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Emergency Medicine | Sarah Yasmine > Burns and Wound Management > Flashcards

Flashcards in Burns and Wound Management Deck (21)
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1
Q

EM: Burn Management
Epidemiology
1. Mortality is highest in patients of what age?

  1. Highest risk is what age and gender?
  2. In children the highest incidence is what injury?

50% of burn patients are admitted to 130 burn centers in US

A
  1. over 65
  2. 18-35 years old and 2:1 male to female in both injury and death
  3. scalding injuries from hot drinks or bath
2
Q
  1. Skin is 2 layers?
    Various thickness
  2. Thickness varies with what?
  3. Skin is ____________ barrier for evaporative loss?
  4. Skin also responsible for control of what?
A
  1. Dermis and epidermis
  2. age
  3. semi-permeable
  4. body temp
3
Q
  1. Cellular changes seen in burns? 4

2. Burn shock is what? 2

A
  1. Cellular changes seen in burns:
    - Intracellular influx of Na/H2O
    - Extracellular migration of K
    - Disruption of cell membrane function
    - Failure of “sodium pump”
  2. Burn Shock with
    - depression of myocardium
    - metabolic acidosis
4
Q

EM: Burn Management
Pathophysiology

  1. Hematologic changes? 3
  2. Local progressive injuries? 3
  3. Cell damage occurs at what temp?
A
  1. Hematologic changes
    - Increase in hematocrit
    - Increase in blood viscosity
    - Anemia due to RBC destruction
  2. Local progressive injury
    - Liberation of vasoactive substances
    - Disruption of cellular function
    - Edema formation
  3. > 113F due to denaturation of protein
5
Q

What are the 3 zones of injury and what occurs in these zones?

A
  1. Zone of coagulation
    -Irreversibly destroyed
  2. Zone of stasis
    -Stagnation of microcirculation
    Can/will extend if not treated appropriately
  3. Zone of hyperemia
    -Increase blood flow
6
Q

Clinical Features – Burn Size

  1. Quantified as?
  2. Rapid method is based on what?
  3. Rule of 9s is?
  4. Which diagrams are best?
A
  1. Quantified as percentage of body surface area (BSA) burned
  2. Rapid method is based on the area of the back of patient’s hand is approximately 1% of BSA
  3. Rule of 9’s breaks portions of body into multiples of 9 with the perineum being 1%
  4. Lund and Browder burn diagram is best
7
Q

EM: Burn Management
Clinical Features – Burn Depth

First degree? 3

A

First Degree

  1. Erythema of skin
  2. Possibly minimal surrounding edema
  3. Minimal pain
8
Q

EM: Burn Management
Clinical Features – Burn Depth
Second degree? 4

A
  1. Deeper than first degree
  2. Involve partial thickness
  3. Very deep sunburn, contact with hot liquids, flash burns from gasoline flames
  4. Usually much more painful than third degree
9
Q

2nd degree burns appear how? 6

A
  1. Red or mottled;
  2. blisters with broken epidermis;
  3. considerable swelling;
  4. wet/weeping surfaces;
  5. painful;
  6. sensitive to the air
10
Q
EM: Burn Management
Clinical Features – Burn Depth
Third degree
1. Damage to which layers? 3
2. Skin appears how? 6
A
  1. Damage to all
    - skin layers,
    - subcutaneous tissues, and
    - nerve endings
  2. Skin appears:
    - Pale white or charred appearance,
    - leathery;
    - broken skin with fat exposed;
    - dry surface;
    - painless to pinprick;
    - edema.
11
Q

EM: Burn Management
Specific Issues: inhalation issues
6

A
Inhalation
1. Carbon around nose
2. Burns involving mouth
3. Significant Resp problems
4. Fires in enclosed areas
5. Remember CO exposure
CYANIDE!!!!!
6. Intubate early…a must!
12
Q

