickness less than 2% TBSA
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14
Q

Moderate Burn Injuries (ABA)

A
  • Partial Thickness 15-25% TBSA
  • Full Thickness less than 10% TBSA
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15
Q

Major Burn Injuries (ABA)

A
  • ALL ELETRICAL BURNS
  • MULTIPLE TRAUMA INJURIES
  • ALL CLIENTS HIGH RISK
  • Partial thickness greater than 25% TBSA
  • Full thickness greater than 10% TBSA
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16
Q

Types of ways to estimate TBSA Burned

A
  • Rule of 9
  • Lund and Browder Method
  • Palmer Method
17
Q

Physiologic Change with Burns

A
  • Major burns (greater than 25%) produce local and systemic effects
  • This includes release of cytokines into systemic circulation
  • Fluid shifts and shock results from hypoperfusion and organ hypoperfusion

EFFECTS OF MAJOR BURNS
- Fluid/Electrolyte Shifts
- Cardiovascular effects
- Renal/GI Alterations
- Immunologic Alterations
- Thermoregulation Alteration

Pulmonary
- Upper/Lower Airway
- Carbon Monoxide Poisoning
- Restrictive Defects

18
Q

Cardiovascular Effects

A
  • Cardiac Depression
  • Edema
  • Hypovolemia
  • Dysrhythmia
  • Peripheral vascular compromise
  • Compartment Syndrome
19
Q

Pulmonary Effects

A

Direct inhalation or systemic response
- Inflammation
- Interstitial pulmonary edema
- Vasoconstriction

20
Q

GI Effects

A
  • Impaired motility and absorption
  • Vasoconstriction
  • Increased pH
  • HIGH RISK FOR STRESS ULCERS (CURLINGS ULCERS) - in stomach/duodenum
  • Loss of mucosal barrier and translocation of bacteria caused by ischemia to the intestines and increased intestinal permeability. (MAJOR SOURCE OF SEPSIS AND MODS)
21
Q

Kidney Effects

A
  • Reduced renal blood flow and GFR
  • Muscle Damage (Myoglobinuria which causes acute tubular necrosis (ATN) and acute rheumatic fever (ARF)
22
Q

Immune Effects

A
  • Compromised humoral and cell-mediated immunity (acquired immunodeficiency)
  • Vulnerable for 1-4 weeks (opportunistic infections are fatal)
23
Q

Metabolic Effects

A

EBB Phase (First 3 days)
- Decreased oxygen consumption, fluid imbalance, shock

Flow Phase
- Adequate burn resuscitation has been reached

Metabolic demand increases
Bodyweight and heat drops

Hypermetabolism persists until wound closes (may flair with complications)