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Burn and Inhalation Injuries

Terms in this set (96)

Burns are what # on the list of leading causes of death?
3rd
What are the three types of burns?
thermal, chemical, electrical
What is the most common type of burn?
thermal
How is a thermal burn caused?
Excessive heat and fire
Thermal includes what kind of injuries?
Skin and Inhalation
What is the most common with industrial and lab accidents?
Chemical
What are the most common agents for a chemical burn?
acid and lye
Chemical includes what kinds of injuries?
skin and inhalation
Electrical counts as what % of burns?
3%
The path of the current determines what?
organ injury; resistance varies with each organ
Electrical burns include what kind of injury?
cutaneous and internal
What does a 1st degree burn look like?
skin is red or bright pink
blistered
soft and wet
What is damaged in a 1st degree burn?
epidermal and possibly the upper dermal layer
Is blanching present in 1st degree burns?
yes
How long does a 1st degree burn take to heal?
less then 2 weeks
Are pain sensors intact with a 1st degree burn?
yes extreme pain
Are grafts necessary with a 1st degree burn?
no
What do 2nd degree burns look like?
skin is red and waxy
wet looking
What is damaged in a 2nd degree burn?
epidermis and dermis
Is their pain sensation with a 2nd degree burn?
variable may be insensitive to a prick or touch
Is blanching present with a second degree burn?
diminished
How long does a 2nd degree burn take to heal?
3-6 weeks
Is grafting necessary with a 2nd degree burn?
no usually
What does the skin look like with a 3rd degree burn?
skin is waxy white or tan
What is damaged with a 3rd degree burn?
entire epidermis and dermis
Is the 3rd degree burn painful?
painless no pain endings
Is there blanching with a 3rd degree burn?
absent
Is there grafting required with a 3rd degree burn?
yes due to the removal of the entire epidermis layer
Is there fluid with a 3rd degree burn?
no
What type of management is necessary with burns?
fluid management due to third spacing
What normally causes a 4th degree burn?
electrical or thermal
What does the skin look like with a 4th degree burn?
skin is charred and depressed and entry site with an explosive appearance at exit
What is damaged with a 4th degree burn?
deep soft tissue, fat, muscle, bone, blood vessels and nerves
What can occur with a 4th degree burn?
fracture or dislocation
What can happen if the current that causes the 4th degree burn passes through the head?
cataracts
What are cataracts?
the lens of the eye becomes opaque and light cannot pass through
Is there pain with a 4th degree burn?
no
What kind of burns can be present with a 4th degree burn?
internal burns
What can happen to tissue that would have to be removed surgically with a 4th degree burn?
necrosis
Is limb amputation sometimes necessary with a 4th degree burn?
yes
Where do inhalation injuries occur?
closed space fire
What happens in a close space fire?
decreased O2 supply
increase Carbon Monoxide
inhalation of toxins
increase in O2 temp when inhaled
Inhalation injuries are classified in what three ways?
Time of onset
Anatomical location
Etiologic agent
What are the anatomical location of inhalation injuries?
1. upper airway
2. lower airway: explosion, steam and results in sever hypoxia and usually fatal
What is smoke made of?
mixture of gas and particulate matter
What are the injuries resulting from toxic gasses ?
1. toxic gasses
2. particulate matter
What are some signs of inhalation injuries?
chest tightness, hoarseness, dyspnea, stridor, wheezing, tacky, nasal hair singed, carbonaceous sputum
What are assessments for patients with inhalation injuries?
patient complains of
1. sore, block nose
2. hoarseness
3. cough, croup
4. tightness in chest
5. difficulty breathing
6. wheezing; asthma attack
What can the RT look for on the patient for inhalation injury?
1. facial burns
2. singed nose hairs
3. carbon particles in nose and pharynx
4. edema or blistering of nasal or oral membrane
5. stridor
What does stridor mean????
Indicated 80% obstruction at the level or the larynx and needs intubated immediately
How do you diagnosis smoke inhalation injury?