EM: Burn Management
Specific Issues

Chemical burns

  1. Which types of chemicals? 2
  2. Do not do what?
  3. Managment?
  4. Which are more serious?
A
  1. Alkali or acids can cause
  2. DO NOT TRY TO NEUTRALIZE
  3. “The solution to pollution is dilution” - - IRRIGATE, IRRIGATE, IRRIGATE!
  4. Alkali burns are more serious than acid burns because the alkalis penetrate deeper
13
Q

EM: Burn Management
Specific Issues

Electrical Burns

  1. What to remember about these?
  2. Why is this true?
  3. Occult destruction of muscle can cause _________ which causes the release of myoglobin and can lead to _______________?
A
  1. Always more serious than they appear
  2. Skin has more resistance than bone, muscle, blood vessels or nerves; therefore deeper structures have more damage
  3. rhabdomyolysis
    acute renal failure
14
Q

Electrical Burns

  1. If urine is dark, assume what?
  2. and increase fluids to achieve a urine output of ____ml/hr
  3. If urine doesn’t clear…….________ to ensure continued diuresis?
  4. Control metabolic acidosis by what? 2
A
  1. myoglobin
  2. 100
  3. mannitol
    • perfusion and
    • add sodium bicarbonate as needed to alkalinize urine to solubilize myoglobin
15
Q

By definition, major burn patients are multiple injury trauma patients: ABCDE
Check for evidence of airway involvement and if present; consider endotracheal intubation EARLY!
Start 2 large bore IVs as soon as possible
Place in non-burned areas if practical
Do secondary survey and
MAKE SURE TO LOOK CLOSELY AT?

A
  1. look closely at eyes for evidence of corneal burns

Estimate depth and extent of burn and record

16
Q

ED management
1. Any patient with > 20% BSA partial-thickness burn needs what?

  1. labs? 5
  2. What on any suspected inhalation injury? 4
  3. Urine for what? 2
  4. Check what status and when in doubt, give?
A
  1. NG tube placed as ileus is likely (yes, NG tube)
    • CBC,
    • electrolytes,
    • BUN,
    • Creatinine,
    • Glucose (Chem 7) should be obtained
    • ABGs,
    • carboxyhemaglobin level,
    • Chest XRay, and
    • EKG
    • myoglobin
    • CPK
  2. Tetanus
17
Q

EM: Burn Management
Emergency Department Management

  1. Remove any jewelry Closely monitor distal pulses in extremities with what kind of burns?
  2. What PRN?
  3. Every patient with significant burns gets a what?!
  4. Critical in monitoring what?
  5. Until a swan or CVP line is placed, it is the only way to ensure what?
  6. Pain control: Especially in patients with widespread what?
A
  1. circumferential burns
  2. escharotomy
  3. foley!
  4. resuscitation
  5. adequate renal perfusion
  6. second-degree burns

ABX………..?

18
Q

Fluid Resuscitation Requirements
1. Adults?

  1. Children?
A
  1. NS or RL 4ml x weight (kg) x %BSA for 1st 24hr

2. NS or RL 3ml x weight (kg) x %BSA (admin schedule same as adult)

19
Q

Minimal burns or burns that are being treated as an outpatient:

  1. Use what?
  2. Re-evaluate how often?
  3. Dressing changes how often?
A
  1. 1% silver sulfadiazine (silvadene)
  2. Re-evaluate every 24 hours until full extent is known
  3. Dressing changes BID until burn stops weeping
20
Q

EM: Burn Management
Emergency Department Management

Transfer Guidelines?
6

A
  1. Partial thickness burns of > 10% BSA
  2. Burns involving face, hands, feet, genitalia, perineum, or major joints
  3. Third-degree burns in any age group
  4. Electrical burns, especially lightening injuries
  5. Burns with preexisting complicating medical disorders
  6. Children with significant burns that are not in a children’s hospital

WHEN IN DOUBT CALL THE REFERRAL BURN CENTER

21
Q

Esophageal burns

  1. Assess what?
  2. Alkali worse in?
  3. Stop at burn with what?
    - Whats this needed for?
A
  1. Airway
  2. Alkali worse than acid
  3. Stop at burn with scope
    • needed to diagnose degree and length