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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?
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200ml
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what do burns lead to 4
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Loss of vascular integrity
Increased capillary permeability Increased interstitial fluid volume Diminution of blood volume |
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when is fluid loss the greatest?
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in the first 24 hours
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when does capillary permeability return to normal?
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48hrs
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fluid loss is proportional to what?
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the size and depth of the burn
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primary cause of burn for 3-14
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flame
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primary cause of burn for 15-60
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industrial accidents
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60+ primary cause of burn?
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accidents
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80% of all burns occur?
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in the home
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first degree burn depth?
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Epidermis
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Second degree burn depth?
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partial thickness into dermis
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Third degree burn depth?
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full thickness through dermis and into or through adipose layer
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what type of burn is associated with erythema, pain, minimal edema, and dry?
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first degree burn
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a man has a sunburn, what degree burn is this?
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1st
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how do you treat first degree burn?
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remove clothing
apply cool compress soothing lotion (optional) |
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what forms with a 2nd degree burn?
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bulla (blisters)
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pt comes in with bulla, edema, mottled red or pink skin, moist, and painful. what degree burn do they have?
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2nd
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patient has hot grease poured down their arm. they present with bulla what degree burn do they have?
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2nd
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when a bulla breaks what is left?
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a moist red mottled area
painful and edematous |
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if you have less than 10% of body surface area affected, how do you treat 2nd degree burn?
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cool compresses
leave blisters intact cleanse wounds occlusive dressing |
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if you have greater than 10% of body surface area affected, how do you treat 2nd degree burn?
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do not cool them down (can lead to hypothermia)
send to hospital |
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what is an occlusive dressing?
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it is absorptive, bulky
eliminates dead space (doesn't let air cross skin and cause pain) give vascular suppor produce splinting effect |
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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
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a burn that Penetrates through the entire dermis and will result in a great deal of edema is what kind of burn
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3rd
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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?
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3rd
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how do you treat 3rd degree burn?
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Remove dead tissue
Cleanse burn area Initial excision and grafting if small Tangential excision and wound closure if large |
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what is a homograft vs a xenograft?
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homograft (cadaver)
xenograft (pig) |
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for skin grafting, where are the first places you want to treat 4
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face, neck, hands, and flexion creases
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please list the ABCDEs of the primary survey
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Airway and C-spine control
Breathing Circulation Disability : mini-neurologic exam Exposure : undress the patient |
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please describe the A from the ABCDEs of primary survey
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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 |
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should you intubate a patient if you see singed eyebrows and nasal hairs, confinement in a burning building, and CO levels greater than 10%?
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yes, these can lead to an airway closure
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what is B from the ABCDEs of primary survey
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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. |
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what is C from the ABCDEs of primary survey
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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. |
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what is D from the ABCDEs of primary survey
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Disability
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if you can feel a radial pulse, what is systolic BP
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80 or above
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if you can feel a femoral pulse, what is systolic BP
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70
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if you can feel a carotid pulse, what is systolic BP
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60
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what is the E of the ABCDEs for primary survey?
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Exposure : undress the patient
burning could still be occurring if the clothes are still on |
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for fluid replacement, how much do you give (parkland formula)
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2-4 ml IV solution/kg body weight/% BSA in 24 hours
give half over the first 8 hours give rest of next 16 |
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what should the urine output be for an adult
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30-50ml/hr
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describe AMPLE for the secondary survey
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A - allergies
M- medications P - past history L - last meal E - event |
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how do you figure the % burn surface area?
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use the anterior surface of the palm of the patients hand
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what is the rules of nine?
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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% |
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when do you want to use a naso-gastric (NG) tube?
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when you have a >25% BSA
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do you hospitalize a full thickness burn patient with a 1% BSA?
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NO! has to be >2%
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if a person has a partial thickness burn of >10% BSA do you hospitalize
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yes!
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if a person has serious burns to the face, feet, genial area, or those that cross flexion creases...what should you do?
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admit them to the hospital
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pt has a burn that is Full thickness > 5 % BSA
what do you do |
transfer to burn unit
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pt has a burn that is Partial thickness > 20 % BSA
what do you do |
transfer to burn unit
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pt has a burn that is associated with fractures or other major injuries
what do you do |
transfer to burn unit
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what is the most common type of infection seen with a burn
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Pseudomonas
due to the water |
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what complication occurs in up to 30% over the first 72 hours of a burn patient?
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Curling ulcers
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which is worse, an alkali or acid burn?
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alkali
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what is the treatment for alkali chemical burns?
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irrigate (drip fluid on them for 8 hours)
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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?
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this is an alkali chemical burn
irrigate (drip fluid on them for 8 hours) |
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how does sulfur mustard work?
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Binds irreversibly to skin
Destroys DNA causes the outer layer of the epithelium to separate from the dermis resulting in bulla. |
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what must you do if someone has sulfur mustard exposure?
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Must irrigate in 2 min
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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?
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NO
More damage than appears on the surface |
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what is commonly associated with electrical burns?
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myoglbinuria (presence of myoglobin in the urine)
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Where do the majority of burns occur?
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AT HOME!!!
they are preventable! |