Burns

Question 1

What age range is at the highest risk of burns?

Answer 1

18-35 y/o

Question 2

Are males or females more likely to have a burn? At what ratio?

Answer 2

Males, 2:1

Question 3

What age range is at the highest risk of scalds from hot liquids?

Answer 3

1-5 y/o

Question 4

Burn injury historically carries a (good/poor) prognosis

Answer 4

Poor

Question 5

Advances in ____ ____ and early excision of wounds has greatly increased survival. Early ____ ____ is very important and referral to _____ is key!

Answer 5

fluid resuscitation; fluid resuscitation; specialized burn center

Question 6

What are the two specialized burn centers in NC?

Answer 6

NC Burn Centers: Wake Forest and UNC Chapel Hill

Question 7

What are the four types of burns? How are they acquired?

Answer 7

Thermal: Scald and Fire injuries, Hot water/grease, smoke inhalation
Electrical: Lightning, household electricity
Chemical: Acids and Alkalis
Radiation: Sunburns

Question 8

What are four crucial assessments that must be made on every burn victim?

Answer 8

Airway management
Evaluation of other injuries
Estimation of burn size (Burn Depth and %BSA)
Dx of CO and cyanide poisoning (Look for soot in the airway, etc)

Question 9

You should have a low threshold for intubation when it comes to burn victims. Some indications that you should intubate a burn victim include ____, ____, and ____.

Answer 9

Suspect airway injury, full thickness burns to face/mouth, circumferential chest burns

Question 10

Direct thermal injury to the upper airway (smoke inhalation) can cause rapid and severe _____ _____ (as a reaction to foreign particles). ____ ____ and ________ are signs of this. Also, be sure to note any presence of a ____ voice, _____/_____, or _____.

Answer 10

airway edema; Perioral burns and singed nasal hairs are signs of this
Note hoarse voice, wheezing/stridor, dyspnea

Question 11

Should you consider burn patients as trauma patients?

Answer 11

Yes!

Question 12

In a burn victim, you should place ______ and begin _____ as soon as possible.

Answer 12

2 large bore IVs

Fluids

Question 13

If a pt has burns all over their arms, you may need to place a _______

Answer 13

central line to establish IV access

Question 14

(Hypothermia/Hyperthermia) is common in pre-hospital pts

Answer 14

Hypothermia

Question 15

T/F You should transfer a burn victim in clean, damp, blankets to best protect their skin

Answer 15

False, they should be clean and DRY

Question 16

In a stable burn victim, what are we most concerned about treating?

Answer 16

their pain and anxiety

Question 17

Is there a need for prophylactic abx tx in burn victims?

Answer 17

No

Question 18

In burn victims, it is important to administer a ______

Answer 18

tetanus booster

Question 19

If a topical abx were needed for better burn protection, what would be a good option?

Answer 19

Cephalexin

Question 20

Why do burn victims suffer increased fluid losses?

Answer 20

Burns cause increased fluid losses due to heat and loss of a protective skin barrier
The burn or inhalation drives an inflammatory response that leads to capillary leakiness and thus intravascular fluid loss

Question 21

Define a thermal burn

Answer 21

Type ofburnresulting from making contact w/ heated objects
Ex: boiling water, steam, hot cooking oil, fire, and hot objects
Related to structural fires and associated inhalation/CO poisoning

Question 22

What is the most common type of burn in pediatric pts?

Answer 22

Scalding, which could be a signifier of abuse (also hot bathtub water)

Question 23

What is the most common cause for hospital burn admissions?

Answer 23

Flames

Question 24

Match the following descriptions of burns with their names (Superficial/1st degree, Partial-thickness/2nd degree, Full thickness/3rd degree, 4th degree)

A. Life-threatening: may extend into tissue, fascia, muscle bone, organs; multiple surgeries usually required.
B. Painless, non-blanching, does NOT spontaneously heal; Skin grafts.
C. Only epidermal layer. Dry, red, painful, blanching. Typically heals in 3-6 days. NO blisters.
D. Takes ~3-8 weeks to heal. Blisters.

