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47 Cards in this Set
- Front
- Back
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11Q:
What important things does the skin prevent? |
- Heat Loss
- Water Loss - Invasion by Bacteria |
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11Q:
What is the avg. water loss/day normally, and with a full thickness burn? |
- Normally: (15ml/meters squared )/hr.
- Full thickness Burn: (200ml/meters squared) / hr. |
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11Q:
Burns result in.... |
- Loss of Vascular integrity
- Increased capillary permeability - Increased interstitial fluid volume (edema) - Loss of blood volume (hypovolemia, hypotension, tachycardia, may cause kidney ischemia) - Increased O2 requirements |
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11Q:
Fluid loss is proportional to.... |
the size and depth of the burn.
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11Q:
Generally fluid loss is greatest when? |
- In the first 24 hours
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11Q:
Capillary permeability will return within how many hours? |
48 hours (then edema resorption begins)
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11Q:
Where do most burns occur? |
- In the home (80%)
- Half of which can be prevented |
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11Q:
What is the etiology of burns by age? |
3-14yo = flame burns
15-60 = industrial accidents 60+ = accidents |
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11Q:
What is the severity of the burn dependent on? |
- Temp. of the heat source
- Duration of the application of heat - Conduction of the tissue (this is dependent on tissue thickness, water content, local secretions and oils, and pigmentation of the skin) |
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11Q:
1st degree burn |
- Epidermis involved
- Erythema - Pain - Minimal edema - Dry - Ability to prevent infection is intact |
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11Q:
2nd Degree burn |
- Partial thickness into dermis
- Bulla formation - Able to heal and repopulate |
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11Q:
3rd Degree burn |
- Full thickness through the dermis and into the adipose layer.
- Dry, white or charred - Leathery appearance - Great deal of edema - Almost painless - Require grafts |
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4th degree burn
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- Passes into the muscle
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11Q:
How to treat 1st degree burn? |
- Remove clothing
-Apply cool Compress (if a small area) -Soothing lotion (optional) -Heals in 5-10 days |
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11Q:
Tx of second degree burn? |
- If less than 10% BSA: cool compress, leave blisted intact, cleanse wounds, occlusive dressing
- Greater than 10% BSA: Hospitalize |
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Q11:
For your knowledge! |
Don't forget to ask about tetanus status on anyone with a burn.
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11Q:
Occlusive Dressing |
- Absorptive
- Bulky -Eliminate Dead space - Give vascular support - Produce a splinting effect - (should be redressed every 2-3 days) |
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11Q:
Tx of 3rd degree burns? |
- Remove dead tissue
- Cleanse burn area - Greater than 3-4cm require grafting - covered with a temporary closure (biosynthetic, amniotic membrane, homograft, or xenograft until a autograft can be done) |
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11Q:
Skin Grafting priorities |
- Face, neck, hands, and flexion creases
- Function then aesthetics |
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11Q:
ABCDE of Primary Survey? |
A- Airway & C-spine
B- Breathing C- Circulation D- Determine Level of responsiveness E- Expose |
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11Q:
Any stridor in association with burns, is a what? |
immediate indication for endotracheal intubation
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11Q:
How long might it take for airway problems to develop? |
24-48 hours
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11Q:
Intubate and transfer to a burn unit if... |
- Facial Burns
- Singed eyebrows and nasal hairs - Carbon deposits in the oropharynx or sputum - Confinement in a building - Mental impairment - Explosion to head or torso -CO levels greater than 10% |
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11Q:
Where are IVs generally started |
- 16 gauge catheter in a peripheral vein
(avoid burned tissue if possible, but burned in the upper extremity rather then a cut-down in the lower extremity) |
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11Q:
What is a formula for fluid replacement? |
2-4ml IV solution / Kg / %BSA in 24hrs
-give 1/2 in the first 8hrs -give the rest over the next 16 hrs Maintain urine output 30-50ml / hr (adult) 0.7-1ml / kg / hr (child, 30kg or<) |
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11Q:
what are the components of the secondary survey for the trauma Pt? |
- A.M.P.L.E.
- Allergies - Medications - Past Hx - Last meal - Event - Complete physical - Associated injuries - Extent and depth of the burn (anterior surface of the palm of the hand = 1% of the BSA) |
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11Q:
What is the rule of nines (for an adult)? |
- each arm = 4 and 1/2%
- each leg = 9% - body = 18% - front of head = 4 and 1/2% - back of head = 4 and 1/2 % - genitalia = 1% |
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11Q:
What is the rule of nines (for a child)? |
- Front of head = 9%
- Back of head = 9% - Body = 18% - Arm = 4 and 1/2% - leg = 7% |
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11Q:
Pts with CO levels less than ....... may be asymptomatic. |
20%
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11Q:
What is the half life of CO? |
4 hours
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11Q:
What is the half life of CO in the body under 100% O2? |
40 min.
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11Q:
What special test may you do in a women of childbearing age? |
- Pregnancy test
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11Q:
For your Knowledge! |
- NPO x 48hrs
- This is done to avoid ileus |
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11Q:
When is an NG tube always indicated? |
- If >25% BSA is burned
- also if they are showing any signs of ileus |
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11Q:
Restlessness and anxiety may be a sign of what? |
Hypoxia or pain
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11Q:
For your knowledge! |
- Urinary catheter is placed and kept for 72hrs.
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11Q:
For your knowledge! |
Antibiotics are seldom needed unless the would is contaminated
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11Q:
Criteria for Hospitalization? |
- Full thickness >2% BSA
- Partial thickness >10% BSA - Serious lesions of the face, feet, peritoneal or genital area - Burns that cross flexion creases |
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11Q:
Criteria for transfer to a burn unit? |
- Full thickness >5% BSA
- Partial Thickness >20% BSA - All 2 or 3 burns involving face, eyes, hands, or peritoneum - Burns associated with fractures or other major injuries - High Voltage electrical burns - Significant chemical burns - Inhalation injuries - Lesser burns with preexisting conditions (ex. DM, CHF) |
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11Q:
What is the most common type of infection seen in burn Pts? |
-Pseudomonas
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11Q:
For your knowledge! |
-Curling ulcers occur in up to 30% over the first 72 hrs.
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11Q:
What are some common complications associated with burns? |
- Infection
- Gastric distension - Paralytic ileus - Fecal impaction - Curling ulcer - Upper respiratory tract obstruction - Intubation injury - Pulmonary insufficiency - Atelectasis (small lung collapses) - Pneumonia - Decubiti |
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11Q:
what type of chemical burn is worse, acid or alkali? |
- Alkali is worse
- Acid must be irrigated with neutral solution for 20-30 min. -Alkali must be irrigated for 8 hrs. |
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11Q:
Sulfur Mustard? |
- this is not a burn, but it is treated like one
- Binds irreversibly to the skin - must irrigate in 2min -remains on cloth for a long time. - destroys DNA, causes a blister, and possible temporary blindness |
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11Q:
Electrical burns, what is important about them? |
- more damage that what appears on the surface
- travels along the nerves and vessels - increases myoglobin output, which can result in renal failure. |
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11Q:
what do you do if your Pt's urine appears dark after a severe electrical burn? |
- You want to keep the kidneys from being damaged.
- Increase output to 100ml / hr - if that does not work, add 25g of manitol and then 12.5g / L of fluid |
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11Q:
What osteopathic technique may be useful for burns? |
Rib raising
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