Burn Injury and Treatment Quiz
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Questions and Answers

Which type of injury can occur due to electrical burns?

  • Cardiac failure (correct)
  • Skin discoloration
  • Nerve regeneration
  • Hair loss

    • Chemical burns are typically less damaging than electrical burns.

    False

    What should be done immediately for a wet chemical burn?

    Flush with copious amounts of water.

    The formation of __________ can damage local tissues in frostbite.

    <p>crystals</p> Signup and view all the answers

    Match the type of burn with its corresponding key characteristic:

    <p>Electrical Burns = Causing internal damage through nerves and blood vessels Chemical Burns = Denaturing of protein and dryness of cells Frostbite = Formation of crystals from freezing fluids Thermal Burns = Affecting skin layers due to heat exposure</p> Signup and view all the answers

    Which of the following statements about chemical burns is true?

    <p>They should be considered deep partial thickness or full thickness until proven otherwise.</p> Signup and view all the answers

    Dressing a rewarmed extremity after frostbite requires no special considerations.

    <p>False</p> Signup and view all the answers

    What happens to peripheral blood vessels in response to cold environments?

    <p>Vasoconstriction occurs.</p> Signup and view all the answers

    What should be done with intact blisters?

    <p>Leave them alone</p> Signup and view all the answers

    Chemical burns should be irrigated with water for at least 10 minutes.

    <p>True</p> Signup and view all the answers

    What mechanism of injury is most common for spinal cord injuries?

    <p>Motor vehicle collision</p> Signup and view all the answers

    Burns of the face should be covered by a topical antibiotic ointment such as _________.

    <p>bacitracin</p> Signup and view all the answers

    Match the type of burn with the correct immediate treatment:

    <p>Ruptured blisters = Remove them Chemical burns = Irrigate with tap water Electrical burns = Monitor for compartment syndrome Facial burns = Apply bacitracin</p> Signup and view all the answers

    What is a significant risk for patients with electrical injuries of the extremities?

    <p>Compartment syndrome</p> Signup and view all the answers

    All patients with multi-system injuries should be suspected of having a spinal injury.

    <p>True</p> Signup and view all the answers

    How often should bacitracin be reapplied to facial burns?

    <p>Every 6 hours</p> Signup and view all the answers

    What is a flail chest defined as?

    <p>Fractures in two or more adjacent ribs in two or more places</p> Signup and view all the answers

    Children are more likely to suffer from rib fractures due to their thicker chest walls.

    <p>False</p> Signup and view all the answers

    What is the most common site of sternal fracture?

    <p>The junction of the manubrium and body of the sternum</p> Signup and view all the answers

    A serious laryngeal injury may present with __________, stridor, and hematoma.

    <p>hoarseness</p> Signup and view all the answers

    Match the following injuries with their treatments:

    <p>Rib Fractures = Observation and possible internal fixation Flail Chest = Ensure adequate oxygenation and pain management Sternal Fracture = Pain relief and baseline ECG Laryngeal Injury = Monitor for airway compromise</p> Signup and view all the answers

    What is the primary concern when a patient has a laryngeal injury?

    <p>Verify cervical injury</p> Signup and view all the answers

    Intubation is always safe for patients with laryngeal injuries.

    <p>False</p> Signup and view all the answers

    What is a direct consequence of paradoxical chest wall movement?

    <p>Atelectasis followed by hypoxia</p> Signup and view all the answers

    Sternal fractures rarely lead to underlying cardiac injuries.

    <p>False</p> Signup and view all the answers

    What is the common intervention for moderate to large pneumothoraxes?

    <p>Chest tube insertion</p> Signup and view all the answers

    What is the primary goal of treatment for a flail chest injury?

    <p>Ensuring adequate oxygenation</p> Signup and view all the answers

    An open pneumothorax occurs when an opening in the chest is more than _____ the diameter of the trachea.

    <p>two thirds</p> Signup and view all the answers

    Match the symptoms of pneumothorax to their descriptions:

    <p>Chest pain = A common symptom related to lung injury Shortness of breath (SOB) = Difficulty in breathing due to air accumulation Decreased breath sounds = Absence of sound on the affected side Tachycardia = Increased heart rate as a response to distress</p> Signup and view all the answers

    What dressing is applied to a sucking chest wound?

