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E-med exam 3 > Burns > Flashcards

Burns Flashcards

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
Q

1 death related to fires

A

Smoke inhalation

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26
Q

Types of inhalants

A

Smoke
Carbon Monoxide
Cyanide

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27
Q

Can you use Pulse Ox to monitor for CO poisoning?

A

NO

oximeter reads it as Oxygen

28
Q

CO poisoning

A

Measure Carboxyhemoglobin levels

Delayed neuro sx
Elderly pts
Prolonged exposure

29
Q

CN Cyanide poisoning

A

bitter almond odor

Sx: HA or AMS
Skin "Cherry red"
Hypotension
Arrhythmia
CVD collapse
Shock
30
Q

Tx for CN poisoning

A

Hydroxocobalamin (Cyanokit)

31
Q

What is Hydroxocobalamin (Cyanokit)?

A

Tx for CN toxicity

heme like molecule w complex cobalt atom

binds to CN forming Cyanocobalamin (Vit B12)

Renal excretion

32
Q

Sx of inhalation- upper airway

A

Hoarse
Stridor
Substernal retractions

33
Q

Sx of inhalation- lower airway

A

Tachypnea
Dec breath sounds
Wheezing/rales/rhonchi
Access muscle use

34
Q

Tx for inhalation

A 
Agress pulm toilet
Saline
Cuppling over anterior chest wall
Diaphragmatic breathing
Mechanical ventilation

PNA prevention and tx

35
Q

Intubate if history suggests these things:

A 
Closed smoke air exposure
Carbonaceous sputum
Facial burn
COhb >5
Hoarse voice
Singed face hair
36
Q

Circulation Resusc

A

Maintain tissue perfusion to END ORGANS

best way is to measure URINE OUTPUT

37
Q

Factors influencing fluid requirements

A 
Burn depth
Inhalation injury (can increase needs)
Delay in resusc
Compartment synd
Electrical burns
38
Q

Should you use diuretics with burns in Circulation Resuscitation?

A

NO, not indicated in acute setting

39
Q

Circulation

A

2 large bore IVs

40
Q

Burns >20 TBSA

A

require Parkland Resuscitation

41
Q

Rule of 9s

A

Each leg: 18
Each arm: 9
Trunk: 18
Head: 8

42
Q

Parkland formula for IVF tx after burn

A

4 mL x person’s body weight x TBSA

half given in first 8 hours

rest given in remaining 16 hours

43
Q

Risk of Under resuscitation

A

Intravascular volume depletion

44
Q

Risk of Over resuscitation

A

Abdominal compartment synd (then renal failure, intestinal ischemia, airway obstruction)

Compartment synd

Pulmonary edema

45
Q

Nutritional considerations with Adult burn covering >25% TBSA

A

Elevation in metabolic rate by 118% and 210% of predicted

46
Q

Nutritional considerations regarding RMR (resting metabolic rate)

A

180% of basal rate during acute admission

caloric needs may exceed 5,000 cal/day

47
Q

Nutritional deficiency risk

A

Impaired immunity

Delayed healing

48
Q

What type of nutritional support is NOT recommended?

A

Total Parenteral Nutrition (TPN)

impairs immunity and liver fx, inc mortality

49
Q

What type of feeding is better tolerated than gastric feeding?

A

Duodenal route

50
Q

High carb, low fat

A

May reduce Infectious morbidity

Shorten hospitalization time

51
Q

Protein needs are 1.5-2 grams /kg which is increased from the norm of

A

0.8

52
Q

Arizona Burn Center Referral Criteria

A

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
Q

Most common complication of burns

A

Infection

54
Q

What bacteria infect burns first?

A

Gram (+) first in 3-5 days

55
Q

Types of skin graft

A

Allograft

Xenograft

56
Q

Complications of burns

A

Abdominal compartment syndrome

Tetanus

57
Q

Abdominal compartment synd

A

Decrease UOP
Elev bladder pressure
Inc Peak exp pressure
Poor ventilation

58
Q

Monitoring for Abd compartment synd

A

Hourly bladder pressure
Decrease IVF
CRRT prn
Possible intraperitoneal catheter for decompression

59
Q

Tx for Abd Compartment synd if unable to reverse

A

Decompressive Laparotomy

60
Q

Tetanus

C. Tetani
Anaerobic, motile, gram (+)

Oval, colorless, terminal spore

A

Resistant to disinfectants and boiling for 20 min

More severe clinical course if symptomatic in the first week

61
Q

Most common manifestation of Tetanus from

A

Minor wound from wood, metal splinter, or thorns

62
Q

Sx of Tetanus

A

Sore throat
Dysphasia

Localized vs Generalized (trismus, lockjaw”

63
Q

How long does it take for Tetanus sx to extend to extensor muscles of the extremities?

A

24-48 hours

64
Q

Wounds prone to Tetanus infection

A 
Present for longer than 6 hours
Deep >1cm
Grossly contaminated
Exposed to salive/feces
Avulsion, puncture, Crush injury
BURNS
Compl of abscess/gangrene
65
Q

Chronic complication of burn

A

Chronic ulcer
Scar contracture
Hypertrophic scarring

66
Q

Major concern with chronic ulceration is formation of

A

Marjolin ulcer- rare aggressive type of skin CA

E-med exam 3 (5 decks)

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