Burns - CEN Review

The skin is the largest organ of the body. It covers the entire surface, protecting the underlying tissues and organs. It acts as a barrier against pathogens, regulates body temperature, and helps in the sensation of touch. The skin consists of three layers: the epidermis, dermis, and hypodermis. It also contains various structures such as hair follicles, sweat glands, and blood vessels. The brain, liver, and lungs are important organs, but they are not the largest in terms of surface area or mass.

Patients who have been exposed to toxic fumes in an enclosed space or found unconscious may have been exposed to carbon monoxide poisoning. Carbon monoxide is a colorless and odorless gas that is produced by the incomplete combustion of fuels. When inhaled, it binds to hemoglobin in the blood, reducing its ability to carry oxygen. This can lead to symptoms such as headache, dizziness, confusion, and in severe cases, loss of consciousness or even death. Therefore, carbon monoxide poisoning is a likely explanation for the symptoms described in the question.

Carboxyhemoglobin is the correct answer because it is a compound formed when carbon monoxide binds to hemoglobin in the blood. By measuring the levels of carboxyhemoglobin, it can be determined if there is carbon monoxide poisoning present in the body. Oxyhemoglobin refers to the combination of oxygen and hemoglobin, carboxyl is a functional group, and pulse oximetry is a non-invasive method used to measure oxygen saturation in the blood, but none of these directly rule out carbon monoxide poisoning.

Lactated Ringers is the IV crystalloid of choice for burns because it contains a balanced electrolyte composition that closely resembles the body's natural fluids. It contains sodium, potassium, calcium, and lactate, which helps to maintain electrolyte balance and prevent metabolic acidosis. This makes it an ideal choice for fluid resuscitation in burn patients, as it helps to replace lost fluids and maintain proper electrolyte levels. Normal Saline and NS 0.45 are also commonly used in burn resuscitation, but Lactated Ringers is preferred due to its balanced electrolyte composition. D5W, on the other hand, is not typically used in burn resuscitation as it does not provide adequate electrolyte replacement.

>20% TBSA are prone to gastric dilitation d/t ileus from burn shock, narcotics, or sepsis.

The given causes of burn - flame, flash, contact, and scald - all fall under the category of thermal burns. These types of burns occur when there is direct contact with a heat source such as fire, hot liquids, steam, or hot objects. Thermal burns result in damage to the skin and underlying tissues due to the transfer of heat energy.

Sebum, the oily substance secreted by the sebaceous glands, helps shed topical bacteria through natural desquamation. Desquamation refers to the process of shedding dead skin cells from the surface of the skin. Sebum acts as a lubricant and helps carry away bacteria, dirt, and dead skin cells, preventing them from clogging the pores and causing infections. This shedding process helps to keep the skin clean and free from harmful bacteria, contributing to its antibacterial qualities.

The Parkland formula, also known as the consensus formula, is used to calculate the amount of intravenous (IV) fluid resuscitation required for burn patients. It is a widely accepted formula that takes into account the patient's weight and the extent of the burn injury. The formula helps determine the initial fluid rate and the total volume of fluid needed within the first 24 hours of burn injury. This formula is considered a consensus because it is commonly used and agreed upon by medical professionals for the management of burn patients.

Cyanosis, pallor, deep tissue pain, progressive paresthesia, and progressive decrease or absence of pulse are all signs of vascular compromise. Vascular compromise refers to a reduction or loss of blood flow to a certain area of the body. In this case, it is indicating that there is a lack of blood flow to the extremity affected by the burn. Escharotomy is a surgical procedure that involves making incisions in the burned tissue to relieve pressure and restore blood flow. Therefore, the correct answer is that these signs signify vascular compromise and require escharotomy.

The eyelids have the thinnest skin on the body. This is because the skin on the eyelids is delicate and sensitive, allowing for the movement and flexibility needed for blinking and closing the eyes. The thinness of the skin also allows for the transmission of light, which is important for vision. Additionally, the skin on the eyelids contains a minimal amount of fat and fewer sweat glands compared to other areas of the body, contributing to its thinness.

The rule of nines is a method used to estimate the total body surface area (TBSA) affected by a burn injury. According to this rule, various anatomical regions of the body represent 9% or a multiple of 9% of the TBSA. This allows for a quick estimation of the extent of the burn injury. Additionally, the pediatric score deviates from the adult score because children have a larger surface area in their head compared to adults. This is important to consider when assessing burn injuries in children.