Answer 24

4th degree = Life-threatening: may extend into tissue, fascia, muscle bone, organs; multiple surgeries usually required.

3rd degree = Painless, non-blanching, does NOT spontaneously heal; Skin grafts.

1st degree = Only epidermal layer. Dry, red, painful, blanching. Typically heals in 3-6 days. NO blisters.

2nd degree = Takes ~3-8 weeks to heal. Blisters.

Question 25

Burns typically evolve over ___-___ hours after injury which complicates ability to predict healing

Answer 25

48-72 hours

Question 26

How long does it typically take for a 1st degree burn to heal? Superficial 2nd degree? Deep 2nd degree? 3rd? 4th? Scar or no scar?

Answer 26

1st degree: 7 days, no scar 2nd degree (superficial): 14-21 days, no scar 2nd degree (deep): 3-8 weeks, scar 3rd degree: months, severe scar 4th degree: months, multiple surgeries required

Question 27

What is the first triage tx that should be performed in pts?

Answer 27

Lukewarm sterile water irrigation, administer pain medications as necerssary (i.e. Tramadol)

Question 28

If a pediatric burn victim has ____% BSA affected, they should be referred

Answer 28

>10%

Question 29

How do you estimate burn size? (hint: it is a 'rule')

Answer 29

The Rule of Nines

Question 30

In adults, anterior and posterior trunk account for ___% BSA, each lower extremity ___%, each upper extremity ___%, and head ___%. In peds ____ y/o the head accounts for larger surface area.

Answer 30

In adults anterior and posterior trunk account for 18%, each lower extremity 18%, each upper extremity 9%, and head 9%. In peds < 3 y/o the head accounts for larger surface area.

Question 31

______ burns are NOT included in the rule of nines, so make sure to thoroughly clean the skin to avoid confusion.

Answer 31

Superficial/1st degree

Question 32

Data suggests inexperienced providers (underestimate/overestimate) size of small burns and (underestimate/overestimate) large burns

Answer 32

Data suggests inexperienced providers overestimate size of small burns and underestimate large burns

Question 33

IV fluids typically given for burns ____% BSA

Answer 33

>10% BSA

Question 34

The tough leathery tissue remaining after a full-thickness burn is called _____

Answer 34

Eschar

Question 35

Describe an escharotomy. What can it be used for?

Answer 35

An escharotomy is performed by making an incision through the eschar to expose the fatty tissue below. It can be performed as a prophylactic measure as well as to release pressure, facilitate circulation, and combat burn-induced compartment syndrome.

Question 36

What is the Parkland formula (used in fluid replacement for thermal burn victims)?

Answer 36

LR 4cc x wt (kg) x %BSA = amount given in 24 hours | Half over first 8 hours, half over subsequent 16 hours

Question 37

LR maintains a more stable ______ than NS in long term resuscitation

Answer 37

Blood pH

Question 38

LR contains less ____ and ____ than NS because large amounts of NS could cause _________.

Answer 38

Na+ and Cl-; hyperchlorermic acidosis

Question 39

``` One liter of Ringer's Lactate solution contains: ___ mEq of sodium ion = 130 mmol/L ___ mEq of chloride ion = 109 mmol/L ___ mEq of lactate = 28 mmol/L ___ mEq of potassium ion = 4 mmol/L ___ mEq of calcium ion = 1.5 mmol/L ```

Answer 39

``` 130 mEq of sodium ion = 130 mmol/L 109 mEq of chloride ion = 109 mmol/L 28 mEq of lactate = 28 mmol/L 4 mEq of potassium ion = 4 mmol/L 3 mEq of calcium ion = 1.5 mmol/L ```

Question 40

In the treatment of thermal burns, are prophylactic abx recommended?

Answer 40

No. Prophylactic antibiotics are not given

Question 41

How often should dressings be changed on thermal burns?

