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Emergency Medicine > Burns > Flashcards

Flashcards in Burns Deck (23):
1

Highest Risk of Burns

Age: 18-35
Male > Female

2

Role of Skin

Semi-permeable barrier
Responsible for control of body temp

3

Cellular Changes Seen in Burns

Intracellular influx of Na/H20
Extracellular migration K
Disruption of cell membrane function
Failure of Na/K pump

4

Hematologic Changes in Burns

Increase in hematocrit
Increase in blood viscosity
Anemia due to RBC destruction

5

When does cell damage occur in burns?

113+ F
Denatures protein

6

3 Zones of Burns

Zone of coagulation
Zone of stasis
Zone of hyperemia

7

Zone of Coagulation

Irreversibly destroyed

8

Zone of Stasis

Stagnation of microcirculation
Will extend if not treated appropriately

9

Zone of Hyperemia

Increase blood flow

10

Burn Size

Rule of 9's
Lund and Browder diagram

11

Clinical Features of First Degree Burns

Erythema of skin
Minimal surrounding edema
Minimal pain

12

Clinical Features of Second Degree Burns

Partial thickness
Very deep sunburn
MUCH MORE painful than 3rd degree

13

Appearance of Skin in Second Degree Burns

Red/mottled
Blisters with broken epidermis
Considerable swelling
Wet/weeping surfaces
Painful
Sensitive to air

14

Clinical Features of Third Degree Burns

Damage to all skin layers
Subcutaneous tissues
Nerve endings

15

Appearance of Skin in Third Degree Burns

Pale white or charred
Leathery
Broken skin with fat exposed
Dry surface
Painless to pinprick
Edema

16

Inhalation Burns

Carbon around nose
Significant respiratory problems
Carbon monoxide exposure
CYANIDE
Intubate early

17

Chemical Burns

Alkali worse than acids
IRRIGATE

18

Electrical Burns

More serious than they appear
Deeper structures have more damage
Can cause rhabdomyolysis
Acute renal failure
Urine Output: 100+ mL/h
Mannitol

19

Management of Burns in the ED

ABCDE
Intubate early if airway involvement
2 large bore IVs
Secondary survey
Look for corneal burns
Estimate depth and extent of burn
BSA 20+% needs NG tube
Labs
Tetanus status
Remove jewelry
Monitor distal pulses
Foley
Pain control

20

Labs for Burn Victims

CBC
CMP
ABGs
Carboxyhemoglobin level
CXR
EKG
Urine myoglobin and CPK

21

Dressing for Burns

1% silver sulfadiazine (silvadene)
Re-evaluate q24h
Dressing changes BID until it stops wheeping

22

Guidelines to Transfer

Partial thickness of 10+%
Burns involving face, hands, feet, genitalia, perineum, or major joints
3rd degree burns
Electrical burns
Burn + complicating co-morbidities
Children

23

Esophageal Burns

Intubate early
Alkali worse than acid
Scope: stop at burn