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Clinical Medicine 4 COPY > Thermal burns and colds > Flashcards

Thermal burns and colds Flashcards

1
Q

Thermal burns most common in who?

A

Males

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2
Q

2 most severe burns?

A
  1. Flame

2. Liquid scald

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3
Q

What degree of burn is caused by sunburn and flashburns?

A

1st degree

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5
Q

Which degree of burn has no blisters, is red, and painful?

A

1st degree

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6
Q

Where is the damage in 1st degree burn and how severe?

A

Minor epithelial damage to dermis

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7
Q

Splash scalds can cause which degree burn?

A

2nd degree

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9
Q

Two types of 2nd degree burn based on depth?

A
  1. Superficial partial thickness

2. Deep partial thickness

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10
Q

Wall thickness of superficial and deep partial thickness burns?

A

Superficial=Thin-walled

Deep=Thick-walled

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11
Q

How long is healing of 2nd degree superficial partial thickness burns? Scarring?

A

2-3 weeks. No scarring

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12
Q

How long is healing of 2nd degree deep partial thickness burns? Scarring?

A

3-6 week heal. Scar likely.

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13
Q

Decreased 2-point discrimination in which type of burn?

A

2nd degree deep partial thickness

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14
Q

Which degree burn caused by immersion scalds, flame burns, chemical burns, and high voltage ?

A

3rd degree

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15
Q

Which degree is full thickness of dermis and epidermis?

A

3rd degree

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16
Q

Which degree burn are white leather appearance with underlying clotted vessels?

A

3rd degree

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17
Q

Do 3rd degree burns have sensation?

A

No

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18
Q

A 3rd degree burn >1cm requires what to heal?

A

Grafting

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19
Q

How does a 4th degree burn occur?

A

Prolonged exposure to 3rd degree burn cause

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20
Q

Which burn is full-thickness destruction of skin, SC tissue, fascia, muscle, and bone?

A

4th degree

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21
Q

What does a 4th degree burn require?

A

Surgical debridment and repair

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22
Q

Which burn is red, blanched white skin?

A

2nd degree deep partial thickness

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23
Q

Which burn is very tender, thin-walled fluid filled blisters?

A

2nd degree superficial partial thickness

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24
Q

Relationship between age and survival for burn size?

A

Inverse relationship between age and survival for any burn size. lower age=better survival

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25
Q

Palm of hand is what percent of Total Body Surface Area?

A

1%

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26
Q

Which burns not included in TBSA when calculating burn percent?

A

1st degree not included

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27
Q

Inhalation injury to upper airway can swell within how long?

A

12-24h after injry

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28
Q

When to intubate upper airway inhalation injury?

A

Soot around nostrils even if ok now

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29
Q

What is an escarotomy?

A

Cut down skin until get to non-burned bleeding skin.

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30
Q

What does escarotomy reduce risk of?

A

Compartment sybdrome in circumferential burns to arms and legs

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31
Q

How many IVs for Moderate Burns (20% TSBA)?

A

1 large bore IV

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32
Q

How many IVs for Severe Burns?

A

2 large bore IVs

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33
Q

Maximal Edema occurs when in burns?

A

24-48h

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34
Q

Kids need what in addition to IV fluids in major burns?

A

D5W d/t hypoglycemia

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35
Q

What does Over hydration increases risk of 3-5 days postburn?

A

ARDS

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36
Q

What guides IV fluid resuscitation in burns?

A

Urine output guides if IV hydration enough or not

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37
Q

Goal urine burns for children and adults?

A

<2 years= 2ml/kg/hr in children <2 years
Older children=1 ml/kg/hr
Adults=30-40ml/h (0.3-0.5 ml/kg/hr)

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38
Q

Why do kids easily become hypoglycemis with burns?

A

In a catabolic state and trying to make proteins

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39
Q

Treatment for severe burns?

A

COLD WATER and keep PT warm

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40
Q

How often change dressings in severe burns

A

BID

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41
Q

When surgery required in severe burns?

A

If not healed in 3 weeks

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42
Q

PTs with major burns should be transported where?

A

Burn center

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43
Q

Do prophylactic abx reduce infection in burns?

A

No

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44
Q

What does reduce infection risk in burns?

A

Local wound care

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45
Q

Low Voltage burn below what?

A

<1000 V

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46
Q

Low Voltage main cause of which heart arrythmia?

A

VF

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47
Q

High Current at which voltage?

A

> 1000

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48
Q

High Current cause of which arrythmia?

A

Asystole

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49
Q

Low Voltage burns depth?

A

Superficial

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50
Q

High Voltage burn depth?

A

Deep

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51
Q

Low Volatage is AC or DC?

A

AC

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52
Q

High Voltage is AC, DC, or both?

A

Both

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53
Q

AC or DC current easier to surpass let-go current?

A

AC. Elbow to flex and bring the body closer to the source.

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54
Q

Rhabdo more common in low or high voltage?

A

High

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55
Q

Low Voltage duration of contact?

A

Prolonged

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56
Q

High Voltage duration of contact?

A

Brief

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57
Q

“Kissing Point Lesion” with which voltage?