Answer 41

Dressings should be changed twice daily

Question 42

In a pt with a thermal burn, you should treat their pain and administer what vaccination if not UTD (up to date)?

Answer 42

Tetanus

Question 43

T/F Silver sulfadiazine (Silvadene) is the most widely used tx for thermal burns

Answer 43

True

Question 44

Silvadene is primarily used as (prophylaxis/tx) for active infection

Answer 44

Prophylaxis

Question 45

Silvadene is not significantly absorbed, but you should still use caution in pts with what type of allergy?

Answer 45

Sulfa Allergic Patients

Question 46

Can Silvadene be used in pts with skin grafts?

Answer 46

No! It DESTROYS skin grafts!

Question 47

In pts with smaller thermal burns, you may use Bacitracin and Neosporin topically, but you should not use Bacitracin or Neosporin in large burns due to what concern?

Answer 47

Nephrotoxicity

Question 48

Is wound debridement always recommended?

Answer 48

No, it is controversial

Question 49

The antibiotic ______ is considered 1st line for tx of cellulitis

Answer 49

Cephalexin

Question 50

Surgery indicated typically for burns not expected to heal within how many weeks?

Answer 50

2 weeks

Question 51

Full-thickness burns with a rigid eschar can cause a ______ effect as edema progresses, which may lead to _________, which is most common in burns on the ______, _____, and _____.

Answer 51

Tourniquet; Compartment syndrome; extremities; abd; thorax

Question 52

What is the recommended tx for an eschar?

Answer 52

Escharotomy, which is performed at bedside

Question 53

The best graft sites include.... What are the best sites for the elderly? For infants/children?

Answer 53

Thigh Thicker skin of back (older pts) Buttocks (infants/children) Scalp

Question 54

_________ grafts are the most common type of skin graft

Answer 54

Split thickness (autografts)

Question 55

Permanent synthetic skin substitutes are (uncommon/common) and may be used in combination with autografts

Answer 55

Uncommon

Question 56

Most chemical burns are caused by _____ and _____

Answer 56

Acids and alkalis

Question 57

T/F Never neutralize acid w/base or vice versa

Answer 57

True

Question 58

How common are chemical burns in comparison to other types of burns? Are they usually mild/moderate/severe?

Answer 58

Less common, but severe

Question 59

____% of all burn center admissions are result of chemical burns

Answer 59

10%

Question 60

In order to properly tx a pt with a chemical burn, what should you do?

Answer 60

CAREFULLY remove the substance: Remove clothes and brush away chemical Copious irrigation with water Wound care and Tetanus

Question 61

Where are a lot of chemical burns seen? How should you assess this type of chemical burn?

Answer 61

Chemical burns are commonly seen in the eye; you should stain it and look for damage

Question 62

Electrical burns make up ___% of admissions

Answer 62

4%

Question 63

Electrical burns are typically seen at what areas?

Answer 63

Areas of electrical contact

Question 64

T/F Electrical burns need admission and care by burn specialist

Answer 64

True

Question 65

What are potential complications of electrical burns?

Answer 65

Cardiac arrhythmias, compartment syndrome, and rhabdomyolysis

Question 66

If a pt presents with entry and exit wounds, you would expect that this injury was obtained via (AC/DC) current. If a pt presents with contact wounds c/o sustained muscle spasms, you would expect for this injury to have been obtained via (AC/DC) current.

Answer 66

DC; AC

Question 67

Electrical burns often cause extensive deep tissue damage to what type of tissues? Examples?

Answer 67

electrically conductive; such as muscles, nerves, and blood vessels

Question 68

Do patients with electrical burns typically have copious or minimal cutaneous injury?

Answer 68

minimal

Question 69

______ injury increases mortality in burn patients

Answer 69

Inhalation

Question 70

In a pt with an inhalation injury, how would we expect the pt obtained an upper airway injury? Lower airway injury?

