Burns Flashcards
(37 cards)
What are the different types of burns?
- Chemical
- Electrical
- Contact
- Scald
- Fire/Flame
Where do Burns occur?
- Recreational
- Streets/Highway
- Occupational
- Home
What are the different layers of skin?
- Epidermis
- Dermis
- Hypodermis
- Muscle layer
What are the classifications of Burns?
- First degree burn (Epidermis)
- Second degree burn (Dermis)
- Third degree burn (Hypodermis)
Describe the initial evaluation and management of Burns
1) Assess airway/breathing
2) Ensure source of heat removed
3) Estimate extent of burn
4) Obtain/ensure adequate IV access
5) Initiate/continue resuscitation
6) Closely monitor urine output
7) Keep patient warm
Describe the Smoke Inhalation Assessment
- Flame burns
- Enclosed space
- Burns to face/mucosal membranes
- Singed eyelashes/nasal hairs
- Carbonaceous sputum
- Hoarseness
- Difficulty swallowing
- Wheezing
- Restlessness/confusion
How do you estimate the TBSA %?
- Patient’s palmar surface = 1% TBSA
- Rule of nines
What is the rule of nines?
- Head (front & back) = 9%
- Back = 18%
- Chest = 18%
- L/R arm = 9%
- L/R leg = 18%
- Perineum = 1%
What are the factors that affect Burn depth?
- Temperature
- Duration of contact
- Dermal thickness
- Blood supply
- Very young/Very old have thinner skin
Describe Superficial/1st degree burn
- Epidermis only
- Pain & redness
- Heals in a few days
- Outer injured epithelial cells peel
Describe Partial Thickness/2nd degree burn
- Entire epidermis & portion of dermis
- Pain, blisters, moist, capillary refill
- Uninjured dermis & epidermal appendages at risk
- Heals spontaneously in 2-3 weeks
- Skin graft may improve functional & cosmetic outcome
Describe Full Thickness/3rd degree burn
- All skin layers affected
- White, hemorrhagic, brown, black or charred
- Inelastic and leathery
- Painless or numb
- Requires skin grafting
What are the properties of IV access?
- Large burn = 2 large bore IV’s
- Smaller burn (<15%) = 1 IV
- Suture IVs started through burns
- IV through non-burn area if possible
EMT/Paramedics start IV fluid:
- Adults @ 500 mL/hour
- Children <40kg @ 250 mL/hour
- Children <10kg @ 125 mL/hour
What is the Calculated Resuscitation in first 24 hours?
Parkland Formula (LR)
2 mL X weight in kg X % TBSA burned
[give 1/2 volume in first 8 hours and the other 1/2 over the next 16 hours]
For patients <10kg, what is the calculated resuscitation in the first 24 hours?
4-2-1 Rule
For 0-10kg: 4 mL/kg/hr
For 10-20kg: + 2 mL/kg/hr
For >20kg: +1 mL/kg/hr
What are the properties of Urine output?
- Place Foley if >20% TBSA
- Do not use diuretics to maintain urine output
- Urine output goal is 100 ml/hr if concern for MYOGLOBINURIA
What is the adequate urine output?
- 1mL/kh/hr in children
- 0.5ml/kg/hr in adults
What is the severity of a chemical burn dependent on?
- Type of chemical
- Concentration of chemical
- Duration of exposure
What is the management for chemical burns?
- Remove any chemicals before flushing with water
- Remove patient’s clothing
- Continue flood for 20 mins after burning has stopped
What is the physiology behind an electric burn?
For electricity to flow, there must be a complete circuit between the source and the ground -> Any substance that PREVENTS is called an INSULATOR -> Any substance that ALLOWS is called a CONDUCTOR -> Human body is a good conductor
What is the severity of an Electric burn dependent on?
- Type of electric current
- Magnitude of current
- Voltage
What is the management for Electric Burns?
- If indicated, begin CPR and apply an AED (Be prepared to defibrillate)
- Give supplemental oxygen and monitor
- Treat soft-tissue injuries with dry, sterile dressings
- Provide prompt transport
What are the different types of Thermal burns?
- Flame burn
- Scald burn (Hot liquids)
- Contact burn
- Steam burn -> Topical burn
- Flash burn (Explosion/lightening)
