Zone of coagulation Zone of stasis Zone of hyperaemia

Burns Case Conference Flashcards by Jodeci Malixi

% TBSA of burn when systemic response is triggered

30%

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3 cardiovascular effects

Increased capillary permeability
Peripheral and splanchnic vasoconstriction
Decreased myocardial permeability

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Respiratory effect

Bronchoconstriction

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Metabolic effect

Increased metabolic rate (up to 3x)

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Immunological effect

Non-specific down-regulation of the immune response (both cell-mediated and humoral)

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5 steps in initial burn management

Trauma primary survey
Secondary survey (history)
Estimate TBSA of burn
Estimate depth of burn
Burn fluid resuscitation

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Primary survey: ABCDE meaning

Airway
Breathing
Circulation
Disability (neurologic evaluation)
Exposure

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Jackson’s Burn Zones

Zone of coagulation
Zone of stasis
Zone of hyperaemia

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Define zone of coagulation

Point of maximum damage (initial point of burn) = irreversible tissue loss due to coagulation of constituent proteins

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Define zone of stasis

Zone of decreased tissue perfusion that is potentially salvageable at the periphery of the site of direct trauma

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Define zone of hyperaemia

Outermost zone where tissue perfusion is acutally increased and where tissue will invariably recover

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Define adequate and inadequate burn resuscitation based on Jackson’s burn zones

Adequate = zone of stasis preserved

Inadequate = zone of stasis lost

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Parkland Formula for fluid resuscitation

4 cc / kg / % TBSA = total fluid to be administered in the first 24 hours

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Purpose of Parkland Formula

ESTIMATION of fluid requirements in burn victim; should also monitor clinically

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Fluid administered in burn victims

Ringer’s lactate

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Reason for not using NS for burn victims

Risk of inducing a hyperchloremic acidosis

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How to clinically monitor fluid requirements

Monitor urine output by means of a Foley catheter and titrate fluids to achieve a specific urine output

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What % TBSA burns can be treated with oral fluids only?

<10 - 15% in children

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How to administer fluids to burn victims based on Parkland Formula

1/2 of fluid given in first 8 h

* 1/2 of fluid given in next 16 h

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Goal urine output in adults and in children burn victims

Adult = 30 cc/h
Children = 1 cc/kg/h

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2 goals of fluid resuscitation in burn management

1) Increase tissue perfusion in the zone of stasis in order to prevent irreversible tissue damage
2) Achieve enough volume to ensure end-organ perfusion while avoiding intracompartmental edema and join stiffness

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AMPLE trauma history meaning

Allergies
Medications
Past medical history
Last meal
Events

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Mechanisms of burn injury

Thermal (scals, flame, contact)
Electrical
Chemical
Cold exposure (frostbite)
Radiation burns

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Mechanism of injury often associated with inhalation injury

Flame

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Method to assess burn size

Standardized Lund-Bower diagram for 2nd and 3rd degree burns (NOTE: Do not include any 1st degree burns in calculation) May also use rule of 9's, but less accurate

%TBSA estimated by patient's palm + fingers

%TBSA of head and neck (rule of 9's)

%TBSA of trunk (rule of 9's; anterior AND posterior)

36% total (18% each side)

%TBSA of arms (rule of 9's)

9% each

%TBSA of legs (rule of 9's)

18% each

%TBSA of genitalia and perineum

Pathology of 1st degree burns

Involvement of epidermis only

Appearance of first degree burns

Dry, red and warm. Blanches to pressure. No blisters, no scarring once healed.

Sensation of first degree burns

Maybe painful

Healing time of first degree burns

Within 7 days

5 degrees of burns

* First degree * Superficial 2nd degree * Deep 2nd degree * Third degree * Fourth degree

Pathology of superficial 2nd degree burns

Involvement of epidermis and upper dermis; most adnexal structures intact

Appearance of superficial second degree burns

Pale pink. Smaller blisters. Wound base blanches with pressure

Sensation of superficial second degree burns

Increased; very painful and tender

Healing time of superficial 2nd degree burns

7 - 14 days

Scarring of superficial 2nd degree burns

Color match defect. Low risk for hypertrophic scarring

Pathology of deep 2nd degree burns

Involves epidermis and significant part of dermis. Only deeper adnexal structures intact

Appearance of deep second degree burns

Blotchy red or pale deeper dermis where blisters have ruptured

Sensation of deep 2nd degree burns

Decreased

Healing time of deep 2nd degree burns

over 21 days

Scarring of deep 2nd degree burns

High risk (up to 80%) of hypertrophic scarring

Pathology of 3rd degree burns

Epidermis, dermis and cell adnexal structures all destroyed

Appearance of 3rd degree burns

White, waxy, charred. No blisters. No capillary refill.

Sensation of 3rd degree burns

None

Healing time of 3rd degree burns

Cannot heal spontaneously

Scarring of 3rd degree burns

Wound contraction. Heals by secondary intention.

Pathology of 4th degree burns

Extension through the subcutaneous soft tissue to reach muscle, tendon, or bone. Associated with limb loss or the need for complex reconstruction

Burn Center Referral Criteria in terms of burn depth (4)

* 2nd and 3rd degree burns >10% of TBSA in patient 50 y-o * 2nd and 3rd degree burns >20% TBSA in other groups * 2nd and 3rd degree burns with serious threat of functional or cosmetic impairment that involve face, hands, feet, genitals, perineum, and major joints * 3rd degree burns >5% TBSA in any age group

Burn Center Referral Criteria in terms of mechanism of injury (2)

* Electrical burns, including lightning injury | * Chemical burns with serious threat of functional or cosmetic impairment

Burn Centre Referral Criteria in terms of secondary considerations related to the burn (4)

* Inhalation injury * Circumferential burns * Patients with preexisting medical disorders that could complication management, prolong recovery, or affect mortality * Any patient with concomitant trauma in which the burn injury poses the greatest risk of morbidity or mortality (physician judgment whether trauma or burn priority)

Leading cause of death in adult burn victims

Inhalation injury

Treatment of CO poisoning

High flow oxygen via a non-rebreathing mask

4 indications of hyperbaric oxygen

* CO level > 25% * Loss of consciousness * Severe metabolic acidosis * Concern for end-organ ischemia

Define excharotomy

Release of ONLY burned skin

Define fasciotomy

Release of edematous muscles from their fascial compartments (incision through all involved fascial layers)

Burns Case Conference Flashcards

NOTE: Includes facts that seem important enough, but especially quizzes facts on the slides that the professor starred (i.e. will probably be on the exam). Left out much of the powerpoint. (60 cards)