Burns Flashcards by Anna Logan

What are the burn statistics?

Gender
Ethnicity
Cause
Place of occurence

Male

Caucasian 20-60 y/o

Fire/flame > scald> contact > electrical > chemical

Home > occupational > street/hwy

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Name the types of burns (7)

Fire/flame
Scald
Steam
Gas
Electrical
Flash
Chemical

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The more viscous the scald type burn, the more significant the damage. True or false?

true

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What is the significance of a burn caused by steam?

Can cause thermal injury to the distal airways of the lung.

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What is the risk related to a gas type burn?

The upper airway is at risk for thermal injury and subsequent occlusion due to edema.

Distal airway injury is more likely to be due to the direct effects of the products of combustion on the mucosa and alveoli.

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What is the voltage needed to create a deep tissue electrical burn?

How does the injury appear?

What is the voltage needed to burn children?

1000 Volts

The injury is normally deep to the skin.

Children can have significant injury between 200-1000V.

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What type of burn involves only the epidermis causing erythema?

First degree burn

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Alkaline substances and acidic substances can burn the skin and can be associated with systemic toxicity describes this type of burn.

Chemical burn

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What type of burn?

partial/superficial or deep
blistering
painful
heal well on own

Second degree burn

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How is a third degree burn defined?

full thickness burn with loss of epidermal/dermal elements

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How do we determine the extent of burn injury? (3)

Rule of Nines

Palm

Lund Browder

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How are the 9’s distributed when assessing burn area?

Head, chest, abdomen = 9%

Each leg = 9%

Each arm = 4.5%

Pubic = 1%

Posteriorly, do not add the head again.

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What criteria does the palm method for assessing burn area use?

Pt’s own palm = 1%

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When is the Lund Browder method for assessing burns most often used?

children

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What is rapidly assessed for when there is a burn injury?

Is there smoke inhalational injury???

Edema can form RAPIDLY preventing successful intubation.

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What can inhalational injuries be caused by? (2)

thermal lesions

exposure to toxic fumes

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EXAM

What are signs/symptoms correlating to inhalational injury? (8)

Stridor
Hoarseness
Use of accessory muscles , increased WOB
Facial burns
Singing of eyebrows
Soot or redness of mucosa in mouth/pharynx
Carbonaceous sputum
Accident occurred in confined space

What is the function of skin? (5)

Protection
Regulate body temperature
Eliminates some wastes
Make Vit D
Detect touch, pain, warmth, cold

What are important points to remember regarding pathophysiology of capillaries? (5)

Capillaries are normally impermeable to proteins.

Lymphatic fluid increased in burn pts.

Body releases histamines, cytokines, and inflammatory agents increasing capillary permeability.

Endothelial cells slide apart.

Fluid accumulation occurs in unburned tissues.

What is escharotomy?

Surgical cuts are made to prevent compartmental syndrome–buildup of fluid.

What other pathophysiological changes may result from burn trauma? (4)

Decreased surfactant

Decreased macrophages to rid of wastes.

Increased neutrophils to prevent infection.

Edema may develop within minutes to 24 hours!

Sloughing of mucosal surface, decreased ciliary function result in decreased airflow and gas exchange. True or false?

true

A picture of distal bronchus.

How is carbon monoxide formed?

combustion of flammable materials

Carboxyhemoglobin will look like regular Hb so looking at O2 saturation in burn pt will be skewed. True or false?

true

Carboxyhemoglobin hinders the delivery of oxygen to body cells which leads to hypoxia. True or false?

true

What kills most people at the site of a fire?

CN toxicity!!! | (Cyanide)

You must order a special blood gas for carboxyhgb called HbCO. True or false?

true

What is the Baux score a function of and when is it used?

function of age + BSA Used for large BSA burns.

A Baux score of 80 is associated with death in 50% of cases. True or false?

False, 110

Inhalational injuries increases the Baux score \_\_\_\_-fold to that of a comparably sized thermal injury or adds ___ years to a Baux score.

10 17

What other factors increase the Baux score? (2)

preexisting comorbidities concurrent trauma

EXAM What is the treatment for burn patients? (6)

1. Aggressive fluid resuscitation 2. Monitor urine output 3. O2 therapy, +/- intubation 4. Escharotomy (preventing restriction of breathing/compartment syndrome) 5. Antibiotic treatment 6. Debridement within a few days to prevent sepsis

What is the most popular fluid resuscitation formula used?

Parkland formula says give crystalloid in 1st 24 hrs.

EXAM What information do you need to obtain in pre-op? (5)

Preexisting issues Labs Respiratory status/vent requirements Drips/drugs Current hemodynamics

EXAM What must be available in the OR prior to patient arrival?

Blood needs to be in the OR prior to the case. Room MUST be warm! Use underbody warmers.

What are anesthetic considerations during the perioperative period? (5)

Tailored to your situation, are you worried about difficult a/w Profound hypovolemia/sepsis NO SUX 8 hours - 2 years post burn NMBs wear off fast due to decreased sensitivity Increased narcotic requirement!

Why do we prohibit the use of Sux 8 hrs to 2 YEARS post-burn?

Increased ACh density which continues to be abnormally elevated for a while.

What are questions to ask yourself during the perioperative period? (7)

Adequate IV and arterial access? Are you staying on top of blood loss? You will quickly be behind. Need FFP? Pt. warm? Epi-soaked laps being used? They're cold! What will the narcotic need to be? Will you be able to extubate?

Estimates say \_\_% of blood volume may be lost for each % of BSA excised.

2% per 1% BSA excised.

What multi-organ system issues do we need to consider? CV Hematologic Renal GI

Increased metabolism increases cardiac demand. Coagulopathy/hypercoagulable state may be present. Inadequate fluid resuscitation may cause renal issues. GI --\> Curling's Ulcers (spont. ulceration of stomach lining, more rare now, but NO NSAIDs in these pts.)