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139 Cards in this Set

  • Front
  • Back
% of burns that are preventable
75-90
mortability rate with inhalation injuries
4%
causes damage to skin and underlying tissues (6)
- heat
-flame
- contact with hot objects/liquids/ steam
- chemicals
- electricity
- sun
what are the functions of the skin (5)
- protect from infection and inj
- prevent loss of body fluids
- temp regulation
- appearance
-sensation
how is burn depth determined (3)
- temp
- length of exposure/duration of contact
- dermal thickness/location of inj
important to remember with children and older adults (2)
-thinner skin
-deeper burn at shorter duration of contact
what are the burn zones (3)
-zone of coagulation
- zone of stasis
- zone of hyperemia
what can effect he zone of stasis (3)
- hypothermia
- inadequate fluid resuscitation
- ineadequate tissue perfusion
why should ice be avoided in burns
makes it worse by decreasing blood flow and converting stasis to coagulation
normal vasculature with fluid loss
zone of hyperemia
deeper areas with no blood flow
zone of coagulation
what is a local reaction: immediate (all burns) (2)
- cap and cell wall destruction
- increased cap permeability
what happens with a local reaction with cap and cell wall destruction (4)
- vasoconstriction
- thrombosis
- ischemia
-worse if hypothermic
what happens with a local reaction to a burn with increased cap permeability (2)
- seepage of plasma proteins, F&E into interstitial tissues
- blister and edema formation
occurs with a major burn (burn size >20%)
systemic reaction
happens with a systemic reaction (15)
- immune suppression
- hyper-metabolism
- decreased circulating volume
- decreased cardiac output
- hypo-tension-perfusion-volemia
- tachycardia
- tissue damage w/ local edema (lungs)
- increased shunting
- increased 02 requirements
- decreased peristalsis/absorption
- low blood flow
- decreased UO
- hgb and myoglobin clogging
- low fluid volumes
- diuresis after 48-72 hrs
why do pts with burns need increased amts of food
hyper-metabolism
what happens with the GI system in sytemic reactions
shuts down
characteristics of a first degree burn (superficial) (5)
-epidermis only
- pink to red
- painful
- no blisters
- heals in 3-5 days(no scarring)
important with 1st degree burns
not included when calculating TBSA burn
Tx for 1st degree burns (6)
- fluids
- over the counter pain meds (NSAIDS)
- mtr for fever (infection)
- cool showers or baths
- moisturization (aloe vera, plain lotion)
- avoid re-exposure
what are black buds
new skin formin
characteristics of 2nd degree burns (partial thickness) (6)
- epidermis and part of dermis
- heal w/o surgical intervention
- blisters
- wet and weepy
- very painful
- blaches (cap refill may be prolonged)
some can turn into 3rd degree burns
2nd
wet and weepy
2nd
dry
3rd
tx of 2nd degree burns
- topicals (decrease risk of sepsis)
what are the topicals used to tx 2nd degree burns (5)
- vaseline
- Abx ointment
- SSD
- ABx soak dsg
- sustained release silver
what do topicals do
protect from infection while the body does the healing
used to debride dirt
SSD
what is SSD aka
marshmallow cream
petroleum based and dry dsg
zeroform
irrigates fluid through dsg
soak dressings
temp covering over partial thickness burns and works good with donor sites
silver impregnated dsg
characteristics of 3rd degree burns (full thickness) (6)
- epidermis/dermis/subQ tissue
- surgical intervention
- insensate (no pain)
- no blanching/cap refill
- charred, bright red, marbled, leathery, tan, waxy, or pearly white
- tight, non-elastic
cut on both sides (non burn to non burn) start at hand and go up or at foot and go up
escharotomy
what are the Sx of circulatory compromise (2)
- 5Ps (pain,pallor,paresthesia, pulselessness, paralysis)
- cold
used to assess peripheral pulses (2)
-doppler
- pulse ox
mgnt of circumferential burns(4)
- elevate burned extremities
- remove clothing/jewelry
- mtr closely
- escharotomy only in consultation with burn center
