Burn & Smoke Inhalation Injuries

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1
The Berkow’s Formula / Rule of 9s is used to quantify burns in pts _______ y.o only
>15 years old
2
Child w/ 1st degree burn & < 5% of their TBSA involved, you can try to allow them to
take fluids by mouth
3
Normal Albumin level
3.4-5.4
4
The Lund & Browder Chart is used to quantify burns in pts _______ y.o only
< 15 y.o
5
Superficial burn involves the
outer layer epidermis which results in pain and erythema. The tissue remains intact and the burn usually heals without scarring in 4 to 5 days.
6
Superficial partial-thickness burn involves the
epidermis and superficial layer of the dermis, causing blistering, erythema, blanching, and pain. Typically heals in 7 to 10 days. Scarring is minimal
7
Deep partial-thickness burn: involves the
epidermis and more than 50% of the dermis, which causes destruction of nerve endings and is erythematous, moist, nonblanching, and less painful. Typically heals in 2 to 3 weeks and causes scarring
8
Full-thickness burn: involves the
entire epidermis and dermis which appears white, waxy, nonblanching, and is insensate due to the complete destruction of nerve fibers. Typically takes over a month to heal with significant scarring
9
The zone of coagulation or necrosis in thermal burns is where the skin has lost _______. its where the _______ of the injury occurs
- all vasculature
- center
10
The zone of stasis in thermal burns surrounds the zone of coag. you'll have some impairment to the ______. Skin is ____
- Vasculature
- viable, but it's still severely damaged
11
The zone of hyperemia in thermal burns is the _____ zone; There's lots of _____, _____, & ______ but good _______
- outer
- edema, erythema, and swelling
- vasculature
12
Alkaline chemicals (i.e fertilizers, oven cleaners) have a __________ because of the difference in their ________
- deeper penetration
- solubility
13
Direct contact electrical burns will have injury at the _____ , the ______, as well as injury along the _______
- entry site
- exit site
- path that the electrical current takes
14
Arc electrical burn injuries (lightning strike) tend to have _______ injuries at the entry and exit sites
deeper thermal
15
There's 2 forms of electricity; ____ current and _____ current. __________ current is what comes out of plugs and car batteries
- alternating and direct
- Alternating
16
Alternating currents are more dangerous bc they cause ____ of the muscles that prevents the patient from _______ r/i increased injury
- tetany
- letting go of electrical source
17
Direct injuries from an electrical burn cause injuries from _______ and also the _______ that may result
- the actual burn from the electrical current
- pathway
- arrhythmias
18
Goal UOP for Infant and Young Children is at least _______
1 ml/kg/hr
19
Goal UOP for Older Children (>12yo or >50 kg) is at least ______
0.5 ml/kg/hr
20
The Parkland Formula is used to determine how much fluid resuscitation the pt needs which is ________ ; 1/2 given in first ___ hours since injury; other ½ given in the following _____ hours. used to tx pt w/ > ___ % BSA burned
- (4ml/kg x %BSA) + Maintenance [if pt is <40kg]
- 8
- 16
- 10%
21
Fluid resuscitation in a burn pt should be done with ______
- LR
- Maintnance D5LR
22
When determining maintenance fluid you use ______ ml/kg for the 1st 10 kg of body weight; ____ ml/kg for the 2nd 10 kg; and then ____ ml/kg for anything over 20kg of weight
- 100
- 50
- 20
23
Burn patients are at extremely high risk for secondary ______ infection
fungal
24
The most common infection seen at the site of superficial burns is __________. Management includes _______ the site and start ________
- Impetigo
- Culture
- Topical abx
25
Burns with invasive infections will develop _____, ____, or _____ discoloration. It'll be _____ and the eschar will ______. Also see s/s of ____ & inflammation of ______
- Black, purple, or red
- Macerated
- Separate early
- SIRS
- Surrounding uninjured skin
26
Definitive diagnosis of invasive infections is a culture with > _____ organisms per gram of tissue
100,000
27
Burn patients are in a persistent _______ state d/t constantly burning energy to heal the skin----> requiring higher need for ______
- hyper metabolic
- nutritional support
28
The goal is to start tube feeds within _______ of injury
24 hours
29
Formula for nutritional support in burn pts: 24 hr requirement
Infants (0-12 m.o): ________
Children 1-11 y.o: _________
Children > 12 y.o: _________
- Infants (0-12 m.o): 2100 kcal/m2 + 1000 kcal/m2 of burn area
- Children 1-11 y.o: 1800 kcal/m2 + 1300 kcal/m2 of burn area
- Children > 12 y.o: 1500 kcal/m2 + 1500 kcal/m2 of burn area
30
Burn pt. are very high risk for ______ w/ enteral feeds, especially when feeds are started > _______ after injury
- diarrhea
- 48 hrs
31
Feeds for a burn pt should include ______, < ___% fat, and initiated w/in _____ of injury if possible to reduce the risk of diarrhea
- Vit. A
- 20%
- 24 hrs
32
Burn pts are at a high risk for diarhea & __________. Fluid resuscitation w/ _______ can be used to prevent this but if the level is < 2 then _______ should be used to replenish
- hypo albuminemia
- 5% Albumin
- 25% Albumin
33
When you increase the albumin level, you're increasing the ______ across the vessel membranes; This will pull fluid _______
- Osmotic pressure
- Back into the blood vessel
34
What are the 3 main components of inhalation injuries?
1. Upper Airway Thermal Injury
2. Chemical Pneumonitis
3. Systemic Poisoning (Cyanide & Carbon Monoxide)
35
Chemical pneumonitis from inhaled chemicals and ______; peaks around day ______.
- Soot
- 3-5
36
Pt can also have a pneumonitis inhalation injury as a result of _____, _____, & ______
edema, debris and infection
37
Systemic poisoning component of inhalation injuries is the result of ______ & _____ toxicity. Cyanide toxicity can be seen from burning ______
- Cyanide & carbon monoxide
- Plastics
38
Hydroxocobalamin is a medication used to tx ________ by.....
- Cyanide toxicity
- binding to cyanide in the blood and help eliminate it from the body
39
A side effect of Hydroxocobalamin to be aware of is that it will cause the patients ______ to turn ______ or ______
- Urine
- Purple or red
40
Amyl Nitrate or Sodium Nitrate are medications that can be used as second line tx for _____
Cyanide toxicity
41
What should you be cautious of when using Amyl Nitrate or Sodium Nitrate to treat cyanide toxicity?
- Can cause formation of met hemoglobin
- Met hemoglobin prevents O2 from binding to RBC
- Can worsen carbon monoxide toxicity
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