Burns

Question 1

What are the 5 types of burns?

Answer 1

1. Thermal
2. Chemical
3. Smoke Inhalation Injury
4. Electrical
5. Cold thermal

Question 2

What are thermal burns?

Answer 2

Burns that are caused by flame, flash, scald, or contact with hot objects
MOST COMMON

Question 3

What are chemical burns?

Answer 3

Result from tissue injury and destruction from necrotizing substances(acid)
- immediately take out contacts and take off clothes containing chemicals

Question 4

What is smoke inhalation injury?

Answer 4

Airway injuries resulting from inhalation of hot air or noxious chemicals that needed to be treated as soon as possible

Question 5

What are three types of smoke inhalation injury?

Answer 5

1. Carbon monoxide poisoning
2. inhalation injury above the glottis
3. inhalation injury below the glottis

Question 5

What is the signs and symptoms of carbon monoxide poisoning?

Answer 5

Cherry red skin, headache, dizziness, nausea, breathlessness, collapse, loss of consciousness

Question 6

What is the signs and symptoms of inhalation injury below the glottis?

Answer 6

Manifests as acute respiratory syndrome
- injury depends on length of exposure to smoke or toxic fumes
- causes inflamed airways with pulmonary edema

Question 7

What is the signs and symptoms of inhalation injury above the glottis?

Answer 7

True medical emergency caused by hot air, smoke, or steam
- facial burns, singed nasal hair , hoarseness, painful swallowing, darkened oral membranes

Question 8

What are electrical burns?

Answer 8

result form coagulation necrosis caused by intense heat generated from an electrical current. Can potentially cause spine injuries, death, and/or direct damage to nerves and vessels

Question 9

What are Cold thermal injuries?

Answer 9

frostbite

Question 10

What is a superficial partial thickness burn?

Answer 10

1st degree burn that involves the epidermis, reddened skin, and pain at injured site
example: sunburn

Question 11

What is a deep partial thickness burn?

Answer 11

2nd degree burn that involves the epidermis, dermis, intense pain, and white/reddish skin with blisters
example: burn from the stove

Question 12

What is a full thickness burn?

Answer 12

3rd degree burn that involves epidermis, dermis, fat, muscle, and bone with little to no pain
example: fire

Question 13

What are the two methods that estimate total body surface area burned?

Answer 13

Lund-Browder Chart and Rule of Nines

Question 14

What are the four phases of a burn injury?

Answer 14

1. prehospital care
2. emergent (resuscitation)
3. acute (wound healing)
4. rehabilitative (restorative)

Question 15

What is prehospital care?

Answer 15

Removes the person from the source of the burn and stop the process. First stage of a burn injury.
Electrical: you remove pt from contact of source Chemical: you brush solid particle off skin
Small thermal burn: Cover with cool, damp towel
large thermal burn: Watch ABC, do not put body in cool water, will CAUSE shock. remove clothing and wrap in dry sheet
Inhalation injury: observe for signs of respiratory distress and treat quickly

Question 16

What is the emergent phase? Primary concerns?

Answer 16

Second phase of a burn injury.
-Period of time required to resolve the immediate problems resulting from burn injury lasting up to 72 hrs
- includes respiratory, cardiovascular systems, wound care, drug therapy, nutritional therapy
PRIMARY CONCERNS: hypovolemic shock and edema

Question 17

What happens during hypovolemic shock?

Answer 17

massive shift of fluid out of the blood vessels as a result of increased capillary permeability causing a decrease in osmotic pressure. Blood goes to important organs(brain and heart)

Question 18

What is the normal insensible loss of body fluid per hour?

Answer 18

50 ml/ hr
sweating, breathing

Question 19

What is the severely burned patient loss of body fluid per hour?

Answer 19

200-400ml/hr

Question 20

What is the complications in the respiratory system in the emergent phase?

Answer 20

The main concern is airway management.

complications: upper respiratory tract injury, direct insult at the alveolar level, pneumonia, pulmonary edema

Question 21

What is the complications in the cardiovascular system in the emergent phase?

Answer 21

Blood goes to the two most important parts of the body: Brain and heart

complications: arrhythmias, edema, necrosis, ischemia

Question 22

What is the complications in the urinary system in the emergent phase?

Answer 22

Decrease blood flow to kidneys causes renal ischema

complications: acute tubular necrosis

Question 23

What consists of wound care in the emergent phase?

Answer 23

should be delayed until a patient airway, adequate circulation, and adequate fluid replacement have been established
cleansing: done in hydrotherapy tub, cart shower, shower, or bed
debridement: done in OR and loose necrotic skin is removed

Question 24

How long can can someone stay in an immersion tank? Why?

Answer 24

20-30 minutes. Any longer can lead to cross contamination of wounds

Question 25

What is the most important measure to be done as soon as the burn patient is able?

Answer 25

range of motion. Must move or it can lead to contractures

Question 26

What immunization is given routinely to all burn patients?

Answer 26

tetanus

Question 27

What consists of nutritional therapy in the emergent phase?

Answer 27

- When bowel sounds return, the patient may eat. - 5000kcal/day - supplements, fluid replacement as needed

Question 28

What is the acute phase in a burn injury?

Answer 28

- Begin with mobilization of extracellular fluid and subsequent diuresis - Concluded when the burn area is completely covered by skin grafts or when the wounds are healed - Necrotic tissue begins to slough, formation of granulation tissue - watch for infections

Question 29

How do you prevent curling ulcers?

Answer 29

Feed right when there is bowel sounds

Question 30

What are the three types of excision and grafting in the acute phase?

Answer 30

1. eschar - removed from subcutaneous tissue or fascia 2. cultured epithelial autographs (CEA) - grown skin from biopsies obtained from patients own skin 3. Artificial Skin - For life threatening full thickness pr deep partial thickness wounds where conventional autografts is not available or advisable

Question 31

With smoke inhalation injuries, what would you look for when the pt comes to the hospital?

Answer 31

Swelling, singed nasal hairs, horse voice

Question 32

How do you prevent contractors in a burn patient?

Answer 32

Move as soon as possible and as much as possible. Keep up with ROM

Question 33

If a pt has swelling from burns, what do you do?

Answer 33

Elevate limbs

Question 34

What are the priorities when it comes to burns?

Answer 34

oxygen and airway

Question 35

How would a burn patient receive medication?

Answer 35

Iv route