Burn Injuries

epidermis and part of dermiswhich layers affected in 2nd degree (partial-thickness) burn?1. hyperesthesia that is sensitive to air currentssymptom of partial-thickness burn?1. blister 2. mottled 3. red base 4. weeping 5. edema5 characteristics of partial-thickness wound?may require graftinghow to manage partial-thickness burn injury?2-3 weekshow long does a partial-thickness burn take to heal?epidermis, dermis, possible subcutaneous; may involve connective tissue and musclewhat layers are affected in 3rd degree (full thickness) burns?1. no pain 2. myoglobinuria 3. shock 4. hemolysis4 possible s/s of full thickness burns?1. dry 2. colors vary from pale white, red, brown, leathery, charred 3. coagulated vessels may show 4. edema4 characteristics of a full thickness burngrafting or amputationwhat treatment might full thickness burn patients need?1. head 9% 2. trunk 36% 3. arms 9% each 4. perineum 1% 5. legs 18% eachUsing Rule of Nines, how much is each body part worth?LR 4mL/kg/TBSA%, give half over first 8 hours, second half over next 16 hoursParkland formula1. pallor 2. pain 3. paresthesia 4. pulselessness 5. paralysis5 s/s of compartment syndromefasciotomytreatment for compartment syndrome1. thermography 2. vital dyes 3. indocyanine green video angiography 4. laser doppler imaging 5. CXR 6. CT 7. US 8. MRI 9. bronchoscopy 10. eye exam10 diagnostics used for burn injuries1. WBCs 2. kidney and liver tests 3. glucose 4. electrolytes (Na, K, Cl) 5. protein and albumin 6. ABGs 7. clotting study 8. drug screening 9. urinalysis 10. lactate levels10 labs used in burn injuriesdecreased PaO2 and pH, increased PaCO2, and carboxyhemoglobinwhat will ABGs show for burn injury?cyanide poisoningwhat might elevated lactate levels mean in burn injuries?1. dry heat 2. moist heat 3. contact 4. chemical 5. electrical 6. radiation6 causes of burns1. barrier against infection 2. prevents loss of fluid 3. maintains temperature 4. excretory 5. produces Vitamin D 6. makes up identity 7. protects against environment7 functions of skin1. coagulation 2. protein denaturation 3. ionization of cellular contentswhat 3 processes occur that cause tissue destruction in burns?1. zone of coagulation (center) 2. zone of stasis (surrounding tissue) 3. zone of hyperemia (outermost)list 3 zones of burn injuryskin and mucosa of upper airway2 areas most common for skin destruction in burns1. cutaneous burn injury (thermal effect) 2. damage to cell DNAwhat happens in a radiation injury?1. decreased CO 2. FVD 3. Anemia 4. coagulation issues4 cardiovascular alterations in burnsloss of plasma volume increases workloadwhat causes decreased CO in burns?fall in BP and fluid leaking from intravascular to the interstitiumwhat causes FVD in burns?1. direct injury 2. intravascular volume loss 3. systemic inflammation 4. edemawhat causes burn shock?some RBCs destroyed/damaged, may still show high hematocrit (from plasma loss)what causes anemia in burns?thrombocytopenia, prolonged clotting and PTwhat coagulation issues occur in burns?1. edema 2. hyperkalemia 3. hyponatremia 4. metabolic acidosis 5. vascular dehydrationlist 5 fluid and electrolyte alterations that occur in burnswithin 4 hours (superficial burns) or up to 18 hours (if deep burns)when does edema occur in burn injury?4 hours to 4 days laterwhen does the reabsorption of edema occur in burn injuries?massive cell destructionwhat causes hyperkalemia in burns?plasma loss and water shifting from interstitial space back to intravascularwhat causes hyponatremia in burns?excretion of bicarbonate from kidneyswhat causes metabolic acidosis in burns?increased H&H and viscositywhat happens to the hemoconcentration in burns?1. thermal damage 2. asphyxiation 3. irritation of tissues3 mechanisms of injury of pulmonary system with burns?1. burn occurred in enclosed space 2. face and neck burns 3. singed nasal hair 4. hoarseness and high pitch voice changes 5. stridor 6. soot in sputum 7. tachypnea/dyspnea 8. red, blistered throat8 s/s of inhalation injurysevere edema from direct thermal injurywhat causes upper airway injury in burns?inhalation of gases causes loss of ciliary action, triggers inflammation and hyper secretion --> mucosal edema, bronchospasm, reduced surfactantwhat causes lower airway injury in burns?carboxyhemoglobin > 10%what is diagnostic of carbon monoxide poisoning?1. cherry red face 2. HA 3. dyspnea 4. confusion 5. nausea 6. fatigue 7. poor judgment 8. hallucination 9. stupor or coma9 s/s of carbon monoxide poisoningO2 and ventilationtreatment for carbon monoxide poisoningAKIwhat is main complication in the kidneys from a burn injury?1. decreased blood flow to kidneys 2. muscles damaged release myoglobin; kidneys have trouble filtering it/occlude renal tubuleswhat are the 2 causes of AKI in burn injuries?urine output is equal or > 30mL/hrwhat is best way to determine if fluid resuscitation has been effective in a burn injury?immunosuppression and sepsiswhat affects does a burn have