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Flashcards in Burns Deck (59):
1

3 layers of skin

Epidermis, dermis and subcutaneous tissue

2

what part of the epidermis is metabolically active

inner

3

A barrier that prevents loss of fluid by evaporation and loss of body heat

Dermis

4

layer of skin w/ blood vessels, nerves, sweat glands, appendages (allow you to regrow skin)

dermis

5

layer of skin that is mostly fat but also has skin appendages, blood vessels, and nerves

Subcutaneous layer

6

what happens w/ a first degree burn

Involves only the epidermis
Epidermal barrier remains intact
No blistering

7

2 types of second degree burns

superficial
deep

8

upper 1/3 of dermis is invovled

superficial 2nd degree burn

9

lower 2/3 of dermis is involved

deep 2nd degree burn

10

if there fluid loss w/ a superficial 2nd degree burn?

not, most barrier intake

11

how long does it take for a superficial partial-thickness burn to heal

10-14 days

12

dry and thickened burn that is red or white
can have high fluid loss and can get infected

deep second degree burn

13

healing time w/ 2nd degree burn (deep)

heal in 4-8 weeks on their own
better outcome w/ skin grafting

14

May look unburned skin
Can be white and waxy to completely black
Can be dark red, but dry and non-blanching
Leathery texture
non-painful

3rd degree (full-thickness) burn

15

tx for 3rd degree burn

full thickness skin grafts

16

a 3rd degree burn where Dermal proteins coagulate and contract is called what
causes skin to be tight

eschar

17

what is an Escharotomy

making an incision for skin to expand so
a person can breathe or save a limb

18

what are respiratory injuries

inhalation
aspiration from unconscious patients
bacterial pneumonia
pulmonary edema
post-traumatic pulmonary insufficiency
ARDS

19

are inhalation injuries more common outside or in an enclosed area?

enclosed area

20

what scenarios should you suspect an inhalation injury

History of closed space exposure
Perioral burns
Intraoral burns
Carbonaceous material in the oropharynx
Progressive hoarseness
Singed facial and nose hairs

21

when should you suspect CO posioning

Suspect in same patients that you suspect of inhalation injury + HA and mental status change

22

can pulse ox and PaO2 be normal in CO poisoning

yes

23

symptoms w/ CO poisoning

Asymptomatic – HA – dizziness – syncope – coma - death

24

treatment w/ CO poisoning

100% oxygen
may need intubation or hyperbaric chamber

25

what do you need to determine if CO poisoning

send off blood for CO levels

26

In trauma what do you want for fluid resuscitation?

2 large bore IV's
(14 or 16 gages)

27

when do you need to do a urinary cath for burns?

>20% TBS

28

what burns are used to determine total body surface area?

only 2nd (deep) and 3rd degree burns

29

what are considered major burns

partial thickeness >25% body adults >20% peds
full thickness burns >10% TBSA
2nd or 3rd involving- hands, feet, fact, perineum, genitalia, major joints
associated w/ inhalation injury
burns + fractures
electrical/ lightning/ chemical
circumferential burns
really young or old

30

what is the consensus formula

2-4 mLs X %TBSA (2nd and 3rd degree) x wt in kgs
give 1/2 of volume in first 8 hours
giver other 1/2 in remainder 16 hours

31

when does "time" for treatment start for burns?

at time of burn
(need to make up those fluids once they get to you)

32

what directs you fluid rate (consensus formula only duies)

BP
pulse rate

33

what should you add to the %TBSA for an inhalation injury

20-30%

34

what can make ARDS worse?

over-resuscitation (too much fluid)

35

how do you tx a superficial partial thickness burn

occlusive dressing to minimize air exposure
no need for topical abx

36

how to you tx a facial superficial partial thickness burn

topical abx

37

what abx do you not want to use on the face?

Silver sulfadiazine, if used more than a few days, can cause blue/gray discoloration

38

how should nutrients be administered to a burn victim

enterally- reduces risk of infection

39

best topical abx for burns

silver sulfadiazine

40

ADR w/ silver sulfadiazine

transient luekopenia

41

ABX that Penetrates eschar better than silver sulfadiazine
Can induce metabolic acidosis

mafenide

42

why do you mesh the skin for a graft?

to cause epithelialization
can cover a large wound
(partial thickness skin graft)

43

when wouldn't you use a mesher for a burn?

on face, joints, etc

44

ulcers that people get in their stomach due to severe burns

curling ulcers

45

how do you prevent curling ulcers

put them on PPI for prophylaxis

46

what can you put on a burn for a fungal infection

nystatin

47

do burns from alkalis or acid penetrate deeply?

alkalis

48

what type burn forms an eschar but doesn't penetrate as deeply

acid

49

what do burns by organic compounds (petroleum products, phenols) do?

dissolve cell membranes

50

tx for chemical burns

brush off dry powders
copiously irrigate w/ water

51

what are low resistance tissues w/ electrical injuries?

nerves
blood vessels
muscles

52

what rhythms can someone w/ an electrical burn go into?

v fib and asystole

53

what is the minimum a person needs to be on telemetry for w/ an electrical burn?

24 hours

54

patients w/ electrical burns are at risk for what

rhabdomyolysis (breakdown of muscle)
compartment syndrome

55

how do you treat rhabdomyolysis

lots of fluids

56

how to determine compartment syndrome?

pain w/ passive movement
lack on sensation between first and second toe

57

how do you diagnose compartment syndrome

put a needle in a muscle compartment to determine pressure

58

tx for frostbite

rewarm in water bath at 40-42.2 degrees for 20-30 minutes

59

what will dead tissue from frost bite do?

become demarcated and usually sough on own