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SU-18 ER > Burns > Flashcards

Burns Flashcards

(45 cards)

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1
Q

larger mortality risk in

A
  1. large burn size
  2. older age/comorbid
  3. female
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2
Q

physiologic effect of thermal injury

A
  1. disruption of sodium/potassium pump
  2. depression of myocardial contractility
  3. increased SVR
  4. metabolic acidosis

ALSO increased H/H, secondary anemia, local tissue injury, release of substances

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3
Q

disruption of Na/K pump

A

direct damage to protein content of cell causes this to break down

intracellular influx of sodium and water

extracellular efflux of potassium

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4
Q

substances released

A 
histamine
kinin
serotonin
arachadonic acid 
free oxygen radicals
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5
Q

zones of burns

A
  1. coagulation
  2. stasis
  3. hyperemia
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6
Q

zone of coagulation

A

irreversible cellular death

vessels essentially destroyed

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7
Q

zone of stasis

A

tenuous state

stagnation of microcirculation

blockage of blood flow

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8
Q

zone of hyperemia

A

increased blood flow

generally spontaneous recovery = congestion

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9
Q

how to quantify size of burn

A

percentage of BSA using Rule of Nines

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10
Q

rule of nines

A

use palm of patient hand (1%)

head, arms (ea.) 4.5
torso, pelvis, legs (ea.) 9

genital is 1%

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11
Q

how do we classify burn depth?

A

according to surgical need

  1. superficial thickness
  2. partial thickness (superficial or deep)
  3. full thickness
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12
Q

superficial thickness burn

A

skin is red, painful, tender NO BLISTER

epidermis

tx: symptomatic, heal 7 days

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13
Q

leading cause of injury in fire patients

A

inhalation injury

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14
Q

partial thickness burn

A

epidermis + dermis

can be superficial or deep

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15
Q

superficial partial thickness burn

A

blistering of skin + sunburn

often 2/2 hot water

tx: surgical evaluation, debridement

heal 14-21 days, no scar

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16
Q

deep partial thickness burn

Caused by:

A

hot liquids, steam, grease and flames

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17
Q

deep partial thickness burn Treatment:

A

Surgical evaluation MUST be provided, debridement and grafting are likely

heal with scar

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18
Q

Full Thickness burn

A

Entire thickness of the skin- All epidermal and dermal layers, and their structure are GONE

Description: Charred, pale, insensate (painless) and leathery

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19
Q

Full Thickness burn Caused by:

Study These Flashcards
A

flames, hot oil, steam

20
Q

Full Thickness burn Treatment:

Study These Flashcards
A

Surgery, grafting guaranteed!

Specialized burn unit

significant scarring, prolonged healing time

21
Q

Fourth Degree: Full thickness+

Study These Flashcards
A

deeper than full thickness burns…extending into and through the subcutaneous fat, muscle and bone

life threatening and require reconsturciotn and amputation

22
Q

Burn Unit Referral Criteria (9)

Study These Flashcards
A
  1. Third Degree Burns (any age)
  2. Electrical Burns
  3. Chemical Burns

  4. Inhalation Injury

  5. Preexisting medical disorders
  6. Burn injury + trauma
  7. Children in hospitals w/o qualified personnel or equipment to care for children

  8. Patients who will require special social, emotional, or long-term rehabilitative intervention
  9. Burn injury in children < 10 y/o and adults > 50 y/o
23
Q

tx of moderate burn

Study These Flashcards
A

hospitalization

24
Q

tx of minor burn

25
causes of inhalation injury
closed space fire incapacitation exposure to smoke (particulates, heat, toxic gasses, unknown)
26
smoke and inhalation injury
particulate matter formed from incomplete combustion of organic substance ignite inflammatory response and edema
27
toxic inhalation list
1. toxic asphyxiants 2. pulmonary irritants 3. systemic
28
types of toxic asphyxiants (2)
1. carbon monoxide | 2. hydrogen cyanide
29
CO
causing CNS hypoxia and coma reduces airway protective measures = aspiration give oxygen to tx
30
HCN
wool, silk, polyurethane and vinyl binds and disrupts mitochondrial ox phos tx: hydroxycobalamin, amyl nitrate, sodium thiosulfate
31
inhalation injury patho
1. damage to endothelial cells = mucosal edema and decreased alveolar surfactant 2. bronchospasm and airway obstruction 3. epithelial sloughing and edema
32
labs for inhaled pt
ABG/VBG and Carboxygemaglobin levels
33
who do you intubate? (inhalation injury)
full thickness burns to face/perioral region circumferential neck burn ARDS progressive horness/signs fo distress respiratory depression or AMS supreaglottic edema and inflammation
34
pre-hopsital management
done by EMS est. airway transport pt promptly remove burning clothes/jewelry 100% humidified oxygen
35
ED management must review
AMPLE ``` allergies medications pertinent hx last oral intake events leading to injury ```
36
during which survey do you classify burn
during secondary survey may need NG tube, urinary Cath
37
diagnostics always done
XRAY (chest) ABG/VBG COHgB UA
38
tx for inhalation injury
100% humidified Oxygen intubation/ventilation bronchodilators and pulmonary toiling burn shock rescuitation formulate
39
what resuscitation formula do we use??
parkland -- universal standard
40
Parkland formula
24 hr fluid requirement = %TBSA burned x Weight in Kg x 4 mL
41
ABX and burn
NO systemic ANTIBIOTIC Prophylaxis for a minor burn, we can do topical
42
pain management in burn
tx symptoms directly with drugs burns are painful -- makes surrounding tissue more painful too (Hyperalgesia)
43
preferred route of pain management
IV/IO 2/2 onset of medication action AND poor GI absorption in PO
44
medications used in pain management
fentanyl/morphine/benadryl IV Ativan, versed NSAIDS
45
prepping pt for transport
do NOT delay transfer don't need to deride, dissect wound do not need to place stuff in wound since it will be reassessed

SU-18 ER (11 decks)

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