emed II exam 1 burns

Question Answer
Depth dependent on depth of heat penetration, Rapid protein denaturation & cell damage, Dead skin tissue = eschar heat induced injury
First to third day after injury, Tissue damage caused by toxic mediators of inflammation- Increased permeability, Later wound conversion if excessive inflammatory mediator injury
Vascular thrombosis/vasoconstriction- Systemic hypovolemia, impairment of perfusion (constricting eschar or edema) produces the same effect- Restrictive eschar –if a chest burn they cant respire very well ischemia induced injury
– Ongoing inflammation = continued tissue damage (i.e. increased neutrophils, proteolytic activity, deactivation of growth factors delayed injury
what are the three zones of burn injury (1) Zone of Coagulation (2) Zone of Stasis (Injury) (3) Zone of Hyperemia
depression of cardiac output precedes what zone of burn injury (3) Zone of Hyperemia
tachycardia precedes what zones of burn injury (2) Zone of Stasis (Injury) (3) Zone of Hyperemia
Hemolysis > hemoglobinuria, Increase RBC lipid peroxidation > fragmented cells, Decrease RBC survival, Decrease hematopoiesis, Increase WBC? Activation of clotting and Depletion of factors > DIC hematologic response
Limited to the epidermis, patient has some blistering Heals in 7-10 days, pt heals w/out scarring mostly, tx w/ cool compress/anagesics, NSAIDs, ointment for comfort, rarely admitted superficial/first degree burn
Involves epidermis and superficial dermis, Typical blistered burn- Usually heals in 2-3 weeks- TX: topical anti-microbial and analgesics or possibly wound care products (Biobrane®, Dermagraft TC®, ionic silver release etc.) aloe vera, medihoney Partial thickness/superficial second degree
Involves through to deep dermis – few epithelial structures remain, Heals in >3 weeks, often with hypertrophic scar- Treat initially with topical antimicrobial; may require skin graft- Admitted for hydration and pain management (can use narcotics) deep partial thickness/ deep second degree
: Involves epidermis, dermis and subcutaneous fat- Treat initially with topical antimicrobial- Requires excision and 1° closure or skin grafting –has to be a cleaner type wound- Admit for resuscitation- Debridements can be chemical or I & D Full thickness/ third degree:
burn that involves deep structures—muscle and bone Full thickness/ fourth degree:
what dressings should you avoid when covering a burn wound wet dressing when covering the burn because it will eventually dry and it could take skin with it if you took it off
what is special about the IV solutions given to burn patients – Warm IV solutions because you don’t want to drop their temperature (body temp already goes down in a burn situation)
what burn patients may need IV fluid therapy (14g or 16g peripheral IV) central line if the patient is hard to stick – May be required in patients with 2° burn >20% or 3° burn >10%
– 4cc/kg/%TBSA burn of LR= Total volume in 24 hrs- First ? of total volume – give in the first 8hrs from time of burn- Remaining ? of total volume – give over the next 16 hrs parkland formula (2nd and 3rd degree burns)
FFP, albumin, dextran, hetastarch colloid fluids
Lactated Ringers, Normal Saline (typically this is what we use) crystalloid fluids
250 mEq Na (Monafo), 180 mEq Na (Warden) hypertonic solutions
Urine output should be ___ cc/hr in adultsUrine output should be ____cc/kg/hr in children 30-60 0.5-1.0
what should the bp and MAP be maintained around when resuscitating a burn systolic> 90 and MAP 65
Over-resuscitation-extra fluid goes into 3rd spacing instead of being reabsorbed into primary circulation diff breathing, labored breathing, crackles when listening to the lung, lactic acidosis, increasing hct and instability fluid creep
how do you tx fluid creep colloid resuscitation, hypertonic solutions, plasma exchange, heavy dose of diuretics with potassium
clinical signs of impaired circulation—cyanosis, impaired capillary refillingprogressive neurological signs (5 P’s = pallor, pain, paresthesia, pulseless, and poikilothermia)PAD and compartment syndrome circumferential extremity burns
cut into the eschar, until subQ fat— prevent compartment syndr- incision in mid-lateral/ mid-medial line of limb and across involved joints- only incise through depth of eschar to nl SubQ tissue- if goes down to musc do a fasciotomy after escharotomy
is anesthesia needed in an escharotomy no
– compartment syndrome to extremities, usually due to electrical injuryo needed if massive swelling is involved fasciotomy
– intra-abdominal compartment syndromeo massive fluid hydration for inhalation injurieso Possible use of peritoneal dialysis catheters if +FAST laparotomy
topical antimicrobial– leukopenia (reversible), poor penetration, slows epithelialization, under 3 mos. Kernicterus (RX) silvadene cream
topical antimicrobial–late allergy, early resistance bacitracin ointment
topical antimicrobial–(Mafenide acetate 15%) – carbonic anhydrase inhibition, systemic acidosis, pain on application (RX) sulfamylon cream
topical antimicrobial–? staining, leeching of electrolytes, methemeglobinemia cerium/silver nitrate
Signs & Symptoms include: Hoarseness, Stridor and/or wheezing, Carbonaceous sputum- Singed nasal hair, eyebrows or facial hair- Edema or inflammatory changes in upper airway inhalation injury
how do you treat an inhalation injury laryngo/bronchoscopy to examine for sgs of inhal injury, humidified O2 by mast, poss intubation, poss use systemic steroids, dont fluid overload
Slough of Mucosa-plugs which in turn clogs up the airway—have to suck out the mucus plugs with a bronchoscopy – Goblet cell injury increases >> decrease surfactant – Ciliated Epithelial Cells-Dysynchronous chemical injury to lower airways
what are the toxic carboxyhgb levels for adults and kids/pregnant women CarboxyHgb levels toxic if >15% in adults, >10% in kids & pregnant women (or teratogenicity)
Cherry Red color – in capillary/ blood tubes, no hyperventilation until late stage, PaO2 is normal, carotid body not affected until lactic acidosis develops, get ABG when pt is obtunded carbon monoxide poisoning
what is the CO2 level of mild CO poisoning – Headache, confusion, nausea 10-20%
what is the CO2 level of moderate CO poisoning – Irritability, dizziness, fatigue, visual symptoms, impaired judgment 20-40%
what is the CO2 level of severe CO poisoning – Hallucinations, ataxia, coma,convulsions, possible tachypnea 40-60%
what is the CO2 level of fatal CO poisoning >60%
what percentage of TBSA do patients start having hyper metabolism Generally > 40% TBSA burn unless septic, > 40% always experience catabolism
The Greatest mortality in burns is due to complications
fibrinous slough, confusion, ileus, leukopenia, temp abnormalities, Exudate – changes quality/ quantity, Ulcerations, Cellulitis, Black spots, get biopsy and quantitative bacterial culture (10^5) to prove pathology sepsis with burns
what is the most common organism seen w/ sepsis with burns and what organism is becoming more common MC pseudomonas Resistant actinobacter increasing
how do you treat burn sepsis – Can use catheter or tube to keep an area apart—as a wicking device or can also be placed deeper into tissue to allow drainage to occur so the deep infection can work its way out
what type of burn coverage for a large burn would you use Autograft (self), Isograft (identical twin), Primary closure, Spontaneous – 2° healing permanent
what type of burn coverage for a large burn would you use ? Allograft (homograft)—another person, Xenograft (heterograft) pigskin, Bioengineered tissue eg.transcyte temporary
intergra®, alloderm, cultured epithelium, fetal tissues (animal/human, products) permanent biological burn coverage

Leave a Reply

Your email address will not be published. Required fields are marked *