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60 Cards in this Set

  • Front
  • Back
you normally lose 15ml/hr with intact skin, with a full burn how much do you lose?
200ml
what do burns lead to 4
Loss of vascular integrity
Increased capillary permeability
Increased interstitial fluid volume
Diminution of blood volume
when is fluid loss the greatest?
in the first 24 hours
when does capillary permeability return to normal?
48hrs
fluid loss is proportional to what?
the size and depth of the burn
primary cause of burn for 3-14
flame
primary cause of burn for 15-60
industrial accidents
60+ primary cause of burn?
accidents
80% of all burns occur?
in the home
first degree burn depth?
Epidermis
Second degree burn depth?
partial thickness into dermis
Third degree burn depth?
full thickness through dermis and into or through adipose layer
what type of burn is associated with erythema, pain, minimal edema, and dry?
first degree burn
a man has a sunburn, what degree burn is this?
1st
how do you treat first degree burn?
remove clothing

apply cool compress

soothing lotion (optional)
what forms with a 2nd degree burn?
bulla (blisters)
pt comes in with bulla, edema, mottled red or pink skin, moist, and painful. what degree burn do they have?
2nd
patient has hot grease poured down their arm. they present with bulla what degree burn do they have?
2nd
when a bulla breaks what is left?
a moist red mottled area

painful and edematous
if you have less than 10% of body surface area affected, how do you treat 2nd degree burn?
cool compresses
leave blisters intact
cleanse wounds
occlusive dressing
if you have greater than 10% of body surface area affected, how do you treat 2nd degree burn?
do not cool them down (can lead to hypothermia)

send to hospital
what is an occlusive dressing?
it is absorptive, bulky

eliminates dead space (doesn't let air cross skin and cause pain)

give vascular suppor

produce splinting effect
a patient comes to you with a burn that is dry, white/charred, leathery in appearance and almost painless

what type of burn is this?
3rd
a burn that Penetrates through the entire dermis and will result in a great deal of edema is what kind of burn
3rd
a man comes in with a white charred burn that is dry and almost painless. he reports riding a motorcycle with his leg up against the muffler. what kind of burn?
3rd
how do you treat 3rd degree burn?
Remove dead tissue

Cleanse burn area

Initial excision and grafting if small

Tangential excision and wound closure if large
what is a homograft vs a xenograft?
homograft (cadaver)

xenograft (pig)
for skin grafting, where are the first places you want to treat 4
face, neck, hands, and flexion creases
please list the ABCDEs of the primary survey
Airway and C-spine control

Breathing

Circulation

Disability : mini-neurologic exam

Exposure : undress the patient
please describe the A from the ABCDEs of primary survey
Upper airway very susceptible

Indications may be subtle

May take 24-48 hrs to develop

CO Baseline (if a flame burn)

Don’t depend on x-ray
should you intubate a patient if you see singed eyebrows and nasal hairs, confinement in a burning building, and CO levels greater than 10%?
yes, these can lead to an airway closure
what is B from the ABCDEs of primary survey
BREATHING

bag valve at 100% O2. Look for evidence of a tension pneumothorax, pneumothorax or flail chest.
If there is a circumferential burn over the thorax then may have to perform an escharotomy down the anterior axillary line.
what is C from the ABCDEs of primary survey
Circulation

Circulation with hemorrhage control. If no pulse begin CPR. Pulse is assessed for rate and quality. If you can feel a radial pulse the systolic BP is 80 or above. Femoral 70, Carotids 60. Put direct pressure on any bleeding sit. Start IVs in both upper extremities even if burned. Less risk of septic phlebitis. Avoid cut downs through burned tissue. Use ringers lactate or normal saline.
what is D from the ABCDEs of primary survey
Disability
if you can feel a radial pulse, what is systolic BP
80 or above
if you can feel a femoral pulse, what is systolic BP
70
if you can feel a carotid pulse, what is systolic BP
60
what is the E of the ABCDEs for primary survey?
Exposure : undress the patient

burning could still be occurring if the clothes are still on
for fluid replacement, how much do you give (parkland formula)
2-4 ml IV solution/kg body weight/% BSA in 24 hours

give half over the first 8 hours

give rest of next 16
what should the urine output be for an adult
30-50ml/hr
describe AMPLE for the secondary survey
A - allergies
M- medications
P - past history
L - last meal
E - event
how do you figure the % burn surface area?
use the anterior surface of the palm of the patients hand
what is the rules of nine?
used for extent and depth of the burn

head: 4.5 in front 4.5% in back
arms: 4.5 in front 4.5% in back
legs: 9% front 9% back
chest: 18%
when do you want to use a naso-gastric (NG) tube?
when you have a >25% BSA
do you hospitalize a full thickness burn patient with a 1% BSA?
NO! has to be >2%
if a person has a partial thickness burn of >10% BSA do you hospitalize
yes!
if a person has serious burns to the face, feet, genial area, or those that cross flexion creases...what should you do?
admit them to the hospital
pt has a burn that is Full thickness > 5 % BSA

what do you do
transfer to burn unit
pt has a burn that is Partial thickness > 20 % BSA

what do you do
transfer to burn unit
pt has a burn that is associated with fractures or other major injuries

what do you do
transfer to burn unit
what is the most common type of infection seen with a burn
Pseudomonas

due to the water
what complication occurs in up to 30% over the first 72 hours of a burn patient?
Curling ulcers
which is worse, an alkali or acid burn?
alkali
what is the treatment for alkali chemical burns?
irrigate (drip fluid on them for 8 hours)
a man comes in after having put in some fresh concrete. he doesn't really have any symptoms until the next day. then he has NASTY ASS BLACK BURNS on his legs...what do you do?
this is an alkali chemical burn

irrigate (drip fluid on them for 8 hours)
how does sulfur mustard work?
Binds irreversibly to skin

Destroys DNA

causes the outer layer of the epithelium to separate from the dermis resulting in bulla.
what must you do if someone has sulfur mustard exposure?
Must irrigate in 2 min
a man gets an electrical burn and only sees an entrance and exit wound of the electricity. He doesn't think this is too big a deal. Is this right?
NO

More damage than appears on the surface
what is commonly associated with electrical burns?
myoglbinuria (presence of myoglobin in the urine)
Where do the majority of burns occur?
AT HOME!!!

they are preventable!