1. Elevated COHb
2. direct observation
-laryngeal edema
-bronchial inflammation
-airway hemorrhage
-airway necrosis
-mucosal ulceration
-charring of airway
What are some carbon monoxide characteristics?
1. odorless
2. goes to alveoli like O2
3. combines with hemoglobin
4. higher affinity the O2
5. can't support cellular respiration with CO
What test has to be done it CO poisoning is possible?
Co-ox
What are the physiological effects of smoke inhalation?
1. increased level of COHb
2. hypoxia
3. bronchospasm
4. surfactant inactive
5. WOB up
6. pul. hypertension
7. decrease compliance
8. increase lung lymphatic activity
What are the signs and symptoms of CO poisoning? 5-10%
impaired visual activity
What are the signs and symptoms of CO poisoning? 11-20%
Flushing and headache
What are the signs and symptoms of CO poisoning? 21-30%
nausea and impaired dexterity
What are the signs and symptoms of CO poisoning? 31-40%
vomiting and fainting
What are the signs and symptoms of CO poisoning? 41-50%
tachypnea, tachycardia
What are the signs and symptoms of CO poisoning? >50%
coma death
How do you treat CO poisoning?
100% O2 or hyperbaric chamber
What is the normal CO for smokers?
9-13%
Is heat necessary for burns?
no chemical
How do chemical burns occur?
inappropriate mixing of chemical of cleaning agents
What happens is toxic agents bind with water in respiratory secretions?
causing acid or alkaline burn in reap. tract
What are the results of chemical burns?
inactive cilia
increased mucous production
damage to surfactant
What are the symptoms of chemical burns?
bronchospasm
increase mucous production
decreased clearing of secretion
What are the treatment of chemical burns?
maintain airway
clear secretion
O2
intubation
How are inhalation burns divided?
upper and lower airway
The upper airway inhalation burns are known by?
1. injury down to vocal cords
2. do not compromise respirations
3. internal respirations not compromised
Are respirations compromised with an upper airway inhalation injury?
no
What % if inhalation burns effect the lower airway?
5%
What is involved with a lower airway inhalation burn?
trachea, bronchi, lung parenchyma
How do lower airway inhalation injuries occur?
explosion or steam
What is steam?
mixture of gas and water vapor, water isn't cooled adequately
What does steam cause?
severe burn to lower airway and parenchyma
What are symptoms of steam inhalation?
increase reap. distress
deteriorating ABG in 24-48 hrs
What is profoundly decreased with a steam inhalation in means to ABG?
PaO2
What are the diagnostic tests done for thermal inhalation injury?
toxic screen, extended ABG, CBC, CXR. Electrolytes
What does a CXR look like for a thermal inhalation injury?
-normal first 24 hrs
- fluid overload and parenchymal burns post 24 hrs
What are the emergency care for all inhalation injuries?
1. maintain airway; intubate
Who do you intubate?
anyone who exhibits questionable reap. status
When does edema peak?
24 hrs making intubation difficult
What is the MV necessary for burn patients?
they have a high metabolic rate resulting in increased CO2 production
healing
high calorie tube
What can occur in woulds?
sepsis
ARDS can come about in how many days?
3-7
Pneumonia can occur in how many days?
2-3
Why do patients have an increased CO2 production?
increase metabolic rate
increased caloric intake
Is there an increased or decreased lung compliance?
decreased
deceases ability to ventilaiton
What causes hypoxemia?
infection and sepsis
V/Q mismatch
Patients may need what done to their chest?
escharotomy: n escharotomy is a surgical procedure used to treat full thickness (third-degree) circumferential burns. Since full thickness burns are characterized by tough, leathery eschar, an escharotomy is used primarily to combat compartment syndrome.
What are the criteria for HBO2 in acute CO poisoning?
history of unconsciousness, COHb> 25%. metabolic acidosis, concurrent pregnancy
What should you never use if a patient has smoke inhalation?
pulse ox get extended ABG
Escharotomy?
slice between muscles; limbs chest back to decrease pressure (internal swelling, edema, compression, blood vessel necrosis
Most common cause of death?
sepsis
What causes CO poisoning?
car exhaust or hot water heater
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