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EMRG 1305 > Week 9- Burns > Flashcards

Week 9- Burns Flashcards

1
Q

What are the functions of the skin?

A
  1. Protection against microorganisms, dehydration, ultraviolet light, and mechanical damage
  2. Sensation of pain, temp, touch, and deep pressure starts with the skin
  3. Mobility allows smooth movement of the body
  4. Exocrine activity occurs by the release of water, urea, and ammonia
  5. Immunity development against pathogens
  6. Regulation of temp
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2
Q

What is epidermis?

A
  • Outermost layer of skin, provides a waterproof barrier and contributes to skin tone
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3
Q

What is contained in the dermis?

A
  • Nerve endings
  • Cutaneous blood vessels
  • Sweat glands
  • Hair follicles
  • Sebaceous glands
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4
Q

What is contained in the subcutaneous layer?

A
  • Adipose tissue
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5
Q

What are burns created by?

A
  • Burns are diffused soft-tissue injuries created by destructive energy transfer
  • Transferred via radiation, thermal, or electrical energy
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6
Q

How high is a temp to cause burns?

A
  • 44C cause burns
  • Severity correlates directly with the amount of heart energy and duration of exposure
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7
Q

What can severe burns cause?

A
  • Cause an increase in capillary permeability, causing intravascular proteins and fluid to move into interstitial space, which increases edema
  • Due to loss of volume there is a decrease in cardiac output. This causes hypotension and end-organ failure
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8
Q

What is the goal of burn resuscitation?

A
  • Is to restore or preserve tissue perfusion
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9
Q

What is the zone of coagulation?

A
  • Source of most damage, little to no blood flow
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10
Q

What is the zone of stasis?

A
  • decreased blood flow and inflammation, necrosis can develop up to 48hrs. later
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11
Q

What is the zone of hyperemia?

A
  • Least affected area, cells typically recover in 7 to 10 days
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12
Q

What is a superficial burn?

A
  • First degree
  • Epidermis only
  • Skin is red
  • Painful
    Ex. sunburn
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13
Q

What is a partial thickness burn?

A
  • Epidermis & dermis
  • Skin is red; usually involves blisters or moisture present; painful; will heal spontaneously but may scar
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14
Q

What is the deep partial-thickness?

A
  • Extends into dermis; damages hair follicle and sweat and sebaceous glands
  • Very painful
  • Often caused by hot liquids
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15
Q

What are the full-thickness burns?

A
  • 3rd Degree
  • All layers of the skin destroyed
  • Skin white and pale, brown and leathery, or charred
  • No pain sensation
  • Usually requires skin grafting
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16
Q

What is fourth degree burn?

A
  • Some texts classify these burns destroying skin, plus bone tissue and tendons
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17
Q

What are thermal burns?

A
  • Caused by fire or other causes of heat injury
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18
Q

What is a flame burn?

A
  • Often partial or full-thickness burns; associated with trauma or inhalation injury

Ex. house fire

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19
Q

What is scald burn?

A
  • Almost 2/3 of burns in children are from scalds from hot drinks/ bath water. Most tend to be superficial/ partial thickness
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20
Q

What are contact burns?

A
  • Be from prolonged contact or extremely hot object. These are common in industrial accidents or where a LOC occured causing prolonged contact
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21
Q

What are the flash burns?

A
  • Occur from explosions with no sustained fire, There is normally a single wave of heat, but in larger explosions blast injuries, fracture, and internal trauma can occur
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22
Q

What two types of shock occur with burns?

A
  • Hypovolemic shock (bc of interstitial fluid)
  • Distributed shock (inadequate tissue perfusion locally, inadequate blood flow)
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23
Q

What are the clinical features of burn shock?

A
  • Hypovolemia
  • Increased blood viscosity due to increased ratio of red blood cells to plasma
  • Reduced cardiac output
  • Increased HR
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24
Q

How long does onset take for burn shock?

A
  • 6 to 8 hours
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25
Q

What is thermal inhalation burns?

A
  • Heat burns the airway tissue
  • Infraglottic and lower airway damage
  • Supraglottic (upper airway) damage
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26
Q

What occurs during thermal inhalation burns?

A
  • Swelling due to burns in the upper airway can be fatal
  • Swelling of the vocal cords can obstruct the airway completely
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27
Q

What is carbon monoxide poisoning?

A
  • CO can displace oxygen from the alveolar air and the blood hemoglobin (has a higher affinity than O2)
  • CO binds to receptor on hemoglobin at least 250 times more easily than oxygen
  • Biggest key indication is if a group of people in the same place all complain of headache & nausea
28
Q

Vast majority of deaths from fires are from:

A
  • Inhalation of toxic gasses
  • Upper airway compromise
  • Pulmonary injury
29
Q

Inhalation of smoke can cause:

A
  • Thermal burns to the airway
  • Hypoxia from the lack of O2
  • Tissue damage and toxic effects caused by chemical in the smoke
30
Q

What are sources of chemical burns?

A
  • Acids
  • Alkalis or bases
  • Corrosive materials
  • Oxidizing agents
  • Phosphorous
  • Vesicants
31
Q

What are chemical burns?

A
  • Tend to be deep tissue, bc they don’t stop causing damage until they are removed completely
  • Extent of damage depends on chemical and duration
32
Q

How to treat chemical burns?

