Burns

Question 1

What are the three types of burns?

Answer 1

Thermal, chemical, and radiation.

Question 2

What piece of basic support is common with burns? Why?

Answer 2

Oxygen.

Inhalation injury, inflammation or compression of airways, increased oxygen demand.

Question 3

What is usually done immediately upon arrival with burns to the neck and throat? What symptom indicates this need?

Answer 3

Intubation. Stridor is a strong indicator of need to intubate.

Question 4

What are the three types of smoke inhalation injuries?

Answer 4

Metabolic asphyxiation - CO bonds with hemoglobin over O2 - pulse ox won’t work here, need SpCO

Upper airway - above the glottis - more dangerous due to more limited airway space

Lower airway - below the glottis

Question 5

What assessment is extremely important with inhalation injuries?

Answer 5

Auscultation of the lungs.

Question 6

What is the Lund-Browder calculation?

Answer 6

An accurate method of determining the percent of body surface area that has been burned.

Question 7

Why is burn area calculation important?

Answer 7

Factors in to fluid resuscitation calculations.

Question 8

Above what TBSA requires fluid resuscitation?

Answer 8

15% in adults, 10% in peds.

Question 9

What 2 types of fluids are used in fluid resuscitation?

Answer 9

Crystaloids & colloids

Question 10

What is the benefit of crystalloid fluids in burn patients?

Answer 10

Salt solutions are cheap volume replacement while maintaining osmolality.

Question 11

What is the benefit of colloid fluids in burn patients?

Answer 11

Large molecules in colloids provide a greater expansion effect than crystalloids and require less volume in sensitive patients.

Question 12

What is the Parkland (Baxter) formula?

Answer 12

Calculates fluid resuscitation volume for the first 24 hours.

4 mL * %TBSA * kg body weight.

Question 13

What are the two rates that the Parkland fluid resuscitation formula runs at?

Answer 13

50% in the first 8 hours, 50% over the following 16 hours.

Question 14

What factors increase the risk for complications from burns?

Answer 14

Old age, young age, preexisting heart, lung, and kidney disease, PVD, uncontrolled diabetes, malnutrition, alcoholism, drug abuse, obesity.

Question 15

Why is high fluid volume throughput important in burns?

Answer 15

Protein from damaged tissue needs to be flushed through the kidneys rapidly to prevent renal damage. Fluid loss through wounds is also accelerated.

Question 16

What is a complication common to circumferential burns? How is it dealt with?

Answer 16

Compartment syndrome. Escharotomy - skin is perforated to relieve pressure. Think of it like a skull flap but for skin.

Question 17

What is given prophylactically to nearly every burn patient?

Answer 17

A tetanus shot.

Question 18

What PPE is necessary for care of a burn pt with open wounds?

Answer 18

Gown, cap, gloves, and mask to protect them from you.

Question 19

What environmental parameter needs to be controlled for both SCI and burn patients?

Answer 19

Room temperature should be ~85, as pt has limited thermoregulation.

Question 20

What wound care complication can develop when pts must be subjected to extreme pain daily? What should be done to mitigate this?

Answer 20

PTSD. Always use IV analgesics before wound care, and assess for need for sedatives as well.

Question 21

What are the phases of burn care?

Answer 21

Pre-hospital - before specialized care is available.

Emergent - stabilization of injury. Think ABCs.

Acute - inpatient treatment of wounds - fluids, nutrition, wound care, surgical care, PT / OT, psychosocial support. Think infection, pain, nutrition, and support.

Rehabilitative - exercise, PT, nutrition, psych support. Think scarring, itching, limited mobility, etc.

Question 22

What are the two types of wound depth?

Answer 22

Full thickness - requires debridement and grafting.

Partial thickness - remove eschar, wound closes in 10-21 days.

Question 23

What are the two types of skin grafts?

Answer 23

Split-thickness - traditional “sheet” of skin, mesh-expanded and then applied to wound.

Cultured epithelial - biopsies are taken from the pt, grown in a lab, and then re-grafted.

Question 24

By how much does the metabolism accelerate in severe burn cases?

Answer 24

50% - 100%

Question 25

Why would a burn patient need TPN?

Answer 25

Throat damage, ventilation, unable to meet increased metabolic demand.