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E-med exam 3 > Burns > Flashcards

Burns Flashcards

(66 cards)

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1
Q

Superficial 1st degree burn

A

Sunburn
Mild scald
Mild electrical burn

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2
Q

Superficial 1st degree burn

A

Red, dry, painful
Blanch w pressure

NO blisters

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3
Q

Superficial 1st degree burn course

A

Pain and red resolves in 2-3 days

Peel day 4

Heal in 7 days without scarring

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4
Q

Superficial 1st degree burn tx

A

Room temperature water- no longer than 5 min

Topical aloe or polysporin, OTC pain med, Tetanus

Dressing not needed

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5
Q

2nd degree burns have two types: superficial and deep

A

Partially extends into dermis- minimal to severe scarring

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6
Q

Partial thickness/ 2nd degree burn

A

Pink, moist, blisters
Blanch

heal in 1-3 weeks

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7
Q

Deep 2nd degree burns

A

Patchy white to red
Non blanching
blisters

heal in 2-9 weeks

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8
Q

Deep 2nd degree burns

A

Hypertrophic scarring common

Joint dysfx

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9
Q

Partial thickness/ 2nd degree burn

wound care

A

Debride wound: goal is re-epitheliazation

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10
Q

Care for 2nd degree partial thickness (superficial)

A

Petrolium based moisturizer or Bacitracin

Occlusive dressing (Xeroform)

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11
Q

Care for 2nd degree partial thickness (deep)

A

Petrolium or Bacitracin and Occlusive dressing UNLESS Eschar is present

If Eschar: Silver sulfadiazine cream, cover w gauze, aggressive PT

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12
Q

Maintenance for 2nd degree partial thickness burn

A

Change dressing 1-2x daily, wash w soap and water

May need Opioids

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13
Q

3rd degree/full thickness burn

A

Eschar- skin charring

Dry, non blanching

hard, leathery texture

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14
Q

3rd degree/full thickness burn

A

requires Surgical repair and skin grafting

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15
Q

3rd degree/full thickness burn; WOUND CARE

A

Wash w soap, water
Silver sulfa cream
Surgical debridement adn wound closure

Opioids

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16
Q

Beyond full thickness, 4th degree burn

A

Involves: muscle, tendon, bone, blood vessel, nerve

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17
Q

Burns w complicated injuries

A

Chemical
Electrical
Lightning
Circumferential

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18
Q

Chemical burn; acute tx

A

Copious irrigation with WATER

do not try to neutralize
monitor progress with Litmus paper

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19
Q

Electrical burn; acute tx

A

FLUID RESUSC even small appearing injuries

Monitor for cardiac abn

May be much worse than it appears (injury hidden under skin)

Risk of RHABDOmyolysis

Muscle damage

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20
Q

Lightning burn

A

most deaths occur within 1 hr of injury

d/t ARRHYTHMIA or RESPIRATORY failure

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21
Q

Circumferential burns

A

High risk for COMPARTMENT SYNDROME

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22
Q

6 Ps of Compartment syndrome (risk with Circumferential burns)

A 
Pain
Paresthesia
Pallor
Paralysis
Poikilothermia
Pulselessness
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23
Q

