CH 33 Burns

What has improved the ability to treat burns?

Better understanding of burn shock, advances in fluid therapy and antibiotics, improved ability to excise dead tissue, use of biologic dressings, formation of specialized teams, and public safety campaigns.

What are the four functions of the skin?

Protection from the environment, regulation of temperature and fluid, sensory communication with the brain, and response to injury with inflammation.

What difficulties may patients with skin injuries experience?

Difficulty with thermoregulation, inability to sweat, impaired vasoconstriction and vasodilation, little or no melanin, inability to grow hair, and little or no sensation.

What is the outer layer of the skin called?

Epidermis.

What is contained within the dermis?

Nerve endings, blood vessels, sweat glands, and hair follicles.

What is the role of subcutaneous tissue?

It is a thick layer of connective tissue between the dermis and underlying muscle and bone.

What can cause serious airway compromise in burn victims?

Inhalation of steam or hot particulate matter.

What are the risks associated with soft-tissue injuries?

Infection, hypothermia, hypovolemia, and shock.

What causes hypovolemic shock in burn victims?

Fluid loss across damaged skin and volume shifts within the body.

What temperature can cause thermal burns?

Exposure to temperatures higher than 118°F (47.8°C).

What are the types of thermal burns?

Flame burns, scald burns, contact burns, steam burns, and flash burns.

What are the three zones described in burn injuries?

Zone of coagulation, zone of stasis, and zone of hyperemia.

How is burn depth categorized?

Superficial, partial thickness, full thickness, and subdermal.

What characterizes superficial burns?

Involves the epidermis only; skin is red and swollen, usually heals spontaneously in 2 to 3 weeks.

What are partial-thickness burns?

Involves the epidermis and dermis, subdivided into superficial and deep partial-thickness burns.

What are full-thickness burns?

Involves destruction of both layers of skin; skin may appear white, waxy, brown, leathery, or charred.

What are subdermal burns?

Involves all layers of skin along with layers of fat, muscle, and bone or internal organs.

What can smoke or superheated gas inhalation cause?

Thermal burns to the airway, hypoxia from lack of oxygen, and tissue damage with toxic effects.

What is carbon monoxide intoxication?

CO evolves from incomplete combustion of carbon compounds and can displace oxygen, binding to receptor sites 250 times more easily than O2.

What are the signs of hypovolemic shock?

Chills and nausea, limits distribution of oxygen and glucose, hampers ability to remove waste products.

What is the importance of adequate fluid resuscitation in burn victims?

It is essential to manage hypovolemic shock and ensure proper distribution of oxygen and nutrients.

What factors influence burn severity?

Exposure time, age of patient, thickness of skin, and concomitant injuries or preexisting medical conditions.

How long does it typically take for superficial burns to heal?

2 to 3 weeks.

What is the primary cause of death from fires related to inhalation burns?

Smoke or superheated gas inhalation.

What happens to sensory nerves in full-thickness and subdermal burns?

They are destroyed.

What is the body's response to injury involving the skin?

Inflammation.

What is the primary function of the dermis?

It provides structural support and houses blood vessels, nerve endings, and glands.

What is a common presentation of carbon monoxide intoxication?

Patients usually present with an O2 saturation of normal or better.

Why should you never trust a pulse oximeter in cases of carbon monoxide intoxication?

It may give misleading readings in the presence of carbon monoxide.

How may patients with serious injuries present initially?

Patients may not act sick, and the severity of injuries may not be apparent until after assessment.

What should be the primary concern when operating near a fire scene?

Safety is a primary concern.

What should you do first when a burned patient comes to you?

Extinguish the flame and cool the burn.

What is the recommended action if a person is on fire?

Have the patient stop, drop, and roll.

What should you do if smoldering cloth adheres to the skin?

Cut it away.

What is the importance of determining the mechanism of injury?

Patients may have sustained other trauma.

What does ABCDE stand for in patient assessment?

Airway, Breathing, Circulation, Disability, Exposure.

What are signs of airway involvement in burn patients?

Hoarseness, cough, stridor, singed nasal or facial hair, facial burns, carbon in sputum, history of burn in an enclosed space.

Why is early ET intubation important in burn patients?

It could be lifesaving.

What is emphasized in circulation management for burn patients?

Fluid resuscitation to prevent burn shock in the first 24 to 48 hours.

What does the Rule of Nines help with?

It divides the body into eleven 9% segments to approximate TBSA burned.

What does the Rule of Palms represent?

The patient's palm represents 1% of the body surface area.

What is the Lund-Browder chart used for?

It provides a more accurate estimation of burn areas.

What should hospital personnel report regarding burns?

Estimations of burn areas, as burns evolve over 24 hours.

What injuries warrant transport of burn patients?

More than 10% TBSA, involvement of face, hands, feet, genitalia, perineum, or joints, full-thickness burns, electrical burns, chemical burns.

What is the significance of obtaining a brief history from burn patients?

Preexisting diseases may influence care and triage.

What vital signs should be monitored in burn patients?

Blood pressure, pulse, SpO2, ETCO2, carboxyhemoglobin percentage (SpCO).

What is the recommended reassessment frequency for critical patients?

Every 5 minutes.

What are the four phases of emergency medical care for burns?

Initial evaluation and resuscitation, initial wound excision and biologic closure, definitive wound closure, rehabilitation, reconstruction, and reintegration.

What should be prioritized in burn management?

Control of ABCs before focusing on the burn itself.

What may be necessary for patients with acutely decompensating airways?