A
  • Pt’s will require decontamination prior to transport to limit skin damage, prevent transmission to you or others
  • Ask for MSDS for any chemical involved in a workplace
33
Q

What chemical of reduction?

A
  • Hydrochloric acid
34
Q

What chemical of oxidation?

A
  • Sodium hypochlorite
35
Q

What chemical of corrosion?

A
  • Phosphorus
36
Q

What chemical of protoplasmic poisons?

A
  • Formic acid
37
Q

What chemical of desecration?

A
  • Sulfuric acid
38
Q

What chemical of vesication?

A
  • mustard gas
39
Q

Acid Chemical Burns of the Eye

A
  • Result from chemicals with a low pH and are usually less severe than alkali burns, bc they don’t penetrate the eye as readily as alkaline substances
  • Acids usually damage only the very front of the eye
40
Q

Alkalis Chemical Burns of the Eye

A
  • Alkalis chemicals have a high pH penetrate the surface of the eye and can cause severe injury to both the external structures like the cornea and the internal structures like the lens
41
Q

Phenols Chemical Burns of the Eye

A
  • Contact with concentrated phenol solutions can cause severe eye damage including clouding of the eye surface, inflammation of the eye, eyelid burns
42
Q

What are electrical burns?

A
  • Tissue damage caused by heat from electricity following from the source entry would to exit wound
  • Extent of injury is related to the amperage, and this is directly related to voltage
43
Q

Electrical injuries related to Non Burn injuries

A
  • Asphyxia
  • Cardiac arrest
  • Neurologic complications
  • Kidney damage
  • Severe tetanic muscle spasms may lead to fractures and dislocations
44
Q

What are lightning injuries?

A
  • Not struck directly
  • Lightning carries enormous electrical power
  • A lightning burn may have a feathery zigzag appearance
  • Arrest is normally secondary to hypoxia as the body receives global depolarization (myocardium normally recover on its own, while there is a delay for the resp centre to recover or thoracic tetany causing resp arrest)
45
Q

What are the 3 types of ionizing radiation?

A
  • Alpha- mild
  • Beta- moderate
  • Gamma- severe, caused by x-ray and account for the majority of injury
46
Q

What can cause radiation burns?

A
  • UV Light- ex. sunburn
  • Can also be caused by x-ray, radiating therapy, or nuclear energy
47
Q

What is acute radiation syndrome?

A
  • Causes hematologic, CNS, and GI changes (vomiting is used to predict survival rate)
48
Q

What are circumferential burns?

A
  • Full thickness burns cause eschar tissue to form and this tissue is tough and not capable of expansion
49
Q

What to do for a recently burned pt?

A
  • Extinguish the flame and cool the burn
  • Stop, drop and roll
  • Remove smoldering clothing
  • Determine mechanism of injury
50
Q

What are the rule of nines?

A

Divide body into 11 sections:
- Back & neck= 18
- Abdomen & chest= 18
- Each leg= 18
- Each arm= 9
- Head= 9
- Genitalia= 1

51
Q

What is the rule of palms?

A
  • Pt’s palm is approx equal to 1% of the pt’s body
52
Q

Fluid Resuscitation

A
  • Pt’s with burns covering more than 20% of the TBSA
53
Q

What is Parkland Burn Formula?

A

Amount of fluid needed in first 24 hrs:

  • 4ml x body weight (kg) x percentage of body surface burned
  • Half of this is given in the first 8 hrs
54
Q

What is superficial burn management?

A
  • Cool superficial burns
  • Stop the burning and relieve pain
  • Don’t cool whole body
55
Q

What is partial thickness burn management?

A
  • Cool as with superficial burns
  • Elevate burned extremities if possible to reduce edema
  • DON’T rupture blisters
  • Establish IV and administer fluids
  • Consider pain management
56
Q

What is the BLS Tx?

A
  • Cover with moist sterile dressing followed by dry sheet
  • <15% moist dressing, cover dry sheet
  • Cooling should be <30 min
  • > 15 % dry sterile dressing
57
Q

BLS Tx for full-thickness burns

A
  • Pain assessment & management
  • Dry dressings are used
58
Q

What is the management of chemical burns?

A
  • Speed is essential
  • Immediately flush exposed areas with copious amount of water
  • Remove pt’s clothing
  • Avoid exposure to chemical
59
Q

Special cases- dry lime

A
  • Must be brushed off before flushing with water
60
Q

Special case- sodium metal

A
  • Reacts with water
  • Burns should be coated with oil
61
Q

Special case- hydrofluric acid

A
  • Requires calcium chloride jelly application
62
Q

Special case- Hot Tar burns

A
  • Immerse the area in cool water
63
Q

What is tx for chemical burns of eyes?

A
  • Flush with large quantities of water
  • Remove contact or the chemical will be trapped between contact and eye
64
Q

What is electrical burn management?

A
  • Protect yourself & bystanders
  • Make sure power is off before touching the pt
  • Open airway, CPR, attach defib pads
  • Damage will be internal
65
Q

What is the management of lightning injury?

A
  • Move victims to safe area
  • May be multiple victims
  • Cardiac arrest caused by lightning strike, continue CPR
66
Q

What is the management of radiation burns?

A
  • Consider whether pt is contaminated w radioactive material
  • Irrigate open wounds gently

EMRG 1305 (12 decks)

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