Burns A&B

Question 1

1 pediatric burn type

Answer 1

Scalding

In kitchen or bathroom

Question 2

Depth of burn may not be observable

Answer 2

For 3-5 days

Question 3

Burn depth assessment

Answer 3

Cause
Appearance
Sensation
Blanching
Hair follicle viability

Question 4

Burn depth classification

Answer 4

Superficial
Superficial partial thickness
Deep partial thickness
Full thickness

Question 5

Superficial (1st degree) burn

Answer 5

Damage of epidermis
Dry, red, blanches
Painful
Resolves in 3-6 days w/out scarring

Question 6

Superficial partial thickness (superficial 2nd degree) burn

Answer 6

Damage into papillary dermis
Blisters
Moist, red, weeping, blanches
Sever pain to touch 
Resolves in 1-3 weeks

Question 7

Deep partial thickness (deep 2nd) burn

Answer 7

Damage into reticular dermis, most skin appendages destroyed
Blisters
Wet or dry waxy w/ poor blanching
Decreased sensation to light touch but intact to deep pressure
Usually scars, likely to need surgical incision and possibly grafting

Question 8

Full thickness (3rd degree) burn

Answer 8

Damage into subcutaneous tissue
Waxy white to leathery dry and inelastic
Does not blanch
Absent sensation to light pressure, intact to deep pressure
Will need sx excision and grafting

Question 9

Fourth degree burn

Answer 9

Damage into fascia, muscle and/or bone
Usually eschar
Pain w/ deep pressure
Will need sx

Question 10

%TBSA - burns

Answer 10

% total body surface area
Rule of nines
Lund browder-more accurate

Question 11

Burns - rule of nines

Answer 11

Based on an atomic region
Burn area is calculated to estimate the exten of injury and prognosis
Superficial burns are not included in calculation
Less accurate for children

Question 12

Burn classification by TBSA - minor

Answer 12

2nd degree 15% in adult
2nd degree 10% in child
3rd deg 2%

Question 13

Burn classification by TBSA - moderate

Answer 13

2nd degree 15-30% in adult
2nd degree 10-30% in child
3rd deg 2-10%

Question 14

Burn classification by TBSA - major

Answer 14

Critical 
2nd degree >30% in adult
3rd degree >10% 
Burn complicated by inhalation injury 
Electrical burn

Question 15

Burns -critical area

Answer 15

Face
Hands
Feet
Genitalia
Perineum
Joints
Ears/eyes

Question 16

Thermal burns

Answer 16

Flame
Scald
Radiation

Question 17

Chemical burns - effects

Answer 17

Tissue damage may continue until chemical is inactivated
May become flammable, causing additional thermal burns
Often full thickness

Question 18

Chemical burns - first aid

Answer 18

Usually copious irrigation
Phenols are irrigated w/ polyethylene glycol
Keep victim warm/calm, monitor vitals often
Monitor vitals frequently

Question 19

Electrical burns can cause

Answer 19

Cardiac arrhythmia
Respiratory arrest
LOC
Seizures
Tetany of skeletal muscles
More severe in extremities
May cause CRPS/other NS disorders

Question 20

Burn like conditions

Answer 20

Stevens-Jonson syndrome - Toxic epidermal necrolysis syndrome: variants of same condition

Other exfoliating skin conditions
Frostbite

Question 21

SJS/TEN

Answer 21

Reaction to medication, 1-3 weeks after starting
Fever—>sore throat, HA, couch
Rash begins, progress to blisters
Diffuse skin necrosis and detachment
Skin exfoliation
Mucous membrane Bullae and sores
May cause sepsis and death
1-14 days active skin rash and skin loss

Question 22

Burns and hemodynamics-injury

Answer 22

Histamine release
Capillary permeability increase
Plasma protein leak out, pulled out
Hypovalemia 
Decreased BP
Vasoconstriction and increased HR

Question 23

Burns - respiratory

Answer 23

Smoke inhalation
Damage to airways and lungs
CO inhalation —> blood, hypoxia, confusion, brain damage
24-48 hours to develop

Question 24

Pt w/ central facial burns

Answer 24

Should be evaluated for hospital admission

Question 25

Burn - respiratory - neck or chest eschar

Answer 25

May cause restricted chest expansion | Eschar onto my or fasciotomy may be required

Question 26

Burns - respiration - Pulm edema

Answer 26

Fluid rescucitation may cause fluid overload May be candidate for hyperbaric oxygen Pt will be monitored in burn unit for respiratory changes during fluid rescuscitation

Question 27

Burns - renal

Answer 27

Urine output closely monitored, generally 30-50 ml/hr Due to decrease in circulation and BP, kidney fix decrease in burn injury Glomerular filtration rate decreases, then will return to normal w/ adequate fluid resuscitation

