Flashcards in Outpaitent Burn Care Deck (30):
Where is the most primary cause of burn deaths in kids?
home. most are under 14 years old. It is the leading cause of death for non-MVA 1-4 years.
What are the first questions to ask?
1. can the patient breath--if no, then ABCs
2. how extensive is the burn-->10% = hospitalize
3. what about fluid replacement--> >20% burn needs IV fluid
4. how did it occur--> tells you how to manage the burn
5. do i keep this patient in my practice?
Describe the extent of the burn injury
severity of burn injury is the product of
- temperature of the burning agent
-time of the exposure
severity influences depth
extent is determiend by TBSA
What is a partial thickness injury?
- superficial : epidermal involvment
-deep: extension into dermis
Blisters, pink, moist, painful. Will heal without surgery, but scar will form. No nerve damage.
Describe a full thickness burn?
all dermis is injured--> yellow, dry, leathery, non-painful. Need surgical excision and skin grafting.
do kids need more fluid than an adult for replacement?
yes. disproportionate body surface area to body weight imposes more fluid requirements. They are more prone to ischemic changes with edema, they have renal immaturity, and limited heat conservation because they have lower muscle mass.
What is a first degree burn?
red, dry painful, not counted in TBSA. treat by drinking a lot of electrolyte fluids.
Describe a second degree burn
moist, pink, painful, blisters, superficial should heal quickly. deeper dermal burn probably needs excision. These are partial thickness
describe third degree burn
dry, leathery, non painful because it has gotten through to the nerve. typically fully thickness
What is the rule of nines?
It is a system to see how much TBSA was burned. It is most important for determining regulation of fluid resuscitation. The rule of nines is for adults. Palm = 1%
What are the pediatric rules of nines?
palm = 1%.
subract 1% from head and add it do legs each year.
What should be used for oral resuscitation?
pedilyte, milk or soy, gatorade...NO WATER. It must contain electrolytes
10% requires IV fluid replacement with
2-4cc / kg adult
3-4 cc/kg pedi/% burn/24 hours
how can you tell if the fluid replacement is working?
It is a reliable reflection of renal artery pressure.
When is escharotomy needed?
when you worry about skin perfusion, specifically compartment syndrome. cut through the wound to allow for skin to get perfused/become more elastic.
Are burn victims able to regulate their temp?
no, they lose that function. they prefer it warm.
who gets scald injuries the most?
What is the most common burn in toddlers? >4yo?
contact burns, flame burns
you walk in on a burn taking place...what should you do?
stop burning process. remove clothing. cool water is okay for short term.
When they arrive to clinic, give appropriate narcotic treatment. then use anti-bad soap to clean with warm water.
How should silvadene be used?
below the clavicle, 2nd medical problems if gets in eyes.
Needs an Rx
Twice daily with dressing changes
Has activity against GPC, AND GNR
What topical is best for faces?
bacitracin. It needs frequent application and it only works against GPC.
What topical might you prescribe if you want to limit dressing changes?
Are systemic antibiotics indicated to help prophylactically?
NO! IF cellulitis does develop, it is usually streptococcal in nature. If it is unresponsive to treatment, admit.
When is surgical intervention indicated?
when healing is not expected to progress without a significant scar formation limiting function or cosmesis
Describe the post-op healing process:
5 days tip new blood supply visible
5-14 days of fragility
2wk-6wk of edema management and hydrating grafts
6 wks -18 months of scar management, hydration and sun avoidance.
What is considered a high voltage burn?
>1000 v -- neuro and cardiac problems, and can get associated symptoms with falls, and serious trauma. Sometimes you may see a contact site: area where electricity exits the body.
If a keloid scar develops, what does it respond to?
steroid injection or excision.
What is the criteria for cancer?
>10% of TBSA burn in pecs, >20% burn in adults
any 3rd degree burns
critical ares that are burned
complex burns: electrical or chemical
failure to heal by 2-3 weeks
inability to tolerate wound care/pain
What should you do about blisters?
leave them alone!!!