what are the tx options for full thickness burns (2)
- debridement/ surgical interven
- temp coverings
what are the types of debridement (3)
- mechanical
- surgical
- enzymatic
peeling by hand
mechanical
SSD dsg (help clean it up)
enzymatic
types of temp coverings (2)
- allograft- homograft (pig skin), cadaver
- dermal substitutes
what are dermal substitutes like
seran wrap
facts about dermal substitutes (3)
- neodermis generation
- covered with ultra thin widely meshed STSG
- "artificial skin"
growing of ones on skin
neodermis generation
used for larger areas (legs, thighs)
mesh grafts
facts about sheet grafts (3)
- used for hands, face, feet
- not ran through mesh
- remains flat
what does a mesh graft do
creates holes
own skin in petry dish and letting it grow
cultured epithelial autografts (CEA)
no surgical intervention and never truly heals
secondary inention (scarring)
what are the full thickness permanent coverings (3)
- autografts (mesh/sheet)
- CEA
- secondary intention
outcome of injury from burns dependent upon what (8)
- age
- TBSA
- depth of burn
- inhalation injury
- pre-existing medical Hx
- timeliness of tx
- appropriateness of tx
- adequate fluid resuscitation
what never goes away with graft
discoloration
which burns can go systemic
chemical full thickness burns (wash them really well)
tricky with fluid resuscitation due to risk of overload
heart issues
takes precedence over burns (5)
- airway obstruction (comes 1st)
- cardiac arrest (place on mtr)
- spinal or head injury
- open chest wounds
- sever abd trauma
need to be careful with FR in what (2)
-heart issues
- head injuries
what is included in the ABCDE assessment
- airway (with C-spine)
- breathing
- circulation, cardiac status, CPR)
- disability, deformity, neurological deficit
- expose, examine, environmental control (stop burning)
what is a significant predictor of mortality
inhalation injury
what are the 3 types of inhalation inj
- carbon monoxide
- upper airway (thermal)
- lower airway ( smoke, chemical)
gets down further bc its not as hot
lower airway
breathing in and damage causes it to constrict
upper airway
causes confusion d/t decrease 02
carbon monoxide
what does increases of carbon cause
knocks off 02 and lets carbon adhere
lower levels or carbon monoxide S&S (10)
- Ha
-fatigue
- flu-like sx
- weakness
- DIB
- dizziness
- nausea
- blurred vision
- may appear intoxicated
-cherry red tongue
higher levels of carbon monxide S&S (4)
- vomitting
- confusion
- heart palpitations
- progress to Sz, coma, death
tx of carbon monoxide inhalation
100% 02 to displace carbon and increase 02
S&S of inhalation injury (5)
- burns of face or neck
- singed nasal of facial hair
- hoarseness, sore throat, cough, difficulty swallowing, black sputum
- SOB, dyspnea
- signs of hypoxia
what are the signs of hypoxia (4)
- disoriented
- restless
-confused
- agitated
mgnt of airway (5)
- remove obstructions
- 100%02 per NRBM
-assist with BVM
- elevate head (aspiration)
- consider intubation (in case swellin occurs)
swell up quick so often need intubation rapidly
kids
used to percuss to remove secretions and carbon
VDR (high frequency ventilator)
important with airway in peds (6)
- obstruct easliy
- void hyperextension
- smaller 02 reservoirs
- limited compensatory mech
- weaker accessory muscles
- intubate with smaller size
late sign of hypovolemia
hypotension
type of fluid used with burns
LR- to pull things back in and pump vasculature
helps with healing
high BP
when are two large bore IVs needed (2)
- adult burns > 20%
- peds burns > 15%
LOC can be affected by what (6)
- hypoxia
- carbon monoxide
- head injury
- pre-existing mental conditions
-drugs
-ETOH
what is AVPU
-alert
-responsiveness to VERBAL stimuli
- responsiveness to PAINFUL stimuli
- UNRESPONSIVE
important with stopping the burning process (4)
- cool burn briefly (5min max)
- exceptions (chemical/tar/asphault)
- no ice
- cover with clean dry covering (sheets,pillowcases, dsg)
important to avoid shivering bc?