    <p>Three-sided occlusive dressing</p> Signup and view all the answers

    Chest tube placement is typically done in the first intercostal space.

    <p>False</p> Signup and view all the answers

    What should be done if an impaled object is present in a penetrating chest injury?

    <p>Stabilize and leave it in place</p> Signup and view all the answers

    What is a possible indication of increasing intracranial pressure (ICP)?

    <p>Sluggish pupillary response</p> Signup and view all the answers

    Bilateral fixed and dilated pupils are indicative of improving brain condition.

    <p>False</p> Signup and view all the answers

    Which cranial nerve is primarily affected when ptosis is observed?

    <p>Oculomotor nerve (CN III)</p> Signup and view all the answers

    Maintaining systolic blood pressure above _____ mm Hg is crucial to ensure adequate cerebral perfusion pressure (CPP).

    <p>90</p> Signup and view all the answers

    What is a major radiographic study used for brain injury evaluation in the emergency department?

    <p>CT scan</p> Signup and view all the answers

    Hyperventilation is the most effective long-term solution to decrease intracranial pressure.

    <p>False</p> Signup and view all the answers

    What effect does hyperosmolar therapy have on intracranial pressure?

    <p>Reduces ICP by creating an osmotic gradient</p> Signup and view all the answers

    Match each condition with its associated cardiac dysrhythmia:

    <p>Contusions = Atrial fibrillation Subdural hematomas = Atrial and ventricular ectopy Severe brain injuries = ST and T-wave changes Traumatic brain injuries = Bundle branch blocks</p> Signup and view all the answers

    Which type of injury is typically easier to assess?

    <p>Penetrating injury</p> Signup and view all the answers

    Blunt trauma injuries are usually located in one specific area.

    <p>False</p> Signup and view all the answers

    Name one common example of a blunt force event.

    <p>Motor vehicle collisions (MVCs), falls, contact sports, or assaults.</p> Signup and view all the answers

    The energy associated with blunt trauma can result in organs and tissues __________ if pressure is not released.

    <p>rupture or break</p> Signup and view all the answers

    Match the following impacts to their corresponding injury descriptions:

    <p>Down and Under = Knee dislocations and femur fractures Up and Over = Head injuries including skull fractures Frontal Impact = Occupants move down and under the dashboard Penetrating Injury = Focused injury assessment</p> Signup and view all the answers

    In a frontal impact scenario, what happens to the occupants at the moment of collision?

    <p>They decelerate to a speed of zero, but differently than the vehicle</p> Signup and view all the answers

    Surface trauma is always present with blunt injuries.

    <p>False</p> Signup and view all the answers

    What type of injuries are likely to occur to the head during an Up and Over impact?

    <p>Head injuries including contusions, scalp lacerations, skull/facial fractures, and cerebral hemorrhage.</p> Signup and view all the answers

    Signup and view all the answers

    Study Notes

    Burn Overview

    • More than 60% of burn injuries are admitted to specialized burn centers.
    • A significant portion of morbidity and mortality associated with burn injuries is due to associated injuries, such as inhalation injury.
    • More than 90% of burns are preventable through education and legislative efforts.

    Burn Etiology

    • Not all burns are caused by fire.
    • Tissue damage can result from exposure to chemicals, hot liquids, tar, electricity, lightning, or frostbite.

    Thermal Burns

    • Represent the majority of burns.
    • Can result from flame, flash, steam, or scalding liquids.

    Scald Burns

    • Scalds from hot liquids are the most common cause of all burns.
    • Exposure to 60°C water for 3 seconds can cause deep partial-thickness or full-thickness burns.
    • 69°C water causes the same burn in only 1 second (e.g., fresh brewed coffee is about 82°C).
    • Common causes include tap water, soups, sauces, cooking oil and grease.
    • Adults older than 60 disproportionately are affected by hot liquids.

    Flame Burns

    • The number of house fires has decreased due to the increased use of smoke detectors.
    • Common causes include careless smoking, motor vehicle crashes, and clothing ignited from stoves or heaters.

