Burn Care

Question 1

primary survey

Answer 1

Airway
Breathing
Circulation
Disability
Exposure

Question 2

what to do for carbon monoxide poisoning

Answer 2

give 100% oxygen until carboxyhemoglobin levels are less then 15%

Question 3

airway assessment

Answer 3

airway control: chin lift, jaw thrust, insert oral pharyngeal airway, assess need for intubation
maintain in-line cervical immobilization in patients at risks

Question 4

breathing and ventilation

Answer 4

listen to breath sounds
assess rate and depth
administer high flow O2
monitor chest wall excursion in presence of deep torso burns

Question 5

circulation

Answer 5

monitor BP, pulse, skin color
establish IV access
assess circulatory status of circumferentially burned extremities
compartment syndrome

Question 6

disability, neurological deficit

Answer 6

if not A&O, consider associated injuries, CO poisoning, substance abuse, hypoxia, pre-existing medical conditions

AVPU:
alert
responds to verbal stimuli
responds only to painful stimuli
unresponsive

Question 7

exposure/environmental control

Answer 7

remove all clothing & jewelry
maintain patient’s temperature: warm room, keep pt covered w/ dry sheets and blankets, warm IV fluids

Question 8

secondary survery

Answer 8

after primary survey and resuscitation efforts are well-established
complete head-to-toe
H&P exam
radiographic and lab studies

Question 9

types of burn injuries

Answer 9

flame
scald
chemical
electrical

Question 10

factors to consider in medical history

Answer 10

pre-existing or associated disease
meds, ETOH, drugs
allergies
tetanus

Question 11

medical history AMPLE

Answer 11

allergies
meds
past med hx, illness, pregnancy
last meal or drink
events/environment related to injury

Question 12

how to determine burn severity

Answer 12

& BSA involved
depth of injury
age
associated/pre-existing disease or illness
burns to face, hands, genitalia

Question 13

rule of 9s

Answer 13

head 9
front torso 18
back 18
right arm 9
left arm 9
right leg 18
left leg 18
genitals 1

Question 14

burn depth factors

Answer 14

temperature
duration of contact
dermal thickness
blood supply
very young or elderly with thin skin

Question 15

partial thickness: first degree

Answer 15

epidermis only
pain and redness, sensitive to air, no blisters
heals in few days
injured epithelial cells peel

Question 16

partial thickness: second degree

Answer 16

entire epidermis and portion of dermis
pain, blisters, moist, capillary refill
uninjured dermis and epidermal appendages at risk

Question 17

partial thickness: second degree treatment

Answer 17

debridement of blisters or nonviable tissue
protect wounds with silver or antiseptic dressings

Question 18

full thickness: third degree

Answer 18

entire thickness of epidermis and dermis
decreased pain, blisters, dry, white, absent capillary refill
possible compartment syndrome

Question 19

full thickness: third degree treatment

Answer 19

replace skin: allograft, xenograft, synthetic skin, autograft

Question 20

fluid resuscitation

Answer 20

2-4mL LR *kg * % BSA burn
1/2 in 1st 8 hrs
1/2 in 2nd 16 hrs

Question 21

burn management principles

Answer 21

stop the burning process
universal precautions
initiate fluid resuscitation
vital signs
insert NG tube
insert urinary catheter
assess extremity perfusion
ventilation status
pain relief (no IM)
psychological assessment

Question 22

initial thermal burn wound care

Answer 22

cover with clean, dry cloth
no ice or cold water soaks

Question 23

initial electric burn wound care

Answer 23

cutaneous and internal injury
consider electrical current cardiac effect
cardiac monitoring x 24hrs

Question 24

initial chemical burn wound care

Answer 24

brush powders from skin
flush with copious amounts of water
remove contaminated clothing
eye irrigation (PRN)
exposure protection for ED personnel

Question 25

burns: initial laboratory studies

Answer 25

hematocrit
electrolytes
BUN
urinalysis
CXR
ABGs
carboxyhemoglobin
ECG
blood glucose