Burns/Frostbite Flashcards

Question

Superficial frostbite care

Answer 1

rewarm with body heat * Analgesia > rewarming is painful (Tylenol, Advil, Dilaudid)

Answer 2

1. slowly rewarmed with bath water (do not touch basin) 2. elevate extremity above heart to reduce edema 3. tetanus shot 4. loose sterile dressing 5. antibiotics 6. iloprost (vasodilator + inhibits platelets)

Answer 3

1. Zone of coagulation: centre of injury; most deep and damaged part * Point of maximum damage * Irreversible tissue loss * Coagulative necrosis 2. Zone of stasis: * Decreased perfusion; can progress if not reversed * Potentially salvageable * Goal of treatment: treat and reverse zone of stasis * Increase circulation and perfusion 3. Zone of hyperemia: * Tissue perfusion increased (from inflammatory process - vasodilation) * Damage is reversible

Answer 4

Normal Blood Capillary: Water is the smallest molecule that can pass through the capillary Postburn Blood Capillary: Permeability is drastically increased due to mass vasodilation and inflammation response, which allows large molecules such as protein to pass through capillaries pores easily. >Commonly results in hypovolemic shock – fluid lost to interstitial spaces and evaporates off > Some distributive shock properties

Answer 5

1.Injury causing cell death (hyperkalemia and coagulopathy) 2. Massive fluid shifts out of vessels due to increased permeability - hypovolemic shock due to sodium shift with fluid evaporation 3. Collioid osmotic pressure decreases (edema and high HcT) = intravascular volume low BP high HR

Answer 6

1. temperature of heat 2. contact time 3. medium of heat (water vs steam) 4. thickness of skin

Answer 7

- only epidermis - dry - pink/red - intact - blanches - no edema - no blisters - some pain

Answer 8

- epidermis and dermis - wet - waxy - red-white - minimal blanching - ++ edema - less blistering - +pain

Answer 9

- epidermis + papillary dermis - moist - weeping - pink-red - blanches - + edema - + blisters - ++ pain

Answer 10

- epidermis, dermis, and fat - dry - leathery - white - charred skin with eschar - absent hair - no blanching - no pain - no blisters - +++ edema Can also progress into muscle and bone

Answer 11

Used to calculate TBSA Total (front and back) Head: 9% Arms: 9% each Torso: 36% Legs: 18% each Groin 1%

Answer 12

STOP the burning process! > By flushing all areas in contact with chemicals 1. Airway * Burned airways swell rapidly * Early intubation 2. Breathing * Possible gas exposure (CO, cyanide) * Circumferential burns around torso 3. Circulation/C-spine * Cardiac status; shock treatment (>20% TBSA) 4. Disability * Neurological status 5. Exposure & Evaluate * Remove all rings, watches, jewelry r/t edema * Remove all clothing from the area * Cool the burn wound 6. Fluid resuscitation * Calculate TBSA

Answer 13

TBSA >20% prevents the development of shock & maintains adequate perfusion/increase perfusion to zone of stasis

Answer 14

Kidney Perfusion (urine output)

Answer 15

Parkland Formula Weight in kg x 4ml x %TBSA= total amount of fluid infused in 24hrs from time of injury

Answer 16

* Give half during first 8hrs * Remaining half over the next 16hrs * Use Ringers Lactate

Answer 17

* Maintain urinary output at 0.5ml/kg/hr (30-50 ml/hr). * For electrical burns (TBSA not calculated) with myoglobinuria, maintain urinary output at 1-1.5ml/kg/hr (~75-100 ml/hr) until urine is clear * Fluids can be increases if urine output is not meeting target

Answer 18

Muscle damage (i.e. electrical burns traveling through body > entry/exit wounds)  myoglobin released into the bloodstream Kidneys remove myoglobin from the body into the urine In large amounts, myoglobin can damage the kidneys Higher urine output/hr is required to help clear the myoglobin

Answer 19

* Increased capillary permeability  fluid leaks into interstitial space (edema)  hypovolemia  SHOCK * Tissue ischemia  anaerobic metabolism and necrosis  acidosis * Dysrhythmias (electrical burns, hyperkalemia, etc) * Electrolyte shifts   Na; hyper (or hypo) K+ * Impaired circulation to extremities/organs * Impaired microcirculation and increased viscosity

Answer 20

* Decreased blood flow to kidneys causes renal ischemia (AKI) * Myoglobin  Acute tubular necrosis (ATN)