    Electrical Burns

    • Electricity passing through the body transforms to heat proportionally to amperage and resistance.
    • Initial injury is on entry and exit points (extensive internal damage).
    • Nerves, blood vessels, and muscle are more susceptible to damage than bone or fat.
    • The smaller the body part affected, the more intense the heat and less it is dissipated.
    • Extensive damage may occur in fingers, hands, forearms, toes, feet, and lower legs.
    • Papillary muscle damage can cause sudden valve incompetence and cardiac failure.

    Chemical Burns

    • Chemicals cause protein denaturing and cell dryness.
    • Chemical concentration and exposure duration determine the extent of the burn.
    • Alkali products cause more tissue damage than acids.
    • Removing wet chemicals quickly via thorough flushing is key.
    • Dry chemicals need to be brushed off before flushing.
    • Chemical burns can be deceiving as to their depth, appearances similar to superficial discoloration until sloughing days later.
    • All chemical burns should be considered deep partial-thickness or full-thickness until proven otherwise.

    Frostbite

    • Occurs when tissues freeze from exposure to freezing or below-freezing temperatures.
    • Body's response to cold is vasoconstriction to reduce heat exchange.
    • Unprotected extremities expose intracellular and extracellular fluids to freezing, forming crystals, and causing tissue damage.
    • Rapid rewarming using warm water, avoiding excessive heat (like steam), and immobilization with a padded splint is critical.

    Burn Assessment

    • Burn depth and extent are assessed to determine severity.
    • Final determination may not be made for several days.

    Burn Depth

    • Burns are described as partial-thickness (2nd degree) or full-thickness (3rd degree).
    • More accurate depth determination is possible within 48 to 72 hours.

    Burn Extent

    • Extent assessment is performed using formulas such as the rule of nines.
    • Age correction (1% subtracted from head for each year up to 10 years, and 0.5% added to each lower extremity).
    • The size of the patient's palm is used to represent 1%.
    • In electrical injuries, describing the injury anatomically is more critical than calculating percentage of BSA burned.

    Burn Severity

    • Based on burn extent, depth, patient age, presence of concomitant injuries, smoke inhalation, and preexisting conditions.
    • Categorization into minor, moderate, and major burns.
    • Criteria for transfer to a burn center, based on these factors.

    Inhalation Injury

    • Burn injury in patients with pre-existing medical conditions can complicate management, prolong recovery, or cause fatality.
    • Any patient with burn injury and concomitant trauma should be initially treated by a trauma center, with transfer to a burn center when stable.

    Pulmonary Response to Smoke Inhalation

    • Inhalation injury or smoke inhalation is a syndrome comprising distinct problems: carbon monoxide intoxication, upper airway obstruction, and chemical injury to the lower airways and lung parenchyma.
    • Majority of deaths are due to smoke inhalation rather than the burn itself.
    • Exposure to carbon monoxide has a high affinity to hemoglobin compared to oxygen, causing muscle weakness.
    • Symptoms are marked by pink-to-cherry-red skin, tachypnea, tachycardia, headache, dizziness, and nausea.
    • Arterial blood gas samples measure the carboxyhemoglobin level.
    • Levels below 15% are usually asymptomatic, 15% to 40% cause headache and confusion, and above 40% leads to coma.
    • Pulse oximeters do not differentiate between oxygenated hemoglobin and carboxyhemoglobin. therefore, patients suspected of carbon monoxide poisoning should be placed on 100% oxygen.

    Management

    • High index of suspicion for smoke inhalation is critical in burn patients.
    • Administrating high-flow oxygen.
    • Patients with COPD should receive immediate intubation to avoid progressive carbon dioxide retention.
    • The half-life of carboxyhemoglobin is reduced to 75 to 80 minutes with 100% oxygen.
    • Hyperbaric oxygen can reduce the half-life to approximately 20 minutes, potentially speeding up recovery.
    • Use of hyperbaric oxygen is controversial.
    • Circumferential full-thickness chest burns require escharotomies.

