BURNS Flashcards
(32 cards)
What are the 4 types of burns?
Thermal
Chemical
Electrical
Radiation
What is occurring pathophysiologically with a thermal burn?
Thermal energy denatures & coagulates proteins. The surrounding zone (zone of stasis) has increased perfusion and is salvageable (if not in hypotension too long)
What can occur physiologically with the patient?
Myocardial depression can occur → leading to hypotension (burn shock) & edematous (burn edema)
In general, when we have a burn patient, what 4 things must we consider?
Severity (based on depth, extent, location)
Associated injuries & trauma (smoke inhalation, CO poisoning)
Other comorbidities/psychological impact
Always consider abuse
Name the 3 layers of the skin from outermost to innermost?
Outer = epidermis
Middle = Dermis
Innermost = Hypodermis (adipose/connective tissue)
What are the 5 levels for depth of burn injury?
Superficial; Superficial partial thickness; Deep partial thickness; Full thickness; 4th degree burn
If a patient has a dry, red, painful burn without any blisters & it blanches without pressure – what level, what layer of skin, and how is the Tx prognosis?
Level = Superficial Layer = Epidermis Tx = Heals 4-7 days without scarring
If a patient has a red, moist, and painful burn, you do notice blistering & it blanches – what level, what layer of skin, and how is the Tx prognosis?
Level = Superficial partial thickness Layer = Epidermis and extends into the dermis Tx = Heals 14-21 days without scarring
If a patient has a whitish burn that is not overly painful that lacks blanching but pressure is felt – what level, what layer of skin, and how is the Tx prognosis?
Level = Deep partial thickness Layer = Epidermis and DEEPER into the dermis Tx = Healing may take 21 days – 3 months; scarring is common
If a patient presents with waxy white/leathery looking burn, that is absolutely painless (except the surrounding areas) – what level, what layer of skin, and how is the Tx prognosis?
Level = Full thickness Layer = Extends through the dermis into subQ tissues Tx = Will NOT heal with skin grafting
If a patient has burn that extends into the fat & muscle – what level and how is the Tx prognosis?
Level = 4th degree burn
Tx = May require amputation
We will always want to re-evaluate the burn depth after 24-72 hours; but what special circumstances will it be essential to re-evaluate in?
“Thin skin”; Age less than 5 or over 55; volar surface of arms, medial thigs, perineum, and ears
If the entire front of a person’s hand is involved in a burn – what %? What if it is front & back of the hand?
Front is 1%
Front & Back of hand is 2%
What else in the body accounts for 1% of total surface area?
Front of neck
Back of neck
Front of forearm
Back of forearm
Top of foot
Bottom of foot
Genitals
If a patients entire from of chest is involved in a burn - what %? What if it is the entire front & abdomen?
Chest = 13%
Chest & Abd = 18%
If an entire leg is involved in a burn – what %?
18% (9% for back & front)
If an entire arm is involved in a burn – what %?
9% (~4% front & back)
What are the 3 special considerations for burns that MUST be transferred to a burn center?
Circumferential burns (even is .1%)
Burns crossing joints
Burns involving face, hands, feet, genitalia, and perineum
Besides the 3 special considerations for burns that must be transferred to a burn center, when else would we refer to a burn center (the MAJOR criteria)?
Partial thickness burns >10% of BSA (>5% in kids)
ANY electrical or chemical burns
Burns associated with smoke inhalation
Burns in patients with pre-existing medical conditions that could complicate management
Burns + trauma (fracture)
Patients who require special social, emotional, or long-term rehab intervention
Children (unless your hospital is qualified)
If a patient has a full thickness burn covering less than 2% of BSA and they’re between the ages of 10-50, what category of burn are they?
Considered a minor burn & can be treated on an outpatient basis
What’s the best approach for treating a burn?
Cool immediately with room temp water
Pain management
Clean burns with mild soap/water
MIGHT drain a large blister if >2cm & is likely to rupture
Topical Abx (silver sulfadiazine if not under the age of 2)
Tetanus immunization of Ig
In the final stages of healing, what can a patient put on their burn?
Non-perfumed moisturizing cream (Vaseline, eucerin) – must avoid Lanolin
What is the basic dressing of a burn involve?
1st Abx ointment
2nd Non-adherent dressing
3rd Fluffed gauze
4th Elastic gauze – don’t forget to wrap fingers/toes individually!
When do you F/U with a burn pt?
24 hours