A

High voltage

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58
Q

Main complication in high voltage exposure?

A

Neurologic (transient agitation/confusion, delayed spinal ability)

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59
Q

Tx for low voltage burn?

A

Clean and dress with topical abx. Splint, elevate, and reassess in 48-72h

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60
Q

Tx for high voltage burn?

A

EKG! IV resus, foley, admit, t/f to burn center.

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61
Q

Degrees of Frost Bite?

A

1st, 2nd, 3rd, 4th (just like burns)

62
Q

Frost Bite is due to what sort of exposure?

A

Prolonged exposure to cold climate -10C. Feels numb for more than a few minutes.

63
Q

Frost Bite symptoms are sudden or progressive?

A

Progressive

64
Q

What happens to fluids in Frost Bite?

A

Creezing and crystalization of fluids in interstitial space and cellular space from progressive exposure to freezing temp

65
Q

What history doubles risk of frost bit?

A

Previous cold injury

66
Q

What does nicotine do to vessels and frost bit?

A

Constricts vessels and makes frostbit worse

67
Q

Does the initial presentation of frost bite damage indicate the end point of tissue damage?

A

No. It gets worse over time.

68
Q

Which degree frost bite is central, white plaque with ring of hyperemia?

A

First degree frost bite

69
Q

Which layer of skin damaged in First degree frost bite?

A

Outter layer

70
Q

How long first degree frost bite takes to heal?

A

Over time

71
Q

Which frost bite looks like heat injury? Clear blisters, hard outter skin with resiliant tissue under, and lots of edema.

A

Second degree frost bite

72
Q

Which degree frost bite is blue-gray?

A

Third degree frost bite

73
Q

Eschars and necrotic tissue occurs in which frost bite degree?

A

3rd

74
Q

T/F Third degree frost bite is deep to the dermis?

A

True

75
Q

Which degree of frost bite includs the muscle, bone, tendon, mottled non-blanching skin, and spontaneous amputation?

A

4th degree frost bite

76
Q

How is frost bite dx made?

A

Clinical

77
Q

Tx for frost bite?

A

Reward ASAP w/40-42C circulating warm water. Dry, loose clothes. Sterile and nonadherent dressings BID-QID. Topical aloe q6h. Aspirate blisters. Elevate and splint.

78
Q

What sort of diet for Frost Bite treatment?

A

High calorie, high protein diet

79
Q

Update which vaccine with frost bite?

A

Tetanus

80
Q

How long can healing from frost bite take?

A

6-12 months

81
Q

Which cold injury has no crystal formation and no tissue loss?

A

Frostnip

82
Q

Frostnip or Frostbite? Blanching of skin with transient numbness and paraesthesias that resolve with rewarming

A

Frostnip

83
Q

What is Trench Foot?

A

Prlonged exposure to wet, nonfreezing cold

84
Q

Who gets Trench Foot?

A

Usually homeless

85
Q

Crystal formation in Trench Foot?

A

No

86
Q

Tx for Trench Foot?

A

Keep feet warm and dry. Reversible.

87
Q

What are painful, inflammatory lesions from chronic repeated exposure to damp, nonfreezing cold temperatures?

A

Pernio

88
Q

Pernio damages what vascular component?

A

Capillary beds

89
Q

Pernio resolve in how long?

A

7-14 days

90
Q

Hypothermia Mild, Moderate, and Severe temps? Mortality?

A

Mild 32-35C (89.6-95F)– low mortality/morbidity

Moderate 28-32C (68-89.6F)– 21% mortality

Severe <28C (<68F)– 40% mortality

91
Q

Which hypothermia does one shiver? When does shivering stop?

A

Mild.

Stops at <31C Moderate

92
Q

When does Paradoxical Undressing occur?

A

Moderate hypothermia

93
Q

Which arrythmia does severe hypothermia cause?

A

VFib

94
Q

When can defibrillate Vfib from hypothermia?

A

≥30C

95
Q

Tx for hypothermia?

A

Rapid reward with hot water bottles in axillae, groin, abdomen.

96
Q

Hyperthermia when core temp above what?

A

38.5C/101.3F

97
Q

What temp is catastrophic hyperthermia?

A

41.1C

98
Q

What is the #1 weather mortality, esp in elderly?

A

Hyperthermia

99
Q

Temp change in Heat Exhaustion?

A

Normal to slight elevation in core temp

100
Q

Tx for Heat Exhaustion?

A

Cool off, IV fluids, time

101
Q

Heat Stroke when core temp above what and what other sign?

A

> 40.5C/104.9F with anhydrosis (not sweating)

102
Q

BP and HR in Heat Stroke?

A

Hypotensive, HR>130

103
Q

Tx for Heat Stroke?

A

Get temp <40C within 30 minutes. Ice baths, etc.

104
Q

Tx for Heat Cramps?

A

Rest, hydrate

105
Q

Tx for NMS or Malignant Hyperthermia?

A

Dantrolene

106
Q

What are Heat Cramps?