    Wound Care

    • Wound care must be delayed until the patient stabilizes to avoid potential complications from swelling affecting circulation to the affected area.
    • Ruptured blisters should be cleaned but intact blisters are left undisturbed.
    • Topical antibacterial agents (e.g., silvadene or bacitracin) are used.
    • Chemical burns require immediate irrigation with tap water or normal saline for extended periods.
    • Electrical burns with massive muscle injury beneath normal skin require gentle cleaning.

    Spinal Trauma

    • The majority of spinal cord injuries occur in males under 38.
    • Motor vehicle collisions (MVCs) are the leading cause of spinal injuries in adults.

    Spinal Anatomy and Physiology

    • Cervical vertebrae are commonly injured.
    • Cervical spine has 7 vertebrae .Thoracic spine has 12 vertebrae. Lumbar spine has 7 vertebrae.
    • The spine is comprised of sacrum and coccyx.
    • Spinal cord, intervertebral disks, and vertebral bodies are part of the spinal structures.

    Patient Assessment

    • Identify and secure all patients with multi-system injuries or significant mechanism of injury.
    • Protect all patients with suspected spinal injury.
    • Methods of protecting spines include:
      • manual immobilization with the hands
      • and with a cervical collar
      • Lateral head support with head blocks or rolled sheets
      • Whole spine immobilization with straps across chest, abdomen, and knees
      • Identify risk factors for injuries:
        • Falls from greater than 3 feet
        • Vehicle collisions at high speed
        • Involved in a rollover or ejections
        • Vehicle damage or intrusion into the passenger compartment
        • Any falls or collisions that produced severe force to the body
        • Patient age
        • Any associated injuries (e.g., injuries to the head or face)

    Mechanism of Injury

    • Defined as the process to study the transfer of energy from the environment to the individual.
    • Essential for:
      • Anticipate injuries
      • Provide diagnosis
      • Provide treatment
      • Preventing future complications

    Mechanism of Injury: Key Concepts

    • Acceleration: Increase in velocity or speed of a moving object.
    • Deceleration: Decrease in velocity or speed of a moving object.
    • Cavitation: temporary cavity creation as tissues stretch and compress.
    • Force: The physical factor that changes a body's motion, whether at rest or already in motion.
    • Inertial resistance: The body's tendency to resist any change in motion.

    Mechanism of Injury Classification

    • Blunt injury: A sudden, forceful impact from a non-sharpened object.
    • Penetrating injury: An injury from a sharper object penetrating the body.

    Thoracic Trauma

    • Mortality rates for thoracic trauma are second only to brain and spinal cord injuries.
    • Focused Assessment Sonography for Trauma (FAST) is important.

    Rib Fractures

    • Common in ribs 4-10.
    • Fractures that separate the sternum from costal cartilage are not evident on a radiograph.

    Flail Chest

    • Defined as fractures in two or more adjacent ribs in two or more places or bilateral detachment of the sternum from costal cartilage.
    • Unstable segment of chest wall moves in opposition to normal movement of the chest wall.
    • Loss of coordinated movement of the chest wall results in hypoventilation, atelectasis, and eventually hypoxia.

    Sternal Fracture

    • Occurs with tremendous force to the chest.
    • Common site includes the junction of the manubrium and body of the sternum.
    • Potential for underlying cardiac and pulmonary injuries, including contusions, blunt cardiac injury, and pericardial tamponade.

    Laryngeal Injury

    • Fracture of the larynx is a rare, life-threatening injury.
    • Symptoms include hoarseness, stridor, hematoma, ecchymosis, laryngeal tenderness, subcutaneous emphysema, crepitus, or loss of anatomic landmarks
    • Intubation can worsen the existing injury, so tracheostomy may be necessary.

    Pneumothorax

    • Accumulation of air in the pleural space, leading to lung collapse.
    • Common causes are lung lacerations and rib fractures.
    • Symptoms include chest pain, shortness of breath (SOB), decreased/absent breath sounds, tachycardia, and tachypnea.

    Open Pneumothorax

    • Opening in the chest that exceeds two-thirds the diameter of the trachea.
    • Loss of negative intrathoracic pressure.
    • Treat by applying a sterile, nonporous, three-sided occlusive dressing over the injury; a chest tube may be required for re-expansion of the lung.
    • If injury is caused by penetrating trauma with an impaled object, the object should be stabilized and not removed in the ED

    Tension Pneumothorax

    • Life-threatening condition resulting from air accumulation in the pleural space; the accumulation forces the thoracic contents to the opposite side.
    • Immediate needle decompression of affected side is critical.