Answer 70

``` Direct heat (upper airway) Inhalation of combustible products (lower airway) ```

Question 71

What are some examples of signs and sx of smoke inhalation?

Answer 71

Cough, wheezing, nares with singed hair, soot in mouth/nose, hoarseness, HA

Question 72

What is the recommended tx for pts with inhalation injury?

Answer 72

Fluids and supportive care (oxygen, possible intubation, bronchodilators, etc)

Question 73

T/F Inhalation injury is commonly obtained via a fire in an open space

Answer 73

False; Fire in an enclosed space

Question 74

Direct inhalation injury causes swelling that is generally worse in the first ___-___ hrs

Answer 74

24-48 hours

Question 75

Combustibles can cause what types of injuries/complications if inhaled?

Answer 75

mucosal injury, bronchoconstriction, obstruction

Question 76

What is a potential consequence of smoke inhalation injury?

Answer 76

CO poisoning

Question 77

T/F CO poisoning contributes to early mortality from smoke inhalation

Answer 77

True

Question 78

CO has an affinity for hemoglobin that is ___-___ times (lower/higher) than that of oxygen, which can lead to _____.

Answer 78

200-250 times higher; anoxia/death

Question 79

What are potential signs and sx of CO poisoning?

Answer 79

Headache, lightheadedness, dizziness, confusion, tachypnea, hypoxia

Question 80

If you suspect a pt has CO poisoning, what PE should be performed? Labs/imaging?

Answer 80

Neuro exam very important | Consider CXR and CO levels

Question 81

How do you tx a pt with CO poisoning?

Answer 81

High flow O2 administration of 100% O2

Question 82

How do you tx a pt with CO poisoning?

Answer 82

High flow O2 administration of 100% O2

Question 83

_________ toxicity is also a risk of smoke inhalation, and has been described as being mostly odorless, but with a slight _____ odor.

Answer 83

Hydrogen cyanide; burnt almond

Question 84

Hydrogen cyanide poisoning should be considered with a pt has sx of CO poisoning but has a normal _______ level

Answer 84

carboxyhemoglobin

Question 85

High flow O2 reduces the half life of CO from _____ mins to ___-___ mins

Answer 85

250 minutes; 40-60 minutes

Question 86

Children ____ y/o and adults ____ y/o are considered high risk burn patients and should be referred to and admitted to a burn center right away

Answer 86

Children <10 y/o and Adults >50 y/o are considered high risk patients

Question 87

There are many guidelines for when to refer a pt to a burn center. Some of them include the following: Partial-thickness burns ____% TBSA Burns involving the ____, ____, ____, ____, ____ or major ____ ____-degree burns in any age group

Answer 87

Partial-thickness burns >10% TBSA Burns involving the face, hands, feet, genitalia, perineum or major joints Third-degree burns in any age group

Question 88

There are many guidelines for when to refer a pt to a burn center. Some of them include the following: ______ burns (including _____ injury), _____ burns, _____ injury Burns in pts with complicated _______ Circumferential burns of _____ or _____ ______ pt in hospital without qualified ______ specialists Burn pts requiring special ____/_____ rehab

Answer 88

Electrical burns (including lightning injury), Chemical burns, Inhalation injury Burns in pts with complicated comorbidities Circumferential burns of chest or extremity Peds pt in hospital without qualified peds specialists Burn pts requiring special social/emotional rehab

Question 89

What are the most important indicators for mortality in burn pts?

Answer 89

Age, burn size and inhalation injury

Question 90

Recent study of >68,000 burn patients found the highest predictors of mortality to be ____, ____, ____, ____, and ____.

Answer 90

``` Age % TBSA Inhalation injury Co-existent trauma PNA ```

Question 91

____ and/or ____ are recommended to burn patients to prevent functional loss

Answer 91

PT; OT

Question 92

_______ of the hand are a huge complication and liability in burn patients

Answer 92

Contractures

Question 93

What type of scarring is common in burn patients?

Answer 93

Hypertrophic

Question 94

What type of rehab is extremely important in burn pts? Why?

Answer 94

Psychological; Depression, PTSD, body image concerns, return to work…