A

Brief muscle cramps during or after exercise in hot environment d/t muscle fatigue and lyte abnormalities

107
Q

what are the 3 zones of full thickness burns?

A

coagulation, stasis, hyperemia

108
Q

what is the coagulation zone of full thickness burns?

A

dead or dying tissue d/t coagulation necrosis and absent blood flow

109
Q

what is the stasis zone of full thickness burns?

A

red and may blanch with pressure, becomes avascular and necrotic by day 3

110
Q

what is hyperemia zone of full thickness burns?

A

blanches with pressure and heals by day 7

111
Q

when does systemic inflammatory response syndrome occur with burns?

A

burns affecting >30% of TBSA

112
Q

what is the mantra for treating thermal burns?

A

ABCs and stabilization of the pt

113
Q

what are 2 complications of thermal burns?

A

infection (major cause of death)

burn shock

114
Q

how are low voltage electrical burns usually caused?

A

hand/mouth d/t contact with exposed wire

115
Q

an oral electrical injury is initially…

A

painless

116
Q

what’s the tx for oral electrical injury?

A

clean and apply petroleum based abx ointment QID

treat with immediate dental prosthetic splinting to reduce need for oral reconstruction surgery in future

117
Q

LOC is most common with what voltage?

A

low voltage

118
Q

baseline EKG for what burns?

A

electrical burns

119
Q

who with electrical burn can be sent home?

A

anyone with mild sx’s and normal CPK/EKG can be sent home after obs in ER

120
Q

what burns must be sent to the burn center?

A

major burns

121
Q

what is classified as major burn?

A
  • partial thickness burns >25% in adults
  • partial thickness burns >20% in <10 y/o or >50 y/o
  • full thickness >10%
  • burns to face, eyes, ears, nose, hand, feet, perineum
  • caustic burns, high voltage burns, high-risk pts, inhalation injury
122
Q

what burns are hospitalized?

A

moderate burns

123
Q

what is classified as moderate burns?

A
  • partial thickness 15-25% in adults, 10-20% in child or older adult
  • full-thickness 2-10% that don’t fit major burn critiera
124
Q

what burns are treated at home?

A

minor burns

125
Q

what is classified as minor burns?

A
  • partial thickness <15% adults, <10% child or older adult

- full-thickness burns <2%

126
Q

hypothermic pt is not pronounced dead until what?

A

until rewarmed to 32 C or above

127
Q

what are complications of hypothermia?

A

rewarming shock, cardiac arrhythmias at <32 C

128
Q

what’s the ABG like for hypothermia?

A

falsely high O2/CO2

129
Q

need what temp of pt to determine degree of hypothermia?

A

core temp

130
Q

how do you slowly rewarm hypothermic pt?

A

warmed IV fluids, heated humidified O2 by mask, warmed blankets

131
Q

how do you moderately rewarm hypothermic pt?

A

warmed IVF, warmed gastric lavage, peritoneal lavage w/45 C fluid

132
Q

how do you rapidly rewarm hypothermic pt?

A

thoracic lavage, cardiopulmonary bypass, ECMO, AV dialysis, warm water immersion

133
Q

what are complications of hypothermia?

A

rewarming shock, cardiac arrhythmias at <32 C

134
Q

what are the 2 types of hyperthermia?

A

heat exhaustion and heat stroke

135
Q

s/s of heat exhaustion?

A

intact MS, fatigue, dehydration

136
Q

2 subtypes of heat stroke?

A

exertion heat stroke, nonexertional heat stroke

137
Q

s/s of heat stroke?

A

AMS, anhidrosis

138
Q

CNS findings for hyperthermia?

A

AMS, seizures, posturing

139
Q

renal findings for hyperthermia?

A

AKI (hypovolemia, low CO, rhabdomyolysis)

140
Q

ABG findings for hyperthermia?

A

respiratory alkalosis or metabolic acidosis

141
Q

lactate for hyperthermia?

A

> 4mmol/L (acidosis)

142
Q

CMP for hyperthermia?

A
  • hypernatremia
  • hypoglycemia
  • hypocalcemia
  • hypomagnesemia
  • hypokalemia (early phase -> hyperkalemia (late phase)
143
Q

avoid what in tx of hyperthermia?

A

avoid overhydration

144
Q

never use what meds to treat hyperthermia?

A

antipyretics, phenytoin, neuroleptics, alpha-adrenergic w/poor CO

145
Q

who do you admit for electrical burns?

A

anything beyond minor low-voltage injury

those with mild sx’s, mild burns, normal CPK and EKG can be d/c’d after several hour observation

146
Q

when do you transfer electrical burn to burn center?

A
  • high-voltage burn
  • significant burns
  • oral burns
147
Q

what are signs of post-rewarming injury?

A

edema w/in 3 hours and lasts 1 weeks

large clear blebs within 6-24hrs

small hemorrhagic blebs after 24hrs if deep

eschar in 9-15 days

148
Q

what are 2 big complications of frost-bite?

A

permanent sensory loss and wound infection

149
Q

what’s the best tx for frostbite?

A

circulating water 40-42Cfor 15-30

Clinical Medicine 4 COPY (10 decks)

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