    Hemothorax

    • Free blood in the pleural space.
    • Usually caused by injury to the intercostal arteries, resulting in bleeding into the pleural space
    • Immediate chest tube insertion is required. If blood loss via chest tube is 1000 ml or more, surgical intervention may be required.

    Pulmonary Contusion

    • 75% of blunt chest trauma cases have underlying pulmonary contusion with about 40% mortality rate.
    • Injury to lung parenchyma (widespread bleeding and ruptures into pulmonary tissue, alveoli, and small airways leading to collapse and loss of ventilation, pulmonary shunting, and hypoxemia).

    Diaphragmatic Injury

    • Lateral impact from an MVC is three times more likely than another type of impact to cause rupture.
    • Most ruptures occur on the left side secondary to the liver's protection of the right side.
    • Chest radiograph and CT scan of chest may demonstrate an elevated diaphragm, loss, of the diaphragmatic shadow, irregularities in the diaphragm, or a gastric tube extending into the chest cavity.

    Blunt Cardiac Injury

    • Formerly known as "cardiac concussion" or "cardiac contusion".
    • Injury is differentiated by echocardiogram.
    • Common symptoms are nonspecific and range from asymptomatic to cardiogenic shock.
    • Dysrhythmias associated with this injury can range from sinus tachycardia to atrial fibrillation/flutter and ventricular tachycardia/fibrillation.

    Penetrating Cardiac Injuries

    • Most victims arrive in the ED in cardiac arrest or significant hypotension due to cardiac tamponade or hemorrhage.
    • The right ventricle is most frequently injured due to its anterior position.
    • Penetrating injuries are associated with high mortality (83%).

    Cardiac Tamponade

    • Rapid accumulation of blood in the pericardial sac decreases ventricular filling.
    • Symptoms (Beck's triad) include hypotension, muffled heart tones, and distended neck veins.
    • Pericardiocentesis may be lifesaving in acute cases.

    Aortic Disruption

    • Majority of victims die at the scene.
    • Common injury sites are the area just distal to the left subclavian artery and just adjacent to the ligamentum arteriosum.
    • The innominate artery, aortic arch, and aortic valve are often affected.

    Esophageal Injury

    • Injury to the esophagus is rare and often fatal.
    • Common cause is instrumentation during invasive procedures such as endoscopy or intubation (causing mediastinitis from contamination by saliva and gastric contents).
    • Surgical repair is often required.

    Head Trauma

    • Traumatic brain injury (TBI) is a leading cause of death and permanent disability.
    • A small percentage of severe TBI patients will have a cervical spine fracture as well.

    Head Trauma Sites and Causes

    • Common trauma sites consist of the scalp, skull, and brain.
    • Common causes include firearm-related injuries, motor vehicle accidents, falls, assaults, sports-related injuries, and recreational accidents.

    Head Trauma: Specific Injury Classifications

    • Categorization by severity into mild, moderate, and severe injuries.
    • Categorization by mechanism of injury, to include blunt and penetrating types, and focal and diffuse injuries.
    • Describes symptoms for each type of injury

    Intracranial Pressure(ICP)

    • ICP results from the combined pressure of brain, cerebrospinal fluid, and blood in the skull.
    • Normal ICP is less than 10 mmHg. Elevated ICP can reduce blood flow to brain tissue, causing damage or death.

    Cerebral Perfusion Pressure (CPP)

    • The pressure difference between arterial and venous blood entering and exiting the brain.
    • Normal CPP is 50-150 mmHg; low CPP indicates a poor prognosis.

    Patient Management Overview

    • Treatment depends on specific injury type, patient status, and presenting symptoms.
    • Management to include but not limited to:
      • Early intubation and targeted ventilation for patients with severe brain trauma (<GCS 8),
      • Adequate blood pressure
      • Maintaining a controlled environment for the treatment of any impaled object injuries.
      • Administering hypotonic or hyperosmolar therapy as needed.

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