Burns

Question 1

Burn injuries per year receiving medical treatment

Answer 1

450,000

Question 2

Burn Hospitalizations

Answer 2

45,000

Question 3

Fire and burn deaths per year

Answer 3

3,500

Question 4

Survival rate upon admission to burn center

Answer 4

94.8%

Question 5

Types of Burns

Answer 5

Fire/flame, scald, steam, gas, electrical, flash, and chemical

Question 6

Fire/Flame Burns

Answer 6

Direct tissue injury

Burns occurring in enclosed spaces carry high risk of CO/CN poisoning and inhalational injury

Question 7

Scald Burns

Answer 7

Resulting from contact with hot liquids

The more viscous and the longer the contact the more significant the damage

Question 8

Steam Burns

Answer 8

Produce extensive injury from the high heat-carrying capacity of steam
The dispersion of pressurized steam and liquid can cause thermal injury to the distal airways of the lung

Question 9

Gas Burns

Answer 9

Upper airway is at risk for thermal injury and subsequent occlusion due to edema
Distal airway injury is more likely to be due to the direct effects of the products of combustion on the mucosa and alveoli

Question 10

Electrical Burns

Answer 10

Electrical burns produce heat injury by passing through tissue
Most problems from these burns present in patients exposed to more than 1000V
Children can have significant injury after exposure to 200-1000V
Most of the injury is deep in the skin
Cardiac injury is common

Question 11

Flash Burns

Answer 11

Flash burns are a subset of flame burns and are a result of rapid ignition of a flammable gas or liquid

Question 12

Chemical Burns

Answer 12

Alkaline substances and acidic substances can burn the skin and can be associated with systemic toxicity

Question 13

First Degree Burns

Answer 13

Involves only the epidermis, erythema

Question 14

Second Degree Burns

Answer 14

Partial thickness
Either superficial or deep
Deep burns do not heal spontaneously

Question 15

Third Degree Burns

Answer 15

Full thickness

Loss of all epidermal and dermal elements extending to subcutaneous tissue (muscle, tendon, and bone)

Question 16

Rule of Nines

Answer 16

Head and each arm = 9%

Chest, back, and each leg = 18%

Question 17

Palm Rule

Answer 17

Palm = 1%

Question 18

Lund Browder

Answer 18

Used to determine burned body surface area in infants and children

Question 19

Smoke inhalational injury

Answer 19

Thermal lesions and exposure to toxic and asphyxiating fumes

Question 20

Signs and symptoms of inhalational injury

Answer 20

Strider, hoarseness, use of accessory muscles (inc. WOB), facial burns, singing of eyebrows, soot or readiness of mucosa in mouth/pharynx, carbonaceous sputum, accident occurred in confined space

Question 21

Integumentary System

Answer 21

Skin and structures derived from it

Question 22

Functions of the Integumentary System

Answer 22

Protects the body, helps regulate temperature, eliminates some wastes, helps make vitamin D, and detects sensations such as touch, pain, warmth, and cold

Question 23

Capillary fluid transport is governed by what equation?

Answer 23

Starling

Question 24

Systemic spillover causes what phenomenon in the unburned tissue of a burn patient?

Answer 24

Fluid accumulation

Question 25

The alveolar microenvironment of burn victims changes how?

Answer 25

Surfactant denaturation causes damage to the lungs Loss of endothelial and epithelial barrier functions Influx of inflammatory cells

Question 26

Edema may develop within what time period for burn victims?

Answer 26

Minutes to 24 hours

Question 27

T/F Burn victims experience a decrease in macrophage, phagocytic and bactericidal functions and increased neutrophils

Answer 27

True

Question 28

In burn victims, sloughing of mucosal surface and decreased ciliary function result in...

Answer 28

Decreased airflow and gas exchange

Question 29

Carbon monoxide poisoning leads to what condition?

Answer 29

Hypoxia

Question 30

Symptoms of Mild (0.08%) Carbon Monoxide Poisoning

Answer 30

Headache, asphyxia, dizziness, dry cough, chest pain, nausea, vomiting, visual and auditory hallucinations, and high blood pressure

Question 31

Symptoms of Moderate (0.32%) Carbon Monoxide Poisoning

Answer 31

Motor paralysis and loosing consciousness

Question 32

Symptoms of Severe (1.2%) Carbon Monoxide Poisoning

Answer 32

Loosing consciousness after 2 or 3 breaths, convulsions, and respiratory arrest leading to death in less than 3 minutes

Question 33

What effect does cyanide have on the body?

Answer 33

It inhibits normal cellular metabolism

Question 34

What value must be obtained in a patient with carbon monoxide poisoning?

Answer 34

HbCO

Question 35

Baux score is a function of what?

Answer 35

BSA plus age

Question 36

A Baux score of what is associated with death in 50% of patients?

Answer 36

110

Question 37

Inhalational injuries add how much to the Baux score?

Answer 37

17

Question 38

What are the mortality risk factors in burn patients?

Answer 38

Age, BSA, inhalational injury, preexisting comorbidities, and concurrent trauma

Question 39

Treatment for Burn Victims

Answer 39

Agressive fluid resuscitation (monitor urine output), Oxygen therapy (possible intubation), Escharotomy (incisions made in the skin; prevents restriction of breathing and/or compartment syndrome), antibiotics, debridement (prevent sepsis)

Question 40

Preop Preparation for Burn Victims

Answer 40

Obtain clear information on procedure, patient preexisting issues, labs, respiratory status or vent requirements, drips and other drugs, current hemodynamics

Question 41

Preparing the OR for Burn Victims

Answer 41

Blood must be available | OR must be very warm

Question 42

What common induction drum should be avoided in burn victims? Why?

Answer 42

Succinylcholine | Increased acetylcholine receptor density

Question 43

T/F Burn victims have increased sensitivity to nondepolarizers

Answer 43

False

Question 44

T/F Burn victims have increased narcotic requirements

Answer 44

True

Question 45

Percent of blood volume lost per percent of BSA excised

Answer 45

2% blood volume / 1% BSA

Question 46

Burn victim cardiovascular concerns

Answer 46

Hypermetabolic state increases cardiac demand | Levels of circulating catecholamines are greatly increased

Question 47

Burn victim hematologic concerns

Answer 47

Coagulopathy or hyper coagulable state | Altered drug metabolism

Question 48

Burn victim renal concerns

Answer 48

Toxicity, inadequate fluid ressucitation causing prerenal azotemia, tubular necrosis due to myoglobinurea

Question 49

Burn victim GI concerns

Answer 49

Curling’s Ulcers