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Flashcards in Burns Deck (59)
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1
Q

3 layers of skin

A

Epidermis, dermis and subcutaneous tissue

2
Q

what part of the epidermis is metabolically active

A

inner

3
Q

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

A

Dermis

4
Q

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

A

dermis

5
Q

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

A

Subcutaneous layer

6
Q

what happens w/ a first degree burn

A

Involves only the epidermis
Epidermal barrier remains intact
No blistering

7
Q

2 types of second degree burns

A

superficial

deep

8
Q

upper 1/3 of dermis is invovled

A

superficial 2nd degree burn

9
Q

lower 2/3 of dermis is involved

A

deep 2nd degree burn

10
Q

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

A

not, most barrier intake

11
Q

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

A

10-14 days

12
Q

dry and thickened burn that is red or white

can have high fluid loss and can get infected

A

deep second degree burn

13
Q

healing time w/ 2nd degree burn (deep)

A

heal in 4-8 weeks on their own

better outcome w/ skin grafting

14
Q

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

A

3rd degree (full-thickness) burn

15
Q

tx for 3rd degree burn

A

full thickness skin grafts

16
Q

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

A

eschar

17
Q

what is an Escharotomy

A

making an incision for skin to expand so

a person can breathe or save a limb

18
Q

what are respiratory injuries

A
inhalation
aspiration from unconscious patients 
bacterial pneumonia
pulmonary edema
post-traumatic pulmonary insufficiency 
ARDS
19
Q

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

A

enclosed area

20
Q

what scenarios should you suspect an inhalation injury

A
History of closed space exposure
Perioral burns
Intraoral burns
Carbonaceous material in the oropharynx
Progressive hoarseness
Singed facial and nose hairs
21
Q

when should you suspect CO posioning

A

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

22
Q

can pulse ox and PaO2 be normal in CO poisoning

A

yes

23
Q

symptoms w/ CO poisoning

A

Asymptomatic – HA – dizziness – syncope – coma - death

24
Q

treatment w/ CO poisoning

A

100% oxygen

may need intubation or hyperbaric chamber

25
Q

what do you need to determine if CO poisoning

A

send off blood for CO levels

26
Q

In trauma what do you want for fluid resuscitation?

A

2 large bore IV’s

14 or 16 gages

27
Q

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

A

> 20% TBS

28
Q

what burns are used to determine total body surface area?

A

only 2nd (deep) and 3rd degree burns

29
Q

what are considered major burns

A
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
Q

what is the consensus formula

A

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
Q

when does “time” for treatment start for burns?

A

at time of burn

need to make up those fluids once they get to you

32
Q

what directs you fluid rate (consensus formula only duies)

A

BP

pulse rate

33
Q

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

A

20-30%

34
Q

what can make ARDS worse?

A

over-resuscitation (too much fluid)

35
Q

how do you tx a superficial partial thickness burn

A

occlusive dressing to minimize air exposure

no need for topical abx

36
Q

how to you tx a facial superficial partial thickness burn

A

topical abx

37
Q

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

A

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

38
Q

how should nutrients be administered to a burn victim

A

enterally- reduces risk of infection

39
Q

best topical abx for burns

A

silver sulfadiazine

40
Q

ADR w/ silver sulfadiazine

A

transient luekopenia

41
Q

ABX that Penetrates eschar better than silver sulfadiazine

Can induce metabolic acidosis

A

mafenide

42
Q

why do you mesh the skin for a graft?

A

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

43
Q

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

A

on face, joints, etc

44
Q

ulcers that people get in their stomach due to severe burns

A

curling ulcers

45
Q

how do you prevent curling ulcers

A

put them on PPI for prophylaxis

46
Q

what can you put on a burn for a fungal infection

A

nystatin

47
Q

do burns from alkalis or acid penetrate deeply?

A

alkalis

48
Q

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

A

acid

49
Q

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

A

dissolve cell membranes

50
Q

tx for chemical burns

A

brush off dry powders

copiously irrigate w/ water

51
Q

what are low resistance tissues w/ electrical injuries?

A

nerves
blood vessels
muscles

52
Q

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

A

v fib and asystole

53
Q

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

A

24 hours

54
Q

patients w/ electrical burns are at risk for what

A

rhabdomyolysis (breakdown of muscle)

compartment syndrome

55
Q

how do you treat rhabdomyolysis

A

lots of fluids

56
Q

how to determine compartment syndrome?

A

pain w/ passive movement

lack on sensation between first and second toe

57
Q

how do you diagnose compartment syndrome

A

put a needle in a muscle compartment to determine pressure

58
Q

tx for frostbite

A

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

59
Q

what will dead tissue from frost bite do?

A

become demarcated and usually sough on own