Burns Flashcards
What are the different types of caused of burn injury?
Thermal - fire, too hot of water
Chemical - acid, some type of chemical, can effect lungs
Inhalation - smoke fire
Electrical - entrance and exit, heart, lungs and stomach can be damaged
Thermal burns
most common type of burn flame scald contact with hot objects Cold Thermal therapy: frostbite
Chemical Burns
Destruction of tissue from necrotizing substances, acids, chemicals
Flush profusely
may need to use saline
Inhalation Burns
Inhalation of hot air, chemicals into respiratory tract
Three types of smoke inhalation injuries
Carbon monoxide poisoning
Inhalation injury above the glottis
Inhalation injury below the glottis
Treat - put them on a face mask of 10L O2
If glottis is swollen then intubate to protect the airway
Cherry red is a sign of carbon monoxide poisoning
Electrical Burns
Intense heat generated from an electrical current
resulting from coagulation necrosis
may result from direct damage to nerves and vessels causing tissue anoxia and death
The severity of the electrical injury depends on the amount of voltage
How do you classify burn injuries?
Severity determined by:
Depth of burn: how many layers
Extent of burn: total body surface area
Location of burn: some areas more susceptible to problems than others
Other patient risk factors: age, other medical problems
Burn degrees: first, second, third, and fourth
1st degree superficial partial-thickness burns
those in which the epidermis is the only layer of skin destroyed
uncomplicated healing occurs in 3 to 5 days
blanches with pressure, top layer of the dermis
2nd degree deep partial-thickness burns
extend into the upper layers of the dermis or even into its deeper layers.
healing occurs in 2 to 3 weeks
blisters, does not blanch
3rd degree full-thickness burns
reach through the entire dermis and sometimes into subcutaneous fat
the skin cannot heal on its own
leathery, gray, insensitive to pain
4th degree burns
damage not only skin but also muscle and bone
Rule of 9’s
one sided - double for both sides head - 4.5% upper chest - 9% abdomen - 9% each arm - 4.5% each leg - 9% genital area - 1% palms - 1%
What are some complications of facial, neck or chest burns?
respiratory obstruction
What are some complications of hands, feet, eye burns?
self-care
What are some complications of ears, nose, buttocks, perineum burns?
infection
What are some complications of circumferential burns?
circumferential burns of the extremities can cause circulatory compromise
may also develop compartment syndrome
In the Pre-hospital care phase of burn management how do you care for the patient?
remove from source rescuers protect themselves stop burning-remove clothes-if airway/breathing impaired-deal with this first Initiate treatment ABC's Cool area - watch for hypothermia Remove clothing Transfer to burn center
In the emergent (resuscitative) phase of burn management how do you care for the patient?
may last from onset to 5 or more days (usually up to 72 hours)
Resolve immediate problems - hypovolemic shock and edema formation
Do a CBC and BMP
If H&H is elevated - start or increase fluid
If H&H is decreased - stop fluids
What are signs and symptoms of fluid loss in burn patients?
decreased BP
increased heart rate
decreased pulsed
dysrhythmias
What could be causes of fluid loss in burn patient?
hypovolemia -“third spacing” - capillary leak
decreased cardiac output
must treat shock
major shifts of electrolytes
What are the possible cardiac complications in the emergent phase of burn management?
dysrhythmias and hypovolemic shock. Impaired circulation in the extremities. If untreated ischemia, paresthesia, necrosis, and gangrene can occur. Escharotomy (a scalpel or electrocautery incision through the full-thickness eschar) is frequently performed. Initially, there is an increase in blood viscosity with burn injury because of the fluid loss that occurs in the emergent phase. Microcirculation is impaired because of the damage to skin structures that contain small capillary systems. These two events result in a phenomenon termed sludging. Sludging can be corrected by adequate fluid replacement.
What are the possible respiratory complications in the emergent phase of burn management?
The respiratory system is especially vulnerable to two types of injury. First, upper airway burns that cause edema formation and obstruction of the airway. Second is the lower airway injury. Upper airway distress may occur with or without smoke inhalation, and airway in that either level may occur in the absence of burn injury to the skin. Chest x-ray may initially appear normal on admission, with changes noted over the next 24 to 48 hours. ABG may also appear normal on admission, but change during hospitalization.
What are the possible urinary complications in the emergent phase of burn management?
ATN, hypovolemic. With full-thickness and electrical burns, myoglobin (from muscle breakdown) and hemoglobin are released into the bloodstream and occlude the renal tubules. Give fluids.
What is the Parkland formula for fluid replacement in burn patients
4cc x kg x BSA
administer half of this total over the first 8 hours and the other half over the next 16 hours
What type of fluids do we start with first
crystalloids and then we move to colloids