Question 28

Burns - renal failure

Answer 28

``` Uncorrected burn shock Hemorrhage Electrolyte imbalance Sepsis CHF ```

Question 29

Burns - GI

Answer 29

Fluid resuscitation Early enteric nourishment w/ staged food intake Mobility Abx use alteration of bacterial flora in intestines

Question 30

Burns - metabolism

Answer 30

Burn trauma increases metabolic demands Ketoacidosis Rapid weight loss Nutritional supplements, close nutritional monitoring to promote burn healing

Question 31

Most common cause of mortality in burn pts

Answer 31

Infection

Question 32

Key to preventing infection - burns

Answer 32

Isolate burn pts to reduce hospital aquifer infections Staff wear protective garments Sterile procedures

Question 33

Burn survival rate estimate - revised baux score

Answer 33

% mortality = pt age + %TBSA (+17 for inhalation injury)

Question 34

Burn tx

Answer 34

``` Initial stabilization and triage Med management Local burn tx Moisture - tendons moist Rehab ```

Question 35

Initial burn tx

Answer 35

Stabilize airway, breathing and circulation -check of resp distress and evidence of smoke inhalation Check carotid pulse Eval depth and extent of burn injury Remove all burned clothing and foreign material Transfer to burn unit f needed Appropriate abx dressing as needed

Question 36

Fluid resuscitation for burns

Answer 36

W/in 2 hours for burns >20% TBSA, use parkland or brooke formula

Question 37

Burn admission criteria

Answer 37

<10% TBSA 3rd degree, electrical, chemical Inhalation Will require social/emotional or long term rehab Comorbidities that complicate management W/ concomitant trauma In children where pediatric care is not available

Question 38

Local burn tx

Answer 38

``` Debridement if necrosis present Appropriate dressings Negative pressure wound therapy as needed Biosynthetic dressings Skin grafting ```

Question 39

Biobrane - pros

Answer 39

``` Biosynthetic dressing Non reactive Readily available for burn centers Less pain for pt Spares skin grafts ```

Question 40

Biobrane cons

Answer 40

Very extensive

Question 41

SJS

Answer 41

<10% TBSA | Death rate 1-5%

Question 42

TEN

Answer 42

``` >30% TBSA Death rate 25% in adults Large amount of fluid and electrolyte loss Infection risk Possible organ failure ```

Question 43

Respiratory effects of hot air, hot steam

Answer 43

Larynx Laryngeal obstructure Bronchospasm

Question 44

Respiratory effects of smoke, hot particles, aspiration

Answer 44

``` Trachea Mucosal slough Infection Bronchiolar plugging Atelectasis Bronchospasm ```

Question 45

Respiratory effects of irritant gases

Answer 45

Primary and secondary bronchus Pneumonia Pulmonary edema Alveolar capillary defect

Question 46

Common burn dressings

Answer 46

``` Silver sulfadiazene w/ gauze or ab bands Made idle acetate w/ gauze/ ab pads Xeroform Silver foam Nanocrystalline silver Silver hydrofiber Hydrogel sheer dressings w/ or without silver ```

Question 47

Burn dressings w/ better outcomes than silver sulfadiazene

Answer 47

Silver Biosynthetic Silicone Hydrogel dressings

Question 48

Features of non contracted group

Answer 48

``` Male Educationed Few associated physcial, medical, social problems Longer length of stay than expected Received rehab 80% of hospital days High pain tolerance Compliant w/ rehab ```

Question 49

Splint position - neck

Answer 49

Netural/slight ext No pillows unless burn on posterior of neck Tilt head laterally to opposite side if burns are one side of neck Neck conformers bust bein full contact w/ neck

Question 50

Splinting chest/ab

Answer 50

Trunk ext, shoulder retraction Lower top of bed, towel roll beneath spine, clavicle staps

Question 51

Splinting - shoulder

Answer 51

Flexion/ab 90-100 Horizontal add 20, ER

Question 52

Splinting elbow/forearm

Answer 52

Full ext, forearm neutral

Question 53

Splinting wrist/hand

Answer 53

Wrist ext 15-20 deg MP flex 70-90, PIP DIP full ext Thumb radial ext, palmar ab

Question 54

Burn position - hip/thigh

Answer 54

0 flex 0 rotation 15-20 abd Elevate w/ pillows Pillows b/n knees Wedges

Question 55

Burn position - knee

Answer 55

Full ext | Ant burn: slight flex

Question 56

Splinting ankle/foot

Answer 56

Neutral assignment b/n 90 or greater DF AFO

Question 57

Burn rehab - acute

Answer 57

PROM/AROM daily Exercises to unaffected area Bed mobility, transfers, standing, gait Consistent w/ therapy 1-2/day Teach educate train

Question 58

Immobilize grafted areas

Answer 58

4-5 days, until takedown and receive order from surgeon | Get clear orders regarding mobility immediately after grafting