Field intubation, surgical airways, or rescue devices.

What should be done for patients with deteriorating airways who might require intubation?

Defer treatment to hospital teams and attempt to intubate only if airway continues to swell.

What is the recommended treatment for patients with patent airways but risk factors for airway compromise?

Use cool, humidified O2 from a high-output nebulizer or aerosol nebulizer with saline.

What should be provided to patients with no signs of airway compromise who are in no distress?

Provide supplemental O2.

When is fluid resuscitation needed for burn patients?

For patients with burns covering more than 20% of the total body surface area (TBSA).

What happens if fluid resuscitation is delayed more than 2 hours?

Mortality increases.

What is the consensus formula for fluid resuscitation during the first 24 hours?

2 to 4 mL × body weight (in kg) × percentage of body surface burned.

How should fluid resuscitation be administered in the first 24 hours?

Half of the calculated fluid should be given during the first 8 hours and the other half over the subsequent 16 hours.

What is fluid creep in burn management?

Fluid creep refers to rapid increasing peripheral edema and compartment syndrome due to excessive fluid administration.

What should be assessed in patients with thermal burns?

Pain, swelling, skin color, moisture and blisters, appearance of wound edges, foreign bodies, bleeding, and circulatory adequacy.

What is the recommended treatment for superficial burns?

Immerse the burn in cool water or apply cold compresses; do not use salves, ointments, or ice.

What should be done for partial-thickness burns?

Cool the burn with water, apply wet dressings, elevate extremities, and administer IV fluids and pain medication.

What is the management for full-thickness burns?

Assess pain, administer pain medication, use dry dressings, and begin fluid resuscitation.

What should be applied for thermal inhalation burns?

Apply cool mist or aerosol therapy and consider aggressive airway management.

How should chemical burns of the skin be managed?

Flush with water for solutions and brush off powders before washing.

What factors influence the damage caused by chemical burns?

Nature of the chemical, concentration, state or temperature of the agent, length of exposure, and depth of penetration.

How are acid burns characterized in terms of treatment?

Acid burns are easier to neutralize and cause destruction and coagulation of tissues.

What is the recommended management for alkali burns?

Alkali burns are more difficult to neutralize and have pronounced effects in burns of the eye.

What is the first step in assessing a patient with a chemical burn?

Ensure safety and decontaminate the patient.

What special management technique is used for dry lime burns?

Remove clothing and brush off as much as possible from the skin, then flush copiously with water.

What is the treatment for burns caused by hydrofluoric acid?

Apply calcium gluconate topical gel.

What should be done for burns caused by gasoline or diesel fuel?

Remove with soap solution.

What is the recommended action for hot tar burns?

Immerse the affected area in cold water.

What determines where inhalation burns affect the airway?

The solubility properties of the gas.

What are the three categories of water-soluble gases?

Highly water-soluble gases, slightly water-soluble gases, moderately water-soluble gases.

What is a key characteristic of Hydrofluoric (HF) acid?

It aggressively binds with calcium ions and may require IV calcium administration.

What should be suspected if a patient was involved in a fire or explosion?

A high index of suspicion for irritant gas exposure.

What are signs of upper airway swelling?

Stridor.

What indicates lower airway involvement in inhalation burns?

Wheezing and desaturation.

What is the first step in managing inhalation burns?

Maintain an acceptable O2 saturation level.

What chemicals are known to cause eye burns?

Acids, alkalis, dry chemicals, and phenols.

What is the recommended action for chemical burns to the eye?

Flush with copious amounts of water.

What should be done if a patient wears contact lenses during an eye burn?

Pause for removal before flushing the eye.

What tool can help with comfort after an eye burn?

Morgan lens.

What are the two injury sites associated with electrical burns?

Entrance wound and exit wound.

What factors influence the degree of tissue injury from electrical burns?

Resistance of body tissues, intensity of current, duration of exposure, and direction of current flow.

What types of burns can electricity cause?

True electrical injury, TASER effects, arc-type or flash burn, and flame burn.

What serious internal injuries can result from electrical burns?

Asphyxia, cardiac arrest, and nervous system disruption.

What is the first step in assessing a patient with electrical burns?

Once the hazard is neutralized, assess the patient.

What is the best treatment for lightning-related injuries?

Prevention by avoiding being the tallest conductor and seeking shelter.

What should be done for patients injured by lightning?

Perform CPR as needed and monitor cardiac rhythm.

What are the three types of ionizing radiation?

Alpha, beta, and gamma radiation.

What is acute radiation syndrome (ARS)?

A condition causing hematologic, central nervous system, and gastrointestinal changes due to radiation exposure.

What should be assessed in patients with radiation burns?

Safety of the scene, required protective gear, and ABCDEs.

What is the average inpatient treatment time for burn patients?

1 day of inpatient treatment for each 1% of total body surface area (TBSA) burned.

What are common long-term consequences of burns?

Problems with thermoregulation, motor function, and sensory function.

What special considerations are there for managing burns in pediatric patients?

Fluid resuscitation may be more challenging and may require more fluid per kilogram.

What risk factors make elderly patients sensitive to respiratory injuries?

Diminished hearing, mobility issues, and medications causing sedation.

What should be prioritized in the management of electrical burns?

Patient care, fluid therapy, and early oxygen therapy.

What is the 30% rule in radiation burn assessment?

It refers to assessing the percentage of body surface area affected by radiation exposure.

What is the recommended management for radiation burns?

Decontaminate patients before transport and gently irrigate open wounds.