Burn shock can be categorized as hypovolemia because burn injuries can lead to a significant loss of fluid from the body. This loss of fluid can result in a decrease in blood volume, leading to hypovolemia, which is a condition characterized by a low blood volume. Burn shock occurs when there is not enough fluid in the bloodstream to adequately supply oxygen and nutrients to the body's tissues. Therefore, categorizing burn shock as hypovolemia is an accurate statement.

not-available-via-ai

The description of painful blisters, appearing moist, red, and involving the epidermis and part of the dermal layer, is characteristic of a second-degree burn. Second-degree burns, also known as partial-thickness burns, affect the outer layer of skin (epidermis) and extend into the underlying dermal layer. These burns are typically painful and can result in blistering, redness, and a mottled appearance. Therefore, the given description aligns with the characteristics of a second-degree burn.

The given answer includes four types of burns: radiation, chemical, electrical, and thermal. These types of burns are categorized based on the source or cause of the burn injury. Radiation burns occur due to exposure to high levels of radiation, such as from the sun or a nuclear accident. Chemical burns result from contact with corrosive substances like acids or alkalis. Electrical burns are caused by electric shocks or currents passing through the body. Thermal burns are caused by contact with hot objects, flames, or scalding liquids.

The metabolic process of the skin involves producing vitamin D. When the skin is exposed to sunlight, a chemical reaction occurs that converts a form of cholesterol in the skin into vitamin D. This vitamin is important for various functions in the body, including maintaining healthy bones and aiding in the absorption of calcium. Therefore, the correct answer is to produce vitamin D.

The signs of inhalation injury mentioned in the question include singed nasal and facial hair, carbonaceous sputum, burns in or around the mouth or nose, hoarse raspy voice, difficulty swallowing, erythematous oropharynx, and stridor. The correct answer, erythematous oropharynx and stridor, are both signs of inhalation injury. Erythematous oropharynx refers to redness and inflammation in the back of the throat, which can occur due to inhalation of hot gases or smoke. Stridor is a high-pitched, wheezing sound that occurs during breathing and can indicate airway obstruction, which can be caused by inhalation injury.

>10% of TBSA

The depth of a thermal burn injury is determined by the duration of contact with the burning agent and the temperature of the burning agent. The longer the contact with the burning agent, the deeper the burn injury will be. Similarly, the higher the temperature of the burning agent, the more severe the burn injury will be. Other factors such as the temperature of the skin and the difference between the time of initial contact and the temperature of the skin may contribute to the severity of the burn, but they are not the primary factors determining the depth of the burn injury.

The correct order of priorities for burn resuscitation is to first address the patient's ABCs (airway, breathing, circulation) to ensure their immediate survival. After ensuring the patient's stability, a secondary survey should be conducted to assess for any other injuries or potential complications. Next, the extent of the burn injury should be estimated to determine the appropriate treatment plan. Finally, fluid resuscitation can be planned and calculated based on the severity of the burn. This order ensures that the most critical issues are addressed first before moving on to the next steps in the resuscitation process.

The correct answer includes the formulas for calculating fluid resuscitation requirements for adults and children with burns. For adults, the formula is 2-4 ml LR x kg x %TBSA, and for children, it is 3-4 ml LR x kg x %TBSA (which may require additional dextrose solution). These formulas take into account the patient's weight, the percentage of total body surface area (TBSA) affected by burns, and the type of fluid (LR or dextrose) to be used. The range in the adult formula indicates that the amount of fluid needed may vary depending on the severity of the burns.

The different types of skin grafts mentioned in the question are autograft, allograft, xenograft, and spirograft. Autograft refers to using the patient's own tissue for the graft, which is a common and long-lasting option. Allograft involves using cadaveric tissue, which is temporary and used as a temporary measure until the patient's own tissue is available. Xenograft involves using pig skin as a temporary graft. Spirograft, however, is not mentioned in the given options and therefore cannot be considered as one of the correct answers.

Partial thickness burns include first degree and second degree burns. First degree burns are superficial burns that only affect the outermost layer of the skin, causing redness and pain. Second degree burns are deeper and involve both the outermost layer of the skin and the layer underneath, resulting in blistering, severe pain, and possible scarring. Third and fourth degree burns are classified as full thickness burns, as they extend beyond the layers of the skin and can damage underlying tissues, muscles, and bones. Therefore, they are not considered partial thickness burns.

The correct answer is third degree and fourth degree. Full thickness burns refer to burns that extend through all layers of the skin, including the epidermis, dermis, and underlying tissues. Third degree burns involve complete destruction of the skin and may extend into the underlying tissues, while fourth degree burns are even more severe, involving damage to the muscles, tendons, and bones. Partial thickness burns with blistered eschar and second degree burns with open blisters do not meet the criteria for full thickness burns.