Procedures for Circumferential burn

A

Escharotomy- cut thru burned SKIN to underlying subQ

Fasciotomy- cut thru FASCIA overlying muscle compartments

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24
Q

ABCs for burns

A

Airway
Breathing: 100% non rebreather
Circulation: 2 large bore IVs

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25
#1 death related to fires
Smoke inhalation
26
Types of inhalants
Smoke Carbon Monoxide Cyanide
27
Can you use Pulse Ox to monitor for CO poisoning?
NO | oximeter reads it as Oxygen
28
CO poisoning
Measure Carboxyhemoglobin levels Delayed neuro sx Elderly pts Prolonged exposure
29
CN Cyanide poisoning
bitter almond odor ``` Sx: HA or AMS Skin "Cherry red" Hypotension Arrhythmia CVD collapse Shock ```
30
Tx for CN poisoning
Hydroxocobalamin (Cyanokit)
31
What is Hydroxocobalamin (Cyanokit)?
Tx for CN toxicity heme like molecule w complex cobalt atom binds to CN forming Cyanocobalamin (Vit B12) Renal excretion
32
Sx of inhalation- upper airway
Hoarse Stridor Substernal retractions
33
Sx of inhalation- lower airway
Tachypnea Dec breath sounds Wheezing/rales/rhonchi Access muscle use
34
Tx for inhalation
``` Agress pulm toilet Saline Cuppling over anterior chest wall Diaphragmatic breathing Mechanical ventilation ``` PNA prevention and tx
35
Intubate if history suggests these things:
``` Closed smoke air exposure Carbonaceous sputum Facial burn COhb >5 Hoarse voice Singed face hair ```
36
Circulation Resusc
Maintain tissue perfusion to END ORGANS best way is to measure URINE OUTPUT
37
Factors influencing fluid requirements
``` Burn depth Inhalation injury (can increase needs) Delay in resusc Compartment synd Electrical burns ```
38
Should you use diuretics with burns in Circulation Resuscitation?
NO, not indicated in acute setting
39
Circulation
2 large bore IVs
40
Burns >20 TBSA
require Parkland Resuscitation
41
Rule of 9s
Each leg: 18 Each arm: 9 Trunk: 18 Head: 8
42
Parkland formula for IVF tx after burn
4 mL x person's body weight x TBSA half given in first 8 hours rest given in remaining 16 hours
43
Risk of Under resuscitation
Intravascular volume depletion
44
Risk of Over resuscitation
Abdominal compartment synd (then renal failure, intestinal ischemia, airway obstruction) Compartment synd Pulmonary edema
45
Nutritional considerations with Adult burn covering >25% TBSA
Elevation in metabolic rate by 118% and 210% of predicted
46
Nutritional considerations regarding RMR (resting metabolic rate)
180% of basal rate during acute admission caloric needs may exceed 5,000 cal/day
47
Nutritional deficiency risk
Impaired immunity | Delayed healing
48
What type of nutritional support is NOT recommended?
Total Parenteral Nutrition (TPN) impairs immunity and liver fx, inc mortality
49
What type of feeding is better tolerated than gastric feeding?
Duodenal route
50
High carb, low fat
May reduce Infectious morbidity Shorten hospitalization time
51
Protein needs are 1.5-2 grams /kg which is increased from the norm of
0.8
52
Arizona Burn Center Referral Criteria
Partial thickness > 10% TBSA 3rd degree Involve face, hands, feet, genitalia, perineum, or major joints Electrical burns Chemical burns Inhalation injury Pt with pre-existing condition Burn PLUS trauma Children in hospital without qualified staff Pts who require special social, emotional, or rehab intervention
53
Most common complication of burns
Infection
54
What bacteria infect burns first?
Gram (+) first in 3-5 days
55
Types of skin graft
Allograft | Xenograft
56
Complications of burns
Abdominal compartment syndrome Tetanus
57
Abdominal compartment synd
Decrease UOP Elev bladder pressure Inc Peak exp pressure Poor ventilation
58
Monitoring for Abd compartment synd
Hourly bladder pressure Decrease IVF CRRT prn Possible intraperitoneal catheter for decompression
59
Tx for Abd Compartment synd if unable to reverse
Decompressive Laparotomy
60
Tetanus C. Tetani Anaerobic, motile, gram (+) Oval, colorless, terminal spore
Resistant to disinfectants and boiling for 20 min More severe clinical course if symptomatic in the first week
61
Most common manifestation of Tetanus from
Minor wound from wood, metal splinter, or thorns
62
Sx of Tetanus
Sore throat Dysphasia Localized vs Generalized (trismus, lockjaw"
63
How long does it take for Tetanus sx to extend to extensor muscles of the extremities?
24-48 hours
64
Wounds prone to Tetanus infection
``` Present for longer than 6 hours Deep >1cm Grossly contaminated Exposed to salive/feces Avulsion, puncture, Crush injury BURNS Compl of abscess/gangrene ```
65
Chronic complication of burn
Chronic ulcer Scar contracture Hypertrophic scarring
66
Major concern with chronic ulceration is formation of
Marjolin ulcer- rare aggressive type of skin CA

E-med exam 3 (5 decks)

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