on the immune system?1. systemic release of cytokines 2. invasive procedures 3. loss of skin barrierwhat 3 things cause sepsis and immune system alterations in burns?hypothermiahow do burns affect thermoregulation?1. Abdominal Compartment Syndrome 2. Altered motility2 complications of burns in the GI system?1. large TBSA % burns 2. large volumes of fluid needed for resuscitation causes edema and decreased abdominal wall compliance2 causes of abdominal compartment syndrome?intra-abdominal HTN >30diagnostic for abdominal compartment syndrome1. distention 2. oliguria 3. difficulties with mechanical ventilations/s of abdominal compartment syndrome1. paralytic ileus 2. curling's ulcer 3. translocation of bacteria3 complications from altered GI motility in burns1. decreased peristalsis 2. decreased bowel sounds 3. distention 4. NV4 s/s of paralytic ileus1. occult blood 2. regurgitation of "coffee grounds" 3. blood vomitus3 s/s of curling's ulcer1. increased catecholamines secreted 2. catabolism breaks down fat and protein 3. increased secretion of ADH, aldosterone, cortisol 4. increased use of glucose and calories 5. increased core body temperature5 metabolic alterations in burns1. extinguish flames or remove from source by "stop, drop, and roll" or "stop, drop, and pat" or smother fire with blanket/rug/coat 2. soak injury BRIEFLY with cool water (NO ICE or prolonged soaks) 3. remove restrictive objects and jewelry 4. cover wound (clean, dry cloth) 5. irrigate chemical burns ASAP5 emergency procedures used at a burn scene24-48 hourshow long is the emergent/resuscitative period?1. establish airway 2. supply O2 3. large-bore IV (usually CVC) 4. cover wound 5. prevent shock5 priorities during emergent phase1. intubate/ventilate (O2, PEEP) 2. cough, suction 3. meds - bronchodilators and/or mucolyticsinterventions for airway and breathing in burns1. dyspnea 2. change in respiratory patterns 3. adventitious breath sounds (wheeze, stridor)3 s/s of ARDS in burns1. fluid resuscitation (>20% TBSA) with Parkland's formula 2. large-bore IV with LR 3. monitor weight 4. monitor output (>30mL/hr) 5. digoxin (to improve CO)5 interventions for circulation in burns1. decreased CO 2. oliguria 3. JVD 4. edema 5. extra heart sounds 6. crackles6 s/s of HF1. sit up 2. give O2 3. IV diuretics 4. IV vasoactive meds4 interventions for HF<95 F (35 C)temperature that indicates hypothermiafoley catheter and NGTinterventions for burns >20% and intubated patientssepsisleading cause of death in burn patients1. opioids (morphine, fentanyl) 2. anesthetics (ketamine, nitrous oxide) 3. antipruritics 4. gabapentin4 types of meds for burn patientstetanus shotwhat else might you give a patient with a burn wound (after checking chart)?48-72 hours after injurywhen does the acute/intermediate phase occur?stridor and dyspneawhich two s/s are ominous in the acute phase?1. upper airway edema 2. mucosal sloughing 3. ARDS 4. VAP4 complications during the acute phase of the pulmonary systemaerosolized heparintreatment of mucosal sloughingventilation >48 hourswhen do VAPs occur?1. FVE 2. hyponatremia 3. hypokalemia 4. anemia 5. metabolic acidosis 6. hyperthermia6 complications during acute phase in the circulatory systemfluid returning back to intravascular space = CHFwhat causes FVE in acute phase?excretion of sodium and loss of sodium from woundscauses of hyponatremia in the acute phasediuresis and return of potassium into the cellcauses of hypokalemia in acute phasehemodilutioncauses of anemia in acute phaseexcretion of bicarbonate from kidneyscause of metabolic acidosis in acute phaseafter shock resolves, body might be a few degrees higher than normal for several weekswhat causes hyperthermia in the acute phase1. loss of skin barrier function (local and systemic immunity impairment) 2. necrotic tissue + serum proteins = environment conducive to bacterial growth2 causes of skin infection from burns1. debridement 2. remove previously applied topical agents before applying new coat 3. gentle cleansing (mild soap and water) 4. clip hair in/around burn 5. water no > 100 degrees 6. room temp 80-856 interventions for wound care1. antimicrobial ointment 2. silver sulfadiazine 1% 3. mafenide acetate 5-10% 4. silver nitrate 0.5% 5. silver-impregnated dressings5 topical meds/dressings for burn woundsmetabolic acidosiswhat do you have to watch for when using mafenide acetate on a burn wound?Na/K levelswhat do you have to watch for when using silver nitrate in burn wounds?1. apply distally to proximally (promotes venous return) 2. wrap fingers individuallyhow to apply circumferential dressings to burn wounds3-5 days over new skin graftswhen to apply occlusive dressings1. nutrition (enteral first, unless prolonged ileus) 2. early excision and drafting 3. give oxandrolone (steroid) improves protein synthesis and metabolism 4. give propranolol (blocks catecholamines) 5. exercise5 treatments for hyper metabolism in burns

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