A burn patient may lose consciousness due to a head injury or inhalation of carbon monoxide. Head injuries can cause a loss of consciousness by impacting the brain and disrupting its normal functioning. Inhalation of carbon monoxide can lead to oxygen deprivation in the brain, resulting in unconsciousness. Both of these factors can contribute to a burn patient losing consciousness.

The age group of individuals who are at high risk for scald injuries includes those who are 65 years old or older. Scald injuries are commonly caused by hot liquids or steam and can result in severe burns. Older adults may be more susceptible to scald injuries due to factors such as decreased mobility, slower reaction times, and thinner skin. It is important to take precautions to prevent scald injuries in this age group, such as setting water heaters at a lower temperature and using caution when handling hot liquids.

The skin performs several crucial functions for the body. It helps in the prevention of loss of body fluid by acting as a barrier and preventing excessive evaporation. The skin also plays a role in the regulation of temperature by controlling heat loss through sweating and dilation of blood vessels. Additionally, the skin provides protection from infection and injury by acting as a physical barrier against pathogens and external forces. Lastly, the skin allows sensory contact with the environment by containing numerous nerve endings that enable the perception of touch, pressure, temperature, and pain.

Fluid resuscitation is not generally indicated for patients with burn injuries involving less than 15-20% of the total body surface area (TBSA). This is because patients with smaller burn injuries can usually maintain adequate fluid balance without the need for aggressive fluid resuscitation. However, it is important to note that the decision to provide fluid resuscitation should be based on the individual patient's condition and other factors such as the presence of inhalation injury or other comorbidities.

The correct answer suggests that the treatment for tar or asphalt burns includes cooling the affected area with cold water, applying petroleum ointment to cover the burn, dressing it lightly, and then removing the tar or asphalt from the burn. This is done in order to assess the depth and severity of the burn. Immediate escharotomy is not indicated in this case.

Petroleum-based topical agents are commonly used for treating partial thickness burns. A&D ointment, neosporin, bacitracin, and polysporin are all examples of such agents. These ointments create a protective barrier over the burn, preventing infection and promoting healing. Neosporin, bacitracin, and polysporin contain antibiotics that further help in preventing infection. Therefore, neosporin, bacitracin, and polysporin are all suitable options for treating partial thickness burns along with silvadene.

fluid shifts from vascular to interstitial, peripheral blood flow is decreased

The correct answer includes the Rule of Nines, Lund and Browder's rule, and the Palm of hand = 1/2% TBSA method. These methods are used to estimate the percentage of the body surface area (BSA) that has been burned. The Rule of Nines divides the body into regions that represent 9% or multiples of 9% of the total BSA. Lund and Browder's rule is a more precise method that takes into account the changing proportions of BSA in children as they grow. The Palm of hand method estimates that the surface area of an adult's palm is approximately 1/2% of the total BSA. By using these methods, healthcare professionals can assess the severity of a burn and determine appropriate treatment.

topical anti-microbials are used for the treatment of burn wounds

The given symptoms of pain, dry red skin, and involvement of the epidermis indicate a first-degree burn. First-degree burns only affect the outermost layer of the skin (epidermis) and typically result in redness, pain, and dryness. The term "partial thickness" can also be used to describe a first-degree burn, as it only affects the superficial layers of the skin. Second-degree and third-degree burns involve deeper layers of the skin and usually present with blisters, which are not mentioned in the given symptoms.

Hyperbaric oxygen is not indicated for the treatment of Carbon Monoxide poisoning. The primary treatment for Carbon Monoxide poisoning is administration of 100% oxygen through a mask or breathing apparatus. Hyperbaric oxygen therapy may be considered in severe cases or when there are complications, but it is not the first-line treatment. Therefore, the correct answer is False.

The skin has multiple major functions, including metabolic, immunologic, and social and interactive functions. Metabolically, the skin helps regulate body temperature and synthesizes vitamin D. Immunologically, it acts as a barrier against pathogens and plays a role in immune responses. Socially and interactively, the skin allows for sensory perception, communication through touch, and expression of emotions through blushing or sweating. These functions highlight the diverse and essential role of the skin in maintaining overall health and well-being.

Carbon monoxide is a common byproduct of combustion, but it is not the only one. Other common byproducts include hydrogen chloride and hydrogen cyanide. Sodium bicarbonate and carbonic acid are not typically byproducts of combustion.

An insensate burn involves the dermis, subcutaneous tissue, muscle, and bone. This means that the burn has affected multiple layers of the skin, as well as the underlying tissues and structures. The presence of muscle and bone involvement indicates a severe burn that has penetrated deep into the body. This type of burn is likely to cause significant damage and may require extensive medical treatment and intervention.

Do not debride wounds or apply topical agents prior to transfer to a burn center.