burns Flashcards
(43 cards)
list layers of skin
- epidermis: 10% of skin thickness
- dermis: 90% of skin thickness
What is a superficial or first degree burn? what layers of skin are involved? how long does it take to heal?
- only the epidermis is involved
- red, painful, no blisters
- heal within 7 days without scarring
managment of a superficial or first degree burn
- frequent moisturization: 4-6 x daily with non-perfumed water or petroleum based product that has low alcohol content
- OTC NSAIDs for pain
- wash area with mild soap and water
- consider tetanus booster
What is a partial thickness burn? what layers of skin are involved? how long does it take to heal?
- extends partially into dermis
- most will heal without grafting in 7-21 days
partial thickness burns are divided into what two types
- superficial
- pink, moist, blisters, painful
- deep
- pink to white, decreased cap refill, may be less painful
management of a partial thickness burn (outpatient)
- keep wound moist
- debride wound
- dressing change 1-2 x daily
- wash wound with each dressing change with mild soap and water
- PO narcotics?
- tetanus booster
extra management for superficial partial thickness burns
- petroleum based moisturizer vs bacitracin
- covered with occlusive dressing such as Xeroform, covered with roll gauze
extra managment for deep partial thickness burns
- petroleum based moisturizer vs bacitracin and cover with occlusive dressing such as Xeroform, covered with roll gauze unless eschar present
-
eschar => silver sulfadiazine cream on 4x4, covered with roll gauze
- slough or piece of dead tissue that is cast off from the surface of the skin
what is a full thickness aka third degree burn? what layers are involved?
- epidermis and full thickness dermis involved
- hard, lethary, insensate
- doesnt feel pain
- only small burns will heal
managment of full thickness aka third degree burn
- almost always requires surgery
- debride wound
- silver saulfadiazine cream on 4x4, covered with roll gauze
- change dressing 2x daily, wash wound with mild soap and water
- PO narcotics
- tetanus
what is a beyond full thickness burn
- involvement of
- muscle
- tendon
- bone
- blood vessel
- nerve
What are the ABA referral criteria: referral to burn center
- partial thickness burns >10% of TBSA
- burns involving face, hands, feet, genitalia, or major joints
- third degree burns
- burns + cocomitant trauma
- burns + preexisting medical disorders that could complicate management
oxygen is give to burn patients via a
100% oxygen non-rebreather
what signs would suggest airway compromise and need to intubate
- closed space injury
- carbonaceous sputum
- facial burns
- COHb > 5
- hoarse voice
- singed facial hair
why is pulse ox not reliable in burn patients
- carbon monoxide has 100x higher affinity for Hb, oximeter reads as O2
what is the preferred tx for cyanide toxicity
- hydrocobalamin (cyanokit)
- binds to CN to form vit B12
what is the number one cause of death related to fires
smoke inhalation
four aspects of tx of inhalation injury
- mechanical ventilation
- pulmonary toilet: set of methods used to clear mucus and secretions from the airways
- PNA prevention
- supplemental nutrition
when is parkland resuscitation used for burns
burns 20% TBSA or greater
- >20% at highest risk for burn shock
what is the rule of 9’s
adult
- head: 9%
- front of torso: 18%
- back of torso: 18%
- each arm: 9%
- genital area: 1%
- each leg: 18%
how does burn create state of shock
- increased perfusion to injured area -> edema
- increased capillary permeability
- decreased oncotic pressure
- pt becomes hypotensive
how can you assess whether you are maintaining adequate tissue perfusion to end organs of burn victims
- urine output
- adult: 0.5 mL/kg/hr
- use foley catheter to monitor
what is the parkland formula
- 4mL Lactated ringer x weight (kg) x TBSA = 24 post burn total fluid
- half of volume is given in first 8 hrs post burn
- rest is given in remaining 16 hours
over resuscitation in burn victims can lead to abdominal compartment syndrome which causes
- decreased renal blood flow -> renal failure
- intestinal ischemia
- respiratory failure