Answer 21

Upper resp tract injury * Edema formation * Mechanical airway obstruction & asphyxia * Injury r/t length of exposure to smoke or toxic fumes Lower airway (inhalation) injury * Direct insult at the alveolar level * Risk for ARDS

Answer 22

* Loss of skin barrier & presence of eschar favor bacterial growth * Hypoxia, acidosis, thrombosis of vessels  impair resistance to bacteria * Risk for SIRS, sepsis, MODS * Blisters: sequestering of fluid & proteins

Answer 23

* Shunting of blood to vital organs  decreased blood flow to gut  paralytic ileus (gastric distention, N/V) * Ischemia of gastric mucosa  duodenal/gastric ulcer; bleeding

Answer 24

* Mediated by catecholamine release (epi, norepi) * Increased metabolic demand increases body temp * “Burn fever”=  temp * Shivering: further increases metabolic requirements

Answer 25

* Release of thromboxane A2 by damaged cells  thrombocytopenia, abnormal platelet function,  fibrinogen levels, inhibition of fibrinolysis * Net deficit in plasma clotting factors (DIC) * Anemia  destruction of RBCs d/t burn injury * Blood loss

Answer 26

* Hypoxia d/t smoke inhalation * Concomitant trauma, substance use/abuse, sedation or pain meds

Answer 27

* A scab or dry crust that results from trauma, such as a burn, infection, or excoriating skin disease * DEAD skin * Potentially dangerous: * risk for compartment syndrome * chest restriction (can be hard; if burns circumferential) * sub-eschar edema * Extensive circumferential full-thickness burn of a limb or chest eschar may cause problems it is unyielding/rigid * Escharotomy may be necessary

Answer 28

1. pain management 2. promote wound healing 3. PT/OT 4. Nutritional therapy 5. psychological

Answer 29

Superficial/uncomplicated burns heal by regeneration (cell division and replenishing the epidermis) within a few weeks o Topical abx (i.e. Polysporin) and gauze

Answer 30

Full-thickness requires surgery  Debridement and grafting or permanent injury and scarring can occur; will not heal by themselves Advanced dressing in partial thickness & deep partial thickness burns  “advanced dressing”= something with antimicrobial ex) silver

Answer 31

1. Absorb & contain the drainage 2. Provide protection for the wound from the environment o Pts with burns are at increased risk for infection o Infected wounds take longer to heal & will increase scar tissue formation 3. Decrease wound pain o Initially, superficial burns are very sensitive to air currents o Deeper burns become more sensitive to air as the heal and nerves are re-enervated o Wound coverings eliminate air currents from the wound surface 4. Permit high humidity at the wound site o A moist environment is critical for epithelial cells to migrate and spread o Re-epithelialization can occur on a dry surface; however, it is slowed down o *moist wound healing is NOT usually used for infected burns or burns with eschar*

Answer 32

* All dressings are done as a sterile procedure * Always soak the inner dressing with sterile NS or water prior to removing the old dressing * You do not want old dressing to adhere to wound because healthy tissue may be removed inadvertently * Cleanse wound with warm sterile cleansing solution. Wipe burn from center toward outer edges * Remove excess exudate, topical ointments and loose eschar using a light scrub * If necessary, lift loose skin/eschar with sterile forceps and trim with sterile scissors, this process should not cause pain or bleeding

Answer 33

* Fluid inside the blisters depresses immune function, affects neutrophils job of killing foreign cells, and enhances inflammation

Answer 34

* Blister is a protective cover for the burn * The blistered skin will gradually wrinkle and collapse onto the healing wound: this skin is a protective layer * If the blister is removed, the wound can become very painful * Spontaneous re-absorption of the fluid will take place in ~ 1 week

Answer 35

* Surgical procedure: skin or skin substitute is placed over a burn or non-healing wound to permanently replace damaged or missing skin or provide a temporary wound covering * Use of patient’s own skin to close the wound (autologous) * Cadaver skin, pigskin, or type of biobrane (expensive) to close the wound * Surgical debridement of full-thickness burns is necessary to prepare the wound for grafting

Answer 36

* An area of skin that has undergone excessive scarring from a deep burn * Caused from thick bands of hypertrophic scaring that restrict joint movement  loss of joint mobility  permanently impair function * Some are unavoidable… but many can be prevented: * Early excision and grafting for full-thickness burns * Stretching, minimum of 5-6 times a day; painful, patients may not adhere * Casting or splinting to position potential contracture area in a stretched position * Having patient do as much for themselves as possible (ie. Self-grooming, eating etc.)

Burns/Frostbite Flashcards

(61 cards)