uses up energy
what should be done with powder substances/ tar/asphalt
powder- brush off
- tar/asphalt- cool it longer
what happens to body with cold body temps
shuts down
very painful
rewarming process
AMPLET
-allergies
- medications
- past medical HX
- last meal or drink
- events and environment
- tetanus (5yrs)
% of hand to burn
each side is 1% and inner webbin .5%
1 hand =2.5
FR with heart Hx
2ml LR x kgs x %TBSA burned
FR with normal pt
4ml LR x kg x %TBSA
facts for FR (4)
- tx to pt response
- 2nd and 3rd degree burns only
- 1/2 in first 8 hrs from time of injury
- balance in next 16 hrs
average output for peds
.75/ml/kg
which pts will require more FR (8)
- high voltage electrical injuries
- inhalation inj
- delayed resuscitation
- associated trauma
- pre-existing dehydration
- ETOH use or abuse
- meth labs
- elderly
urine output for pts with high voltage electrical injuries
75-100ml/hr
what happens with myoglobinuria
peeing blood (rips apart kidneys)
labs to mtr with burns (8)
- ABGs
- carboxyhemoglobin
- CBC
- electrolytes
- glucose
- BUN/Creat
- drug ad ETOH screen
- type and cross for trauma
# that dies from fires and burns yearly
1000
children under what age twice as likely to die from fire
under 5
causes of burns in kids under 4 (3)
-scalds (tap water/ cooking)
- contact burns (grill,iron)
- low voltage electrical burns
causes of burns in kids 5-8 (3)
- flame burns (fire play)
- matches/ lighters/ flammable liquids
- high voltage electrical injuries
causes of burns in young adults (2)
- cooking related (home and work
-MVCs (road rash)
child abuse (6)
- scalds
- immersion
- pour
- running water
- contact
- other
recognition of child abuse scalds (7)
- sock or glove like line
- even depth circumferential
- definitive lines of demarcation
- water level apparent
- areas of sparin
- v-shaped perineal burns
- injuries inconsistent w/ story
documentation of abuse should include what (5)
- initial hx
- repeat hx
- social hx evaluation
- photographs
- parental interaction w/child
types of burns
-thermal
- chemical
- electrical
thermal burns include... (5)
- flame
- contact
- scald
-steam
- tar
chemical burns include... (3)
- acid
- alkali
- organic compounds
electrical burns include (3)
- high voltage
- low voltage
- lightening
tx options for thermal burns (2)
- vaseline
- silver impregnated products
tx of tar and asphalt (4)
- immediate colling
- stop the burning process
- remove as much clothing as possible
- do not attempt to remove tar or asphalt
characteristics of acids (3)
- ph 1-4
- extensive tissue destruction
- bathroom cleaners/rust removers/ pool cleaners
characteristics of alkalis (4)
- ph 8-14
- oven and drain cleaners
- fertilizers
- line markers at sporting events
characteristics of organic compounds (3)
- flammable
- phenois (disinfectants)
- petroleum prodcts ( gas and cresote)
chemical injuries caused by what (3)
- absorption
- inhalation
- ingestions
determines severity of chemical injuries (7)
- agent
- concentration
- depth of injury
- volume
- extent of BSA involved
- mechanism of action
- duration of contact
Tx of chemical burns (4)
- protect self
- stop progression of injury
- remove all clothing
- immediate irrigation (20-30 min)
-
what can no chemical neutralization cause
a new heat source w/ more burns
% of electrical burns
3%
measurement of the amt of electrical currrent (what hurts/kills ppl)
amps
pressure of the current (affects how theyre hurt)
volts
earth or something in contact with the ground (completes the circuit)
ground
facts about alternating current (AC) (4)
- more common and deadly
- ventricular fib
- tetanic contraction of muscles
- freeze to the source
what is an alternating current
grabs you and pulls you in over and over
facts about direct current (DC) (3)
- car or industrial batteries
- electrosurgical devices
- lighting
hits once and lets go
direct current
instant frostbite
anhydrous ammonia
tx for anhydrous ammonia
flood with H20
what does anhydrous ammonia smell like
rotten eggs
cause of mouth and hand burns to children
low voltage
results off low voltage injuries
charred skin on top and white underneath
current stops at bone and shoots somewhere else
high voltage
which is the worst with high voltage injuries
exit wound
helps with oxygenation, carbon and secretion removal
VDR ventilation
last option and few survive
CRRT
help with scar formation
pressure garments
typicallly length of stay =
%of burn
can sometimes heal on their own
faces
used to increase ROM and decrease contractions
splints
facts about CEA (6)
- cultured from pts own cells
- no dermal component
- very fragile
- length of time to grow
- expensive
- can be combined with dermal substrates( cosmetic/ functional)